Self as Water

Self as Water

It was only recently, when filming Healthy Relationships with Dr. David Mars, when he said this phrase: core neurobiological self, that we realized this was the proper neuro-scientific way of speaking about something ancestrally deep that doesn't translate well into English and the modern view. Through trauma, the body-mind system becomes like a veil of increasing thickness, obscuring our relationship with our own essence.

The following is a chapter from our book Restorative Practices, on this topic

Sometimes an event occurs and it makes sense to us, we can let it in, integrate it. We meet, greet one another, and I smile at you. You can probably let that in if my smile is genuine. You feel it, there is energy exchanged, but it makes sense. An event is distressing when it doesn’t make sense to us. We meet, greet one another, I grit my teeth at you. You feel it, it doesn’t feel good. But although there may be discomfort (arousal), there is not likely injury. You walk away undamaged. You might think, What’s wrong with that guy? But you can shrug it off. Trauma, on the other hand, is overwhelming experience too distressing to fully integrate. We meet, greet one another, I hit you in the face. This actually causes you an injury. You are impacted. A trauma is something that we don’t know how to make sense of, at a physiological level: an equation that doesn’t resolve, a ripple that doesn’t settle back into the pond. It changes something in our nervous system, and our nervous system doesn’t fully return to baseline afterwards.

I invite you to visualize your core neurobiological self as a spherical droplet of water, bathed in the light of the Sun. Wellness equals (=) You as a water droplet. Trauma is something that forces some part of it to change state: liquid to gas or gas to ice. To stabilize or contain the energy of an event, you–or some tiny part of you–changes state. Stabilized in the Connection state we are liquid water. A spherical droplet. The traditional purpose of culture: make us all into water droplets.

Trauma comes, something happens that wasn’t supposed to happen, and this overwhelming energy dys-regulates us, and some particle is forced to change state: it evaporates or it it freezes. It responds to the injury by changing state. This injury might have physical attributes: bruises, scars. But in our analogy of water, what we are talking about is the nervous system. The tiniest molecule of water splits off and changes state. Inside the droplet now, the tiniest fragment of ice. Outside the droplet now, the tiniest breath of vapor. The cost of this, at first, is not perhaps discernable except to the most sensitive of us. Perhaps not even to you, except when you see me again, and wince. But soon, more and more of the droplet is in another state. For many of us, the story of our developmental trajectory is a sequence of unresolved traumatic experiences, accumulating. This is a tragedy, because there are technologies to heal these injuries, and in a healthier world they wouldn’t keep accumulating. We would have a circle of caring mentors to turn to, and they would be versed in Restorative Practices, and help us get back home to baseline: back to the water droplet. But hurt people hurt people, and disconnected people are generally not good at bringing others back into connection.

Information does not flow with integrity across states. This is the quantum mechanical nature of things. When the information of our totality (core neurobiological self or Original Self) is distributed across non-connection states (vapor and ice rather than liquid water), there begin to be gaps in awareness. This structures in different ways. As they constellate into more stable formations, we name them with disease structures that reflect their morphology and increasing severity but not their origin. At first they seem to be accumulations or attributes of mood: irritability, anxiety, sadness, depression. As they increase in intensity and duration they become personality disorders: Borderline, Narcissistic, etc. And beyond that they are identified as forms of ‘psychosis’: Dissociation. Fragmentation. Dissociative Identity Disorder. Schizophrenia. These are adaptations to un-integratable experiences, archived through state change, locked into compensatory structuring. Ice, vapor.

Our job is to become a droplet again. This is our original nature. Things get stuck like this because we live in an unequal society that inequitably distributes safety, because we regularly sustain traumatic injury, because we live in a society of systemic disconnection and unacknowledged differential advantage, and because we don’t have healing technologies that allow us to integrate and heal these experiences. We have a medicine and mental health system that doesn’t accurately trace the origin of these injuries (they occur at a specific moment, even if they are repeated it is a series of specific moments), or know how to heal them. Fortunately, there is an immense body of indigenous and traditional wisdom and medicine that does know how to heal them. There are practitioners of these forms all over the world. In the United States, in the past twenty years we’ve seen a proliferation of body-based trauma therapeutic modalities, with their common theoretical reference point in Polyvagal Theory, that are figuring this out. It is not a coincidence that pioneers in these fields have trained with shamans, attended ceremonies. Dr. Peter Levine, PhD, who developed Somatic Experiencing, says that he received the technology partly in a dream, where it was handed to him in a sacred box. Dr. Stephen Porges, the Developer of Polyvagal Theory says, with deep humility, that he didn’t discover Polyvagal Theory: he translated it into neurophysiology. What we are talking about here is older and deeper than modern science. One of our mentors, who is an acupuncturist, was in turn mentored by a much older Chinese acupuncturist who owns a piece of tortoise shell inscribed with proto-Chinese script. The script tells of the transmission of acupuncture from the Neanderthal people to the proto-Chinese people. Acupuncture is commonly thought to be of Chinese origin, several thousand years old. It is of Neanderthal origin, and probably several hundred thousand years old. The Neanderthal people did not possess anatomical atlases. There is no evidence they had a written language. They could see energy bodies. They worked directly because they could see the Life force moving. Those who can see this develop ways of working with it. Cultures based in connection learn to help people get back when deviated from it because they can directly perceive connection and what disconnects. Our (modern society’s) medicine and mental health can’t do this because they originate in disconnection.

The largest epidemiological study of trauma ever done was conducted by Dr. Vincent Felitti, MD, and Dr. Robert Anda MD. At the time of the study in 1998, Dr. Felitti was Chair of Preventive Medicine at Kaiser Permanente in San Diego, and Dr. Anda was an epidemiologist at the CDC. Dr. Felitti was working on two health programs: an obesity program, and a smoking cessation program. At this time, the popular conceptualization of trauma was that it was a marginal phenomenon: something experienced by veterans during war, or by those severely abused as children. The Adverse Childhood Experiences (ACES) study, as it came to be known, dramatically altered our conceptualization of trauma, demonstrating a graded dose-response relationship between exposure to early adversity (childhood trauma) and adverse health outcomes later in life across all physical and mental health domains. In plain language: the more early adversity you experience, the sicker you will be as an adult. In metaphorical language: the more your water droplet contains ice, or has gone to vapor, the more this will manifest in dis-ease.

The case that gave rise to the study was a patient of Dr. Felitti’s in the obesity clinic who, with doctor supervision, on a fasting diet with vitamin supplementation, lost 300 pounds in 51 weeks. Astounded by this result, Dr. Felitti was studying her case. Subsequently, something happened in her life, and she regained 37 pounds in three weeks, something he said that he did not think was physiologically possible. She proceeded thereafter to regain the entire 300 pounds more quickly than she had taken them off. Dr. Felitti sat down with her to try to understand what had happened. Trigger warning: what comes next is distressing. The patient explained to Dr. Felitti that when she was 10 years old, her initial weight gain occurred when she began to be chronically sexually abused by her grandfather. When she had entered the clinic, she weighed more than 400 pounds. She dropped from 400 pounds, to 130 pounds in less than a year, then regained all of the weight faster than she had taken it off. Her weight re-gain was triggered when, at her slender weight, she was sexually propositioned by a work colleague. She described regaining the weight: she would awaken standing in front of an open refrigerator, open containers strewn about. She was sleep eating. Something about the sexual advances was so profoundly distressing to her that her body took her to eat asleep. When you read this, I hope that, with deep compassion, you are able to understand how powerful these depth forces in our body-mind are that are driving our behavior. We must resist the temptation to pathologize this woman. Rather, let us respect the marvelous intelligence of the body that knew that to make her safe again, she had to put mass back on.

Dr. Felitti explained that in that interview he began to understand that often, what we are treating as the problem in public health (in this case, obesity) was actually someone’s solution to a much deeper problem that we couldn’t see (in this case, the weight was protective–an insulation from this childhood trauma). He began to wonder how many of his other patients engaged in weight loss, or smoking cessation, had begun to gain weight or use tobacco as a mechanism to cope with some kind of early adversity. He began to understand that treating the obesity or the tobacco use was simply addressing symptoms.

Western medicine and psychiatry is about to go through a paradigm shattering transformation, and it will largely do this kicking and screaming, but it will do this none the less. The reason it will do this is because much of western medicine and psychiatry does not work, and if it doesn’t do this it will become increasingly irrelevant in treating much of what ails us (surgery, infectious disease, and severe mental illness excepted). The reason it doesn’t work is the same reason that treating Dr. Felitti’s patient’s obesity without understanding the underlying trauma driving it will never resolve the patient’s weight problem. If we were to be able to treat and repair the underlying traumatic injury in Dr. Felitti’s patient, the weight problem would spontaneously resolve, because the weight problem is actually a solution. It solves the problem of preventing the patient from experiencing sexual advances. It is an effective if costly solution. If she weighs 400 pounds, she is not likely to be sexually propositioned, because men will most likely not find her sexually desirable. If she is not propositioned, the profoundly traumatic sexual violations she repeatedly experienced by someone who was supposed to care for her will not be near the surface of awareness, will not be re-triggered, with the concomittant risk of exposing her to the almost unbearable psychological and physiological distress that accompanied these experiences. If we could help her feel safe again in her own body, and help her resolve the traumatic stress of those early encounters, the core need driving the requirement for insulation from attention would dissolve.

A 2013 article in the Journal of the American Medical Academy states that 60-80% of visits to primary care physicians are stress-related. I recently presented a keynote at a national conference of integrative physicians, where I asked 180 of them what percentage of their patients were coming to them for stress-related problems. 20 of them said 100%. All of them said it was at least 80%. In plain language, 4 out of 5 visits to these doctors are stress related. The reason that western medicine and psychiatry are failing is because they can’t help 4 out of the 5 people coming in to primary care. They can’t help 4 out of 5 people because western medicine arose from a mind body split. The origins of allopathic medicine are in a worldview that conceptualizes the body as a mechanistic physical engine, and the brain/mind as a chemical process. It therefore assigns care of the body to physicians and care of the mind to psychiatrists. It further atomizes care of the body into organ-specific, or organ-system-specific specialists (gastro-intestinal, ear nose and throat, etc.). Both primary care and psychiatry have been co-opted by pharmaceuticals, but psychiatry in particular is in the business of prescribing. I am personally deeply grateful for pharmaceuticals. I needed to take a psycho-tropic medication for several years, and while it had severe side effects, it provided relief that nothing else would. I am not anti-medication. That said, allopathic medicine has a profound and intractable problem in how it conceptualizes, and therefore teaches, and therefore treats the interactions between the mind and body.

For the 4 people (out of 5) who come to the doctor for something stress-related, the symptoms will always be mind-body symptoms, because anything stress-related involves the Autonomic Nervous System, which is the neural architecture of the mind-body connection. The Nervous System is divided first into central and peripheral branches. The Central branch is the brain and spinal cord. The Peripheral is what branches off of that. The Peripheral system is divided into Somatic and Autonomic components. The Somatic system controls and coordinates muscle movement. The Autonomic system has two primary functions: 1) regulation of the internal milieu- this is the homeostatic regulation of all that happens inside the body that you don’t have to think about: your heartbeat, breathing, digestion, immune function, vascular contraction and dilation to control the distribution of blood in the body, etc. The second function 2) is to, based on a neural apprehension of safety or threat, surface either singly or in combination a variety of neural platforms that tune the body, emotions, and mind to engage with the environment in characteristic ways. The most penetrating, complete, and incisive theoretical work in this domain has been done over the past forty years by Dr. Stephen Porges, and his laboratories. Dr. Porges is the Developer of a body of theoretical work called Polyvagal Theory. The Polyvagal Theory explains the relationship between the Autonomic Nervous System (ANS) and behavior. It explains how, via the vagal system, which is the primary neural conduit of the ANS, several distinct neural platforms have evolved to either, when we feel safe, tune our physiology to functional calm so that we can connect, relate, and get close to another in reciprocal relationship, or, when we feel threatened, tune our physiology to high arousal, mobilization (movement) and polarization (who is with me/ who is against me) to respond to danger, or, in cases of lifethreat, to immobilize us, drop our metabolic rate, and flood our system with endogenous opiates (painkillers) to numb us to impending death. In the Polyvagal Theory are the neurological keys to a new mind-body medicine, rigorously grounded in neurophysiology, that re-writes and re-constellates the patterns that drive much of the symptomology that modern people are suffering from.

I recently sat down with a physician who is a high-level executive in a large health system in San Francisco, who confessed confidentially to me that the system was having rapidly accelerating difficulty with a category of patient that was costing them a great deal of money, and whom they were having trouble effectively treating. The case is illustrative of what we are discussing. In our work, we have identified ten symptom constellations, which are all Autonomic, and seven of which she related. These include:

Anxiety

Depression

Gastro-intestinal distress

Sleep difficulties

Auto-immune disorders

Migraines

Fibromyalgia

All of these symptoms, and symptom constellations, are autonomically-driven, and all have physical as well as psychological components. In other words, they are all mind–body symptoms. To take a single example of this, the incidence of gastro-intestinal disorders in the United States has skyrocketed in recent years. This includes disorders such as irritable bowel, colitis, food sensitivities, and general gastric distress. Typically, a patient comes to see their primary care doctor complaining of stomach discomfort: nausea, gas, bloating, stomach pain, etc. Often, after a medical examination, if organic dysfunction is ruled out, over the counter medications are dispensed. Dietary changes may be recommended. If the issue doesn’t resolve, the primary care doctor refers to a gastro-enterologist. Gastro-enterology may treat with medications, antibiotics, or more experimental therapies. For many patients this does not resolve the problem. The reason is because although the dysfunction is presenting as digestive difficulty, the problem is not in the digestive system, but rather the neural regulation of digestion. The source of the problem is in the brain. When a person is in a chronic defensive neural platform (fight, flight, freeze, shutdown) digestion is disrupted.

The sub-diaphragmatic organs of the viscera are innervated (neurally fed) by both the sympathetic nervous system and the dorsal vagal system, which exert control over digestion. When humans do not feel safe, and move into defensive platforms of behavior chronically, the neural regulation of the gut is altered. In simple terms, biology is designed to conserve energy. If you are running away from a bear, the body’s genius is to down-regulate all non-essential functions so that you have the energy to get away. You don’t need to digest food to get away from the bear, so neural down-regulation of digestion happens as a matter of course. We know this anecdotally, because we know that in situations of extreme terror, a person may shit their pants. This is the dorsal vagal regulation of the gut at play. The sympathetic and dorsal systems, working in concert, may tighten or loosen the bowels, evoking constipation or diarrhea.

For the patient, they have now been to see their primary doctor, and a specialist, and though the may have some symptomatic relief, the problem hasn’t been resolved. At this point, they may be referred to psychiatry, told the problem is in their heads. In psychiatry, they could be prescribed anti-anxiety medication, or placed on another pharmaceutical, with potentially cascading side effects. Still, the problem hasn’t been resolved. The symptoms may not have even been resolved. At this point, the patient has also become costly to the medical system. The problem for allopathic medicine, the problem the executive was sharing with me, is that there are more and more of these patients. I nodded, agreeing with her. Four out of five, I said. Statistically, that is where they are headed.

What is showing up in primary care is what is showing up in our lives. We live in a modern world where the cues of threat are everywhere. The ACES study, to which we earlier referred, which eventually had obtained data from over 1 million patients, paints a startling portrait that sheds light on what the medical system is beginning to understand. 67% of adults in the study had experienced at least one adverse childhood experience. These were adult patients of a private medical system, largely college educated, who could afford private insurance. Two out of three of them had experienced some form of childhood adversity. Trauma is a stress phenomenon. Its signature is autonomic dysregulation. The ACES study, an extraordinary and groundbreaking study, has been criticized for what it didn’t ask about. The study was designed to inquire into 10 categories of early childhood trauma, including abuse, neglect, and household dysfunction. It did not inquire into what we would call social traumas, namely racism, sexism, or homophobia. Had it included questions that asked Have you ever been made to feel unsafe because of your gender or your race or your sexual orientation? the number of people who had experienced adversity would have assuredly been higher. 80% perhaps? 4 out of 5 people? If, finally, it had included a question about ecological trauma, or alienation from nature, it seems likely that the rate of adversity would rise to 100%. This is why we say that to be modern is to have trauma.

We have created a modern society where most people feel unsafe. The bodies of people who feel unsafe turn on neural platforms of defense. One neural platform of defense is the fight or flight system. The emotional correlate of the fight response is irritability and anger. The emotional correlate of the flight response is anxiety. Another neural platform of defense is the dorsal vagal (shutdown) system. The emotional correlate of the dorsal system is depression. All of these defensive platforms alter the neural regulation of the gut creating digestive difficulties. All defensive platforms alter sleep physiology. Remember the list of symptoms the executive gave us? Now do you understand?

A medicine and mental health system that cannot effectively address Autonomic Dys-regulation becomes increasingly irrelevant to people’s well-being because it won’t help people feel better. The deeper question we can ask here is why is this happening, and what do we do about it. I would propose to you that The Origin Story answers both of these questions. At the deepest level, the story of the last 10,000 years is a story of accelerating deviation from an ancestral baseline in connection. This has rapidly accelerated in the past 500 years, since Europe killed off most of its indigenous people and went crazy, initiating global waves of colonization, enslavement, and genocide. Our conundrum, as a species, is that we have advanced digital technology, 17th century colonial institutions, and paleolithic stress physiology. The marriage of these creates a perfect storm. Your nervous system is designed to respond to bears, but these days there are bears everywhere. All of us have bears in our computers. Every time you open your email there are bears. The news? Crawling with bears: a bear factory. If you are a woman, or black, or brown, just open your front door: bears everywhere. It used to be you just saw bears in the woods. Now it’s all bears, all the time. I don’t want to dismiss Coronavirus, because it is real. But as a female African-American colleague shared with us recently in a group: If you think feeling unsafe when I step out my door is news to me, you haven’t been paying attention.

Because the stress response just happens, while the connection and relaxation responses have to be evoked (we have to experience a visceral sense of safety, and then settle into this), much of our evolutionary history has been concerned with creating cultures that provide a nest. If there are bears out there, we have to create a nest in here. The purpose of culture, we could say (and connection phenomenologist and deep nature connection expert Jon Young says this outright) is to connect. Culture’s job is to connect us with ourselves, one another, and the living world. That is what culture does. Culture, says Jon, is not artifacts. It is a verb. It is that which connects. For most of our evolutionary history, this happened as a matter of course. We lived outside until very recently, evolutionarily speaking. It’s only in the past couple of hundred years that we’ve been able to seal out the outdoors. Now, we live and work and travel in climate-controlled boxes. Our ancestors in the Kalahari desert lived outdoors one hundred percent of the time. The average American, by contract, is outdoors seven percent of the time. San bushmen in the Kalahari living the Old Way, living in the manner of our ancestors, don’t have mental health issues. They won’t go into houses, because they note that when people start going inside, they get weird. They lose touch with something. They forget who they are. The San living the ancestral lifeways say that modern people are no longer human. That we’ve lost our best parts. For most of human history, we lived in small tribal bands of about 150 people. This is an ancestral technology. A tribe is a technology. A group of this size functions to turn on and optimize our social neurobiology. The size is not accidental, or coincidental. It further breaks down into groups of 45-50, 15, and 5. These numbers are not random. There is a natural order within these ancestral technologies. An order that reflects our oldest and deepest biological structures and yearnings.

We would propose to you something very simple. If the disease of modern people is trauma, and the root of trauma is a disruption of safety, and a disruption of safety comes from disconnection, we have to repair connection. If the root of disease is disconnection, it is a profound irony that our medicine and mental health treat people in isolation, because ancestral evidence supports the notion that we need to heal in community. This is why we stopped using the word self-care in our work. Humans don’t really do self-care. Yes, yes, of course we need to take care of ourselves, but it’s more like co-care. From our first breaths, regulation is co-regulation. We regulate with. It is the attunement of our caregivers that teaches us to regulate ourselves. We need community care. The neuro-developmental model we have spent the past 25 years developing (or resurrecting–because it is the transposition of an ancestral model into a modern context) is centered around the ancestral technology of a community around a fireplace. We heal in community. We come back to the ancestral fire, and we learn to share a context once again. We don’t have to have all of the answers, because each of us coming together brings a piece of the answer, and the intelligence of the community, where there is equity and respect, is greater than the sum of its parts. What a great relief! We don’t have to know everything. We just have to show up and be really present. What helps us get well is not having the answers: it is being present, even when it is hard. We heal in this way because at the deepest biological level, this is what we are yearning for: to feel safe, to be witnessed, to be seen, heard, validated. To be allowed to bring all of ourselves: to come home. I am astonished and profoundly humbled by how quickly people find themselves feeling at home in these circles–and it speaks to our common humanity and our common origins. We know, in the very marrow of our bones, what it feels like to sit in a circle and tell stories around a fire. We have been doing this since we came down out of the trees.

In our work there are always two strands. Turning on connection and remediating adversity. Connection, and repairing what gets in the way. We are connection phenomenologists. Our objective is to create the most useful global school of connection phenomenology in the world. Its form is a non-heirarchical multi-cultural alliance called the Restorative Practices Alliance. In traditional and indigenous cultures, when people got deviated from connection, there was a body of Restorative Practices, a restorative wellspring that they could draw from. Humanity has a vast treasure in these practices. They are ceremonial practices, meditative practices, movement practices of dance, of song, of music. They are relational practices, peace-building practices, conflict tranformation practices, restorative justice practices. They are nature practices, the arts of life, tracking, survival skills.

In general, there is a 3-part pattern in our work. First, we have to notice. We have to assess, and self-assess. Where are we in this moment? How do we feel? This is an embodied question, and a question of state identification. Where do we locate ourselves on a stress map? Are we angry, are we anxious, are we shutdown? Because being able to locate ourselves on a map orients us, and gives us some clue how to get back to center.

Second, we have to down-regulate our defensive responses, should they be activated. This website maps a variety of ways to do this, and the characteristic patterns of the defensive states so that we can understand what we need to do to feel safe again. Each defensive state is an attempt to get us back to safety. When we understand the language of the states, we can work with them, and meet our own needs.

Thirdly, we want to turn on connection. We can’t do this until we feel safe enough. Many people find meditation challenging because the modern mindfulness movement does not yet understand Polvyagal Theory, so it often gives people instructions that contradict the needs of their nervous system states. To feel safe going inward, we first must down-regulate defensive states. Not until that happens does it make sense, or is it safe, to bring our attention inside.

When we are able to learn to do and to live these things in relationship to ourselves, and a diverse community of Others, something very interesting happens: we recover more and more of our core neurobiological self. And as this happens, as we turn back into water droplets, we are able to remain differentiated, our fullest selves, while merging back into the Ocean that is the collective: of Humanity, and of Nature herself, Wakan Thanka, the holy mysteriousing, our true spiritual parents, our true identity, our true name. Sat nam.