1.6.0

The Casual Polyvagal Supporters

Call them opportunists, visitors, or name-droppers. They go shopping around. Are they in or out? Hard to say. Sometimes, like Nijenhuis, they even devote several pages to the PVT without taking a definitive stand. 

We can describe two groups.

1.6.1

The Name-Droppers

These authors like Ledoux, Hill, Dahlitz, and Kozlowska, mention the PVT in passing.

  • Joseph Ledoux is a fierce opponent of MacLean. He devoted five lines to Porges in Anxious (2015, p. 299). When asked in the summer of 2022 what he thought of Porges, he “couldn't remember the guy.”

  • In The Practitioner's Guide to the Science of Psychotherapy (2022), Richard Hill & Matthew Dahlitz give an extensive and sometimes confusing account of the PVT. They mistakenly put the words “safety and social engagement” in the mouths of Berthoud and Neuhuber (2000), who are, actually, opponents of such “polyvagal” expressions. At least Hill and Dahlitz mention that some seekers disagree with the PVT and encourage readers to explore the arguments presented.

  • In Fear and the Defense Cascade: Clinical Implications and Management (Kozlowska, 2015), the authors drop a quote twice: “According to Porges' polyvagal theory, ...”. In her subsequent publications, Kozlowska didn't mention the PVT again.

1.6.2

Structural Dissociation

The second group mostly overlaps the trauma and dissociation scene. Otto van Der Hart, Ellert Nijenhuis, Kathy Steele, and Suzette Boon are names that appear when discussing structural dissociation. Instead of looking at the distancing effect of trauma, structural dissociation focuses on dissociative identity pathology. Neuroimaging research by Reinders (aka Simone Reinders) and Schlumpf supports her work.

Van Der Hart, Nijenhuis, and Steele co-authored The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Hart, 2006). This book lays the groundwork for structural dissociation. However, it was too early for her to discuss PVT then.

In Copying with the trauma-related dissociation (2011) by Steele, Boon, and van der Hart, there is no mention of the PVT. Kathy Steele makes the first mention of PVT in a 2012 flyer (IETSP, Paris) by including books by Porges and Ogden in the recommended bibliography. In Treating Trauma-related Dissociation (2017), Steele, Boon, and van der Hart mention the PVT several times.

Using a polyvagal vocabulary, Steel, Boon, and van der Hart explain that traumatized patients have “defective neuroception,” perceiving danger where it does not exist and failing to detect the danger that does exist. Social engagement is related to the myelinated vagal branch. The authors describe the different reactions (three layers) to the threat. Fainting is the extreme manifestation of dorsovagal deactivation. Flaccidity (flag) and fainting are produced by the parasympathetic system (especially the dorsal parasympathetic branch). A two-page table summarizes the polyvagal perspective. However, in the fifth chapter (part 1.1), they explain how their concept of dissociation (cf. The Haunted Self) differs from the perspective of Lanius (2014), Porges (2011), and Schore (2009, 2012). For the polyvagal authors, dissociation is a manifestation of underactivation. For the “structuralists,” dissociation can include both overactivation (even extreme overactivation) and underactivation. Numerous parts of the personality are overactivated, so the patient moves from overactivation to underactivation, depending on which part is in control.

In the ISC program, a polyvagal-friendly institution, we find Boon, Nijenhuis, Steele, and van der Hart in the company of Peter Levine, Pat Ogden, Ronald D. Siegel, Ruth Lanius, and Stephen Porges. In June 2023, Suzette Boon presented at the conference Attachment and Trauma: The State of the Art of Psychotherapy (London), organized by the ISC. At least four of the presenters were «polyvagal authors.» However, none of the four «structuralists» are on the list of NIBCAM experts. In summary, we can’t consider Boon, Nijenhuis, Steele, and van der Hart as true “polyvagalists.” They lack the necessary enthusiasm for the PVT, and their journey has long since taken them elsewhere.

Ellert Nijenhuis

A brilliant mind that doesn't hesitate to take long detours into philosophy, Nijenhuis has been paying attention to Porges' work since the early 2000s. He has often cited PVT concepts in his seminars and articles on structural dissociation.

  • In Traumatic Dissociation, Neurobiology and Treatment (Vermetten, Dorahy, Spiegel, 2007), Nijenhuis and Den Boer try to integrate PVT into the theory of “structural dissociation” in chapter 11, pp. 221-222.

  • In the excellent book on Dissociation and the Dissociative Disorders (Dell, O'Neil, 2009), Schore includes Porges on pages 111-112 and 123, while Nijenhuis and Den Boer present the PVT on pages 348-352. They don't engage but add some minimal personal interpretations in light of the structural dissociation.

  • Similarly, in The Trinity of Trauma: Ignorance, Fragility, and Control (2015, pp. 431-435), Nijenhuis devotes five neutral pages to Polyvagal Theory. The penultimate paragraph begins, “To the extent that Polyvagal Theory is correct, …” Nijenhuis, a critical thinker, goes his way. He has his system, and PVT doesn't fit.