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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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Understanding & Treating Shock: In the Face of Natural Disasters and Other Tragedies

Shock has many stages and layers as it progresses. To my perception it freezes one in both space and time, it activates subcortical reflexes. I believe, we as bodyworkers need to understand what to look for and to learn how shock influences anatomy and physiology, that way we can more effectively treat this elusive demon.

While acute shock is best left to the EMTs and emergency rooms, sub-clinical shock from feeling completely overwhelmed and that which becomes chronic are dysfunctions that our profession can help with once appropriately trained. In its sub-clinical form, people in shock present with a stunned or blank look in their eyes, stooped shoulders, and an altered gait pattern. Even those whose spirits refuse to capitulate to the enormity of a calamity are betrayed by the exhaustion and strain of their voices and posture.

Polyvagal Theory: A Neurological Roadmap

A retired psychologist friend in Mexico City sent me astute observations of people's behavior in the face of their recent devastating earthquakes.1 His perceptions match my own, drawn from many decades of individual and separate clinical observations. Therefore, I propose — can one experience trauma without some degree of shock?

Steven Porges' PolyVagal Theory gives us a possible neurological roadmap to understanding the human response to natural disasters. Porges' Theory postulates that the right vagal posterior trunk is in charge of our ancestral responses of fight, flight, or freeze. But this portion of the nervous system also regulates fainting and I speculate that its activation also adds to our cognitive confusion in reaching out to others to devise cooperative problem solving options.2

In distilling his theory, I have come to believe that as humans, we either spring into action, we shut down behaviorally and emotionally, or we respond with a subtle mixture of both ancestral strategies. I theorize that both immobilization and mobilization aspects of the older (right) vagal system are often activated simultaneously.  Metaphorically, one foot is on the gas while the other at the same time is pushing down on the brake pedal.

Understanding & Treating Shock: In the Face of Natural Disasters and Other Tragedies - Copyright – Stock Photo / Register Mark One personal vignette during the aftermath of Hurricane Irma that reflects this notion of mixed activation was that my wife and I took care of all of our immediate neighbors' homes and needs, yet it did not occur to us to walk around the corner to the neighbor on the next street. He had spread a sheet along his street side wall with the message, "No Power."

Even this obvious call for help did not stimulate us to reach out. After nine very uncomfortable days in tropical heat buffered only by a single generator his nephew, Jason, knocked on our door wanting to look for downed electrical lines. He described that his uncle was a former electrician and believed that just one wire needed to be reconnected at the corner transformer that fed our neighborhood.

Emboldened with this knowledge, Jason and I set out to find a line supervisor who might have the authority to redirect resources to explore this theory. It required some chutzpah and persistence, but within an hour power was restored. Collaborative problem solving elevated our quality of living as a result of a single interactive decision. One of Porges' significant contributions is that the right vagal system is composed of unmyelinated fibers, while those of the left vagal anterior trunk are composed of myelinated fibers, which transmit information faster and have evolved to be more attuned to facial expressions, voice tone, skin temperature, and posture, all components of human cooperative problem solving.

He further suggests that all roads of the autonomic nervous system, both sympathetic and parasympathetic, lead back to the heart and then to the brain and spinal cord.2-4 Neural dis-coordination for so many ensues when catastrophic events occur reducing the supply of freshly reconstituted blood with oxygen, nutrition and hormones that is desperately needed to support our capacity to perform necessary movements as well as clear thinking.

When faced with an environmental disaster people can't hide their ailments and their heightened levels of stress and distress. It suddenly becomes obvious for those who have the training to recognize and comprehend what these alterations in facial expressions, posture, voice tone, skin color and variations in temperature mean. The classic definition of "shock" is circulatory insufficiency, yet I have consistently seen the echoes of previously accreted shock and trauma in clients' who daily present to me with chronic somatic conditions. That is why it is so important to treat shock in its early stages.5

The Human Response

Here are some categories for our profession's consideration to expand our collective comprehension of how to remedy the human response to shock:

  • Reflex activation and how to re-calibrate them
  • Equalizing pressure differentials between the body's three great cavities
  • Balancing sympathetic and parasympathetic outflow
  • Mobilizing the gut tube
  • Re-seating the heads of the humeral and femoral bones into their capsules
  • Mobilizing the upper cervical vertebrae and the TMJ
  • Mobilizing our ankles (osteopathy suggests they function as the body's second heart)

Please allow this article to be an invitation to all of our profession's thinkers and teachers to add to and clarify these ideas. We can and should do more in the face of environmental disasters. People need our educated perception, our manual skills, and our knowledge of how to restore normal movement patterns and physiological function. We need to commit to supporting our country's first responder system within our communities and to more effectively treat the general public as they struggle to recover and re-create their lives from natural disasters.


  1. Rigney J. Washington State Migrant Educational Programs (Yakima, Wash.), 1972 - 2004.
  2. Wikipedia. "Stephen Porges.", 2017.
  3. Wikipedia. "Myelin.", 2017.
  4. Shea M. The Autonomic Nervous System (ANS) Below the Diaphragm (unpublished manuscript), 2017.
  5. Guyton AC. Textbook of Medical Physiology, 8th Edition. New York: Harcourt College Publishers, 1991.
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