You've done the workup. The labs are normal, the cardiac workup is clean, and the patient still has chest pain. Now what?
In the third episode of the Roots of Care series, Raj Sundar asks Sophia Malik and Rachel Weiner to explain polyvagal theory in plain language and to say honestly where it's useful and where it isn't.
What follows is a working tour of the nervous system as a clinical lens: the social engagement state, sympathetic activation, and dorsal vagal shutdown, and what each can look like sitting across from you in an exam room. Hypertension, anxiety, and insomnia on one side. Fibromyalgia, IBS, chronic constipation, and depression on the other. Along the way: why a patient who looks calm may be deeply shut down, what "appease" is and why it doesn't show up in the usual fight-flight-freeze list, and how a physiologic state is different from an emotion — which turns out to matter a great deal when you're trying to name what you're feeling and can't.
Raj tries it live on himself midway through, which is worth watching.
Some of what we cover
-Polyvagal theory in plain terms, and how to hold it as a useful model rather than a settled one.
-Sympathetic and dorsal vagal states as clinical patterns.
-Fight, flight, freeze, and appease — including what flight looks like when nobody leaves the room.
-Separating sensation from story, and why a new meaning has to arrive rather than be applied.
-Listening to the body's story alongside the patient's story. What to do when the workup is negative.
-Validation as a tool. Where to start if you want real training in this.
Guests
-Sophia Malik, MD, MPH — Family physician and Somatic Experiencing® Practitioner
https://www.drsophiamalik.com
https://drsophiamalik.substack.com
-Rachel Weiner, MD, MPH — Family physician
Resources mentioned
-Somatic Experiencing® (SE™)
https://traumahealing.org/
https://www.somaticexperiencing.com/
-Compassionate Inquiry® (CI)
https://compassionateinquiry.com/en/
https://drgabormate.com/
-Stephen Porges on polyvagal theory — many short talks and interviews available on YouTube
-Peter Levine — talks and clips on YouTube
-"When Agreement Is Not Consent" — Nkem Ndefo and Rae Johnson (available online)
-Unnatural Causes (documentary series)
Books
-Kathy Kain and Stephen Terrell, Nurturing Resilience
-Alaine D. Duncan and Kathy Kain, The Tao of Trauma
-Stephen Porges, Our Polyvagal World
-Deb Dana on clinical applications of polyvagal theory
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. Ep. 1: How Trauma Shows Up in Primary Care Visits. Ep. 2: Illness, Disease, and the Whole Person. Coming next: Healing, Land, and Community.
