INTRODUCTION
Recently, I described how the "Polyvagal Theory" of Dr Stephen Porges not only provides an elegant explanation for Parkinson's Disease and all its symptoms, but also suggests the actions we can take towards healing, see
THE NERVOUS SYSTEM AND PARKINSON'S DISEASE.
Here, we return to this Nervous System (NS) dysfunction perspective of PD, and explore further how it informs us about what we can do to progressively decrease our symptoms.
SOCIAL ENGAGEMENT, MOBILIZATION & IMMOBILIZATION
Central to the NS-based explanation of PD is the concept that there is a triumvirate of biological "threat & safety" responses in human beings. When our bodily system detects a threat or danger (via an unconscious, autonomic process which Dr Porges refers to as "neuroception"), the first line of defence is the most evolved part of our NS response, referred to as "Social Engagement "or social co-operation. This response involves "checking in" with any other humans around to seek reassurances of safety, or if a threat is deemed present by the "group neuroception" to determine if there is "safety in numbers". Social Engagement occurs through our abilities to express and read emotions via facial expressions and body language, to communicate vocally, generating signals more generally, and working together in collaborative mode to make the whole social group, and thus individuals safer.
However, if our danger sense decides that Social Engagement activities are not sufficient to make us safe, or if we are isolated or alone, then a less evolved part of our NS is called into play, which readies us for "Mobilization", or in other words, Fight-or-Flight. If, in turn, our system decides that Mobilizing still isn't sufficient to make us safe, or there is nowhere to run and nowhere to hide (which is so often the case in modern life), then a "last resort" part of our NS is called to action. This is the most ancient and primitive biological response in the animal kingdom, which is to "Immobilize" - we are shut down or "locked down", causing us to freeze in order to feign death.
Through understanding this NS hierarchy, I now believe that people with PD have become trapped in negative feedback loops in which the Immobilization part of our system has become permanently switched on, with the Social Engagement and Mobilization "programs" have been weakened or atrophied. Indeed, in a recent interview, Dr Porges relates:
"Every intuitive clinician knows that if they look at people’s faces and listen to their voices, which are controlled by muscles of the face and head, they will know about the physiological state of their client. They know that when they are dealing with clients, who are traumatized, there is no prosody (a lack of intonation in the voice); they know that the upper face will have little emotion expressed. In addition, these same clients will also have difficulties in regulating states and may rapidly transition from a calm to a highly reactive state. Now we can start to see this physiological play act out in different contexts."
While Dr Porges is not saying this in connection to PD in particular, everyone affected by the condition will recognize these features as some of the primary symptoms of the disease.
The Descent into Disease
Due to this Nervous System based framework of understanding, I now believe that many cases of "Idiopathic" and Early Onset Parkinson's may arise due to a sequential inhibition of the triumvirate of Nervous System "programs". First, the Social Engagement system wanes, weakens or atrophies. In some cases, this part of the NS might never have developed properly in the first place, as I now understand is my own situation. I was born Cesarean, premature and would not feed properly. As a child, I had a tendency to play on my own, to exist in my own world of imagination, and to "be happy in my own company", euphemistically referring to a tendency to isolate myself. These tendencies continued into my teenage years and adult life.
The weakening of the NS itself may occur through combined insults via a number of potential sources. Indeed, in speaking to very many people diagnosed with forms of PD around the world, it seems that most of us have our own unique histories of problems which may cumulatively impact on our health. Ingredients in this "recipe for attrition" can include: injuries (physical traumas); mental health issues (emotional traumas); viral or fungal infections; nutritional deficiencies; toxins or allergens in the environment; genetic factors; developmental set-backs; imbalances in gut bacteria.
When the Social Engagement is weakened, the next program in the hierarchy then begins to take more control/becomes more active in addressing perceived threats. Next up in the firing line is the Mobilzation/fight-or-flight program. I have previously discussed in my article
THE BEAST WITHIN AND PARKINSON'S DISEASE
how I lived/survived on adrenal stress for decades before my diagnosis. I now see why this was the case - because my Social Engagement abilities were too weak to keep my system feeling safe, it had to resort to the Mobilization program more often than it should be needed. Indeed, thinking back now, I also understand why I literally could never sit still for more than a few minutes, and would panic in places where it was difficult to engage in Mobilization responses, such as in a lecture or in the cinema. Furthermore, I could never settle, but just had to keep moving and pushing myself on, in the moment, in life and in my overarching ambition in my career.
I've often noted a common personality type in people who have similar symptoms to myself, which we might simply term as "driven" or "serious". Interestingly, in his book
LIMITLESS: HOW YOUR MOVEMENTS CAN HEAL YOUR BRAIN. An Essay On The Neurodynamics Of Dystonia,
Dr Joaquin Farias also observes common personality profiles or patterns of people with dystonia, one of the major symptoms of PD:
"I do not agree with defining my patients as dystonics. What defines them is their personalities, which themselves are very special. People who develop dystonias are hypersensitive, brilliant, impulsive, and have great determination. Among the people affected by dystonias we find United Nations politicians, surgeons, athletes, Olympians, company presidents, dancers, famous musicians, artists, and writers. "
Unfortunately, the Mobilization part of the Nervous System was never meant to switched on permanently, and so eventually people who "thrive" or "survive" on the adrenal stress response end up with what might be called "burn out" or "adrenal fatigue". Thus the second line of NS defence starts to becomes weakened, inhibited or atrophied too. One biological manifestation of this is that the body and brain stop producing enough dopamine. Dopamine is not only the neurotransmitter required for initiating movement, it is also the precursor (chemical building block) of adrenaline (nor-adrenaline in the brain). This is therefore a double whammy for the Mobilizing program of the NS, as without dopamine it can no longer either initiate nor sustain Fight-or-Flight defensive responses.
At this point, our system has to fall back on the Primitive Reflexes associated with the Immobilization part of our NS. Dr Farias also identifies, through his detailed observation of many hundreds of clients over years of practice, that different types of dystonia directly correlate with specific groups of these autonomic (unconscious) reflexes.
As the first two lines of defence have now become too weak to "compete" when our biological system feels unsafe, the Immobilization programs start to get called to action too quickly and too easily. We begin to inhabit "Freeze" and our bodies become more and more involuntarily controlled through the primitive reflex responses identified by Dr Farias. Unfortunately, this can rapidly escalate into a vicious circle, as the system starts to feel increasingly unsafe through lack of sensory information, pain, loss of balance, etc. Hence, if the original failures of Social Engagement and Mobilization programs are not addressed, the result is an "degenerative disease".
PROGRESSIVE SYMPTOM REDUCTION
This Nervous System perspective of Parkinson's Disease is a hopeful one, as it states that with persistent practice and targetted therapies, the symptoms of PD can be progressively relieved over time. This is because, notwithstanding physical severing of nerves, the programs of the NS can be re-strengthened and regrown through correct and consistent stimulation and exercises, both in regards to the sensory neuronal networks, which provide information about the internal and external environments to the brain, and also the motor neurons which receive instructions to move from the brain. As someone once said:
"neurons which fire together, wire together"
My thought process on suggested therapies is as follows. We can seek to reduce symptoms by reverse engineering the sequence of NS program weakening through the pursuit of stimulating, strengthening and re-integrating the inhibited Mobilization and Social Engagement functions. I have been pursuing such lines of inquiry myself for some time, and have found that, in doing so, my symptoms continue to reduce in severity, while, at the same time able to slowly but surely continue to lower my drug burden.
A very important caveat for all suggested exercises below is highlighted by this contribution by my friend Cheryl Townsley, Wisdom Coach:
"Rebounders (more stability than large trampolines) can be very helpful. The key is to start very slowly. The Health Bounce is keeping both feet on the mat and gently going up and down. Start with only a minute. If unstable, use a stability bar or put the rebounder in a corner so you can have your hands on the wall. Slow and steady. Really helps the lymph, brain, every muscle and so much more. You can do multiple times per day just keep it slow. Once acclimated, you can begin to do any move you do in your other exercises on the rebounder."
The point which Cheryl makes is vital: starting slow and steadily building up over time is very important for everyone, but especially those of us with compromised Nervous Systems. Going at it fast and furious is likely to cause symptoms to get worse.
The very best way to re-establish mobility and re-integrate the primitive reflexes is through dance and music therapy, in my view and experience.
Participating in dance groups or classes may be optimal, as this provides real life social interactions together with the movement therapy. Similarly, regularly singing to music is a very powerful technique for mobilizing the head, jaw, neck and shoulder region, as well as significantly strengthening the vocal part of Social Engagement. Combining singing with social group activities (choirs or singing classes) provides real world social engagement opportunities at the same time. I have also found practising emoting via making facial expressions to music a very useful therapy.
Boxing based therapy is another example, which may help to regrow a healthy adrenal "fight" NS program, making the NS feel safer through being able to physically protect itself, while providing significant movement and balance retraining at the same time. Similarly, cycling, running and fast walking exercise help to strengthen a healthy adrenal flight response. Again, all these can be combined with social groups activities, such that they are not just exercises, but forms of play.
SOCIAL ENGAGEMENT NERVOUS SYSTEM STRENGTHENING EXERCISES
In seeking to re-establish our Social Engagement NS programs, I believe there are a number of quick exercises one can do throughout the day, at home, in our time and when our own energy levels and bio-rhythms permit. Persistently playing with these types of idea could be very helpful over the long term. The nerves responsible for Social Engagement can be stimulated very directly, as I've previously covered in
THE VAGUS NERVE AND PARKINSON'S DISEASE
and
THE CRANIAL NERVES AND PARKINSON'S DISEASE,
but here we consider fun and less direct ways to stimulate this part of our Nervous System.
Firstly, I've found that listening to personalized and tailored choices of songs which have a "lullaby" quality can be therapeutic, based on a suggestion of Dr Porges that a human (female) sing-song tone of voice can help the NS feel safe. Furthermore, singing along to these, whether out loud or in silently in one's own head, may increase the therapeutic value. Indeed, I've recently discovered that, by learning a "play list" of such easy listening lullaby-type songs, enough to recite in my own mind, can provide a powerful tool to help block the anxious and racing thoughts that many of us people with PD suffer from. In, particular, I have found singing these to myself at night can really help me to get, or return, to sleep much faster, by interrupting my own thoughts.
Music therapies for adults necessarily need to be bespoke and highly tailored to the individual, due the strong associations with emotions and memories that music can illicit. However, as an example of the type of quality of song which can be useful, here is one of my current favorites:
Another version of this technique is to try light-hearted sing-along compositions. A good example of this is:
Our Social Engagement NS programs reads the signs of the threat/safe detection systems (neuroception) of others: we can detect the danger or safety signals emanating from the people around us (this feedback in threat detection in groups can cause mass panic, for example). I have therefore explored viewing humans engaged in behaviours which can only occur under conditions of perfect safety, I have indeed found this can help to calm my own NS and stimulate my Sensory Engagement programs to feel safe. Suggestions include looking at videos or pictures of people smiling, laughing, having fun, and just being plain silly. Here are some examples of which I've found personally therapeutic to watch - but to be clear, it is very important to observe mindfully and try to feel and embody the emotions being expressed, especially attempting to read their faces and body language, for this to work optimally.
Social Engagement can also cut across mammalian species. Hence animal and pet therapies can have very significant benefits in stimulating and strengthening this part of our NS too, and is being applied to great effect for symptom reduction in autistic spectrum people, for example.