You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

T
CHAPTER 5
BODY-BRAIN CONNECTIONS
Life is about rhythm. We vibrate, our hearts are pump­ing blood.
We are a rhythm machine, that’s what we are.
—Mick­ey Hart
oward the end of his career, in 1872, Charles Dar­win pub­lished The
Expres­sion of the Emo­tions in Man and Animals.1 Until recent­ly most
sci­en­tif­ic dis­cus­sion of Darwin’s the­o­ries has focused on On the Ori­gin of
Species (1859) and The Descent of Man (1871). But The Expres­sion of the
Emo­tions turns out to be an extra­or­di­nary explo­ration of the foun­da­tions of
emo­tion­al life, filled with obser­va­tions and anec­dotes drawn from decades
of inquiry, as well as close-to-home sto­ries of Darwin’s chil­dren and
house­hold pets. It’s also a land­mark in book illustration—one of the first
books ever to include pho­tographs. (Pho­tog­ra­phy was still a rel­a­tive­ly new
tech­nol­o­gy and, like most sci­en­tists, Dar­win want­ed to make use of the
lat­est tech­niques to make his points.) It’s still in print today, read­i­ly
avail­able in a recent edi­tion with a ter­rif­ic intro­duc­tion and com­men­taries
by Paul Ekman, a mod­ern pio­neer in the study of emo­tions.
Dar­win starts his dis­cus­sion by not­ing the phys­i­cal orga­ni­za­tion
com­mon to all mam­mals, includ­ing human beings—the lungs, kid­neys,
brains, diges­tive organs, and sex­u­al organs that sus­tain and con­tin­ue life.
Although many sci­en­tists today would accuse him of anthro­po­mor­phism,
Dar­win stands with ani­mal lovers when he pro­claims: “Man and the high­er
ani­mals … [also] have instincts in com­mon. All have the same sens­es,
intu­ition, sen­sa­tion, pas­sions, affec­tions, and emo­tions, even the more
com­plex ones such as jeal­ousy, sus­pi­cion, emu­la­tion, grat­i­tude, and
magnanimity.”2 He observes that we humans share some of the phys­i­cal
signs of ani­mal emo­tion. Feel­ing the hair on the back of your neck stand up
when you’re fright­ened or bar­ing your teeth when you’re enraged can only
be under­stood as ves­tiges of a long evo­lu­tion­ary process.
“When a man sneers or snarls at anoth­er, is the cor­ner of the canine or eye tooth raised on the
side fac­ing the man whom he address­es?” —Charles Dar­win, 1872
For Dar­win mam­malian emo­tions are fun­da­men­tal­ly root­ed in biol­o­gy:
They are the indis­pens­able source of moti­va­tion to ini­ti­ate action. Emo­tions
(from the Latin emovere—to move out) give shape and direc­tion to
what­ev­er we do, and their pri­ma­ry expres­sion is through the mus­cles of the
face and body. These facial and phys­i­cal move­ments com­mu­ni­cate our
men­tal state and inten­tion to oth­ers: Angry expres­sions and threat­en­ing
pos­tures cau­tion them to back off. Sad­ness attracts care and atten­tion. Fear
sig­nals help­less­ness or alerts us to dan­ger.
We instinc­tive­ly read the dynam­ic between two peo­ple sim­ply from
their ten­sion or relax­ation, their pos­tures and tone of voice, their chang­ing
facial expres­sions. Watch a movie in a lan­guage you don’t know, and you
can still guess the qual­i­ty of the rela­tion­ship between the char­ac­ters. We
often can read oth­er mam­mals (mon­keys, dogs, hors­es) in the same way.
Dar­win goes on to observe that the fun­da­men­tal pur­pose of emo­tions is
to ini­ti­ate move­ment that will restore the organ­ism to safe­ty and phys­i­cal
equi­lib­ri­um. Here is his com­ment on the ori­gin of what today we would call
PTSD:
Behav­iors to avoid or escape from dan­ger have clear­ly evolved to
ren­der each organ­ism com­pet­i­tive in terms of sur­vival. But
inap­pro­pri­ate­ly pro­longed escape or avoid­ance behav­ior would put
the ani­mal at a dis­ad­van­tage in that suc­cess­ful species preser­va­tion
demands repro­duc­tion which, in turn, depends upon feed­ing,
shel­ter and mat­ing activ­i­ties all of which are rec­i­p­ro­cals of
avoid­ance and escape.3
In oth­er words: If an organ­ism is stuck in sur­vival mode, its ener­gies
are focused on fight­ing off unseen ene­mies, which leaves no room for
nur­ture, care, and love. For us humans, it means that as long as the mind is
defend­ing itself against invis­i­ble assaults, our clos­est bonds are threat­ened,
along with our abil­i­ty to imag­ine, plan, play, learn, and pay atten­tion to
oth­er people’s needs.
Dar­win also wrote about body-brain con­nec­tions that we are still
explor­ing today. Intense emo­tions involve not only the mind but also the gut
and the heart: “Heart, guts, and brain com­mu­ni­cate inti­mate­ly via the
‘pneu­mo­gas­tric’ nerve, the crit­i­cal nerve involved in the expres­sion and
man­age­ment of emo­tions in both humans and ani­mals. When the mind is
strong­ly excit­ed, it instant­ly affects the state of the vis­cera; so that under
excite­ment there will be much mutu­al action and reac­tion between these,
the two most impor­tant organs of the body.”4
The first time I encoun­tered this pas­sage, I reread it with grow­ing
excite­ment. Of course we expe­ri­ence our most dev­as­tat­ing emo­tions as gut-
wrench­ing feel­ings and heart­break. As long as we reg­is­ter emo­tions
pri­mar­i­ly in our heads, we can remain pret­ty much in con­trol, but feel­ing as
if our chest is cav­ing in or we’ve been punched in the gut is unbear­able.
We’ll do any­thing to make these awful vis­cer­al sen­sa­tions go away, whether
it is cling­ing des­per­ate­ly to anoth­er human being, ren­der­ing our­selves
insen­si­ble with drugs or alco­hol, or tak­ing a knife to the skin to replace
over­whelm­ing emo­tions with defin­able sen­sa­tions. How many men­tal
health prob­lems, from drug addic­tion to self-inju­ri­ous behav­ior, start as
attempts to cope with the unbear­able phys­i­cal pain of our emo­tions? If
Dar­win was right, the solu­tion requires find­ing ways to help peo­ple alter the
inner sen­so­ry land­scape of their bod­ies.
Until recent­ly, this bidi­rec­tion­al com­mu­ni­ca­tion between body and
mind was large­ly ignored by West­ern sci­ence, even as it had long been
cen­tral to tra­di­tion­al heal­ing prac­tices in many oth­er parts of the world,
notably in India and Chi­na. Today it is trans­form­ing our under­stand­ing of
trau­ma and recov­ery.
A WINDOW INTO THE NERVOUS SYSTEM
All of the lit­tle signs we instinc­tive­ly reg­is­ter dur­ing a conversation—the
mus­cle shifts and ten­sions in the oth­er person’s face, eye move­ments and
pupil dila­tion, pitch and speed of the voice—as well as the fluc­tu­a­tions in
our own inner landscape—salivation, swal­low­ing, breath­ing, and heart rate
—are linked by a sin­gle reg­u­la­to­ry system.5 All are a prod­uct of the
syn­chrony between the two branch­es of the auto­nom­ic ner­vous sys­tem
(ANS): the sym­pa­thet­ic, which acts as the body’s accel­er­a­tor, and the
parasym­pa­thet­ic, which serves as its brake.6 These are the “rec­i­p­ro­cals”
Dar­win spoke of, and work­ing togeth­er they play an impor­tant role in
man­ag­ing the body’s ener­gy flow, one prepar­ing for its expen­di­ture, the
oth­er for its con­ser­va­tion.
The sym­pa­thet­ic ner­vous sys­tem (SNS) is respon­si­ble for arousal,
includ­ing the fight-or-flight response (Darwin’s “escape or avoid­ance
behav­ior”). Almost two thou­sand years ago the Roman physi­cian Galen
gave it the name “sym­pa­thet­ic” because he observed that it func­tioned with
the emo­tions (sym pathos). The SNS moves blood to the mus­cles for quick
action, part­ly by trig­ger­ing the adren­al glands to squirt out adren­a­line,
which speeds up the heart rate and increas­es blood pres­sure.
The sec­ond branch of the ANS is the parasym­pa­thet­ic (“against
emo­tions”) ner­vous sys­tem (PNS), which pro­motes self-preser­v­a­tive
func­tions like diges­tion and wound heal­ing. It trig­gers the release of
acetyl­choline to put a brake on arousal, slow­ing the heart down, relax­ing
mus­cles, and return­ing breath­ing to nor­mal. As Dar­win point­ed out,
“feed­ing, shel­ter, and mat­ing activ­i­ties” depend on the PNS.
There is a sim­ple way to expe­ri­ence these two sys­tems for your­self.
When­ev­er you take a deep breath, you acti­vate the SNS. The result­ing burst
of adren­a­line speeds up your heart, which explains why many ath­letes take
a few short, deep breaths before start­ing com­pe­ti­tion. Exhal­ing, in turn,
acti­vates the PNS, which slows down the heart. If you take a yoga or a
med­i­ta­tion class, your instruc­tor will prob­a­bly urge you to pay par­tic­u­lar
atten­tion to the exha­la­tion, since deep, long breaths out help calm you
down. As we breathe, we con­tin­u­al­ly speed up and slow down the heart,
and because of that the inter­val between two suc­ces­sive heart­beats is nev­er
pre­cise­ly the same. A mea­sure­ment called heart rate vari­abil­i­ty (HRV) can
be used to test the flex­i­bil­i­ty of this sys­tem, and good HRV—the more
fluc­tu­a­tion, the better—is a sign that the brake and accel­er­a­tor in your
arousal sys­tem are both func­tion­ing prop­er­ly and in bal­ance. We had a
break­through when we acquired an instru­ment to mea­sure HRV, and I will
explain in chap­ter 16 how we can use HRV to help treat PTSD.
THE NEURAL LOVE CODE7
In 1994 Stephen Porges, who was a researcher at the Uni­ver­si­ty of
Mary­land at the time we start­ed our inves­ti­ga­tion of HRV, and who is now
at the Uni­ver­si­ty of North Car­oli­na, intro­duced the Poly­va­gal The­o­ry,
which built on Darwin’s obser­va­tions and added anoth­er 140 years of
sci­en­tif­ic dis­cov­er­ies to those ear­ly insights. (Poly­va­gal refers to the many
branch­es of the vagus nerve—Darwin’s “pneu­mo­gas­tric nerve”—which
con­nects numer­ous organs, includ­ing the brain, lungs, heart, stom­ach, and
intestines.) The Poly­va­gal The­o­ry pro­vid­ed us with a more sophis­ti­cat­ed
under­stand­ing of the biol­o­gy of safe­ty and dan­ger, one based on the sub­tle
inter­play between the vis­cer­al expe­ri­ences of our own bod­ies and the voic­es
and faces of the peo­ple around us. It explained why a kind face or a
sooth­ing tone of voice can dra­mat­i­cal­ly alter the way we feel. It clar­i­fied
why know­ing that we are seen and heard by the impor­tant peo­ple in our
lives can make us feel calm and safe, and why being ignored or dis­missed
can pre­cip­i­tate rage reac­tions or men­tal col­lapse. It helped us under­stand
why focused attune­ment with anoth­er per­son can shift us out of
dis­or­ga­nized and fear­ful states.8
In short, Porges’s the­o­ry made us look beyond the effects of fight or
flight and put social rela­tion­ships front and cen­ter in our under­stand­ing of
trau­ma. It also sug­gest­ed new approach­es to heal­ing that focus on
strength­en­ing the body’s sys­tem for reg­u­lat­ing arousal.
Human beings are astound­ing­ly attuned to sub­tle emo­tion­al shifts in the
peo­ple (and ani­mals) around them. Slight changes in the ten­sion of the
brow, wrin­kles around the eyes, cur­va­ture of the lips, and angle of the neck
quick­ly sig­nal to us how com­fort­able, sus­pi­cious, relaxed, or fright­ened
some­one is.9 Our mir­ror neu­rons reg­is­ter their inner expe­ri­ence, and our
own bod­ies make inter­nal adjust­ments to what­ev­er we notice. Just so, the
mus­cles of our own faces give oth­ers clues about how calm or excit­ed we
feel, whether our heart is rac­ing or qui­et, and whether we’re ready to
pounce on them or run away. When the mes­sage we receive from anoth­er
per­son is “You’re safe with me,” we relax. If we’re lucky in our
rela­tion­ships, we also feel nour­ished, sup­port­ed, and restored as we look
into the face and eyes of the oth­er.
Our cul­ture teach­es us to focus on per­son­al unique­ness, but at a deep­er
lev­el we bare­ly exist as indi­vid­ual organ­isms. Our brains are built to help us
func­tion as mem­bers of a tribe. We are part of that tribe even when we are
by our­selves, whether lis­ten­ing to music (that oth­er peo­ple cre­at­ed),
watch­ing a bas­ket­ball game on tele­vi­sion (our own mus­cles tens­ing as the
play­ers run and jump), or prepar­ing a spread­sheet for a sales meet­ing
(antic­i­pat­ing the boss’s reac­tions). Most of our ener­gy is devot­ed to
con­nect­ing with oth­ers.
If we look beyond the list of spe­cif­ic symp­toms that entail for­mal
psy­chi­atric diag­noses, we find that almost all men­tal suf­fer­ing involves
either trou­ble in cre­at­ing work­able and sat­is­fy­ing rela­tion­ships or
dif­fi­cul­ties in reg­u­lat­ing arousal (as in the case of habit­u­al­ly becom­ing
enraged, shut down, overex­cit­ed, or dis­or­ga­nized). Usu­al­ly it’s a
com­bi­na­tion of both. The stan­dard med­ical focus on try­ing to dis­cov­er the
right drug to treat a par­tic­u­lar “dis­or­der” tends to dis­tract us from grap­pling
with how our prob­lems inter­fere with our func­tion­ing as mem­bers of our
tribe.
SAFETY AND RECIPROCITY
A few years ago I heard Jerome Kagan, a dis­tin­guished emer­i­tus pro­fes­sor
of child psy­chol­o­gy at Har­vard, say to the Dalai Lama that for every act of
cru­el­ty in this world there are hun­dreds of small acts of kind­ness and
con­nec­tion. His con­clu­sion: “To be benev­o­lent rather than malev­o­lent is
prob­a­bly a true fea­ture of our species.” Being able to feel safe with oth­er
peo­ple is prob­a­bly the sin­gle most impor­tant aspect of men­tal health; safe
con­nec­tions are fun­da­men­tal to mean­ing­ful and sat­is­fy­ing lives. Numer­ous
stud­ies of dis­as­ter response around the globe have shown that social sup­port
is the most pow­er­ful pro­tec­tion against becom­ing over­whelmed by stress
and trau­ma.
Social sup­port is not the same as mere­ly being in the pres­ence of
oth­ers. The crit­i­cal issue is reci­procity: being tru­ly heard and seen by the
peo­ple around us, feel­ing that we are held in some­one else’s mind and heart.
For our phys­i­ol­o­gy to calm down, heal, and grow we need a vis­cer­al feel­ing
of safe­ty. No doc­tor can write a pre­scrip­tion for friend­ship and love: These
are com­plex and hard-earned capac­i­ties. You don’t need a his­to­ry of trau­ma
to feel self-con­scious and even pan­icked at a par­ty with strangers—but
trau­ma can turn the whole world into a gath­er­ing of aliens.
Many trau­ma­tized peo­ple find them­selves chron­i­cal­ly out of sync with
the peo­ple around them. Some find com­fort in groups where they can replay
their com­bat expe­ri­ences, rape, or tor­ture with oth­ers who have sim­i­lar
back­grounds or expe­ri­ences. Focus­ing on a shared his­to­ry of trau­ma and
vic­tim­iza­tion alle­vi­ates their sear­ing sense of iso­la­tion, but usu­al­ly at the
price of hav­ing to deny their indi­vid­ual dif­fer­ences: Mem­bers can belong
only if they con­form to the com­mon code.
Iso­lat­ing one­self into a nar­row­ly defined vic­tim group pro­motes a view
of oth­ers as irrel­e­vant at best and dan­ger­ous at worst, which even­tu­al­ly only
leads to fur­ther alien­ation. Gangs, extrem­ist polit­i­cal par­ties, and reli­gious
cults may pro­vide solace, but they rarely fos­ter the men­tal flex­i­bil­i­ty need­ed
to be ful­ly open to what life has to offer and as such can­not lib­er­ate their
mem­bers from their trau­mas. Well-func­tion­ing peo­ple are able to accept
indi­vid­ual dif­fer­ences and acknowl­edge the human­i­ty of oth­ers.
In the past two decades it has become wide­ly rec­og­nized that when
adults or chil­dren are too skit­tish or shut down to derive com­fort from
human beings, rela­tion­ships with oth­er mam­mals can help. Dogs and hors­es
and even dol­phins offer less com­pli­cat­ed com­pan­ion­ship while pro­vid­ing
the nec­es­sary sense of safe­ty. Dogs and hors­es, in par­tic­u­lar, are now
exten­sive­ly used to treat some groups of trau­ma patients.10
THREE LEVELS OF SAFETY
After trau­ma the world is expe­ri­enced with a dif­fer­ent ner­vous sys­tem that
has an altered per­cep­tion of risk and safe­ty. Porges coined the word
“neu­ro­cep­tion” to describe the capac­i­ty to eval­u­ate rel­a­tive dan­ger and
safe­ty in one’s envi­ron­ment. When we try to help peo­ple with faulty
neu­ro­cep­tion, the great chal­lenge is find­ing ways to reset their phys­i­ol­o­gy,
so that their sur­vival mech­a­nisms stop work­ing against them. This means
help­ing them to respond appro­pri­ate­ly to dan­ger but, even more, to recov­er
the capac­i­ty to expe­ri­ence safe­ty, relax­ation, and true reci­procity.
I have exten­sive­ly inter­viewed and treat­ed six peo­ple who sur­vived
plane crash­es. Two report­ed hav­ing lost con­scious­ness dur­ing the inci­dent;
even though they were not phys­i­cal­ly injured, they col­lapsed men­tal­ly. Two
went into a pan­ic and stayed fran­tic until well after we had start­ed
treat­ment. Two remained calm and resource­ful and helped evac­u­ate fel­low
pas­sen­gers from the burn­ing wreck­age. I’ve found a sim­i­lar range of
respons­es in sur­vivors of rape, car crash­es, and tor­ture. In the pre­vi­ous
chap­ter we saw the rad­i­cal­ly dif­fer­ent reac­tions of Stan and Ute as they
reliv­ed the high­way dis­as­ter they’d expe­ri­enced side by side. What accounts
for this spec­trum of respons­es: focused, col­lapsed, or fran­tic?
Porges’s the­o­ry pro­vides an expla­na­tion: The auto­nom­ic ner­vous
sys­tem reg­u­lates three fun­da­men­tal phys­i­o­log­i­cal states. The lev­el of safe­ty
deter­mines which one of these is acti­vat­ed at any par­tic­u­lar time. When­ev­er
we feel threat­ened, we instinc­tive­ly turn to the first lev­el, social
engage­ment. We call out for help, sup­port, and com­fort from the peo­ple
around us. But if no one comes to our aid, or we’re in imme­di­ate dan­ger,
the organ­ism reverts to a more prim­i­tive way to sur­vive: fight or flight. We
fight off our attack­er, or we run to a safe place. How­ev­er, if this fails—we
can’t get away, we’re held down or trapped—the organ­ism tries to pre­serve
itself by shut­ting down and expend­ing as lit­tle ener­gy as pos­si­ble. We are
then in a state of freeze or col­lapse.
This is where the many-branched vagus nerve comes in, and I’ll
describe its anato­my briefly because it’s cen­tral to under­stand­ing how
peo­ple deal with trau­ma. The social-engage­ment sys­tem depends on nerves
that have their ori­gin in the brain stem reg­u­la­to­ry cen­ters, pri­mar­i­ly the
vagus—also known as the tenth cra­nial nerve—together with adjoin­ing
nerves that acti­vate the mus­cles of the face, throat, mid­dle ear, and voice
box or lar­ynx. When the “ven­tral vagal com­plex” (VVC) runs the show, we
smile when oth­ers smile at us, we nod our heads when we agree, and we
frown when friends tell us of their mis­for­tunes. When the VVC is engaged,
it also sends sig­nals down to our heart and lungs, slow­ing down our heart
rate and increas­ing the depth of breath­ing. As a result, we feel calm and
relaxed, cen­tered, or plea­sur­ably aroused.
The many-branched vagus. The vagus nerve (which Dar­win called the pneu­mo­gas­tric nerve)
reg­is­ters heart­break and gut-wrench­ing feel­ings. When a per­son becomes upset, the throat gets
dry, the voice becomes tense, the heart speeds up, and res­pi­ra­tion becomes rapid and shal­low.
COURTESY OF NED KALIN, MD
Three respons­es to threat.
1. The social engage­ment sys­tem: an alarmed mon­key sig­nals dan­ger and calls for help. VVC.
2. Fight or flight: Teeth bared, the face of rage and ter­ror. SNS.
3. Col­lapse: The body sig­nals defeat and with­draws. DVC.
Any threat to our safe­ty or social con­nec­tions trig­gers changes in the
areas inner­vat­ed by the VVC. When some­thing dis­tress­ing hap­pens, we
auto­mat­i­cal­ly sig­nal our upset in our facial expres­sions and tone of voice,
changes meant to beck­on oth­ers to come to our assistance.11 How­ev­er, if no
one responds to our call for help, the threat increas­es, and the old­er lim­bic
brain jumps in. The sym­pa­thet­ic ner­vous sys­tem takes over, mobi­liz­ing
mus­cles, heart, and lungs for fight or flight.12 Our voice becomes faster and
more stri­dent and our heart starts pump­ing faster. If a dog is in the room,
she will stir and growl, because she can smell the acti­va­tion of our sweat
glands.
Final­ly, if there’s no way out, and there’s noth­ing we can do to stave off
the inevitable, we will acti­vate the ulti­mate emer­gency sys­tem: the dor­sal
vagal com­plex (DVC). This sys­tem reach­es down below the diaphragm to
the stom­ach, kid­neys, and intestines and dras­ti­cal­ly reduces metab­o­lism
through­out the body. Heart rate plunges (we feel our heart “drop”), we can’t
breathe, and our gut stops work­ing or emp­ties (lit­er­al­ly “scar­ing the shit out
of” us). This is the point at which we dis­en­gage, col­lapse, and freeze.
FIGHT OR FLIGHT VERSUS COLLAPSE
As we saw in Stan’s and Ute’s brain scans, trau­ma is expressed not only as
fight or flight but also as shut­ting down and fail­ing to engage in the present.
A dif­fer­ent lev­el of brain activ­i­ty is involved for each response: the
mam­malian fight-or-flight sys­tem, which is pro­tec­tive and keeps us from
shut­ting down, and the rep­til­ian brain, which pro­duces the col­lapse
response. You can see the dif­fer­ence between these two sys­tems at any big
pet store. Kit­tens, pup­pies, mice and ger­bils con­stant­ly play around, and
when they’re tired they hud­dle togeth­er, skin to skin, in a pile. In con­trast,
the snakes and lizards lie motion­less in the cor­ners of their cages,
unre­spon­sive to the environment.13 This sort of immo­bi­liza­tion, gen­er­at­ed
by the rep­til­ian brain, char­ac­ter­izes many chron­i­cal­ly trau­ma­tized peo­ple, as
opposed to the mam­malian pan­ic and rage that make more recent trau­ma
sur­vivors so fright­ened and fright­en­ing.
Almost every­one knows what that quin­tes­sen­tial fight/flight response,
road rage, feels like: A sud­den threat pre­cip­i­tates an intense impulse to
move and attack. Dan­ger turns off our social-engage­ment sys­tem, decreas­es
our respon­sive­ness to the human voice, and increas­es our sen­si­tiv­i­ty to
threat­en­ing sounds. Yet for many peo­ple pan­ic and rage are prefer­able to the
oppo­site: shut­ting down and becom­ing dead to the world. Acti­vat­ing
flight/flight at least makes them feel ener­gized. That is why so many abused
and trau­ma­tized peo­ple feel ful­ly alive in the face of actu­al dan­ger, while
they go numb in sit­u­a­tions that are more com­plex but objec­tive­ly safe, like
birth­day par­ties or fam­i­ly din­ners.
When fight­ing or run­ning does not take care of the threat, we acti­vate
the last resort—the rep­til­ian brain, the ulti­mate emer­gency sys­tem. This
sys­tem is most like­ly to engage when we are phys­i­cal­ly immo­bi­lized, as
when we are pinned down by an attack­er or when a child has no escape
from a ter­ri­fy­ing care­giv­er. Col­lapse and dis­en­gage­ment are con­trolled by
the DVC, an evo­lu­tion­ar­i­ly ancient part of the parasym­pa­thet­ic ner­vous
sys­tem that is asso­ci­at­ed with diges­tive symp­toms like diar­rhea and nau­sea.
It also slows down the heart and induces shal­low breath­ing. Once this
sys­tem takes over, oth­er peo­ple, and we our­selves, cease to mat­ter.
Aware­ness is shut down, and we may no longer even reg­is­ter phys­i­cal pain.
HOW WE BECOME HUMAN
In Porges’s grand the­o­ry the VVC evolved in mam­mals to sup­port an
increas­ing­ly com­plex social life. All mam­mals, includ­ing human beings,
band togeth­er to mate, nur­ture their young, defend against com­mon
ene­mies, and coor­di­nate hunt­ing and food acqui­si­tion. The more effi­cient­ly
the VVC syn­chro­nizes the activ­i­ty of the sym­pa­thet­ic and parasym­pa­thet­ic
ner­vous sys­tems, the bet­ter the phys­i­ol­o­gy of each indi­vid­ual will be
attuned to that of oth­er mem­bers of the tribe.
Think­ing about the VVC in this way illu­mi­nates how par­ents nat­u­ral­ly
help their kids to reg­u­late them­selves. New­born babies are not very social;
they sleep most of the time and wake up when they’re hun­gry or wet. After
hav­ing been fed they may spend a lit­tle time look­ing around, fuss­ing, or
star­ing, but they will soon be asleep again, fol­low­ing their own inter­nal
rhythms. Ear­ly in life they are pret­ty much at the mer­cy of the alter­nat­ing
tides of their sym­pa­thet­ic and parasym­pa­thet­ic ner­vous sys­tems, and their
rep­til­ian brain runs most of the show.
But day by day, as we coo and smile and cluck at them, we stim­u­late
the growth of syn­chronic­i­ty in the devel­op­ing VVC. These inter­ac­tions help
to bring our babies’ emo­tion­al arousal sys­tems into sync with their
sur­round­ings. The VVC con­trols suck­ing, swal­low­ing, facial expres­sion,
and the sounds pro­duced by the lar­ynx. When these func­tions are stim­u­lat­ed
in an infant, they are accom­pa­nied by a sense of plea­sure and safe­ty, which
helps cre­ate the foun­da­tion for all future social behavior.14 As my friend Ed
Tron­ick taught me a long time ago, the brain is a cul­tur­al organ—
expe­ri­ence shapes the brain.
Being in tune with oth­er mem­bers of our species via the VVC is
enor­mous­ly reward­ing. What begins as the attuned play of moth­er and child
con­tin­ues with the rhyth­mic­i­ty of a good bas­ket­ball game, the syn­chrony of
tan­go danc­ing, and the har­mo­ny of choral singing or play­ing a piece of jazz
or cham­ber music—all of which fos­ter a deep sense of plea­sure and
con­nec­tion.
We can speak of trau­ma when that sys­tem fails: when you beg for your
life, but the assailant ignores your pleas; when you are a ter­ri­fied child lying
in bed, hear­ing your moth­er scream as her boyfriend beats her up; when you
see your bud­dy trapped under a piece of met­al that you’re not strong
enough to lift; when you want to push away the priest who is abus­ing you,
but you’re afraid you’ll be pun­ished. Immo­bi­liza­tion is at the root of most
trau­mas. When that occurs the DVC is like­ly to take over: Your heart slows
down, your breath­ing becomes shal­low, and, zom­bielike, you lose touch
with your­self and your sur­round­ings. You dis­so­ci­ate, faint and col­lapse.
DEFEND OR RELAX?
Steve Porges helped me real­ize that the nat­ur­al state of mam­mals is to be
some­what on guard. How­ev­er, in order to feel emo­tion­al­ly close to anoth­er
human being, our defen­sive sys­tem must tem­porar­i­ly shut down. In order to
play, mate, and nur­ture our young, the brain needs to turn off its nat­ur­al
vig­i­lance.
Many trau­ma­tized indi­vid­u­als are too hyper­vig­i­lant to enjoy the
ordi­nary plea­sures that life has to offer, while oth­ers are too numb to absorb
new experiences—or to be alert to signs of real dan­ger. When the smoke
detec­tors of the brain mal­func­tion, peo­ple no longer run when they should
be try­ing to escape or fight back when they should be defend­ing
them­selves. The land­mark ACE (Adverse Child­hood Expe­ri­ences) study,
which I’ll dis­cuss in more detail in chap­ter 9, showed that women who had
an ear­ly his­to­ry of abuse and neglect were sev­en times more like­ly to be
raped in adult­hood. Women who, as chil­dren, had wit­nessed their moth­ers
being assault­ed by their part­ners had a vast­ly increased chance to fall vic­tim
to domes­tic violence.15
Many peo­ple feel safe as long as they can lim­it their social con­tact to
super­fi­cial con­ver­sa­tions, but actu­al phys­i­cal con­tact can trig­ger intense
reac­tions. How­ev­er, as Porges points out, achiev­ing any sort of deep
intimacy—a close embrace, sleep­ing with a mate, and sex—requires
allow­ing one­self to expe­ri­ence immo­bi­liza­tion with­out fear.16 It is
espe­cial­ly chal­leng­ing for trau­ma­tized peo­ple to dis­cern when they are
actu­al­ly safe and to be able to acti­vate their defens­es when they are in
dan­ger. This requires hav­ing expe­ri­ences that can restore the sense of
phys­i­cal safe­ty, a top­ic to which we’ll return many times in the chap­ters that
fol­low.
NEW APPROACHES TO TREATMENT
If we under­stand that trau­ma­tized chil­dren and adults get stuck in
fight/flight or in chron­ic shut-down, how do we help them to deac­ti­vate
these defen­sive maneu­vers that once ensured their sur­vival?
Some gift­ed peo­ple who work with trau­ma sur­vivors know how to do
this intu­itive­ly. Steve Gross used to run the play pro­gram at the Trau­ma
Cen­ter. Steve often walked around the clin­ic with a bright­ly col­ored beach
ball, and when he saw angry or frozen kids in the wait­ing room, he would
flash them a big smile. The kids rarely respond­ed. Then, a lit­tle lat­er, he
would return and “acci­den­tal­ly” drop his ball close to where a kid was
sit­ting. As Steve leaned over to pick it up, he’d nudge it gen­tly toward the
kid, who’d usu­al­ly give a half­heart­ed push in return. Grad­u­al­ly Steve got a
back-and-forth going, and before long you’d see smiles on both faces.
From sim­ple, rhyth­mi­cal­ly attuned move­ments, Steve had cre­at­ed a
small, safe place where the social-engage­ment sys­tem could begin to
reemerge. In the same way, severe­ly trau­ma­tized peo­ple may get more out
of sim­ply help­ing to arrange chairs before a meet­ing or join­ing oth­ers in
tap­ping out a musi­cal rhythm on the chair seats than they would from sit­ting
in those same chairs and dis­cussing the fail­ures in their life.
One thing is cer­tain: Yelling at some­one who is already out of con­trol
can only lead to fur­ther dys­reg­u­la­tion. Just as your dog cow­ers if you shout
and wags his tail when you speak in a high singsong, we humans respond to
harsh voic­es with fear, anger, or shut­down and to play­ful tones by open­ing
up and relax­ing. We sim­ply can­not help but respond to these indi­ca­tors of
safe­ty or dan­ger.
Sad­ly, our edu­ca­tion­al sys­tem, as well as many of the meth­ods that
pro­fess to treat trau­ma, tend to bypass this emo­tion­al-engage­ment sys­tem
and focus instead on recruit­ing the cog­ni­tive capac­i­ties of the mind. Despite
the well-doc­u­ment­ed effects of anger, fear, and anx­i­ety on the abil­i­ty to
rea­son, many pro­grams con­tin­ue to ignore the need to engage the safe­ty
sys­tem of the brain before try­ing to pro­mote new ways of think­ing. The last
things that should be cut from school sched­ules are cho­rus, phys­i­cal
edu­ca­tion, recess, and any­thing else involv­ing move­ment, play, and joy­ful
engage­ment. When chil­dren are oppo­si­tion­al, defen­sive, numbed out, or
enraged, it’s also impor­tant to rec­og­nize that such “bad behav­ior” may