EFTA00809967.pdf

ACCESSING the HEALING POWER of the VAGUS NERVE EFTA00809967 I I EFTA00809968 ACCESSING the HEALING POWER of the VAGUS NERVE SELF-HELP EXERCISES FOR ANXIETY, DEPRESSION, TRAUMA, AND AUTISM Stanley Rosenberg North Atlantic Books Berkeley. California EFTA00809969 Copyright 0 2017 by Stanley Rosenberg. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the written permission of the publisher. For information contact North Atlantic Books. Published by North Atlantic Books Berkeley, California Cover art by jasmine Hromjak All other illustrations by Sohan Mie Poulsen; 0 Stanley Rosenberg .211 Photographs by Tau Bjorn Rosenberg Cover design by Nicole Hayward Book design by Suzanne Albertson Printed in the United States of America Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism is sponsored and published by the Society for the Study of Native Arts and Sciences (dba North Atlantic Books), an educational nonprofit based in Berkeley, California, that collaborates with partners to develop cross-cultural perspectives, nurture holistic views of art, science, the humanities, and healing, and seed personal and global transformation by publishing work on the relationship of body, spirit, and nature. North Atlantic Books' publications arc available through most bookstores. For further information, visit our wcbsite at www.northadanticbooks.com or c MEDICAL DISCLAIMER: The following information is intended for general information purposes only. Individuals should always see their health care provider before administering any suggestions made in this book. Any application of the material set forth in the following pages is at the reader's discretion and is his or her sole responsibility. The author takes full responsibility for representing and interpreting the ideas related to the Polyvagal Theory. The author's interpretations and representations of the Polyvagal Theory may vary in intent and accuracy from the writings and presentations by Dr. Stephen W. Purges. Library of Congress Cataloging-in-Publication Data Rosenberg, Stanley, 1940— Accessing the healing power of the vagus nerve : self-help exercises for anxiety, depression, trauma, and autism I Stanley Rosenberg. pages cm ISBN 978-1-62317-024-0 (Trade paperback) — ISBN 978-1-62317-025-7 (Ebook) I. Depression, Mental—Alternative treatment 2. Anxiety—Alternative treatment. 3. Autism—Alternative treatment 4. Vagus nerve. 5. Self-care, Health. I. Title. RC537.R63844 2016 616.85'27—dc23 2015028780 1 2 3 4 5 6 7 8 9 printer 23 22 21 20 19 18 North Atlantic Books is committed to the protection of our environment. We partner with FSC-certified printers using soy-based inks and print on recycled paper whenever possible. Printed on recycled paper. EFTA00809970 To Linda Thorborg EFTA00809971 I I EFTA00809972  TABLE OF CONTENTS Foreword by Stephen Porges, PhD xi Foreword by Benjamin Shield, PhD xv Acknowledgments xvil Preface xix Introduction: The Autonomic Nervous System iocir PART ONE: Anatomical Facts Old and New: The Polyvagal Theory 1 Overcoming Health Challenges: Are You Fighting the Heads of the Hydra? 1 The Heads of the Hydra: Common Problems Related to Cranial- Nerve Dysfunction 3 Chapter 1:Get to Know Your Autonomic Nervous System...__....__....__...._ 7 The Twelve Cranial Nerves 7 Cranial Nerve Dysfunction and Social Engagement 13 Treating the Cranial Nerves 21 The Spinal Nerves 22 The Enteric Nervous System 26 Chapter 2: The Polyvagal Theory__....__....__....__....__.__....__....__....__....__ 29 The Three Circuits of the Autonomic Nervous System 29 Goldilocks and the Three ANS States 30 The Five States of the Autonomic Nervous System 33 The Vagus Nerve 36 Two Branches of the Nerve Called "Vagus" 39 =Stress: and the Sympathetic Nervous System 49 EFTA00809973 Chapter 3: Neuroception and Faulty Neuroception 57 Faulty Neuroception and Survival 57 Other Causes of Faulty Neuroception 61 The Story of Antacus 62 Chapter 4: Testing the Ventral Branch of the Vagus Nerve 65 Simple Evaluation from Facial Observation 65 Objectively Evaluating Vagal Function through Heart Rate Variability (HRV) 69 Testing for Vagal Function: Early Experiences 71 Discovering the Polyvagal Theory 73 Testing for Vagal Function: Cottingham, Porges, and Lyon 78 A Simple Test of the Pharyngeal Vagus Branch 81 How to Test for Pharyngeal Ventral Branch Function 82 Therapists can Test for Vagal Function without Touching.... 84 Chapter 5: The Polyvagal Theory—A New Paradigm for Health Care? 87 A Polyvagal Approach for Psychological and Physical Conditions 88 The Healing Power of the Polyvagal Theory 91 Relieving COPD and Hiatal Hernia 91 Treating a Hiatal Hernia 98 Diaphragmatic Breathing 101 Shoulder, Neck, and Head Pain: CN XI, Trapezius, and SCM 102 The Levator Scapulae Muscle 104 The "Trap Squeeze Test" for Shoulder and Neck Problems 115 Health Problems Related to Forward Head Posture 117 Relieving Migraine Headaches 123 Chapter 6: Somatopsychological Problems. 131 Anxiety and Panic Attacks 135 Phobias 141 Antisocial Behavior and Domestic Violence 143 Post-Traumatic Stress Disorder (PTSD) 151 EFTA00809974  Depression and the Autonomic Nervous System 156 Bipolar Disorder 157 ADHD and Hyperactivity 161 Chapter 7: Autism Spectrum Disorders 163 Hope for Autism: The Listening Project Protocol 166 The Role of Hearing in Autistic Spectrum Disorders 171 Treating Autism 177 Technique for Rounding a Flat Back of the Head 178 Concluding Remarks 183 PART TWO: Exercises to Restore Social Engagement 185 The Basic Exercise 186 Neuro-Fascial Release Technique for Social Engagement 195 The Salamander Exercises 199 Massage for Migraines 204 SCM Exercise for a Stiff Neck 206 Twist and Turn Exercise for the Trapezius 208 A Four-Minute Natural Facelift, Part 1 212 A Four-Minute Natural Facelift, Part 2 217 Severing all the Heads of the Hydra 219 Appendix 219 Notes 221 Index 233 About the Author 235 EFTA00809975 I I EFTA00809976  FOREWORD I met Stanley in June 2002, when I spoke at the United States Association for Body Psychotherapy Conference in Baltimore. The evening before my talk I received a message from Jim Oschman asking if he and Stanley could attend. Jim explained that I would enjoy meeting Stanley and learning about his work. After my talk, Stanley explained his desire to identify objective measures, such as heart rate variability, that could be used to conduct research to validate the clinical work he was doing. I was curious and wanted to learn more about his work, his approach, and why he was interested in measurements of vagal function. I mentioned to him that I had spondylolisthesis, a condition in which a vertebra slides forward over the bone below it. He casually responded, "I can fix it." I asked him how long he thought it would take. He said about ten to fifteen seconds! At this point I was trying to figure out what he could do in ten to fifteen seconds. I had assumed, based on his training in Rolfing and craniosacral techniques, that his treatment would require several sessions. Given my history with an orthopedic specialist, I was curious if a somatic therapy could be effective. The suggestion that it could be rehabilitated in a few seconds was outside my worldview. My diagnosis was based on a slippage in the lower spine at the junction of lumbar and sacral vertebrae. The slippage caused back pain and possibly a progressive deterioration that would lead to surgery. I was diagnosed by an orthopedic surgeon, who imposed on me a fear of surgery to motivate progress in physical therapy. Following my graduation from physical therapy, I went to a sports medicine physician who prescribed a back brace to limit mobility. From this portfolio of health care professionals, I received contradictory instructions; the physicians encouraged me to immobilize the lower back, while the physical therapists encouraged me to move and work on flexibility. By the time I met Stanley, it was not dear to me how to treat my condition to minimize symptoms and avoid surgery. Wh t Stanley generously offered tom,"welcomed the opportunity. Stanley instructed me to go on my hands and knees, and xi EFTA00809977  ACCESSING THE HEALING POWER OF THE VAGUS NERVE to relax and keep my spine relatively level. Then, with the fingers from both hands going in opposing directions, he moved the tissue over the vertebrae that had slipped. As he did this, the vertebrae immediately and effortlessly slipped into position. For fifteen years I have used a modification of his procedure to remain pain free. I understood immediately what he was doing. The physical manipulation, which gently moved the upper levels of tissue, signaled the body to relax. The relaxation was sufficient to reorganize the neural muscular regulation that supported the spine, allowing the vertebra to gently fall into place. Thus Stanley was transmitting signals of safety to the neuromuscular system that enabled the system to immediately shift from a defensive state of contraction, in which it attempted to protect the vulnerability of the lower spine, to a state of safety in which a gentle touch would functionally allow the system to find its natural position. Stanley's method confirmed that a metaphor of safety is manifest throughout the body and not merely in the social engagement system via the muscles of the face and head, or in the viscera via ventral vagal pathways. In all aspects of the human anatomy, safety is expressed by the down regulation and the constraint of defense. When safety occurs, the structures can retune themselves to support health, growth, and restoration. Functionally, Stanley's work is based on his implicit understanding that when the nervous system is manifest in a state of safety there is a welcoming to touch, which can be used to align bodily structures and optimize autonomic function. Our first meeting captured Stanley's essence and brilliance. It captured his passionate desire to alleviate pain and suffering. It captured his compassionate approach that supports states of safety through gentle co-regulation. And it captured his intuitive understanding of the integrated systems of the body. Stanley and I have now been good friends for fifteen years. In multiple visits we have discussed how his manipulations shift autonomic state to promote health, growth, and restoration. As this book conveys, he has brilliantly integrated features of the Polyvagal Theory with features from craniosacral and other somatic therapies. To do this, he artfully extracted xii EFTA00809978  Foreword the primary principle of the Polyvagal Theory: the structures of the body become welcoming to touch and manipulation when in a state of safety. According to the Polyvagal Theory, the body, including the neural regulation of skeletal muscle, functions differently when in a state of safety. In the state of safety, ventral vagal pathways coordinate the autonomic nervous system. In this state, the defensive features of the autonomic nervous system are constrained, and the body is welcoming not only to the social engagement behaviors of prosodic vocalizations and facial expressions, but to touch. Underlying Stanley's clinical successes is his ability to connect and co-regulate the client through interactions between the client's social engagement systems, and to convey cues of trust and concern that trigger the beneficial attributes of the ventral vagal circuit in promoting a state of safety through the entire body. Stanley is not a traditional therapist trained within a discipline. His training crosses disciplines, and his approach is more consistent with the traditions of a healer. Healers enable the body to heal itself, and Stanley functions in this role. He co-regulates his clients, enabling and empowering them to heal through the body's own mechanisms. His interest in the Polyvagal Theory comes from his implicit understanding that when states of safety are manifest in the structures of the body, the body is poised to serve as a platform for healing. Accessing the Healing Power of the Magus Nerve is Stanley's personal expression of his insight into and appreciation of the role that vagal pathways play in the healing process by calming the body and enabling the body to welcome touch. By intuitively understanding this integrated process, Stanley has developed a system of manipulations that promote states of safety, allowing the body to retune the nervous system, thus optimizing behavior, mental health, and physiological homeostasis. As a scientist, I do not experience the world of the therapist. As a therapist, Stanley does not experience the world as a scientist. However, Stanley's gift lies in his ability to implicitly organize information from science and to apply it therapeutically in an intuitive, insightful, and helpful manner. Stanley's contributions as a creative therapist are unique within the complex health care environment. Fortunately, his powerful EFTA00809979  ACCESSING THE HEALING POWER OF THE VAGUS NERVE insights, metaphors, and treatment models are beautifully conveyed and archived in Accessing the Healing Power of the Vagus Nerve. Stephen W. Porges, PhD, Distinguished University Scientist, Kinsey Institute, Indiana University, and professor of psychiatry, University of North Carolina xiv EFTA00809980  FOREWORD There are times in history when need is met with equal brilliance. We are blessed with one of these rare moments. Stanley Rosenberg's Accessing the Healing Power of the Vagus Nerve gives the reader tools to navigate and treat some of the most complex of maladies. Stanley brings forward this new wave of thought with the foundation of his almost half-century of clinical experience, trainings, and teaching. Accessing the Healing Power of the Vagus Nerve provides insights into the genesis of physical and emotional conditions, the reasons why they often have not been successfully treated with conventional methods, and effective tools to resolve them. Our well-being is dependent on a functional and adaptive nervous system. At the heart of our adaptability, especially to stress, is the vagus nerve. This cranial nerve is integrated into our entire physical and neurological matrix. The vagus nerve is central to every aspect of our life. It can provide us with deep relaxation as well as offer immediate response to life-and-death situations. It can be both the cause and the resolution of countless disorders. Additionally, the vagus nerve can provide us with the needed deep personal connection to others and our environment. I have had the privilege of knowing Stanley for over thirty-five years. I have studied together with him, learned from him, and taught for the Rosenberg Institute. I know of no other practitioner more qualified to bring together all the essential elements that are presented in this book. Accessing the Healing Power of the Vagus Nerve unlocks the mysteries of chronic disorders. There are many books published that explain these conditions, but none so successfully delves into the underlying basis of how and why these conditions develop. Whether for therapists, sufferers, or simply readers who wish to learn more about themselves and others, Accessing the Healing Power of the Vagus Nerve is a must-read. We owe Stanley Rosenberg a debt of xv EFTA00809981  ACCESSING THE HEALING POWER OF THE VAGUS NERVE gratitude that he has woven his decades of insight into a fascinating and unforgettable work. Benjamin Shield, PhD, author of Healers on Healing, For the Love of Cod, Handbook for the Soul, and Handbook for the Heart xvi EFTA00809982  ACKNOWLEDGMENTS Thanks to Stephen Porges, who formulated the Polyvagal Theory—his teaching and writings opened a world of understanding and have allowed me to help many people in my clinic and to teach other clinicians. He has been a friend for more than a decade and an inspiration in my for- mulating and writing of this book. He also reviewed an early draft of this manuscript and helped to clarify important points. Thanks to Alain Gehin, my friend, mentor, and primary teacher in osteopathy and craniosacral therapy for more than twenty-five years. I also extend my gratitude to Professor Pat Coughlin at Geisinger Commonwealth School of Medicine (formerly known as the Commonwealth Medical College), who has been my main teacher of anatomy and physiology and who helped to edit the anatomical references in this text. Linda Thorborg was an inspiration in the development of many aspects of my hands-on techniques and has co-taught optimal-breathing courses with me. Thanks to Kathy Glass, my developmental editor, who took my chaotic notes and shaped them into this book. I have been living in Denmark and speaking Danish for thirty-five years, and my English language, especially my written language, has suffered. Looking back, I see that Kathy took on a near-impossible task of helping me to formulate my thoughts—and completed it with style. Benjamin Shield and Jacqueline Lapidus also helped me with the editing of early drafts. Also, thanks to Mary Buckley and Erin Wiegand, editors from North Atlantic Books, who helped put my manuscript into its final shape. Thanks to some of my other teachers, including Jim Oschman, who wrote the book Energy Medicine; Tom Myers, author of the book Anatomy Trains; my four teachers in tai chi and chi gung: John Chung Li, Ed Young, Professor Cheng Man-Ch'ing, and Hans Finne; my teacher in mindfulness and Vipassana meditation, Joseph Goldstein; my teachers in Rolfinge: Peter Melchior, Peter Schwind, Michael Salveson,,Louis Schului and Timothy Dunphy, Ann Parks, and my other teachers in healing, massage, and other body therapies over the years. xvii EFTA00809983  ACCESSING THE HEALING POWER OF THE VAGUS NERVE Thanks also to my colleagues at the Stanley Rosenberg Institute, as well as all of my students, patients, and my many friends over the years, especially Ira Brind, Benjamin Shield, Anne and Philip Neess, Lise Pagh, Charlotte Soe, Mohammed Al Mallah, Gordon Enevoldson, DeeDee Schmidt Petersen, Trine Rosenberg, and Donna Smith. Thanks to Filip Rankenberg and my other colleagues at Manuvision. Also, thanks to Sri Sri Ravi Shankar for his interest in our form of craniosacral therapy and for his support over the years. Thanks to my children, Annatrine, Erik, and Tau; my grandchildren; my mother and father; and my brothers, Jack, Allen, and Arnold. xviii EFTA00809984  PREFACE Stanley Rosenberg, an American-born body therapist living in Denmark. This book proposes a new approach to healing based on my experiences as a body therapist working within the framework of a completely new understanding of the function of the autonomic nervous system—the Polyvagal Theory, developed by Dr. Stephen Porges. The autonomic nervous system not only regulates the workings of our visceral organs (stomach, lungs, heart, liver, etc.) but is closely tied to our emotional state, which directly influences our behavior. Thus the proper working of our autonomic nervous system is central to our emotional as well as physical health and well-being. Dr. Porges's Polyvagal framework has allowed me to achieve positive results with health issues as far-ranging as chronic obstructive pulmonary disease (COPD), migraine headaches, and autism—to name just a few. I have been doing various forms of body therapy for more than forty- five years. That career was a far cry from Swarthmore College, from which I graduated in 1962 after majoring in English literature, philosophy, and history, participating in an intensive honors program. When I go to college reunions, I find that most of my friends became college professors, doctors, lawyers, psychologists, and other professionals. I am the only body therapist out of the two hundred and fifty students from my class. BEHIND THE SCENES:THE PHILOSOPHY OF ACTING During my time at Swarthmore I became interested in theater, and Japanese theater in particular. That led me to a graduate program in theater at the University of Hawaii, where we put on plays from Japan, China, India, and Thailand. After two years, I left the sandy beaches of Honolulu and moved to the crowded, dirty, noisy streets of the Lower East Side of Manhattan along with other young theater hopefuls. From time to time, I helped Ellen Stewart, the producer of La MaMa, a popular off-off-Broadway theater where aspiring actors and directors put xix EFTA00809985  ACCESSING THE HEALING POWER OF THE VAGUS NERVE on new plays by hopeful but as yet undiscovered playwrights. I do not know whether it was my fate, my good luck, or my nose for finding good people to work with, but I was blessed that Ellen took me under her wing. After touring with her and a small theater troupe through Europe, Ellen insisted that I visit the Odin Theater, a small experimental venue in Denmark On Ellen's recommendation, I ended up as assistant to Eugenio Barba, director of the Odin Theater. Barba wanted the actors to create something new in every detail of their performance. On one occasion, Barba and his actors spent two days rehearsing one small scene—trying variations of staging, expressive body movements, and unusual patterns of vocal expression—that took only ninety seconds when it was finally finished and incorporated into the play. Barba had been trained for three years as an assistant director at a Polish theater directed by Jerzy Grotowski, who had a reputation for doing some of the most exciting theater performances in the world at that time. Grotowski was both an innovative theater director and a theorist of the connections between mental, physical, and emotional processes. Grotowski's actors explored the physical and emotional aspects of extreme moments in the lives of their characters. They went into a world that was halfway between reality and fantasy, exploring dreamlike states invoked by traumatic experiences. After three years as Grotowski's assistant. Barba also spent a year in India studying classical Kathakali dance theater, which uses extraordinary forms of stylized expression including masks, costumes, makeup, and frequent use of mime. To attain the high degree of flexibility and muscle control required for this art's body movements and footwork, Kathakali dancers undergo a strenuous course of training. To help them meet these challenges and achieve the necessary flexibility, they receive sessions of body massage. All of these experiences influenced Barba and the Odin Theater; the acting training that I experienced there had its origins in Grotowski's work, and included acrobatics, yoga, and freestyle movement improvisation. I stayed at Barba's theater for an entire year, taking part in the daily training in voice, movement, and emotional expression. )C( EFTA00809986  Preface In his "Statement of Principles," Grotowski wrote, "The main point then is that an actor should not try to acquire any kind of recipe or build up a "box of tricks." This is no place for collecting all sorts of means of expression:" My exposure to this philosophy at the Odin Theater shaped my approach to everything I did for the rest of my life, including learning and exploring body therapy. In voice training, for example, we did not sing a song with a melody and text written by someone else. We did not try to imitate anything that we heard someone else do, but to explore the world of sounds that we generated in our own imagination—sounds that we had never heard anyone make before. This could take hours, days, or sometimes a week or more before I felt I had succeeded in making the exact sound I had imagined—and there was no one else who could judge whether I had made the "right" sound or not. Once I had made that sound, I never repeated it. I went on to the next sound that appeared in my imagination, and worked toward expressing that. This same approach has manifested itself in my approach to bodywork. Main Gehin, my primary teacher and mentor in craniosacral therapy, visceral massage, and osteopathic techniques, once said something very similar to what learned at Odin Theater: "You learn techniques to understand principles. When you understand the principles, you will create your own techniques." He also continually emphasized one principle: "Test, treat, and then test again." TAI CHI Body therapy came naturally into my work of teaching actors. As a teacher and director, I pushed actors out of their comfort zones and beyond the usual limitations of their movement and vocal expression. We worked, for example, with mime and acrobatics. Along the way I found a short book on shiatsu massage, and I included that as part of our training to help the body move better. While I was exploring the world of experimental theater in New York City, I also learned tai chi from Ed Young, a student and translator of xxi EFTA00809987  ACCESSING THE HEALING POWER OF THE VAGUS NERVE Professor Cheng Man-Ch'ing, one of the great tai chi masters of the twentieth century. Tai chi is unparalleled as a source of knowledge about natural ways of moving the body. Practicing the tai chi form every day is the kung fu of knowing yourself, similar to deeper forms of meditation in other traditions. The movements of tai chi are continuous, spiraling, and "soft" compared with those of "hard" styles of self-defense such as karate, where the movements are in straight lines, fast, and with definite beginning and ending points. The goal of tai chi as a martial art is not to become stronger and faster than your opponent but to use your own body awareness, flexibility, and kinesthetic sense to find where your opponents are tense—and then "help" the opponents use their own force against themselves. The ideal of tai chi is to use "a force of four ounces to deflect a thousand pounds." This concept has become an integral part of my body therapy. Some people doing massage and body therapies push hard into their client's body, with the intention of going deep. By contrast, I try to find the exact center of tension and the exact angle for me to push to increase the tension, and then use the minimum amount of force necessary to get the body to release itself. I often use no more than a few grams of pressure. ROLFING AND OTHER INSIGHTS After five years in New York, I moved back to Denmark and taught acting at the National Theater School for a year. Being a foreigner and trying to make headway in the Danish theater world without any network was harder than I had thought. So I decided to leave my work in theater and to support myself teaching tai chi and giving body therapy sessions. In Denmark I kept hearing about Rolfinge, a form of hands-on body therapy created by Ida Rolf' that had the reputation at that time of being the gold standard of body therapy. (Rolling is a form of "structural integration," the generic name for a form of connective-tissue massage that has the goal of helping clients have better posture, breathing, and movement.) EFTA00809988  Preface The idea of working from an inner intention, as we had done in our voice training at Odin Theater, came up in my discussions with Siegfried Libich, a German Rolfer. When he mentioned "working with intention" as an important element of Ida Rolf's teaching, I decided to take a series of ten Rolfing sessions with him. The effect of those sessions on me was so profound that I decided to learn the approach myself I became one of the first of three Rolfers in Denmark, and I have now been working with this form of bodywork for more than thirty years. In theater, actors usually take on the physical tensions of their characters, but in Rolfing we work to release the typical physical characteristics and habitual emotional patterns that limit our clients, restrict their movements, and cause pain and discomfort. The focus is on balancing tensions in the connective tissues of the body rather than "relaxing" the muscles, which is the usual approach to body therapy. The result is that they can move in new ways and have greater emotional flexibility. They can liberate themselves from cliches that have previously limited their freedom of expression, and move toward a more creative and authentic version of themselves. Rolfers not only work with their hands; they also learn to read the body. Movement and postural analysis are an important part of the training that other modalities of body therapy had not yet begun to teach. Rolfers ask,"Where is the body out of balance? Where is the flow broken in a movement? What needs to be done to bring it back into `shape'?" After I had been Rolfing for a few years, I began to hear other Rolfers talking about craniosacral therapy as a new frontier in body therapy. I went on to study that too, as well as other forms of osteopathic techniques including visceral massage and joint manipulation. During the following twenty-five-year period, I kept on learning from the best teachers I could find, attending advanced classes and trainings at least thirty days a year. In Denmark I was able to develop my skills as a body therapist slowly, over more than four and a half decades. I am currently in my mid-seventies, and I believe that my life has moved more slowly here in Denmark than if I had followed a similar path doing body therapy in the United States, where financial opportunities are greater and more Erin EFTA00809989  ACCESSING THE HEALING POWER OF THE VAGUS NERVE tempting, so that many successful therapists outgrow their practices and move on to other more lucrative endeavors. Also, I believe that the fashions regarding, which therapy is "in" and which is "out" change more quickly in the United States than in Denmark. I have been blessed to be able to follow my own path at my own tempo. Alain Gehin, my craniosacral teacher, said that becoming a skilled body therapist is not so much "knowing about" something intellectually but "learning how to do something with your hands." He claimed that a body therapist first begins to attain what the French call savoir faire-"know-how"— after giving ten thousand sessions. I have an image of myself, despite my American roots, as having apprenticed to become an Old-World European craftsman. I have had time to study, to practice, and to develop skills. I have had the luxury to be able to keep reaching for a greater level of finesse, sensitivity, and creativity with my hands. All these ingredients were in the mixing bowl when I met Stephen Forges and was blown away by his new interpretation of how the auto- nomic nervous system functions—which I will explain later in this book. xxiv EFTA00809990  INTRODUCTION: THE AUTONOMIC NERVOUS SYSTEM A discovery is said to be an accident meeting a prepared mind. —Albert Szent-Gyorgyi, Hungarian-born biochemist (1893-1986) who won the Nobel Prize for his discovery of Vitamin C in 1937' It doesn't matter how much you drive around, you will never get to where you want to go if you don't have the right map. —Stanley Rosenberg I practiced various forms ofbody-oriented therapies for more than thirty years, but I eventually realized that I was using the wrong map. When I learned about Stephen Porges's Polyvagal Theory, his ideas expanded my understanding of how the autonomic nervous system functions, and immediately I had a better map. The autonomic nervous system is an integral part of the human nervous system, monitoring and regulating the activity of the visceral organs—heart, lungs, liver, gall bladder, stomach, intestines, kidneys, and sexual organs. Problems with any of these organs can arise from dysfunction of the autonomic nervous system. Before the Polyvagal Theory, there was a widely accepted belief that the autonomic nervous system functioned in two states: stress and relaxation. The stress response is a survival mechanism activated when we feel threatened; it mobilizes our body to prepare to fight or flee.' So in the stress state, our muscles are tense, thus enabling us to move faster and/or exert more power. The visceral organs work to support this extraordinary effort by our muscular system. When we have won the fight and neutralized the threat, or when we have gotten far enough away so that we are no longer in danger, our relaxation response kicks in. We remain in this relaxed state until the EFTA00809991  ACCESSING THE HEALING POWER OF THE VAGUS NERVE next threat appears. In the old view of the autonomic nervous system, relaxation was characterized as the "rest and digest" or "feed and breed" state. This state was attributed to the activity of the vagus nerve, also known as the tenth cranial nerve, which, like all cranial nerves, originates in the brain or the brainstem. In this old, universally accepted interpretation, our autonomic nervous system vacillated between states of stress and relaxation. However, problems arise when we get stuck in a stress state even when the threat or danger has passed, perhaps because our work or lifestyle is continually stressful. For many decades, chronic stress has been recognized as a health problem, with an enormous amount of scientific research devoted to understanding the harmful effects of long-term stress. Attempts to treat and manage chronic stress spawned a widespread movement on the part of health-care practitioners, who wrote (and continue to write) a vast number of popular articles for a general audience in newspapers, magazines, books, and blogs. The pharmaceutical industry also began to provide a wide range of anti-stress drugs that have netted the corporations handsome profits as the use of these medications has soared. Yet, in spite of all these resources, many people continue to feel that they have not been helped sufficiently. They still feel stressed. Many believe that our society is getting more and more stressful every year, and that individuals are more stressed out as a result. Perhaps the problem is that we have been using the wrong map. With the old understanding of the autonomic nervous system, we have not yet been able to find truly effective methods of stress management. Like almost everyone working in the medical world and the alternative- therapy scene, I shared existing beliefs about the way that I thought the autonomic nervous system worked. Every day in my clinical practice, I used what I had learned about the old stress/relaxation model of the autonomic nervous system. The fact that my treatments worked served as a confirmation that this understanding of the autonomic nervous system was correct. I enjoyed passing on what I had learned to students who wanted to acquire the various skills of body therapy that I had been using xxvi EFTA00809992  Introduction: The Autonomic Nervous System successfully. I taught the old model of autonomic nervous system function in all my courses in body therapy. As my classes filled, I founded a school, the Stanley Rosenberg Institute in Silkeborg, Denmark. In 19931 invited a few of the therapists I had trained to teach some of the introductory courses so that 1 could concentrate on teaching the more advanced courses. Eventually other teachers took over the more advanced courses as well. The specialty of our school was craniosacral therapy, which has its origins in the work of William Garner Sutherland (1873-1954), an American osteopath and the founder of osteopathy in the cranial field (OCF). (Osteopaths in the United States are licensed, with the same basic training and privileges as medical doctors.) While exploring dried cranial bones in an anatomy dissection lab, Sutherland found that he could fit the sawtooth edges of adjacent cranial bones together—but he noticed the possibility of slight movement between two adjacent bones. At the time, the belief was that if something existed in nature, there must be a reason for it. Sutherland postulated that the movement of the bones facilitated circulation of the cerebrospinal fluid, and he gathered techniques into what has become "craniosacral therapy." CRANIAL BONE MOVEMENT The cranial bones are held together by a system of elastic membranes that allow for slight movement between the individual bones. When Sutherland carefully palpated the bones of his patients' skulls, he was able to sense a slight but perceptible movement of the individual bones of the cranium in relationship to each other. Sutherland noticed that many of his patients with medical problems originating in their nervous systems had restricted movement between the bones of their cranium. By releasing some of those tensions, he felt that the subtle movement of the bones was increased. This approach enabled him to help several of his patients with a wide variety of health issues that had not been helped by the usual medical treatments of medicine or surgery. made EFTA00809993  ACCESSING THE HEALING POWER OF THE VAGUS NERVE Whereas medical doctors tend to prescribe medicines to treat stress and other medical conditions, the craniosacral approach is a hands-on therapy that has proven to be particularly effective in improving the function of the nervous system. It can reduce chronic stress, release tensions in the muscular system, and bring better balance to the hormonal (endocrine) system. Sutherland developed therapeutic techniques in three areas: 1) releasing tension in the membranes; 2) releasing restrictions between the individual cranial bones; and 3) improving the flow of the cerebrospinal fluid. THE BRAIN-BODY BARRIER There is a physical structure made up of epithelial cells that envelop the brain and spinal cord. These cells form what is called the blood-brain barrier. There is no direct circulation of blood directly to the neurons of the brain and spinal cord. Instead, the tissues of these structures are surrounded by colorless cerebrospinal fluid, which circulates to deliver necessary nourishment to the cells of the brain and spinal cord and to carry away waste products of cellular metabolism before returning to the blood. The cerebrospinal fluid is found in small amounts in the blood throughout the entire body, but it is finer than the rest of the blood. It contains no red or white blood cells, and fewer impurities than blood. In the brain the cerebrospinal fluid is filtered out of the blood and circulates through the cranium in the spaces surrounding the brain and spinal cord. After circulating around the brain and spinal cord, the cerebrospinal fluid returns to the jugular veins, where it rejoins the blood returning to the heart from the rest of the body. Then it is circulated from the heart and freshened by the lungs and kidneys. The blood supply to the brainstem and the nerves arising there is crucial to the function of the five cranial nerves whose function is necessary for the state of social engagement, which includes the ventral branch of the vagus nerve. Removing restrictions to this blood supply is at the core of successfully improving the function of the ventral branch of the vagus nerve and the owlii EFTA00809994  Introduction:The Autonomic Nervous System other four cranial nerves necessary to social engagement. Some of the best ways to achieve this are found in the domain of craniosacral osteopathy. For decades, craniosacral education was the exclusive domain of osteopathic physicians. They traditionally restricted attendance in their courses to licensed osteopaths and students enrolled in osteopathic medical schools. However, some of the hands-on disciplines were eventually taught to non-osteopathic physicians and students. Because many of those techniques were so effective, an eager market for them developed among practitioners of alternative and complementary therapies. One American osteopath, John Upledger, broke with tradition and began teaching craniosacral techniques to non-osteopaths. Much of the focus of Upledger's work was on unwinding the tension in the membranes. He founded the Upledger Institute, where I took my first course in craniosacral therapy in 1983. Craniosacral therapy has now become popular with alternative therapists all over the world. In 1995, after I had been successfully practicing what I had learned from the Upledger Institute, I went on to study with Main Gehin, a French osteopath who specialized in biomechanical craniosacral therapy. His focus was on releasing tension in the connective tissue spanning adjacent cranial bones, thereby allowing them to move more freely.s A few years after that I took introductory courses in biomechanical craniosacral therapy, which focuses on increasing the circulation of the cerebrospinal fluid. All three approaches have the same goal that Sutherland espoused—to improve the function of the craniosacral system. MY OWN CLINICAL PRACTICE In my own practice I preferred biomechanical craniosacral therapy, which reminded me of my work with Rolfing. BC' is specific; it helped me find the exact places in the cranial joints that needed releasing and provided me with more than 150 specific techniques to release these tensions. This powerful approach often effectively restores the function of the cranial nerves in a short period of time. EFTA00809995  ACCESSING THE HEALING POWER OF THE VAGUS NERVE In my clinic, in addition to treating clients with craniosacral therapy, I gave individual sessions in Rolfing, which balances the myofascia (myo- means "muscle"; fascia refers to connective tissue). I also offered sessions in visceral massage to improve the function of the digestive and respiratory systems. As I worked with techniques from these various modalities, I observed changes in the client's nervous system in terms of stress and relaxation during the course of a hands-on treatment. My work with patients was extremely successful. As time went on, more and more people wanted to learn my techniques, and the Stanley Rosenberg Institute grew to employ twelve teachers working on a part- time basis. Courses were taught in Danish. In Denmark alone we educated several hundred students over several years. These therapists in turn treated thousands of patients. My reputation spread beyond the borders of Denmark, and I taught in several other countries as well. The idea of the two-state (stress and relaxation) function of the autonomic nervous system played a prominent role in our curriculum. I taught about it in my classes on craniosacral therapy, visceral massage, and connective-tissue release. Together with an American neurologist, Ronald Lawrence, MD, I even wrote a book, Pain Relief with Osteomassage,‘ about pain relief and hands-on treatment, based on this interpretation of the autonomic nervous system. When I first heard Stephen Porges lecture about his Polyvagal Theory in Baltimore in 2001,1 had been working successfully with body-oriented therapies for almost thirty-five years. Porges's theory, however, was right up my alley, and it gave me a whole new outlook on the autonomic nervous system. This in turn gave me a new and more effective way to help my patients. Porges's Polyvagal Theory brought about a revolutionary advancement in my understanding of the autonomic nervous system. According to this theory, five cranial nerves (CNs) must function adequately in order to attain the desirable state of social engagement. These five nerves are CN V, VII, IX, X, and XI, and they all originate in the brainstem. Before I heard Porges speak, I had studied anatomy with Professor Patrick Coughl