The East-West Approach to the Traumatic Stress Response

In this episode, I sit down with my guest, Alaine Duncan, to discuss her innovative and integrative approach to understand and treat complex trauma. Alaine Duncan is a licensed acupuncturist, a Somatic Experiencing practitioner, and a very gifted educator. She has a unique approach to acupuncture that integrates modern understandings of the neurobiology of traumatic stress with ancient healing principles from Chinese medicine. She co-authored the book, The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory in Trauma Treatment.

Chinese and Western medicine operate from different foundations, but they are compatible with each other to give the best possible outcomes for your health. The journey to understand Chinese medicine starts with an introduction to two major principles called Yin-Yang theory and Five-Element theory. Alaine Duncan and I discuss these two principles in this episode as well as the influence of Taoist philosophy on Chinese medicine’s approach to health.

The Impacts on Your Third Opinion

There is an inseparable relationship between two parts of a whole. One part of your body cannot be well unless the other part is thriving. This is why you have to understand the big picture, and not just your illnesses as separate conditions on a list. The mind, body and spirit are connected to define your state of health, which is why mental illness should be treated in the context of the whole person.

In this episode, Alaine Duncan and I discuss:

• Acupuncture’s core value in restoring essential regulation in the body that becomes dysregulated from disease
• The introduction of Chinese medicine principles of Yin-Yang and Five-Element theories
• Taoist philosophy and how it pertains to the Chinese medicine principles
• Polyvagal theory and the role of the autonomic nervous system in responding to a perceived threat, which includes
  • Sympathetic nervous system
  • Parasympathetic nervous system (dorsal and ventral vagus nerve)
• The definition of complex trauma, sympathetic arousal and parasympathetic collapse
• The zone of resiliency and regulation that all people have and the zone that healthy people operate within
• The five steps to the self-protective stress response and how any of these steps can be thwarted from completion with experiencing complex trauma
• The role of epigenetics in creating transgenerational trauma and re-establishing resilience and growth in future generations

Speaker Opportunities

If you are looking for a speaker for your next event, click here.

Traditional Five-Element Theory with Two Main Cycles

• Generating Cycle
• Restricting, or Controlling, Cycle

Complex Trauma and the Zone of Resiliency (Regulation)

• Disrupted, depleted, stuck, disorganized Qi
• Sympathetic Nervous System and Parasympathetic Nervous System no longer co-regulating
• Zone of Resiliency is narrowed
• “Normal” rise and fall is outside its range

The Self-Protective Response and the Five Elements

Resources

Follow Third Opinion MD on Instagram to receive updates on podcast episodes and more!  #thirdopinionmd

The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory and Trauma Treatment, by Alaine D. Duncan with Kathy l. Kain, Berkley: North Atlantic Books, 2019. You can purchase through this link (supports independent book stores) or anywhere you choose to shop online.

Review and Join Alaine Duncan’s Newsletter: News & Views on acupuncture and integrative medicine, bridging worlds for trauma survivors.

Linear and Circular thinking explained: Western Medicine’s philosophical approach is partly influenced by Aristotle’s concept of noncontradiction. An example would be how the concepts of A (presence) and non-A (absence) cannot exist at the same time. This differs from the Eastern medical model that embraces a more circular perspective and understands duality in a more complex way around the laws of Yin and Yang.

• For more information on Aristotle and his law of noncontradiction, review: https://en.wikipedia.org/wiki/Law_of_noncontradiction.

For more information on the laws of Yin and Yang, see my blog on this topic, entitled: How the Yin and Yang Principles Apply to Your Health

Trauma effects can be inherited and potentially reversed: Here is the article mentioned in the episode by Andrew Curry called “A Painful Legacy.” This citation mentions the research conducted by Isabelle M. Mansuy, professor of neuroepigenetics at the University of Zurich and the Department of Health Science and Technology of the Swiss Federal Institute of Technology in Zurich, Switzerland.

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Transcript

Barbara de la Torre: You’re listening to Third Opinion MD. I’m your host, Barbara de la Torre. I’m a physician and artist with a mission to show you how to navigate through the existing healthcare system, introduce you to new ways of thinking about taking of yourself, about listening to your inner doctor, and forming your own third opinion. In this season we’re going through understanding what integrated medicine can look like from the inside out. In this episode I am delighted to be interviewing a woman who has taken Eastern and Western medicine and blended them in a beautiful way when it comes to treating trauma.

[music with sample discussion]

Alaine Duncan: I think acupuncture’s core value is in seeking and building essential regulation. It’s really about balance and regulation, and balance between these two opposing forces that the Chinese called Yin and Yang; one turns into the other, just like the back of the hand and the front of the hand are connected to each other. Day turns into night; night turns into day; they transform into each other.

Traumatic stress is essentially a state where there’s profound dysregulation in the body. Often there’s both too much arousal, and at the same time, recently followed by too much collapse. One will be dominant but the other will be in the background. Acupuncture becomes this fabulously appropriate approach to helping trauma survivors find regulation and balance, which is mostly what they’re craving.

[end music and begin show]

Barbara: Alaine Duncan is a licensed acupuncturist. She is a somatic experiencing practitioner, and a very gifted educator. She has a unique approach to acupuncture that integrates modern understandings of the neurobiology of traumatic stress with ancient healing principles from Chinese medicine. She co-authored the book, “The Tao of Trauma, A Practitioner’s Guide for Integrating Five Element Theory in Trauma Treatment.” You can purchase the book through the resource section of my website, on the show notes, or wherever you buy books online. It is my honor to have you on the show today.

Alaine: Thank you.

Barbara: First of all, I want to share with you something. I’ll also disclose to the audience that I took your course, but it’s not how I first knew about you. When I was still in corporate medicine, and this was in 2019, right after your book was published, I discovered your book. I bought it and I even brought it with me – I was going through a lot of stress. I knew I needed to leave corporate medicine. I had the book in my hand, and I asked someone about whether they’d heard of this book or not, or they’d heard of you and they said, “No, not really.” Three years later, I was looking at my emails. Sometimes I get things that I will glance at and delete. But your course came up. I had no time to take your class but – let me tell you – I shuffled, and I rearranged. You were on my reading list for this year. I said, “Well, I guess I better read it.” [Laughs] I’m almost done with your book, but I couldn’t wait to get you on my show. What you teach is so valuable. I knew that when I signed up for your course, I was not going to be the same person. That’s what I want you to know right now, and it’s true.

Alaine: What’s different? How are you not the same person?

Barbara: I think I’m connecting the dots. I realized that my lens was a little bit foggy with trauma, even though I have actually been the go-to person in clinics for the “difficult patient” to see me. We know what that means; it means a patient who hasn’t been heard. When I dealt with patients who had emotional, physical, or sexual trauma, I could work with them. I have background in psychiatry. I didn’t finish the residency because I changed to family medicine. I studied acupuncture. I am an immigrant. I’m an artist. So, I’ve lived in different communities to understand trauma.

Yet, I take your class and it was like – you know in the movies where the person’s doing detective work and suddenly a flood of images comes in and you’re just like, “Aha.” So, I’m not the same person anymore because I went through – probably about two or three weeks after I took your class – mourning. It was a mourning process, but in a really good way; sort of a death of who I was before and a birth of who I am now. So it was very profound.

Alaine: Well, that’s really touching to hear.

Barbara: Yes, I really mean it. There is such gratitude for what you do in this world that you have now given me another tool for my toolbox to help more people – and my mission is very big. A lot of people would ask me, “Really, is that possible?” And I said, “Of course, one step at a time.” So thank you.

Alaine: Well, I’ve become quite convinced that the dynamics of trauma and the healing of trauma are really fundamental to the polarization we’re experiencing in our society, to the mitigation of the inflammation response that we’re finding – not only in our healthcare, in our physical bodies, but also in our social relationships – in our global climate experience, in the nature of war and peace, that healers have a very important role to play in creating the world that we really want to live in. The door is through this integration of East meets West, and trauma physiology, and the various treatment approaches that emerge out of that integration.

Barbara: Let’s just start from the beginning. Why do you work with trauma? How did you get to this place in your life?

Alaine: In 2003 or 4 – somewhere around there – I was listening to the radio in the car. The parents of Lance Corporal Jeffrey Lucey were being interviewed. He had been in Fallujah, came home, and had the most loving parents – dad was a nurse, mom was a social worker – very attentive, loving parents. But the VA failed him, and he couldn’t live with what he’d seen and what he’d been asked to do. He committed suicide in their basement. I heard these parents – and my own children were about the same age as Jeff was, at the time. I just thought, “Acupuncture could have made a difference for this young man and could make a difference for this family. We have to do something.” At the time, I was really rather naïve. I thought that I could make a difference in the direction of the war. Then 20 years later … We just put out the ripples that we can put out. We can’t always control the direction, who they touch, or why.

That was the beginning. I knew that I didn’t know much about military culture. I knew that I didn’t know much about trauma, although I’d been in practice for 15 years by then. So, I brought the Somatic Experiencing Traumatic Institute to Silver Spring, Maryland, where I was working, to train clinicians in how to work with trauma. They were insightful enough that they were willing to train mental health providers as well as bodyworkers and acupuncturists. They were the only group that was training acupuncturists and bodyworkers as well as mental health people. So, they had the insight that trauma doesn’t only affect the mind, it also affects the body. It has a powerful impact on physiology.

Very early in the training, they described the sympathetic nervous system as “arousal,” and the parasympathetic nervous system as, “restoration,” or as “quiet.” I said, “Well, that sounds an awful lot like yin and yang.” This description of neurophysiology actually runs distinctly parallel as what I understand as an acupuncturist.

Barbara: Let’s stop there for just a minute and go over some of these concepts, because that’s a lot, and they’re all important. One is the idea that acupuncture can help someone with trauma. One of the things that I find in this country is that acupuncture, because it’s had such difficulty integrating into the medical landscape, into the mainstream, people really don’t understand its full potential. Chinese medicine has made its way into other countries where it’s evolved, changed, and flourished in different and unique ways. Acupuncture’s just one branch in Chinese medicine. People, they have so little understanding of the concepts of Chinese medicine, that they think acupuncture is just for pain, because it reflects what insurance covers. Pain, or nausea in pregnancy, that it “works for.”

However, in Western medicine, there is such a, I would say, Aristotle point of view, where A and non-A cannot exist together. Again, that’s a very deeply ingrained philosophy in Western medicine; whereas Eastern medicine has this circular view where A and not-A exist at the same time. They inform each other. They can’t exist without each other. More of a quantum kind of concept with the fact that it’s circular, and mind, body, spirit are connected, and we have to look at people as a whole person. Now it gets very interesting. How can acupuncture help?

Alaine: I think acupuncture’s core value is in seeking and building essential regulation. It’s really about balance and regulation, and balance between these two opposing forces that the Chinese called Yin – or the dark, the quiet, the feminine – and Yang – or the active, the assertive, the bright, the light, and the masculine. One turns into the other, just like the back of the hand and the front of the hand are connected to each other. Day turns into night; night turns into day; they transform into each other. Traumatic stress is essentially a state where there’s profound dysregulation in the body. Often there’s both too much arousal and at the same time, recently followed by too much collapse. One will be dominant but the other will be in the background. Acupuncture becomes this fabulously appropriate approach to helping trauma survivors find regulation and balance, which is mostly what they’re craving.  

Barbara: If we look at Taoist principles – which, Chinese medicine has Taoist, Confucianist, and some Buddhist principles ingrained – one of the most beautiful things – and you mentioned this in your book – is the law of Yin and Yang, and the law of the Tao. Very loosely translated, the Tao is the way things are, the way of the universe, the way of nature. We’re not looking at this from a religious point of view. If you would think of Chinese medicine, one way of understanding it is 5,000 years of keen observation and writing things down.

Alaine: I think the other thing about the Tao that’s important to mention is that it’s the impulse out of which life emerged. So it’s a little bit like The Big Bang. But what it means is that everything is related because everything emerges out of the same impulse. A human’s experience of life is related to an animal’s experience of life, is related to the rocks that make up the mountain and the water that runs down the side of the mountain, and the tree that grows. We’re related to all these essential elements of nature; we’re part of them, they are part of us. We can look to nature and the Tao as a wise sage to help us as we navigate our experiences through the cultural cycle, the seasons through our lives, as well as the seasons of our year, our days.

Barbara: So, the Yin and Yang is a duality, but not exclusive duality. It’s an understanding of a relationship of opposites in how they are dependent upon each other. They’re a part of each other. They influence each other. I have an article on my website that I encourage people to look at. It explains the principles of Yin and Yang if you’re not familiar with it.

Almost like when I took your course, when you start to read about Yin and Yang, you will not look at things the same way. You just don’t. It’s a very caring way of dealing with changes in life. If they’re wonderful or if they’re extremely challenging. It’s a great way to look at it. The other is the five elements. These are the two things that are so fundamental to understanding Chinese medicine and how it works, and not just acupuncture, but any time of energetic medicine in Chinese medicine, qi gong –

Alaine: These Taoist sages from 4,000 years ago, they were keen observers, as you said. They looked at the movement through the agricultural cycle and divided it into five slices of a circular pie. They named those five phases after five elements – the metal, the water, the wood, the fire, and the earth. They said that as we go through the cycle of the year, the cycle of growth in the cultural cycle, the more that we can align ourselves with the impulses of those five elements, the healthier we’ll be.

In the wintertime, the alignment of nature is to be quiet, deep and dark, and restful. In the summertime, the law of nature says be joyful, be in connection, be in laughter, be in play, be in your fullness. There are organs associated with each of those five elements. There are emotions associated with each of them and spiritual qualities, spiritual tasks, and tissues of the body. We can heal these different aspects of ourselves in their own season by paying attention and aligning ourselves with the energy of that particular season.

Alaine: Exactly. Let’s take a look at the season that we’re in now, at the time of this recording, Spring. Spring is the time where you plant the seeds for harvesting in the Fall. For example, what you do to your body, what you do with your thinking, what you do with your planning, will then bear fruit later on, whether it’s good for you or not good for you, either rotten fruit or fruit that you can harvest and eat. But Springtime also has an organ associated with it – would be the liver. When we’re talking about organs we’re talking about, not just the organ, but what we call “meridians,” or “channels,” through which qi moves.

Qi is difficult to translate, but this life-force energy that is so important for it to move smoothly in the body, with blood, with the circulation, how we eat, how we breathe, how we think – all of that is qi. If the qi flows, we’re healthy. Like you said, if we live with the seasons, if our little ecosystem adapts with the flow of the ecosystem around us – that includes people, environment, animals, nature – then we’re healthy.

In the Springtime we have liver, and the associated negative emotion would be anger, sometimes, intense anxiety too. Anger is the primary. You and I, as practitioners tend to see the typical symptoms that come up in the Spring – headaches, dizziness, vertigo, anger. Gosh we’re seeing a lot of that right now.

Alaine: I think our whole world is in a state of high sympathetic arousal that creates a lot of inflammation. We’ve got war in Ukraine. We’ve got global warming. We’ve got threats to racial justice. We’ve got all kinds of stuff happening. I think that, in my integrative framework, the wood element also belongs to the sympathetic nervous system, in Western terms, which is also the Mobilization Response, the fight or flight response. The other aspect of the wood element that people sometimes forget in the midst of thinking about it as representing anger, is that it also represents benevolence. When you think about the trees in the Amazon that are producing oxygen for the whole world to use to breathe and thereby create qi, the benevolence of the forest is very clear. 

The other dimension of this benevolence is that it’s always on. It’s always available to us. We don’t have to go seek out our sympathetic nervous system. If we feel threatened, it will become available to us immediately, absolutely immediately. The problem becomes if we don’t have adequate parasympathetic system, if we don’t have adequate break on our sympathetic system, we won’t know how to live in community with other people, because we’ll just be cranky all the time. We’ll be angry, frustrated, full of rage, and will knock down doors instead of checking the handle to see if we can just open it. The pandemic has resulted in so much social isolation that we haven’t tickled, nurtured, or cultivated that parasympathetic ventral vagal function in the same way as we might have otherwise. I think it’s put us in a more brittle state as a world’s people, with regard to our sympathetic arousal and our inadequate capacity to temper that arousal through relationship, through understanding and the dynamics of relationship.

Barbara: Let’s now go over – what you’re referring to is polyvagal theory. The autonomic nervous system, how we understood it before, and now through this wonderful, more recent theory, how we can now understand ourselves better as humans, and with issues of trauma and complex trauma. Would you mind going over that?

Alaine: This fellow named Stephen Porges is the developer of polyvagal theory. He’s a psychologist and a research scientist. What he says is that instead of two branches of our autonomic nervous system – sympathetic and parasympathetic – that our parasympathetic system actually has two branches within it – the ventral vagus nerve, or the social break on the sympathetic, and the dorsal vagus nerve, or the freeze, or the more primitive break on the sympathetic arousal.

Barbara: I think one of the things that people know is fight or flight; they know that. They know fight or flight. They know that either we’re feeling really calm or we’re feeling nervous. But most people don’t know that the parasympathetic nervous system are the breaks that we need for that active sympathetic nervous that’s always on.

Alaine: Yes. When we experience a sense of threat – say we’re just walking down the street and we see someone who we think we don’t trust. If our parasympathetic nervous system, if our ventral vagus nerve is fully functional, we will have curiosity about that person, rather than conclusion. We’ll be able to distinguish our discomfort about someone new from our fear about, “they might be a threat.” If our capacity for curiosity and relationship has been thwarted along the way and we are mistrustful of this person, the next step would be to use our sympathetic system, which is either we’re going to run away from them, we’re going to bolt down the street to protect ourselves, or we’re going to clobber him over the head.

The most important tool that human beings have – and other creatures that have a limbic system in their brain – is our parasympathetic ventral vagus social engagement system. It’s what allows us to live in community with the capacity to distinguish discomfort from fear. So, we’re going to use ventral vagus first. If that doesn’t work, we’ll use sympathetic. But if our sympathetic system also fails, if we can’t run fast enough to evade this saber-toothed tiger, we will eventually collapse because the impulse to run faster is requiring our heart to beat so very fast that it ultimately will cause a heart attack if we don’t slow it down. We have to slow it down in order to save our life. Stephen Porges talks about these three systems as neurologic platforms that we move between. They’re all there to save our life. We will move to the dorsal vagus, which is this powerful freeze, or powerful break on the arousal and the heart, in order to protect us.

We’re on the side of a mountain and a rock has fallen on our leg, we’re going to shout for help. We’re going to use our ventral vagus first. After that doesn’t work, we’re going to push, and push, and push as hard as we can, with our sympathetic system. When we realize we can’t do that anymore, we’re going to go unconscious. That’s going to protect our core vitality. We’re going to save a little bit of our energy for our healing later. Not moving makes us less interesting to the predators in the mountain. They’re going to be less interested in eating us. It’s going to give us some endorphins that help us not feel pain.

When a group of burly hikers come along and are able to move that rock and carry us off the mountain, we have a little bit of qi left to help us with the healing and the recovery that needs to happen. If they’re kind, those burly hikers that came to protect us – if they’re kind, if they touch us in tender ways, in caring ways, they aren’t too anxious and frightened themselves – it will actually help cultivate that ventral vagal capacity that will allow us more opportunity to heal. It will help us heal if we’re met with that kind of caring parasympathetic, ventral vagal, social engagement, energetic.

Barbara: Here’s what’s interesting – and this is something that you teach in your classes, and you mention in your book – the ventral vagus is something that has to be cultivated in our life, especially in our childhood, up to young adulthood. Boy, that really explains why not everybody’s walking around with a cultivated ventral vagus.

Alaine: We have enough ventral vagus when we’re born to find the breast and to suckle. But until the first six months of life, the first year of life, the first five years of life, and then, as you say, into adolescence, we continue to cultivate it. We cultivate it in experiences of being met by a loving caregiver who goos and coos at us, who responds when we cry because we have a wet diaper, or we’re hungry, who recognizes us as a distinct other and loves us with eyes that make good eye contact, and all of that.

If we receive that, our body is going to learn how to digest food, the heart is going to learn how to regulate various systems of the body, we’re going to do well. But if we don’t get that capacity built, or we don’t have an external ventral vagus to help us regulate experiences of arousal when we’re an infant, then we’re going to rely on that dorsal vagal, that freeze response, to mitigate the arousal in our heart. When that happens, not only does our heart slow down, but the peristalsis in our guts gets compromised.

Then as an adult, we’re going to be more challenged to transform food into blood and energy, so we’re going to be likely to gain weight around the middle. One of the key underpinnings of obesity is early developmental pre and perinatal trauma. We’re going to have trouble, maybe with autoimmune illness, because the T cells are produced in the gut, by the gut biome, and that’s been compromised. We may have mental health issues because serotonin and other neurotransmitters are produced in the gut that affect our mind and our capacity to be happy and regulated with our thinking. We’re going to be more likely to have pain patterns, to struggle with addictions, with relationships, all kinds of stuff. All of this is documented very clearly in the Adverse Childhood Experiences research that’s now housed at the Centers for Disease Control here in the United States.

Barbara: That was conducted in the late-90s, correct?

Alaine: Yes, it started at a weight loss clinic in Southern California. People would come in and they would lose 50, 100, and 150 pounds, and then they would gain it back. The physician who was running that study was a good enough scientist that he sat down, and he talked to people and asked them what it was all about. They developed this questionnaire, did the research, and found almost a universal multiple experiences of trauma like losing a parent, sexual abuse, violence in the home, drug addiction in the home, all those kinds of things that gave an experience of terror to an infant who didn’t have capacity to self-soothe.

Barbara: This is not just affecting … People maybe even born into a family that’s very loving but if there’s any unresolved transgenerational trauma going back a few generations, that can also affect us through the genes.

Alaine: Like a child who has to have a surgery, or a child who’s born premature. Loving parents, but has to spend time in an incubator, and doesn’t get the touch that it needs. The issue of epigenetics that you bring up is quite a fascinating one. There’s been research in Holland, after what they called the Dutch Hunger Winter, in World War II. Women had inadequate food during their pregnancies. The impact, not only on their child, but also on their child’s child. It continued through a couple of generations. There’s also a lot of research in Israel, with Holocaust survivors, with survivors of the World Trade Center, here in the United States, showing that the impact of traumatic stress gets stored in genetic tissue that can then communicate similar dysregulation to children and grandchildren. I was just in a class last weekend, and someone was referring to their husband. His ancestors had survived the pogroms. As a three-year-old, he would hide a salami in his sock drawer, because that impulse to need to have food stored away was in his tissues. So, he had salamis in his underwear drawer.

Barbara: What was that? If you could summarize that incident in history.

Alaine: The pogroms? The attacks on Jewish people in Russia.

Barbara: Was that during the time of Stalin?

Alaine: Yes. It was during the time of Stalin.

Barbara: Even just looking back at my own history, I just think, “Wow.” We are all really affected.

Alaine: But the good thing to know, the important thing to know – because this can get to feel so dire – there’s also research on resilience. What they’ve found is that a child who maybe has generations and generations of traumatic stress behind them, if they experience enhanced resiliency activities – good attention, stimulating educational games, and people who love and care for them – they will turn that experience of trauma into expanded resiliency. The lessons from that experience in the ancestors become warnings and guidance to help you cope with today. The more that we can provide children with loving attention, the more we’re going to be able to transform these impacts of the horrible things that human beings have done to each other through the centuries, into expanded capacity to manage and navigate and create the world that we want to live in.

Barbara: The ACE study that we were talking about, the Adverse Childhood Experience study where it was, I believe, 17,000 participants in that study – you were mentioning they found that it affects multiple systems in our body, which is why I believe these patients are sometimes labelled as difficult patients because we can’t peg them for one system in the Western medical model. They stump acupuncturists too, because they don’t fall into those patterns that they learn in their system. That’s one of the ways that the lens cleared for me. I know these things are connected, I would see that, but I wouldn’t see it in the books. We just know from talking to these guys.

Alaine: That’s because Western medicine, and even acupuncturists are too often guided towards fixing a problem, so diagnosing a certain, discreet illness or dysregulation, instead of being guided towards enhancing core regulation. People end up with what I call, “complex multi-symptom illness.” In the same person there will be chronic migraines, autoimmune illness, irritable bowel syndrome, and a pain pattern. An acupuncturist who is not trained or a physician who is not trained at holding the essential core regulation of a patient, and supporting that, will go first to this symptom, then to that symptom, and then the other symptom. They may help that one symptom, but because they haven’t attended to the core regulation, the symptom will reappear because the problem is the dysregulation at the center. So we need to have approaches that help people find balance and regulation, in order to let go of these various symptoms that they are struggling with.

Barbara: Share with me if I’m explaining this correctly – the idea of your core regulation, or your zone of resilience, is that sinewave, Yin-Yang, bouncing up and downward in a gentle fashion, which we all have, regardless of how dysregulated we are.

Alaine: Absolutely, and that wave exists in what I call a “zone of resiliency,” so it doesn’t go too high, it doesn’t go too low. It’s got these boundaries that help contain it so that we go into Summer, but we don’t go into 120 degrees. We go into Winter, but we don’t collapse into the Arctic. We flow between these two states that are held in some form of tension and keeps us regulated.

Barbara: It’s this wonderful new language that you’ve offered for me to share, because I remember telling patients – the ones that would say, “What’s going on?” I said, “Well, there’s the you that just needs to be freed,” the way Michelangelo would talk about freeing the sculpture from the marble. There’s this sacredness and this balance in a person, and I would often try to look for that healthy person within someone, like “I know you’re in there.”

You studied acupuncture, then you started to focus on trauma. Then with this zone of regulation, one of the things you talked about was the importance of bringing the body back into the healing work.

Alaine: This is very curious. Neuroscientists have defined five steps in our Self-Protective Response, five steps that predator-prey animals, including human beings, go through at they navigate a life-threatening or dangerous situation. Those five steps are mirrored in the five elements of Chinese medicine. My core thesis is that it follows along with the somatic experiencing work that was developed by Peter Levine. If we make it through all those five steps successfully, there won’t be any residue from the trauma that remains behind in our tissues. But usually, it’s one of those steps – sometimes more than one – gets thwarted along the way that we will have a need to complete that step-in order to find our healing.

The overlay of Chinese medicine with those five steps means that – to use the example of the wood element that we were talking about earlier – if we were thwarted in our Mobilization Response, there are resonant tissues and resonant organs associated with the wood element where we can look in and see, “I wonder if you’re there, thwarted Mobilization Response.” That would be – the tendons and the ligaments are the associated tissue. The eyes are the associated sense organ. The blood is the associated fluid. We can use touch techniques, needles, food, exercise, herbs, qi gong, tai chi, and all these different – what I call – energy medicine approaches with a focus on the tendons, the ligaments, the eyes, the blood, and so forth, to find where that body is storing the incomplete Mobilization Response, so that it can be released, and we can move through the whole cycle of the five elements.

Barbara: The animals in the wild don’t get thwarted. They complete those five steps.

Alaine: Either the bunny rabbit completes the five steps – runs away from the fox – and if it doesn’t successfully complete them, it becomes lunch for the fox. The rabbit takes time after successfully running away to say, “Well, I don’t hear the fox. I don’t smell the fox. I don’t see the fox. I must be safe.” So the conclusion, “I must be safe,” comes from an organic embodied experience of safety. Whereas, humans, we’ve got this big neocortex that tends to override our sensations. We trip and fall down some stairs, and we don’t even take time to notice that we didn’t break a leg, and we’re standing up, running away, and hoping nobody sees us. But we would do so much better if we would let our senses tell us, “I’m all here. I’m all intact. I didn’t hurt anything. I’ve got a little bruise here. Let me just hold it a little bit and give it a little pat.” Somebody comes along, offers you some water, take it, say, “Thank you.”

Barbara: Oh my gosh, you’ve just opened up a whole box here of layers of what we’re dealing with in society, locally, nationally, globally. I would say it’s not the sole contributor, but the fact that we’re automating so many things, we’re relying on other things taking care of what our senses should be doing. On top of it, we’re two years in isolation. Really compromises –

Alaine: Really, really compromises.

Barbara: You had worked with the military for about 10 years, is that right?

Alaine: Mm-hmm.

Barbara: Do you work with civilians now or a variety of groups?

Alaine: Primarily with civilians. What I’m doing most primarily is teaching now. There are some military people in my classes, as well as civilians. Probably the 10 years that were the most meaningful in my clinical practice were the 10 years I spent working at the DC Veterans Administration Medical Center where I helped establish the integrative health and wellness service, treated hundreds of veterans. I think the biggest thing was coming into relationship with people who I had seen as other, previously, finding a sense of oneness with them and love for them, and appreciation for the sense of comradeship and connection that they had for each other, in a way that – no civilian will ever experience, the quality of care and connection that a military unit who gets deployed together will experience with each other.

Barbara: It’s not the same, but I see that in healthcare workers, a similar vein, where if you haven’t been there, it’s hard to understand. Doctors may not share a lot about what’s going on with them. I speak about Western medical doctors but I’m sure this may be the case, also, for other practitioners, as well.

Alaine: I think anytime where there’s a system where people rely on each other, like say a critical care unit of a hospital where you’re relying on each other to help get this person with advanced COVID, who needs to be on a ventilator, and has cardiac myopathy, and all kinds of stuff going on, and there’s a whole team of people working together, there’s a quality of, “We’re relying on each other, we’re a team, we’re all in this together,” that creates a bond that’s pretty irreplaceable.

Barbara: One of the things that I’m going over in some of the episodes is medical training, and traumatic experiences that happen with the training itself.

Alaine: Right, sleep deprivation.

Barbara: Well, abuse – verbal and emotional abuse – a hierarchical system that’s actually loosely based on military hierarchy, except that it’s not a respected hierarchy. It’s so complicated. You also have issues of gender, issues of sexual orientation, lack of representation of providers for patient populations. In other words, a patient goes in and doesn’t see anyone that looks like them, that they can identify with, that matters. On both ends of the spectrum, you have patients who can be traumatized in the healthcare system, retraumatized in the healthcare system, and then you have practitioners who are traumatized, but they talk about it more as a rite of passage, because that’s just what you do. Even just as my mom alluded to in episode five, she said, “You just move on.”

Alaine: You just suck it up. In other words, you cultivate a management strategy that overrides your own impulses in order to cope with the system, and you end up being damaged as a result.

Barbara: Would you mind sharing with us the five steps of the Self-Protective response, Alaine?

Alaine: I like to think of them in a layered way because we move through these five steps, but they also provide us what I think of as five capacities for navigating stressful events. Let’s circle around them. We’ll start with the metal element, which is the lung and the colon. I call the function of the metal, Awaken Arousal. We need a capacity to notice that there’s something new in our environment. That might be something as mundane as, “Now there’s a pothole in the street that I walk on every day to work. I can’t just be in the clouds. I need to notice the pothole, or else I’m going to trip and break my ankle.” That capacity for mindful awareness that the meditation teachers talk about is really our first step to notice and be curious – not be in judgment or in conclusion, but the capacity to be curious about what’s here and what’s now. Cultivating that capacity for curiosity will help us navigate a sense of danger and experience of danger.

The next step I call Signal Threat. This belongs to the water element, and the kidney and the bladder are the organs associated with the water. When the kidney experiences fear – which is the signal for threat – the kidney gets tight and hard, lifts up, and that little adrenal gland that sits on top of the kidney gets pressed up against the diaphragm and secretes adrenaline. When our blood system is flooded with adrenaline, we have to experience, we can only experience profound threat or profound rage. But we can only be dysregulated in that way. The Signal Threat is the task of the kidney. It gives us the capacity to distinguish discomfort from fear.

I think the best example of someone who didn’t make that distinction were the murderers of Ahmaud Arbery. They saw a black man running through their neighborhood. They assumed fear and were unable to notice that they were uncomfortable, and that the problem was their discomfort, not that Ahmaud Arbery was a source of fear. So, I think of this particular capacity as being a critical one for safety in our neighborhoods, and safety in terms of domestic violence, and in terms of all kinds of things, is people’s capacity to notice, “I’m uncomfortable,” and then take care of their discomfort, instead of lobbing their discomfort onto someone else and taking it out on them and naming it as fear.

Barbara: And then knowing that the discomfort and feeling safe can coexist.

Alaine: Yes, absolutely. I’m uncomfortable, but I’m not in danger. That’s an important thing to be able to be aware of. The next step is the Mobilization Response. The important thing, or the capacity that the wood element gives us with our mobilization, is the capacity for our mobilization to be commensurate with the level of threat. In other words, if we need a flyswatter, we use a flyswatter, we don’t use a 12 gauge. If we’re angry with our child for running out into the street, we scoop them up in a vigorous way, but we don’t need to beat the crap of out of them. Our mobilization needs to be commensurate with the level of threat. This is how we will use that capacity well and stay in community.

Barbara: Is this taught for parenting classes?

Alaine: My goal is to teach this stuff to enough people that someone in every domain of life will carry this information into those domains.

Barbara: Such valuable information.

Alaine: The fire element is next. When the water experiences this profound fear, and signals threat, it sends that message to the fire element. The first impulse of the fire is to create relationship, like, “I feel threatened. Who’s here to help me?” Can I capture the eyes of the driver who looks like he’s going too fast and is going to run me over? Can I catch their eyes and help them realize this is a human being who’s crossing the road? Can I seek out their neighbors when there’s an issue in the community, so that we can come together to resolve it? Can I make relationship?

If we’re unable to make relationship, because we’ve experienced relationship-based threat in the past and our capacity to trust people has been compromised, we won’t be able to make those kinds of social engagement initiatives to protect ourselves. Instead, we will go into high arousal. Our heart will send out, with the heartbeat, with the heart pulse, a very high and pounding message to the entire kingdom of the body. The fire’s job is to command a response. The water signals the threat, and the fire commands the response. The whole kingdom of the body, to take care of this life threat. That’s the job of the heart, to take care of the whole body. It will continue to do that until either the wood gives the message, “Job complete, we’re OK. At ease.” Or we discover that it wasn’t really a threat after all, we just thought it was a threat. Then the heart will back down.

If the heart continues in that high arousal because the sense of threat continues, sooner or later, the water element, essentially, is going to throw water on the fire and stop the heart from beating so darn fast, because we’re threating our life with high cardiac arousal. That’s when the corruption of the digestion, peristalsis in the guts, and cardiac injury happens. If we need to repeatedly throw that water on the heart, throw that freeze response on the activation, that’s how we end up with complex multi-symptom illness.

Barbara: I’m going to provide us a resource so that the audience can look at this five-element star, circle. Because there’s two cycles going on – there’s a generating cycle that moves on the perimeter of the circle in a clockwise direction. Then if it’s controlling, that’s like you’re drawing the star in the circle.

Alaine: That’s right. Each element has a promoting aspect and a compromising aspect. The water promotes the wood, but it also has a job to compromise the fire, to hold it in tension. The last step I call Digest the Gristle, and that belongs to the earth element, whose job is to help us assimilate the lessons that are inherent in any danger or life-threatening experience. There’s always a lesson in there that we could harvest so that the next time something similar happens we actually have better capacity to manage it. The important capability within that is that is that we help our patients and ourselves to harvest lessons that expand our life experience, rather than contract our life experience.

If we harvest a lesson, “I can never trust people who drive blue pickup trucks, because it was a blue pickup truck that ran the red light and hit me,” what if our nephew comes home with a new blue pickup truck and wants you to admire it? All of the sudden, you’re going to be at odds with your nephew, who you love. We need to harvest appropriate lessons that make our life bigger and allow people to make mistakes and be forgiven. Then we come back to the metal element with an enhanced capacity and enhanced sense of our own value, and our own capacity, and our own resilience, which is the gift of the metal element, which is knowing ourselves to be a gem. So, all of the sudden we’re a bigger gem because we have this enhanced capacity of having gone through those five steps.

Barbara: With generations of trauma, there was an experiment that … Was it with mice? Could you talk about that?

Alaine: It was published in Science Magazine. The article is called, “A Painful Legacy: Mice Hint at How People’s Emotional Trauma May Affect the Biology of Their Children and Their Children’s Children,” by Andrew Curry, and it’s Science Magazine. What they did was they put male mice in a cage. They simultaneously put electric shocks in the floor of the cage and pumped cherry blossom smoke into the cage while the shocks were being administered. The mice understandably came to associate the smell of cherry blossoms with being shocked. So, it got so that they could not shock the mice, but just pump in the smoke, and the mice would jump, squeal, and all of that, as if they were experiencing electric shocks.

Then they brought female mice into the cage, mated them, and took the male mice out. The pups that were born had never met their fathers. But when they pumped cherry blossom smoke into the cage, the pups acted as if there was an electric shock coming through the floor. They not only acted that way, they also secreted cortisol, adrenaline, and other stress chemicals, in a way similar to their fathers. Mice are not nearly as complex as human beings, in terms of our genetics, but they reproduce faster, so it’s easier to study. It at least lends some credibility to the impact of epigenetic experiences being transmitted through our genetic lineage.

What they found was that seven generations of mice continued to experience high arousal state with the cherry blossom smoke. Then they took one generation. They gave them carpeted cages that were large. They gave them good running wheels and other toys to enhance their development. They had plenty of good food. They had all the things that mice like, sort of like, Mouse Canyon Ranch, you know? In one generation they reversed the expression of the Cherry Blossom smoke.

Barbara: Just one generation.

Alaine: One generation. I’m a little Pollyannaish, but I think that it’s really important that we provide loving, caring attention with good education, and all of that, to our children. I think we can make a really big difference just being a coach for the basketball team, being a leader in the scouts, directing the choir, participating in community theatre, admiring the new bike that comes by, going and shooting balls in the park with the kids. All those kinds of things can make a world of difference.

Barbara: Harvesting our history, our legacies. We can do that.

Alaine: Because there’s a way to look at that instincts around cherry blossom smoke as dad, grandad, great-grandad, are informing their descendants what to be afraid of, what to be suspicious of. There’s a way that there’s enhanced resiliency in that cherry blossom smoke, as well as, obviously, the cherry blossom smoke isn’t really a threat, so there’s a misjudgment about the cherry blossom smoke. But we just have to turn the wheel just a little bit. We can turn this wisdom from the ancestors into an enhanced capacity instead of a compromised capacity.

Barbara: We can actually restore our path into a blueprint, and not a fixed map that can’t be changed.

Alaine: And the other important message from that research is that these are not life sentences. We can have experienced a horrible thing. We can have experienced a very challenging infancy and childhood, but it’s not immutable. We can help people repair.

Barbara: I really want to see that more and more in our Western mental health approach. That’s one of the reasons why I left psychiatry. Even though they were starting to study the plasticity of the brain and the idea that we can change things, they still were very fixated on PTSD being – which, you and I both agree, we don’t like even that term. Post-traumatic stress disorder is just doing disservice to complex trauma. But the idea that it’s permanent – it’s not. But I remember I was told by my supervisors, they scoffed at that. I asked, “What if?” Now it’s so validating to see that one generation, we can make a difference.

Alaine: I prefer to think of it as a traumatic stress response and define it as, “too much, too fast, without adequate support,” and complex multi-symptom illness, restoring regulation is our key initiative, our key approach.

Barbara: Some take home points from this would be, we can make much more profound changes than we are made to be aware of in our existing system, that we have to involve the body as well as the mind, especially if trauma is pre-verbal, we have to have some type of body-type therapy.

Alaine: Trauma lives in the body, not in the mind. It lives in our tissues. It gets stored in our tissues.

Barbara: The mind isn’t all of our cells, actually. Every cell is in important. The last thing I wanted to bring up is just what advice would you give to listeners out there who either are aware or know someone who has experienced trauma, how to approach the healthcare system, because not everybody is what we would call, “trauma informed.” One of the things that you do is that you teach practitioners in acupuncture to be more trauma-sensitive.

Alaine: I actually work with acupuncturists and other energy-based providers, so there are bodyworkers and there are mental health providers who have a somatic orientation, somatic psychotherapists, who train with me as well. “Energy-based medicine” is something to look for if you can’t find an acupuncturist or other person who’s studied Tao trauma material. Look for a craniosacral therapist. Look for a somatic psychotherapist. Look for a somatic experiencing trained therapist. Look for someone who’s studied EMDR, the eye-movement desensitization and recovery. Look for someone with a background in understanding traumatic stress. Because if people work with you with an exclusively cognitive approach, trying to help you change your mind about what happened to you, it isn’t going to get you home.

Barbara: It’s not going to get you home.

Alaine: You need someone who’s going to work with you from the body up, not from the mind down.

Barbara: Wonderful. Alaine Duncan, thank you for doing what you do, thanks for being on this show. I want to mention a couple of things that you’ve done that I encourage people to look into. One is a book that we talked about called, “The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory and Trauma Treatment,” by Alaine Duncan and with Kathy Kain, who’s a somatic experiencing instructor. This is an amazing book. Even if you just read a few parts, it’s so illuminating. It explains integration, polyvagal theory’s covered here. Also, your newsletter, I will include a link to that in the show notes. What else are you up to this year?

Alaine: I’ve got a pretty exciting year coming up. I’ll be starting my year-long, five session series of classes for providers, for acupuncturist, mental health providers, energy-based medicine people. I call it the Tao of Trauma, and we do one class in each of the five seasons of the year that covers each of the five steps of the Self-Protective response. That’s going to start up in the fall with cohorts in Ohi, California and in Silver Spring, Maryland, and one online – a virtual cohort. We’ve learned a lot of things in these past two years, and one is how to teach online. In the fall, in November, at the Pacific Symposium, which is the biggest acupuncture conference – maybe in the world, but certainly United States. Looking forward to that, as well. You can keep up at my website at, integratedhealingworks.net and with my newsletter, “News and Views on Integrative Healing,” it comes out monthly – for dates and registration information.

Barbara: All right, well, thank you.

Alaine: My pleasure.

[music]

Barbara: In a time of crisis, there is always an opportunity to make change, especially when we’re dealing with such epidemic proportions, with mental health crises across our communities, our nation, and globally we are experiencing trauma on a massive scale. Something like Post Traumatic Stress Disorder does not have to be permanent. By thinking beyond one system, we create hope.

I’d love to hear from you. Please send me your comments, questions, or suggestions, for future topics and guests you’d like to have on the show. You can find the contact form under the “Podcast” tab at the website, ThirdOpinionMD.org. Be sure to follow or subscribe to this podcast and submit a rating on your favorite podcast player.

Third Opinion MD Podcast is produced by me, Barbara de la Torre. Music is licensed through Audio Jungle. Any comments made by the host or guests on Third Opinion MD reflect opinions about healthcare and self-care. Please consult with your own physician for any medical issues that you may be having. Thank you for listening.

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