The body keeps the score

I have been talking about the body keeping the score in therapy, as Bessel van Der Kolk says for a while now. It’s so obvious to me that our emotions and symptoms are so much more than just ‘in our head’. But I’ve definitely infused more of my sessions lately with the polyvagal theory by Stephen Porges.

Polyvagal theory in an embarassingly simplified version, is the idea that our nervous system is involved with our mental health symptoms. If you imagine a ladder, our nervous system has three identified levels, safe, fight/flight/fawn and freeze. These are biologically set as ways that our body responds to perceived threats in order to keep ourselves safe.

Our nervous system is meant to do certain things when we perceive a threat to keep ourselves safe - among the most significant, it suppresses our immunity, sex hormones and even growth hormones. It affects our vital organ functionality, specifically digestion. This is to prioritize blood flow to the most necessary parts of the body to mobilize and protect ourselves.

Here’s the fly in the ointment. When we have experienced trauma, or unrelenting chronic stress, our body takes over as an animal intent on survival. It says, we have had this bad, unpredictable thing happen, and so we are going to stay on high alert to make sure it doesn’t happen again. When we have had a threat, the brain perceives threat from all stimulus, even safe things. This basically means we stay stuck in heightened nervous system arousal, which leads to a lot of difficulty with our behaviors and moods. The important thing about this is to understand that this is not something we are choosing! We are being run by our default settings that are intent on our survival.

This results in really difficult symptoms to manage. We respond with flight responses, which is anxiety, rumination and obsessive thinking. Our fight response is irritability, frustration and anger. Our fawn response is appeasing behaviors, while deferring our own needs. When it isn’t safe to fight/flight/fawn, our nervous system shuts down, and goes into freeze state. This looks like disconnection, numbness, increased pain tolerance, shame, shut-down, dissociation and feeling trapped or stuck.

I say all of this to help people understand their responses to life. The even more significant piece of teaching this is about helping people release their responsibility and shame they feel for their mental health issues. To start to understand that they did not cause their responses, but can be a part of healing these injuries feels like the most important work I can do.