92 I Safety, Threat & The Nervous System (Part 2)

Episode Description

Check out the full series on ⁠⁠⁠Youtube - Roots of Care Series⁠⁠⁠

Overview:

We continue our Roots of Care series by exploring how symptoms serve as a form of communication, delving into the fundamentals of somatic experiencing and the practical application of polyvagal theory in clinical care. Together, we break down the nervous system’s adaptive states—including the social engagement system, sympathetic drive, and dorsal vagal shutdown—highlighting how trauma can shape the body’s responses. We reflect on our own skepticism about new models and discuss the value of separating emotion from physiology, expanding our capacity for self-awareness and connection with patients.

Three Takeaways: 1. The Value of Practice-Based Evidence

The conversation highlights a tension in medicine between evidence-based practice versus practice-based evidence. While polyvagal theory may not be universally accepted or supported by large clinical trials, it offers a functional framework that many find therapeutically valuable in practice, encouraging open-mindedness about models that provide clinical utility

2. Importance of Allowing Sensations to Evolve

Instead of forcing a narrative or assigning immediate meaning to symptoms, the episode advocates for attending to and staying with bodily sensations as they change. Doing so can lead to natural resolution or dissipation of discomfort, as witnessed in the live demonstration with a feeling of chest pressure and calf tension that dissipates through mindful attention

3. Clinician as "Meaning Maker" - and Its Limits

There’s reflection on how frequently clinicians assign meaning to patients’ symptoms, inadvertently establishing themselves as sole "meaning makers." This can lead to disconnection or frustration, particularly when the meaning is unclear or unsatisfactory to both clinician and patient (e.g., labeling symptoms as "just IBS"). The episode encourages clinicians to share meaning-making with patients, exploring the bodily story together

Guests

⁠⁠⁠Sophia Malik, ⁠⁠⁠MD, MPH — Family physician and Somatic Experiencing® Practitioner (⁠⁠⁠https://drsophiamalik.substack.com)⁠⁠⁠
Rachel Weiner, MD, MPH — Family physician

Resources mentioned

Books

About Roots of Care A series on whole-person, trauma-informed, and community-centered primary care, produced as part of the Healthcare for Humans podcast.

Next Step: