Polyvagal Theory & Autism

Polyvagal Theory & Autism

The Polyvagal Theory is based on the work of Stephen W. Porges PhD. This theory is based on the vagus nerve and the way that it works within the body to help us interact with our world.

In a nutshell The Polyvagal Theory suggests that we have three main ways of operating: we can be in an open state where we can be calm and our social faculties (eyes, ears, face, voice, connection to heart), digestive and cognitive faculties, like executive functioning and working memory, are all online and available for us to use.

We can be in a flight/fight state where the body is focused on excitement or threat and a lot of our social and cognitive faculties are less online. Our taste buds, our digestion also turn off as we don’t need to be digesting food when we are about to run or fight. Energy is diverted and conserved for our safety. As the eyes and ears start to shift to the danger response, they are also less able to process a wider range of light and sound.

Lastly, in order to keep us safe, our body can go into an involuntary, immobilised state. For example, if a lion gets too close and you cannot run, fight or stop still in your tracks (freeze), the body has another option; it will take over to make so you are not interesting to the lion. Here you cannot move, make a noise, blink or feel. This is your best option for survival and often the lion finding you inanimate, will walk away. It is in this state that we start to disassociate and go into meltdown.

If the body has very early in life had an experience of threat – for whatever reason – it can get stuck in an immobilised state and think that this is normal. The person can grow up and be really smart, they can be all kinds of wonderful, but not have a lot of choice when it comes to how they are going to respond to the world because they are, more or less, in constant state of shut-down. So many people are living in a highly constricted body state.

When we look at autism, there are a lot of similarities. Communication, social connection, motor movement and control, taste and digestion issues, executive functioning, working memory, noise and light sensitivity all require the body to be in a good enough place. When we are immobilised (to a greater or lesser degree) we don’t have full access to all our faculties. When we are in a constant state of flight/fight or immobilise, our bodies can hurt; we can experience too much pain, or none at all. We can be hyper alert to everything, or have hypo-reactivity. Ultimately, we don’t have full control.

To regain control, we need to teach the body how to be in a more parasympathetic (calm) state. It is virtually impossible to intellectually teach this to someone who does not have a good relationship with their body. This is why most of our therapies fail. When we teach the body how to be in a deeply relaxed state, we give people a chance to feel better, to make better decisions, self-regulate and live in a way that makes them happy, because they start to have a choice as to how their body behaves.

This is not about fixing autism. Autism is a genetic and environmental disposition that is multi- layered. While this is true, it is also true that autists often suffer from a variety of physical and mental issues that can be greatly assisted by helping the body to become more robust. When our body is more fully online, we have a greater capacity to live the life we want to lead.

Brain Plasticity & Autism

Brain Plasticity & Autism

We used to think that the brain was fixed and not capable of change, but it’s not true. The brain is capable of changing – at any age – and when we work with the body as well as the mind, we have an even greater capacity to make positive changes.

People on the autism spectrum, whether they can speak; whether they are hypo or hyper reactive; whether they are five, fifteen or fifty are all intelligent and all have highly sophisticated nervous systems that are capable of learning.

When we work directly with the nervous system and avoid overly complicated social and cognitive tactics; when we work with transparency, clarity and have an inclusive and empowered approach -we can make magic happen. However, it’s not magic, it’s the brilliance of a brain/body system that wants to be free and when it is shown how, with kindness and grace, it has an amazing, adaptive capacity to grow and develop and let people be more of who they want to be.

Body Cognition

Body Cognition

When we are stuck in an immobilised (hypo) state it can be hard to feel what is going on in your body because our interoceptive capacity has been turned off. When we are in a hyper- alert state, we can feel too much, or nothing. This skill of interoception is something that comes on and offline depending on what state we are in.

It’s not much use teaching people stuck in an immobilised state to cognitively try and work out what’s happening in their body – because they can’t! They can’t because the body and nervous system are not in the right physical state. We literally can’t feel things or ‘know’ things about our internal state when we are in shut-down. If we’ve always been in shut-down, we’ve probably never learnt to do this.

When we teach the body how to be in a more relaxed and composed state, this function can come online. Body cognition is about learning how to listen to your body, how to respond to it with kindness and to build a relationship with it, so you can feel you have mastery over your system and get to live the life you want to live.

Unpacking Anxiety

Unpacking Anxiety

Anxiety is the most common mental illness, affecting 300 million people worldwide. Symptoms include worrying, ruminating and obsessing & panic attacks. The smallest doubt can activate a red flag in the brain, overriding all logic. Untreated, it can develop into OCD and depression.

Traditional therapies like Cognitive Behaviour Therapy (CBT) focus on changing unhelpful thoughts and behaviours that contribute to, and feed, anxiety. However, these require people to use their brain and will to overcome a highly limbic – body dominant – state and often they fail. This inability to control the mind can sometimes cause further anxiety and feelings of inadequacy.

It turns out that the body informs the mind much more than we have previously thought and this changes our focus on working with anxiety. Recent advances in neuroscience indicate just how beholden we are to our body for our mental wellbeing and just how much the body informs and influences the mind.

While the brain is very much a part of the problem in anxiety – the amygdalae, the flight/fight centre in the brain, when active, literally dominate and inhibit access to the brain’s prefrontal cortex (our executive functioning, strategic planning, will to live, higher cognition and language) – what we do not really appreciate, is just how responsive the brain is to information being sent from the body.

Our body goes into flight/fight long before we consciously know about it. At least 80% of our sensory information is first assessed in the gut. Signals of danger are sent from the gut, via the vagus nerve and spinal cord, to the brain and it is only then that the amygdala go into full flight. Once activated they send repeat memories of danger so that we keep vigilant to stay safe. Unless something changes, we can get stuck in this heightened state.

The body and mind work as a whole and the body very much informs the mind. For example: the amygdalae are part of the body’s limbic system and are informed by the gut and nervous system. The vestibular system (balance, posture, sense of self) and social engagement system (cranial nerves -eyes, ears, face, voice, swallowing, connection to heart, lungs and digestion) are deeply connected to the prefrontal cortex; and all these things are heightened or limited depending on the detection of safety or danger.

When the body is in a calm state, we have good access to eyes, ears, face, voice, heart, feelings, we can move well, think and communicate easily. When we are in a flight/fight state our cortisol and heart rate go up, our digestion turns off ; our ears attune to danger ; our eyes shift focus, they go rigid; the optic nerve – contrast and brightness gets depressed; and when we are immobilized, the body literally takes over and switches us off from access to our social, emotional and physical functions.

In these heightened, non-restorative states our digestive system is seized and we cannot properly absorb vitamin B12, make serotonin, dopamine, myelin, and our immune system is compromised – because all these things are made in the gut and our gut goes offline in an anxiety state. The longer we are in an anxiety state the less resilient we become because we need all these physical things to keep us mentally strong. The longer this lasts the less resilient we become and the more prone we are to anxiety.

At this time breathing techniques and mindfulness are really difficult for a lot of people. Showing anxious people how to work directly to calm the body can sometimes be much more efficient. When you learn how to be in a calm state and how your eyes, ears, face, voice and thinking can come back ‘on line’, you feel like yourself again. When you consistently teach your body to be in this state, you improve your vagal tone – your ability to deal with stress.

Working directly with the body with gentle body focused exercises can be much faster than trying to work first with the mind. The more you can train the physical nervous system know how to be calm and respond well to stress, the more you can begin to strengthen and keep yourself in a restorative state. You begin an upward spiral of health, vitality and strength. And you are much less susceptible to anxiety and much less likely to rely on medication for your wellbeing.

The Potency of the Dorsal State

The Potency of the Dorsal State

So much of our focus on the Polyvagal Theory centres around honouring and validating the ventral vagus and teaching people to move up from the dorsal states and into the light of the ventral states.

According to the polyvagal theory the ventral vagus – the second branch of the parasympathetic nervous system and our newest evolutionary function – supports our capacity to have healthy relationships, it regulates our physiology, it is the place from which we keep ourselves safe and connected through socially engaged behaviour. Being socially connected, being able to articulate our thoughts, to make eye contact, to be awake and open to other people and experiences are hugely important for our survival. Our modern world has been perfecting these skills for over three thousand years and it no wonder we prize them as highly as we do. We have surpassed the beasts! We are the top of the food chain. We are intellectual, we can dominate our lower processes. We have control and we value those who have control.

The dorsal vagus is the first branch of the parasympathetic nervous system and is part of our ancient biology. In high activation it is responsible for our involuntary shut-down response – we freeze, faint, fold, feign or fragment. In low activation it allows us to engage in activities that are essential for the organism – digesting, producing stores of nutrients and substances vital to our continued health such as myelin, dopamine and serotonin. It is here that we sleep and dream, it is here our brain can action neural pruning and make sense of the day; it is where we nurse our babies and where we share healthy sexual intimacy. The dorsal state is seen as ‘rest and digest’ but it is so much more. It is a deeply alive place that is not as apparent to the naked eye.

When we move through the dorsal states, we can share time with people (and ourselves) on a deeper level. It is here where we spend time relaxing and drinking wine with our friends; it is here we meditate and spend time with our faith. Our bodies literally need to be in the right physiological mode in order for us to engage with this kind of play. We can use drugs and alcohol to take us there and we can train our mind-body through physical and mental practices to develop the skills to gain access to our inner world or higher states.

A worrying trend in the upcoming world of therapy based on the Polyvagal Theory is the emphasis on the superiority of the ventral vagal states. Like we do in the real world, we consciously and unconsciously give higher value to the ability to be able to smile; to smooth things over; to articulate our thoughts with clarity; to use soft eye contact to soothe and engage those around us. If we or our client cannot do this, it is assumed that we need to get them back into the mode where they can have this ability, this control, this self-mastery. It can seem a worthy goal and the quicker the better. Let’s all hack that vagal nerve and get back to work!

We feel safe when the social system, via the ventral vagus, is in play. People are easy to read, they don’t trigger our flight/fight system, and we can more easily get what we want; people like us more. So, we idealise this capacity and rightly so. It is our highest evolutionary function; it sets us apart from the beasts! But what are we missing when we all too often veer our therapeutic approach towards this end? Who are we serving and are we serving them well with our all too good intentions? Are we of any use to our autistic clients coming from this unquestioned psychological sanctuary?

In our therapeutic approach we psychologists and therapists all too often over prioritise the ventral vagal states (our capacity to socially engage). It’s not surprising since some of our best-known models for the PVT are ladders with the ventral states at the top that can only imply superiority of this function. We are encouraged to ‘climb the ladder’ up and out of the dorsal states, up into the lightness of the social engagement system! We honour the people who have met this challenge well, they are a success story for us as therapists and we also see ourselves as successful when we render our capacity to be just so.

To do this we need to take ourselves to a deep dorsal state. The Japanese call this Hara. It is the ‘deep power of original being, where the will is silent, the heart is quiet and work is accomplished naturally, without effort.’ It requires ‘the abdomen to be soft, the body relaxed, as to strengthen and support the functioning of the internal organs’*1

Current neuroscience is allowing us to perceive the reality of these fluid brain states and make sense of why initiation rituals were undertaken at these times; but we have long forgotten the tradition and history of engaging in this type of activity. For the modern world, the higher order dorsal states have become quite unreal, something silly or superstitious. To quote the British Commander in the movie ‘Pirates of the Caribbean: ‘the immaterial is immaterial’!

We have moved on from the abstract world and into one of the ‘survival of the fittest’ and our modern psychology is steeped with unconscious bias towards the advantages of the material world. Our psychologists generally are not trained in the deeper world of the dorsal vagus. If you can’t measure it, it doesn’t exist. If you live in this wayward and abstract landscape, you might have a psychological disturbance, an imbalance – and there’s medication for that! We value people the most who can operate in the land of the ventral vagus, those who can well utilise executive functioning and word things just so. People who can smile and connect and stay on track are the success stories for us. All too often, this is an underlying, unstated goal of therapy and it is backed up by the oft cited ladder analogy of the polyvagal theory with the ventral vagus firmly at the top.

This all gets tricky when we start working with people on the autism spectrum. People on the spectrum often don’t easily inhabit the world of the ventral vagus. It can be exhausting to be ‘on’ all the time, to make eye contact, engage your speech in a way that is socially acceptable. Often utilising executive functioning skills takes a lot of work and for some, these abilities are often or always out of reach. We tend to infer from this that these people are a little under par. We have a desire to ‘fix’ them or, since we can’t, we help them to manage themselves as best they can in our material world. Our emphasis on safety and survival means that we can’t see how they can be fully rounded, intelligent human beings because they just haven’t got what it takes. We can love them, assist them, be proud of our desire to stand up for disability rights, but we still feel sorry for them because they can’t do what we can do. And they know it.

The million-dollar question is – what if we are looking at this the wrong way around? What if, because we have lost the ancient language of the dorsal states, we miss the vitality and vast intelligence that is staring us in the face? What if, and not in a paternalistic way, there was something autistics had to teach us? Something that we have long forgotten? Maybe, like diligent Buddhists, when people spend their days deep in the bowels of the dorsal state, when they are continually in an unsocialised mind state – they are not doing nothing, they are inhabiting a whole other world? When you are in an immobilised state you have access to and are informed by thoughts and dreams, complex ideas and connections that defy the pathology label autism (and I would argue intellectual disability) has been given. You might not be able to share it, but in this place, you are privy to an indescribable vastness of mind.

Autistics have a highly complex model of the world that is full of incredible insights and wisdom. This can feel too big for the ordinary world and can be too hard to take out into the light of day to be witnessed by people who operate on an entirely different system. One father wrote to me ‘I compare my son to the SLA 3D printer we recently purchased, which does all its printing unseen, deep in a vat of dark resin, only to emerge all at once, in the end with a beautifully detailed print. I, on the other hand, am more like a typical resin printer that thinks aloud and prints everything where everyone can see it, eager to share everything with the world as I go. Though his ‘printing’ is done in the dark, it is deep and highly artistic. He has so much ‘printing’ going on deep in his soul that is precious”. People long to be understood from their world but find it almost impossible to translate it into the quick efficiency of the normal world, especially with a security driven body system that shuts down without a moment’s notice.

People on the spectrum excel at auditory and visual tasks, they are often faster at visual thinking and pattern recognition. Some see a much wider spectrum of colours than is available to the average mind. Many can feel and know colours in a way that the ordinary mind cannot. There can be an intense sensitivity that informs as much as it is hard to handle in the material world. A young woman with intellectual disability I work with can hear the plants when they open in Spring. It took her mum ages to work out what she was doing every year standing stock sill in the garden– till she asked and was told in no uncertain terms what was happening!

All manner of beauty on our world – art, science, construction, architecture, medical frontiers- have been informed by the autistic mind when the person has had the resources to unleash the beauty stored within. This heightened capacity may have developed due to the brain being forged in a constricted internal system, or it may be another evolutionary upgrade. It’s a little chicken and egg and we may never know, but it’s present and true and it allows a presence, an intelligence that people who have not lived this way cannot readily access, nor often understand. They see it as odd, other; they can be impatient not knowing how to sit and wait and make the right spaces and open inquiry that allow the magic to unfold. Mostly, our therapists have been taught to use modern techniques that have little meaning in the fluid, dorsal world. They have been taught to bring this keen mind back into the land of the two dimensional, not knowing how to appreciate the three (or four) dimensional. Because of this, often our autism therapies don’t begin to touch the sides.

I not only see myself on the spectrum, I also work with those on the spectrum. I know what it is like to be treated as if you are stupid or boring because you cannot think of something connected or refreshing to say and your facial affect is not soothing to those in front of you. I have experienced isolation and the grief of living in a world that values the kinds of abilities I can only muster for so long until I need to go hide. I know what it’s like to disappoint people who see the brilliance in me only to find that it is not supported by a constant, robust outer self.

I also know what it was to find the Polyvagal Theory and what it meant to me to be able to explain all this at scientific level and how it has allowed me to better care for myself and now to care for other people. I have watched so many people experience a life change, families and participants, just by appreciating this knowledge, and I know what it affords a 13-year-old young woman or a 20-year-old young man to know that it is their physical system, then executive system that drops out and that it is not about their innate intelligence.

These people are more than bright. When they feel safe and well met, they are stunning in all sorts of ways and mostly because they exist in a realm of deep empathy and compassion. They see through eyes that have not been as inculcated with an egoic state, they see far and wide. Yes, they do have trouble with working memory, it goes offline with your executive functioning under duress. Yes they do have trouble holding their temper and self-regulating to a greater or lesser degree, but what I am finding – through a simple loyalty to the basic truth of the Polyvagal Theory – is that if you can find a way to teach the physical system how to know more than just the deep state; you change the game.

You can’t do this from a top down oriented therapy. We are teaching the system something new, something it hasn’t known before. It’s not an intellectual exercise to bring the body to a new stasis. The usual mental strategies and breathing techniques have only a little value here. They work on the assumption that the body pre-appreciates this state and can move toward it. You can’t imagine yourself into if you’ve never been there. It’s not possible for a system that hasn’t felt this before to know where it’s going. You have to teach it that it’s true, experientially.

You can’t do this work if you think the ventral states are the best and you are working from an assumption that you are trying to get people back up to scratch. You can’t do it with a vagus nerve ‘hack’ mindset and a wish for a toolbox of tricks to apply on your client to get them into ship shape! You can’t do it if you do not genuinely think there is nothing to fix. These are all orientations I see from teachers and therapists I see in my workshops and I have to gently, slowly show them something they don’t know. That we are working with deep space. That we are working with a timeless, vast intelligence alongside a very narrow capacity to know and regulate a very trigger-happy flight/fight system – that won’t relax or be compliant just because you want it to, but will the minute we get it right. Always we are working in a glorious mass of contradictions. We are steeped in chaos theory, but underpinned by a very basic and sound appreciation of the polyvagal theory. We hold onto that and let all the rest go.

To dive into the deep, to let someone in to your private, sacred space you have to feel safe, you have to give permission. We know this with typical clients but it is amazing how this gets lost when we are working with people with a different operating system. We can help people to feel safe by sharing the ideas of the Polyvagal Theory in ways that are individually meaningful. If students (clients) get a straight-forward, age-appropriate, intellectual choice to participate rather than a pretty coercion by using the social-engagement skills of the therapist to get them to relax and comply, then they can be truly present to the process. If we are always transparent; always clear on our intentions and we show that the client always has final say over what happens in the session, we get farther quicker. If we give room for them to have disdain for the process; to think what they want and to be open to the possibility that they might learn something new if they engage; if we teach them we are willing to be patient and creative to allow this to happen; if they have a right to say no -then we have set up some of the conditions necessary to play in the deep end.

It is all highly creative; it is all highly individual. It rests on a fluidity, an ability to work without a script, an ability to trust in a process that might make no sense and might not even work. It relies on the therapist not being in command, but a Sherpa, a guide. One with knowledge but not all the knowledge, because the one you are with might know/do/think/be, more that you can ever imagine. If they are given some space inside to breathe and some consideration for their considerable intelligence great things can happen.

What happens, when we get it right, is that the student sees more, feels more. The mind starts to clear, they start to have an experience of themselves from a new perspective. Instead of intellectually trying to develop a new vision of self for our client, one that they can cling to, to pull themselves out of the mud; instead we alleviate the body and see a new protagonist emerge. Usually this new person is like Excalibur! Drawing the sword deep from bound stone, we see emerge a new energy, a new potency that enhances the figure, our student, who knew but didn’t know his destiny, who knew but couldn’t find the power to drive her life. We open the possibility for power to emerge, long locked inside a highly immobilised or highly driven yet switched off system. We find the key.

It’s a treasure map, we have an inkling of where the key may be and together, we go searching. There are clues, signposts that we learn, together, to read. We make notes, we recognise when we’ve made gains. There are no rules. There are no charts and measurements. The measurement is in the growing prowess of the student, changing patterns of behaviour recognised by themselves, friends, family and others, not predetermined by a narrow set of parameters signified by others. We watch capacity grow in whatever way it wants to. We watch potency be released, forged by years of being bound by an all too tight system. It is breath-taking, it makes you weep and stand in awe of the courage, facility and sheer brilliance of the people who live and breathe their every day from the dorsal state.

Yes, we are moving them into ventral states. It is the right for every human being to have the full range of human capacity to use the body where and when you can. What we are mindful of – at all times – is that we are not working to the expense of the dorsal. It informs us at every turn. It guides us and much as we guide it. When we are finished our journey, we have perhaps loosened its shackles, but we don’t ever eradicate the dorsal in favour of the ventral state. The dorsal is a friend, an ally. It keeps us safe and moves us in ways that are faster and braver than we can ever consciously think. It replenishes us, it is where we know ourselves deeply. It is where we engage with the sky, the earth, the trees, the water, the land. All the things we humans know we need to re-engage with, deeply and profoundly if we are to save this planet we love to live on. All this connection to more than the individual self, comes from the deep, dark, sacred dorsal space that the autistic mind knows so well.

The Ancient Greeks used to say their best years were behind them. As if they knew that there were competencies that had been lost in the growth of modern civilisation. In neuroplasticity when the brain is growing something new, it will subdue some capacities for a time, then bring them back into view. Perhaps the remarkable numbers of autism being counted today are witness to an awakening of an old timeless skill that we have long forgotten, and long forgotten to treasure?

*1 www.shiatsuman.com