DRIVE TIME DEBRIEF: A Physician Wellness Podcast with The Whole Physician

Polyvagal Theory, Part 1: Episode 188


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 🚨 Does This Sound Like You?

"I feel totally numb. I don't care anymore, and I hate that I don't care."

"Even when I sleep, I wake up tired."

"I used to be so empathetic. Now I just want everyone to leave me alone."

What you're experiencing isn't just burnout—it's dorsal vagal shutdown.

🪜 The Polyvagal Ladder: Your 3 Nervous System States

1. Ventral Vagal (Safe Zone) ✨ Calm, connected, creative, social - where we want to be

2. Sympathetic (Fight or Flight) ⚡ Heart racing, hyperalert, frantic productivity mode

3. Dorsal Vagal (Shutdown/Freeze) 🥶 Emotional flatness, complete disconnection, life behind glass Your body playing dead like a possum

🔥 The Burnout Cycle

Sympathetic overdrive (constant productivity) → Dorsal collapse (complete numbness)

You're cycling between: Fixing everything frantically → Can't even get out of your car at home

🧬 The Science

The Vagus Nerve has two branches:

  • Ventral (newer): Social connection and safety
  • Dorsal (older): Shutdown when overwhelmed
  • Dorsal shutdown creates:

    • Slow heart rate, reduced oxygen
    • Flattened affect
    • Inability to think critically
    • Moving through life underwater
    • 💡 The Revolutionary Reframe

      This isn't weakness. This is evolution.

      Your nervous system developed this over millennia. When fight/flight fails, your body chooses shutdown to conserve energy and protect you.

      🏥 Why Doctors Are Vulnerable

      We live in near-constant sympathetic overdrive:

      • Override hunger, fatigue, basic needs
      • Constantly fixing, moving, answering calls
      • Always "on" for everyone
      • Eventually, the system flips to shutdown.

        🎯 What Shutdown Looks Like:
        • Staring blankly at charts, unable to type
        • Driving home in complete silence
        • Can't connect with your kids even though you want to
        • Loss of empathy for patients (and hating it)
        • Collapsing on couch, holding remote, not moving
        • The Game-Changer

          Just having words for this changes everything.

          "I'm experiencing dorsal vagal shutdown." "I'm in my dorsal vagal era." "This is a nervous system state—not who I am."

          Naming it is a technique for getting out of it.

          🎭 Your Dorsal Vagal Era

          Taylor Swift has fascinating eras. You have your dorsal vagal era. Nearly every burned-out physician experiences this.

          The empowering news: This isn't permanent. Nervous system states change. You can climb back up the ladder.

          🔬 For the Scientists

          When your partner says you're "being emotional":

          "Actually, I'm experiencing dorsal vagal shutdown due to prolonged sympathetic overdrive."

          Boom. Science.

          📍 Coming Next Episode

          How to climb out of shutdown with medical tools, therapy approaches, and daily practices.

          💪 The First Step: Awareness

          You're not broken. Your nervous system is doing exactly what it evolved to do.

          Share your stories: [email protected]

          Your nervous system can heal. Let's climb together.

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          DRIVE TIME DEBRIEF: A Physician Wellness Podcast with The Whole PhysicianBy Drs. Cazier, Dinsmore and Morrison

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