# Polyvagal Theory Podcast Transcript - Proofread
This is the Drive Time debrief, episode 188.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And today we are gonna talk about something fascinating called the Polyvagal Theory. Laura, give us an explanation—what's going on here? We're so glad you guys are here and this topic was interesting to me because I'm always curious about how the nervous system relates to how we feel and how we respond to stress, and I came across this concept of polyvagal theory and I thought, oh my gosh, this explains so much of what we experience in burnout.
So just wanted to share it with you guys. This affects almost every doctor that we've been in contact with who has had symptoms of burnout. And even some who don't identify, they just say, this is what happens to me when I get off shift. But we haven't had language for it. So if you've ever said, I feel totally numb, I don't care anymore, and I hate that I don't care. Even when I sleep, I wake up tired. I used to be so empathetic. Now I just want everyone to leave me alone. If any of that sounds familiar, then today's episode is for you because what you're describing may not just be burnout. It may be a nervous system state called dorsal vagal shutdown.
And once you understand what's happening in your body, you can begin to climb your way out of it. So first we're gonna talk about something called the Polyvagal Ladder. Your nervous system has three main states, often described as a ladder in what's called polyvagal theory, and that is first the ventral vagal, which is where we're feeling calm, connected, creative. This is where we feel safe, open, and regulated, and oftentimes social.
Then there's sympathetic. We're all familiar with that sympathetic state where we're in fight or flight. Our heart might be racing. We might be talking fast. Sometimes we'll even get tunnel vision. Our body mobilizes for survival.
And then the third state is the dorsal vagal state, and that is a state where we might freeze or shut down. It's a state when our brain thinks everything is too much and the threats are too high, it's a protective state to protect us while we die. That's what that is. Your body says, this is too much. I just need to disappear.
So in burnout, doctors often cycle between that sympathetic overdrive and dorsal collapse. So we might be having frantic productivity and then we move to absolute numbness so it can feel like emotional flatness, withdrawing from loved ones. I've heard this often, docs going home and saying, I just—like they have young kids. They wanna be able to connect with them and they just feel like they can't. Loss of empathy for patients. Profound exhaustion that rest doesn't fix, and feeling like life is happening behind glass.
So here's the reframe that we want to offer, is that these are normal responses that have developed over millennia and it's not weakness when we get home and can't get out of the car for a while. That is our body and our nervous system trying to put us in a conservation mode, is trying to protect us, and that's what our body thinks it's doing, is protecting us. Even though if we stay in that state, it can really affect our relationships and our lives in a lot of negative ways, and so that's why we wanna share this information with you guys to help you know what's happening there and how to get out of it.
That's really good because I think some people, just to hear this, the 10,000 foot view, you would almost be like, am I depressed? You know, like, am I clinically depressed? While there sounds like there's some overlap, but it's interesting to hear this physiology because while you are still able to like, do your job, get up and show up and go to work, it seems like coming home when you experience all this, like it's evident—well it leads to burnout, but I could see where I used to question like, do I need a therapist? Like, what's wrong with me? Do I need to go talk to someone? Am I, you know, depressed? Am I—what's happening?
So this is great to talk about and also to normalize this conversation because I'm sure people out there, or at least our colleagues are like, oh yeah, this is me every day last week. So rest assured that this is helpful to know where this is coming from, but let's zoom in a little bit.
The vagus nerve, which is cranial nerve 10, regulates much of your autonomic nervous system. The dorsal vagal complex is the older unmyelinated branch. It originates in the dorsal motor nucleus in the brainstem, and primarily innervates organs below the diaphragm. So when you're overwhelmed, this dorsal vagus slows the body down. So it looks like bradycardia, reduced oxygen consumption, gut slow down, basically super slow. You are like moving through water or looking behind glass, you have a flattened affect and you're really disconnected from making any logical decisions or complex, critical thinking, which is kind of what I felt like.
So think of it as a possum playing dead. In humans, this looks like collapse on the couch, staring at the chart screen, unable to type or staring in front of the TV and just holding the remote, not really budging.
So where did this theory come from? Steven Porges first proposed polyvagal theory in the 1990s, integrating research from evolutionary biology, neuroscience and psychiatry. He coined the term neuroception, which is the body's subconscious threat detection system. His work showed that the vagus nerve has two distinct branches, a myelinated ventral vagal system that supports social connection and the older dorsal vagal system that drives shutdown.
Research since has confirmed that vagal tone and flexibility are critical for emotional regulation, resilience, and recovery from trauma. So what feels like burnout "numbness" is actually your nervous system choosing shut down when fight or flight has failed.
That's so interesting to just have, like you said, just having words now, like I am experiencing dorsal vagal shutdown. Yeah, I'm in my dorsal vagal phase. I'm in that era, and that's actually a technique for getting out of it, is to be able—is to be able to name it like that. Yep. Yeah. Dorsal vagal power. Taylor Swift has, yeah, Taylor Swift has far more fascinating eras, and I just have my dorsal vagal era. So you're in good company though. You're in good company. Yeah.
Yeah. Because doctors are especially vulnerable. We override fatigue, hunger. We don't pee or eat the entire, you know, time that we're at work, we are constantly running. We live in near constant sympathetic overdrive, always. Fixing, moving, stabilizing patients, answering calls, responding to patients. I mean, we set the system—hey, can I talk with them please? Eventually. Yeah. What's going on and why? What is going on? Yeah. How did I get into this?
Eventually the system flips—dorsal shut down. Emotional numbness, disconnection and exhaustion. If you have also driven home with zero noise, no radio, no nothing. I remember just getting home from work too, like, and just TV was on, radio, everything. Like, I needed nothing but silence. I needed to just like sit there and like, I couldn't even, I didn't want to even have a single thought. Nope.
But just knowing that term and knowing that's not who you are, it just happens to be the nervous system state that you're currently in. Not forever, but currently. That's great news because nervous system states change all the time and maybe we can start to notice it and take steps to fix that.
Yeah. How reassuring that I have been told that I am a little emotional at times by the one who's supposed to love and cherish me the most. But how reassuring that it isn't just emotional, that I can come back with some physiology and some biological components. I listen here, scientists, let me tell you about my current state. But understanding the nervous system is really the first step back and how empowering to be able to explain it, to be able to know the science behind it, to be able to recognize, because like Laura said, first step is awareness and being able to have this information.
So we're going to continue this in the next episode, and we'll explore how to climb out of our shutdown and get the medical tools, therapy approaches, and daily practices that will help you return to life.
So that's it for today's episode. Friends, if you found this conversation helpful, the best way to support us is by leaving a review. It helps other physicians find the podcast and it moves us up on the list. And also, we'd love to hear from you. So if you can relate to your dorsal vagal era and if you've had experience with this, then email us at [email protected]. And don't forget to follow us on the socials. We love connecting with you there.
Our next free masterclass is coming up soon, and that is where we share practical, doable steps to help you thrive in the dumpster fire of medicine. The link to register is in the show notes. And if you can't join us live, that's okay. There's always a replay.
So until next time, you are whole, you are a gift to medicine and the work you do matters.
