The Sensitive Gut

Understanding IBS

How other people can make us ill

Stephen-Porges-picture-for-blog

Dr Stephen Porges

We are sociable creatures. The way we relate to each other does not only determine our behaviour, it also affects our physiology and the way we perceive ourselves and the world in which we live.

The acknowledgement, recognition, appreciation and love of family, friends and other people can make us feel safe and confident. We just have to glance at social media to see just how much we need other people. But it can all go horribly wrong. Friends may ignore us, children reject us, lovers abandon us, other people may try to control us, restrain our activity, even threaten and abuse us. People can be dangerous. Forcible restraint is a frequent feature of trauma and chronic abuse. Few of us avoid the loss of somebody close to us during the course of our lives.

And the effect can be so much worse if we have felt ignored or rejected, controlled or restrained by our parents during childhood or if we have been abused or threatened by other people. Then we may be overly sensitive to threat and see danger in a look, a tone of voice or a gesture. This triggers alarm or despair, which can dysregulate all of our physiological systems.

In a recent workshop I attended, Stephen Porges, distinguished behavioural neuroscientist and inventor of The Polyvagal Theory, asserted that human beings are a traumatised species, easily spooked to take fright. Few people manage to avoid some kind of trauma during life, though some of the most frightening episodes may have occurred so early we cannot remember them. Trauma retunes our nervous system to be hypervigilant to danger. Living in close proximity with others can make us very sensitive to cues that might rekindle bodily memories of trauma and trigger alarm of dissociation.

There is no such thing as a baby

It all starts in infancy. As Donald Winnicott once famously said, ‘there is no such thing as a baby’. There is only the relationship with the mother. The mother (or main caregiver) is everything to her infant, she feeds him (or her), keeps him clean, provides warmth and comfort, soothes him when he is upset, and offers him security. Infants love being cuddled; they relax and feel ‘safe’ in the arms of their ‘mother’. And as they grow, they may play happily by themselves or with others as long as they know their mother is there for them. Such connectivity provides the safety that facilitates the infant’s ability to regulate himself.

Connection, recognition, synchronicity and reciprocity; there are the factors that trigger our social engagement system and cause us to feel secure, well and happy. Just look at the way mothers and infants gaze into each others eyes. Was there ever such love? Listen to the way they communicate, the soothing baby talk and the cooing responses. Notice the way they hold each other, the skin to skin contact. This is co-regulation. Mother calms and reassures and her baby ‘tells’ mum she is doing a good job. Both feel good. But if mother is depressed or distracted, or if she does not receive encouraging responses, then she will be unable to soothe her baby, who may feel insecure and suffer an interruption in emotional development.

What happens between in infancy can set the pattern for feelings and relationships well into adulthood. The children of absent or avoidant mothers may fail to engage with others and tend to play by themselves. If mother is too distracted by their smart phone, their children may grow up finding solace not in social relationships but in the virtual world of computer games and fantasy on their tablets. Mothers who lack confidence and are inconsistent may have fretful children who find it difficult to manage by themselves. These behavioural difficulties may be replicated in adult relationships. We all know couples who have become bonded, but do not feel safe with each other – ‘can’t live with them, can’t live without them’. Predictability is a major condition for feeling safe. If people don’t respond when we expect them to, we feel a sense of threat.

How do other people affect us

Connectivity (safety, synchronicity and reciprocity) is the neural love code that links social behaviour with both mental and physical health. That is not to say that everything has to be attuned all of the time. Ruptures will happen, but repair of those is what allows people to grow and develop.

Regulators of our social behaviour are embedded in the way we look at each other, our tone of voice, our posture and movement. Our feelings are encoded in our bodies and mediated through the autonomic nervous system. This consists of three components.

The Ventral Vagal Complex (VVC)

By about four months of life, social connectivity replaces food as the main regulator of an infants physiological state. This was famously illustrated by Harlow’s demonstration that baby monkeys would go to robot monkeys with fur rather than wire monkey-shaped frames with milk. Social connectivity develops together with what is called ‘the ventral vagal complex’, which includes other cranial nerves besides the vagus and comprises myelinated (rapid transmission) motor fibres controlling facial expression, tone of voice, breathing, heart rate, the neck muscles, gut function and even modulates listening through the nerve to the stapedius muscle, controlling the alignment of the small bones in the middle ear. All of these functions are involved in social engagement, supporting the body’s need for safety, social function, health, growth, restoration, reproduction and digestion.

Sympathetic nervous system (SNS)

This develops much earlier and is the alarm or fight and flight system that mobilises the body for action, diverting blood flow from the gut, liver and kidneys to the heart, lungs, brain and muscles, increasing respiration, pulse and blood pressure, suppressing gut motility, digestion and secretion and enhancing alertness. The steroid hormone, cortisol recruits and conserves the energy that supports mobilisation.

The dorsovagal complex (DVC)

The dorsovagal complex is a much more primitive system than its ventral counterpart. It protects the body against irresistible threat by suppressing activity as a last ditch attempt to ensure survival, but it is also activated during loss, grief, stress, illness, boredom or exhaustion. Activation of the DVC slows the heart and respiration, shuts down consciousness, raises the pain threshold, but also has a major influence on the gut inducing vomiting and defaecation. Wild animals triggering this system can lose consciousness and appear dead (play possum), which may cause predators to ignore them. But when activated in humans, the effects are often less dramatic and may induce ‘absences’ or ‘dissociations’, amnesia, despair, extreme fatigue, faintness, helplessness and immobility (freeze). The threshold for activation varies among us and within us according to the context our our previous experience.

A Hierarchy or Interplay of Responses

As the most recently developed, the ventral vagal complex (VVC) can regulate activity in the sympathetic and dorsal vagal systems. This is known as ‘the vagal brake’ and allows people to enjoy the stimulus of adventure and excitement as long as they know there is a safe place to return to, or to engage in sport and activity as long as they realise it is a game and there are boundaries. The safe presence of a friend can help maintain control in a threatening situation and keep the VVC and cortex on-line. Similarly, feelings of safety may recruit the DVC and allow immobilisation to occur without fear during relaxation, sleep, sexual activity, illness or childbirth. Hormones can modulate this. For example, oxytocin facilitates trust and intimacy between lovers or and suppresses pain and panic during childbirth.

Under conditions of threat, the ventral vagal complex reacts first as we try to keep our brain in gear and deal with the problem. If that shuts down, it removes the vagal brake. As a result, the disinhibited sympathetic alarm system may cause us to either lose our temper and fight or take fright and run away. Finally if thought or resistance becomes impossible, activation of the DVC may cause us to dissociate from what is happening.

Recovery can reverse the sequence. If the danger has passed, some animals will rouse themselves from their collapsed state and shake themselves, activating the sympathetic nervous system, before moving off to forage for food. Similarly, if people feel triggered to hopelessness and despair by some situation that carries memories of threat, it helps to get the body to move, even if this is just rocking back and forth. People can switch between states of activity and collapse depending on how situations evolve.

We should not necessarily think of these different components of the autonomic nervous system as separate and independent. Life and physiology is more complicated than that. It is best to think of an interplay of activity. Not only does can the ventral vagal modulate the so-called alarm and collapse systems, but combined activation of both the SNS and DVC may bring about such expulsive physiological crises as vomiting, diarrhoea, childbirth or sexual orgasm.

Relevance to IBS.

Abuse is four times as high in patients with IBS as in otherwise healthy subjects. Trauma is only second to gastroenteritis as the instigator of IBS and often co-exists with it. Difficulties in childhood and problems with relationships are very common in patients with IBS.

Anxiety and depression is very common in people with IBS , and so many people express feelings of despair and helplessness. ‘I’m desperate’ and ‘my doctor doesn’t listen to me’ are the two most common complaints in letters to The IBS Network.

Measurements of heart rate variability suggests that people with IBS have lower ventral vagal tone, indicating that the vagal brake has been released allowing expression of the sympathetic and dorsal vagal system. Also SNS activity and cortisol secretion is higher is people with IBS.

People who suffer predominantly with diarrhoea often appear more anxious and expressive than people, whereas those with constipation appear more withdrawn. Some people can switch between the two states of being.

Neuroception

It is important to remember that our behaviour and our bodily sensations are not always our responsibility; they may occur outside our conscious control. Events that have no significance in the here and now, can nevertheless trigger bodily memories of restraint or abandonment that we have buried away in our subconscious. The body reacts to these cues via the primitive branches of the autonomic nervous system (SNS and DVC) while when it is all over, our cognitive brain tries to make sense of it all by concocting a credible narrative we can live with. ‘It is all due to my diet’ ‘You make me feel depressed/ill’. My doctor never listens to me’. Stephen Porges has coined a new term for this. It is ‘neuroception’ or somatic intuition. ‘The body remembers’ by Babette Rothschild and ‘The body keeps the score’ by Bessel van der Kolk are two recent monographs that describe how the body responds to memories of what has happened.

People who have suffered life threat often perceive threat where there is none. Helping a person understand why and how they might change their response is the purpose of more analytical forms of psychotherapy.

Nevertheless human beings are also a flexible and adaptable species. Neuroception is not just about feelings of danger, it is also about those situations that can make us feel safe. Recovery is often a case of replacing feelings of threat and danger with confidence and safety.Ho

2 comments on “How other people can make us ill

  1. Pingback: Diarrhoea and constipation: chaos, control and a possible explanation. | The Sensitive Gut

  2. Pingback: Love-sick | The Sensitive Gut

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This entry was posted on June 7, 2017 by in Autonomic Nervous System, Brain and Gut and tagged .

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