A Polyvagal Understanding of Being Human

Editor’s Note: This article originally appeared on Mad in Finland. The author, Suvi Järvinen, is “a forest soul” studying to become a solution-oriented brief therapist. 

One Sunday, an apple tree and a gentle summer breeze. A crooked pile of books on the table in the garden, a lovely mug full of oat milk coffee intuitively chosen from the pottery stall the day before. The apple tree rustled as I waded through the books. I was once again confused after reading Psykiatria (2021), Henriksson, Haravuoren and Lönnqvist’s article on psychological crises, adjustment disorders and stress reactions (the topics of the article are already an interesting combo considering that they are discussed in the same article).

It seems as if the authors are not always up to date on the current psychiatry debate, let alone ready to admit that there are effective drug-free remedies and support available for various symptoms, the underlying causes of which would be good to find out before making diagnoses or writing prescriptions for drugs and then more drugs for side effects. It would be great to know the affiliations and connections of the authors of different articles with, for example, different representatives of the pharmaceutical industry—there is always so much variety in dealing with medical treatment and the invitation to try many different preparations that you will surely find the right one! I thought about how badly the clients’ brain chemistry is mixed with different preparations before finding the “suitable” one, and could it be that the person is already so sick and has given up that they agree to medical treatment?

In any case, it is contradictory to first write that medicines are a secondary way of helping people and then, however, one should test as many different preparations as possible to ensure that a suitable one is found. Drug treatment is also stated to be secondary to psychosocial methods, but despite that, the description of drug treatment gets more column space in the book and nothing is said about the different options of psychosocial rehabilitation. Psychotherapy is written about, but even there it is admitted that, for example, a person suffering from PTSD symptoms is not able to benefit from intensive psychotherapies.

There is no way to open this. I wonder if the reason could be, for example, insufficient tuning into the state of social connection because the amygdala is activated sensitively and the person gets the feeling that interaction with others is even life-threatening? What about poor mentalization ability, which is due precisely to the fact that the load affects the human brain and nervous system, and that again manifests itself as a lack of mentalization ability. I really missed the fact that the article would have shown, even in the slightest, that the authors are aware of psychophysical methods and, for example, the polyvagal theory. So I started to write about it myself, when I felt like I wanted to talk a little about this.

Are EMDR’s mechanisms of action unclear?

I came across EMDR therapy while reading about trauma years ago. I have Shapiro’s work on the subject in my home library, and I link the effect mechanisms of that form of therapy to Porges’ polyvagal theory in my own database. Henriksson, Haravuoren and Lönnqvist write in their article in Psykiatria that EMDR’s mechanisms of action are “still unclear”, but admit that it works well. Even with a quick Google search, you can see that information on the mechanisms of action is indeed available and the effectiveness of the treatment has been published quite extensively. I checked this website myself: https://emdr.fi/emdr-tutkimustietoa/

Francine Shapiro published a comprehensive work on the subject in 1999, and in the beginning of her book she says that eye movements are scientifically linked to higher cognitive processes and the functioning of the cerebral cortex. Shapiro says that he discovered the effect of eye movements on mind loops while taking a walk one day in 1987. The first study was conducted in the same year. So it is not a very new thing. I wonder why Henriksson, Haravuoren and Lönnqvist end up acknowledging this in their article like that. Would proper substantiation and acknowledgment of the effectiveness of EMDR have undermined the introduction of medical treatments in this context? Would it have even deprived the entire work of its status and threatened psychiatry as a discipline?

Understanding the neural causes behind mental health symptoms requires admitting that what has been considered a “disease” could actually be caused by circumstances. This would really threaten everything that psychiatry strives to be. Maanmieli and Sarvela (2022) state that studies unequivocally show that people who use mental health services have a lot of traumatic experiences. However, the history of trauma is often ignored and the focus is only on symptoms and medication. The experience of many patients is that psychiatric treatment has not wanted to get to know their life story or what kind of things have led to their illness. Gabor Maté has claimed in an interview (2017) that a traumatic event is behind every mental illness. According to him, it’s also about not meeting our natural needs. According to Maté, at the core of trauma is the alienation from ourselves, our bodies and our emotions caused by our modern lifestyle.

Polyvagal understanding for working with people

On the waves of Maté’s thoughts, I naturally float towards Porges’ polyvagal theory. A concise and intuitive information package about how the human brain and nervous system work and how it is reflected in human behavior and interactions with others. In the end, everything revolves around a person’s well-being and mental balance (just like that important vagus nerve, you can smile a little here) around a sense of security. With the help of neuroception, a person continuously and on a non-conscious level scans the environment from the perspectives of safety and threat.

Peter A. Levine is one of the pioneers of trauma research, along with Bessel van der Kolk. His work Waking the Tiger: Healing Trauma was published already in 1997. His work has a solid understanding of evolutionary psychology and the book approaches trauma and trauma-related symptoms precisely by clarifying how mammals work and how those different nervous states of alertness also guide human activity when a person is exposed to danger or long-term stress. Levine calls for a holistic approach to trauma treatment. He writes in his preface:

“Trauma is traditionally considered a disordered state of mind that is psychological and medical in nature. Modern medicine and psychology outwardly proclaim the unity of mind and body – in practice and greatly underestimating the profound interaction of the two in the healing of trauma. Over time, body and mind have merged into unity. This unity forms the philosophical and practical background assumptions for the majority of the world’s traditional healing systems. However, this unity is sadly missing from our modern way of understanding and treating trauma.”

At the end of his book on the polyvagal theory, Porges formulates the matter in such a way that the theory challenges us to think about how the human nervous system works, and what kind of responses this activity causes in people’s behavior and being with others. He writes that the theory challenges clinicians to consider unusual behavior and physiological responses as adaptive responses. According to him, various mental health problems are caused by the fact that a person has a deficient ability to enter the state of social connection neurologically; to an area where the most important factor is the feeling of security. If a person is afraid, he is not able to act in a socially sustainable way. If a person reacts to things through stress and load, you cannot, for example, promote things with him in a way that would be fruitful for both parties.

In this case, I was thinking about many different professions and interventions in customer work. The challenges of detecting adaptive behavior lie in the fact that it is a means of survival for a person and he can be skilled at hiding the fact that the different layers of behavior actually protect a wounded part or parts of himself. The difficulties of getting into a state of social connection and the challenges of social commitment come to mind when thinking about the different features of the neuropsychiatric spectrum. In his work, Porges writes entire chapters about autism and borderline personality. According to him, several traits associated with autism can be explained through the functioning of the vagus nerve. Porges writes about borderline personality disorder with the understanding that the “personality type” classified as a disorder has its roots in the early 19th century and that it was invented when there was no other way to group patients with psychotic and neurotic symptoms together. According to Porges’ research, people with this diagnosis do not have neuroception “normally” and have great difficulties with the state of social connection. They act on the basis of the fight-or-flight response in situations where there is no real danger or threat. Needless to say, this leads to conflicts and problems with others.

I came across an interesting article (2016) on the Duodecim website about emotional trauma and the polyvagal theory , and I was glad that the authors have no affiliations. The article states that increasing the understanding of nervous arousal states can help the client relate their own feelings to broader, even evolutionary dimensions. Anssi Leikola, Jukka Mäkelä and Marko Punkanen write that in a psychotherapeutic treatment relationship one can make good use of information from the polyvagal theory and, for example, invest in creating a very safe feeling and interaction relationship. They write that the synergy of polyvagal theory and trauma research is a fresh starting point in psychiatry. However, this important issue is not raised in the article in Psykiatria regarding psychological crises, adjustment disorders and stress reactions.

In Psykiatria, Henriksson, Haravuoren and Lönnqvist sideline the increased state of alertness in connection with the difficulties of falling asleep in people who have experienced traumatic things when they delve deeper and link the various symptoms of the autonomic nervous system to feelings of panic. At this point, the authors could have even mentioned Porges’ (1999) pioneering theory, but they didn’t. The authors consider multiple disorders. It’s an exciting thing that people who have experienced shocking things show symptoms diagnosed as panic disorder or that they get a diagnosis of depression. By understanding how humans (and other mammals) work nervously, one could avoid multiple diagnoses and truly make people feel better! It is unfathomable that even this latest edition does not take into account the abundant psychophysical dimension, which nevertheless exists and is acknowledged.

I wonder how many people there are, whose various difficulties and symptoms are ultimately due to nervous reasons. I remember reading that many who end up in prison have attachment damage and developmental childhood trauma in the background and that social skills have remained undeveloped due to toxic environments and not having received enough love and security. The prison environment, with its strict routines, may be the first place to breathe for many, due to its safety and predictability. I am reminded of the Swedish expert’s call to invest in schools so there is no need to invest in prisons. There have been worrying changes in Finnish schools in recent years, and student nausea has increased. I thought about how nervous requirements are taken into account in today’s schools. In any case, school violence or the threat of it does not help matters or promote learning, because learning is not possible if a person is afraid.

The same could be thought about in workplace conditions and in working life more broadly. What kind of requirements are set today and what kind of environments do we work in and what do we do? Work exhaustion as a cause of sick leave is also on the rise. What about the unemployed? In Sari Näreen and Lena Näreen’s (2022) work, Työttömyys Sattuu, they state that unemployment is even a traumatizing experience for a person, when various unemployment measures start to dominate the use of time and periods of daily allowance payment rhythmize everyday life. They write: “It is traumatic to have to experience that one’s life is no longer in one’s own hands, but that the authorities can intervene”.

Finally

Porges’ polyvagal theory creditably underpins the symptoms considered to be mental disorders. I’m not the only one who has felt this is a natural way to approach the subject. The works describing the trauma-informed approach and methods of operation (e.g. Johanna Linner-Matikka and Tiia Hipp, eds., Trauma-Informed Approach; Karoliina Maanmieli and Kati Sarvela, A Common Mind: Trauma Awareness for Mental Health Work and Kati Sarvela and Elisa Auvinen, A Common Language: Trauma Awareness for Meeting People) offer a great information package on the subject for everyone who works with people.

It’s a little strange that Psykiatria doesn’t include these things when dealing with this topic. Porges points out already in 1999 that especially those working with trauma have benefited from the broader understanding of the subject offered by the polyvagal theory: “in understanding mental health symptoms and in developing interventions and treatment models respecting the client’s quest for safety”.

Humans seek safety, but have to endure more and more uncertainty thanks to social structures. Nursing relationships are not permanent, and those who have experienced traumatic things may be offered quick sedatives, when it would be more important for the person to be met and understood. A gentle, space-giving presence and the nervous calmness of another person would help better. So many are sent home alone with jars of medicine, and weeks later, a discussion time with a professional is written on the note, if even that.

I think that the understanding that ultimately we all look to others for safety should guide all human endeavors, and especially should be unwavering on the part of those who provide medical interventions. In mentalization therapy, the focus is on examining the interaction relationship and the reactions it causes and striving for understanding. It has been researched that breaks in the therapeutic alliance are critical for trust and a sense of security. How we as humans communicate in these moments can have a fundamental and even shocking effect. Breaks in communication are places where you can become sensitive to the presence of another person, and admit that now I don’t understand if we look at this issue together. The idea of ​​an alliance can be extended to all human work. Cooperation cannot be done without an alliance, and an alliance cannot be formed without security.

When we read about the current government’s various measures and cuts, I can’t help but think about what it does to feelings of security or faith in the future. What is clear is that, being human, we simply need to be able to be and breathe in an environment that suits us neurologically. Inappropriate conditions cause nausea. The headlines about giant kindergartens and schools, the increased anxiety symptoms among young people and the fact that mental health reasons are really the biggest reason for granting disability pensions come to mind. I hope that we could focus on the things that are essential to human well-being. These can be brilliantly approached, for example, through the increased understanding of the polyvagal theory, and what’s best; exercises that enhance the function of the vagus nerve are certainly suitable for all of us.