I've been following this thread for many years, and also focusing on the myth of the triune brain or the "hydraulic" brain, which is absolutely everywhere in trauma therapies.

I would ask which aspects of Porges's hypotheses your patients find helpful, and whether alternative explanations could be found so that they aren't working with disconfirmed ideas. There was a very good response about this in earlier conversations, and I'll go see if I can find it. The essence was that professional ethics requires that we not present incorrect information to vulnerable people.

Hello Laure,

It was actually Paul Grossman who answered in October 2019. This answer was in response to Bernice Gonzales, who achieved healing through the disconfirmed polyvagal model (and associated models):

" Dear @bernice gonzales ,

Of course, humanism should remain fundamental. It is wonderful that you have been helped by somatic experiencing or some related therapy. Nevertheless, the therapy, itself, may be of huge benefit, although the physiological explanation of its effects are unfortunately wrong. You benefited from the complex lived experience of the treatments, not the supposed physiological changes that occurred. Experience is much more complicated than cascades of (brainstem) vagal activity (how about all those higher-up midbrain and cortical centers, if you need to remain physiological in your explanation).

Actually, Peter Levine was doing somatic experiencing well before he came into contact with the polyvagal speculations and only later retro-fitted his explanation for the therapy‘s mechanisms of action. Terms, such as “dorsal vagal shutdown” to explain dissociation or emotional freezing are, according to the very best (and only) evidence, simply wrong. Furthermore, they also reduce complex human experience to a brainstem reaction. In fact, there is zero evidence that the dorsal motor nucleus is involved at all, and substantial evidence to the contrary. That’s just the way it is. Maybe the vagus is partially involved (almost certainly the centrally located nucleus Ambiguus, not dorsal centers), but it’s a lot more complicated than that. If you require some biological metaphor, then one with more scientific substance will probably do you better and will not be so jarring as a false belief that sooner or later will be acknowledged as wrong (all the evidence is already available, but there are too few serious experts interested in taking the time to evaluate it).

So please believe your experience but, at the very least, leave room for some doubt about what caused your improvement. All the best."

I do think the arousal one experiences with trauma, retraumatization and related memories is a physiological response of the autonomic nervous system, which includes sympathetic and parasympathetic nerve functions including the vagus. This is an incredibly complex system that i sure cannot claim to even nearly understand. There are some old (post-war) theories in German research (the Kippschwingungsprinzip) that sound suspiciously similar to Chinese Medicine, in that the vagus would become more active when a persistent sympathetic activation has been moved the system out of its homeostatic balance, and the vagus tries to swing it back. Just an illuminating theoretical model that I am not sure has ever been proven. Somatic Experiencing (SE) and other differentiated mind-body approaches can be very efficacious in the right patients/clients. This is not questioned and of course warrants good clinical studies to support them.

How SE may work is a separate question. I am convinced that the autonomous nervous system plays a major role during the SE sessions. And i agree that SE pays particular, careful, and sophisticated attention to symptoms and experiences related to it. There is a theoretical article (Peter Levine is co-author) that I actually 'helped' into a scientific journal (by Peter Payne; Frontiers in Psychology). It was not based on Porges' thinking, which would have made it difficult to publish it there. Also, I have friends who underwent and others practice SE. All great people! Otherwise they would not be my friends. :-)

However: When homeopathy 'works' it is not based on simile-similibus pharmacological 'theories' of past centuries. Acupuncture cannot be well explained by Western science/physiology and can have impressive effects. You can/should still practice these methods. And they do require that you fully endorse them to have a healing potential. Paul's critique does not have to affect your work/practice at all. It is just that the human body (and psyche) is so incredibly complex, and that we all want to understand it and feel that we have a scientific backing for what we do. The vagus remains a key player in our human psychophysiology. It does not have to fit into Porges' concepts and models.

Thank you for your thoughtful responses. My clients report that their experiences of dissociation, freezing, numbing, and loss of executive function (reasoning, thinking clearly, remembering, making judgements about safety, hypothesizing about possible outcomes of actions) often feel out of their control (which they actually are at that moment) and inexplicable. As you can imagine, these reactions increase their sense of shame and isolation, and support their innate belief that they are crazy. Porges's explanations (rather, my rather rudimentary ones) present them with a model that makes sense of their symptoms and, in between episodes of high distress, allows them to rationally choose coping behaviors that lead to consciously reduced heart rate, slowing and deepening of breath, physical ease, and reduced anxiety and fear.

I do take issue with the inclusion of my professional ethics as a consideration in my presentation of Porges's material to my clients. My clients are vulnerable, but they're not mindless, and from an ethical standpoint, I think it's more important to present material (and no technique is without its scientific detractors) as one alternative, rather than unilaterally dismiss possible helpful approaches. That is, unless they're in the realm of conversion therapy.

For me as a clinician, Dr. Mehling's response spoke to both the clinic and the laboratory scenarios.

Thanks again.