“It is no measure of health to be well-adjusted to a sick society.”
09 October 2019 was World Mental Health Day. Social media used their platforms to have conversations about the pain, despair, darkness and loneliness of those suffering from mental illness. The World Health Organisation used the day to focus on Suicide Prevention. They shared that every 40 seconds, someone takes their own life. Be quiet with this, before you read on.
Click here to go to their website
Not many of us have been spared the loss of a beloved through suicide. I know I haven’t. It leaves a terrible legacy to those left behind who are consumed with thoughts about the hopelessness, loneliness, despair and the fear that their loved ones would have surely felt in those final days and those final hours. Those left behind often feel that they were not good enough, or their love was not enough to have kept their loved one safe and alive.
It was only after reading Stephen Porge’s Polyvagal Theory that I came to understand what is happening on an autonomic nervous system level, and why conventional interventions, may not necessarily help the depressed and the suicidal. I hope the summary I provide below, is helpful to you.
We have all heard of the Fight and Flight response and we understand it as the body’s system of protection and defense. When we execute fight or flight we do so from the spinal sympathetic nervous system, and this is referred to as mobilization. The sympathetic nervous system is also recruited for daily physical activity. When we are mobilized, for fight or flight, the body produces stress hormones noradrenalin, adrenalin and cortisol to help us execute the body’s innate protective mechanism
That said, in the interests of conforming to social order and norms, the human mammal has been socialized from a very young age, to not fight with or flee from those they know. We are also socially conditioned from a very early age to especially not fight with or flee from adults and our caregivers, even if they are harming us. It is worth noting, that even if we do not execute fight or flight, as soon as the nervous system senses danger, real or perceived, adrenalin and cortisol are produced in the body. This unused cortisol and adrenalin, creates a feedback loop of constant danger between body and brain. .
So, in the absence of fight of flight, the body has another protective mechanism and this is called Freeze. Polyvagal theory helps us understand the freeze response, and the role of the Dorsal Vagus Nerve in shutting down, freezing the body and allowing a person to disassociate from current reality. The dorsal vagus is a most primitive nerve and is found in the entire animal kingdom.
You may have heard the term “playing possum”, which describes a possum, most famous for this behaviour, feigning death in an attempt to escape death, hoping that the predator is tricked into believing that it is already dead and will thus leave it alone. This is when the dorsal vagus is doing its protective work. Many other species in the animal kingdom do this, including snakes, spiders and fish. The human autonomic nervous system is also capable of the same protective function and is involuntarily recruited when we are faced with extreme danger.
In a healthy nervous system, the dorsal vagus nerve oversees the essential work of rest and digest of the parasympathetic nervous system. It brings the body to rest after mobilization, calming the body by lowering- heartbeat, blood pressure, breathing etc. It also allows safe immobilization; sleep, relaxation, intimacy. It is also involved in the digestive function.
Directly translated from latin, vagus means Wanderer; appropriately named because the vagus nerve has such a broad reach, connected to or wandering through the immune, respiratory and gastro-intestinal systems. There is a body of science called psycho-neuro-immunology, which is making links between our life experiences, our neurological and body responses and chronic illnesses. To borrow a phrase from Caroline Myss, our biology becomes our biography.
In a nervous system dis-regulated by chronic trauma or an acute episode of endangerment, where fight or flight is thwarted, the dorsal vagus shuts the body down and shuts off access to the pre-frontal cortex, the seat of executive function. In a dorsal vagus shut down, the person is in a “feign death” state and is trying to protect the SELF.
Neuroscience informs us that the human mammal does not have the autonomic flexibility that our animal counterparts have, and that even after the danger has passed, we are unable to readily engage mobilization and social engagement after it has experienced a feign death response.
We see a manifestation of this in people with an altered state of consciousness, presence and alertness; we may describe them or they may describe their inner states as depressed, disassociated or shut down.
If the person is unsupported or unable to move from a place of shut down, to mobilization and then to social engagement (controlled by the ventral vagus), suicide becomes a high possibility.
The implication for us as practitioners is to recognize that our first responsibility is to help our clients come into association with their bodies and to feel safe in their bodies. Our role is to help them regulate and to restore a sense of physical and emotional safety.
Imparting knowledge about the autonomic nervous system and the role of the dorsal vagus helps clients understand why they are feeling (helpless, hopeless, emotionally frozen) and how it came to be in the first instance; it enables a client to create distance from the label and taint of pathology and replace it with understanding, compassion and appreciation for the body’s intelligence and instinct for survival.
In contrast to the use of only medication or talk therapy, the practice of mindfulness, meditation and body-based interventions, such as TRE (Tension and Trauma Release), Somatic Experiencing, EMDR are critical to an intervention process.
The benefit of understanding Polyvagal Theory is that it gives us a lens through which we can work holistically and effectively; on an energetic and physiological level, an emotional level and a cognitive level.
And having said that, all depressed people do not always appear shut down; we know too that people are gifted in masking their pain and loneliness because that very charade helped them survive trauma and difficulty. To coin a phrase, people’s insides do not always match their outsides.
Be gentle with the people you meet.
Their outsides may not match their insides.
Click here to listen to a podcast from the Azania Mosaka show, which aired on 23/10.
Leato’s story corroborates so much of what Johan Hari shared in his book Lost Connections. It is a book that truly shifted my understanding of depression. If you have not already, and if you suffer from depression or have a beloved person suffer from depression, I urge you to read Lost Connections – uncovering the real causes of depression and the unexpected solutions.
Johann Hari wrote this book after completing a journey of exploration and research, to make sense of his own pain, of his questions and his despair as a person diagnosed as clinically depressed and who had been medicated for depression from the age of 14.
He lists 9 causes of depression and anxiety: he suggests that if we are disconnected from any or a combination of these life-giving things, we will be prone to depression, depressive episodes and anxiety.
- Disconnection from meaningful work
- Disconnection from other people
- Disconnection from meaningful values
- Disconnection from childhood trauma
- Disconnection from status and respect
- Disconnection from the natural world
- Disconnection from a hopeful and a secure future
- & 9 Genes and Brain Plasticity
He poignantly describes depression as grief for our lost connections to life giving experiences. People who are depressed are grieving; grieving a loss not fully articulated, and not fully understood by professionals who are assigned to helping them.
I close by leaving another of his messages with you:
It’s not serotonin, its society
It’s not your brain; it’s your pain
Depression is not a mental health issue, there is a sanity in the sadness, it is saying, you shouldn’t have to live this way.
A final quote from his book, where he reference Dr Anda, whom he describes as a pioneer in the field of research into depression:
“When people have these kinds of problems, it’s time to stop asking what wrong with them, and time to start asking what happened to them”.
Be gentle with yourselves and those around you