A Taste of the forthcoming Dismantling
Dismantling Season: A Preview
2026 has been a big year in autonomic science and related disciplines. The year started off with a bang when Swiss mindfulness researcher Paul Grossman recruited 38 colleagues to publish a sweeping critique of Polyvagal Theory. The article was published in a fairly obscure Italian Journal called Clinical Neuropsychiatry. The same issue that contains Grossman’s critique contains Porges’ rebuttal – esoteric – and is essentially a refusal to engage Grossman’s arguments on epistemological grounds (he asserts Grossman is not critiquing PVT but a straw man version of the theory). These two papers put together led to a cascade of assertions that Polyvagal Theory was debunked – made largely by people who do not understand Polyvagal Theory or Grossman’s assertions. I was deeply, directly, and personally involved in this collision of ideas, communicating directly with Grossman over LinkedIn (not pretty) as well as the executive leadership and inner circle at the Polyvagal Institute, who asked for my advice.
I have two significant forthcoming pieces about this controversy. One of them is written largely for clinicians in a narrative register and is forthcoming in the Psychotherapy Networker: Separating Signal from Noise in the Polyvagal Controversy: A Personal History. The other is a paper co-authored with Heather McDuffie PhD and provides a mechanism for resolving the 20-year stasis in this debate. The preprint of this is is forthcoming here, as part of Dismantling season.
On July 27th the Feinstein Institute for Medical Research had the audacity (not that I dislike audacity, to be clear) to assert that it was making publicly available the world’s first comprehensive human vagus nerve maps. People are understandably excited about this and it would be great if the very methods that they had employed did not make this methodologically impossible. While it does represent a substantive advance in the trunkline representation of these systems, the mapping continues to suffer from a fundamental category error that precedes its construction: necrotic anatomy cannot map the fine fiber network. So this is not in fact a comprehensive map of the vagus; it is a comprehensive map of the trunk lines of the vagus. This difference matters deeply for an AFFEREENT SYSTEM. A map of the highways in New York City is very different than a map of the streets of New York City. If you need to find a house, the highway map will not get you there. In the same way that no reasonable person would mistake a highway map for a map of every street- a comprehensive map of the trunk lines of the vagus should not be mistaken for a map of the Vagus. Sorry- it is NOT a comprehensive map of the human vagus nerve anymore than the denuded trunk of an oak tree is a comprehensive map of the oak tree.
This brings me obliquely to one of the quiet themes of the year - which is when a research paper is published by a group that fails to disclose their financial interest in the ostensibly neutral conclusions they have come to. Do a little digging and you will soon discover that Kevin J Tracey MD, a neurosurgeon and the president and CEO of the Feinstein Institutes for Medical Research at Northwell Health is also the author of a pedestrian book on the vagus (The Great Nerve: How New Science of the Vagus Nerve and How to Harness its Healing Reflexes) as well as the inventor of a recently FDA approved vagal stimulator. The book is an extended marketing piece for the vagal stimulator. The research proposes to find more individualized and specified targets for vagal nerve stimulation, which is to say that it well aligns with the financial interests of the developers of this technology.
I have argued elsewhere and will argue here again that this entire focus on vagal stimulation is medieval. Category errors in the foundations of modern neuroanatomy have prevented us from understanding the actual scope and nuance of these systems. You do not need to put a bolt of electricity into someone’s neck to change the parametric inputs to the vagus nerve. There are much more nuanced, attuned, and safer ways to do this. Furthermore, absent an understanding of both neuroception (moment-to-moment neural detection of safety, danger, lifethreat), and the way that it gates pervading neurochemistry means that in certain cases vagal stimulation is likely to have exactly the opposite of the intended effects with the specific populations (people with a dysregulated ANS) it is designed to benefit.
Like the new stellate ganglion blocks (I have not yet heard of one of these that worked) which seem to be just as likely to fail as to succeed- allopathic medicine and mainstream neuroscience’s fundamental failure to understand the entire picture of how autonomic state is created leads to interventional strategies that are foundationally misguided. I have no idea how these things are being FDA approved, although given the current administration, which is authorizing peptides, dismantling the vaccine schedule, and whose chief lies to make videos with Kid Rock while sitting in hot tubs and cold plunges in his jeans drinking milk, I guess I shouldn’t be surprised.
Thankfully, Dr. Tracey is not the author of this study. The conflict of interest is thereby present but not central. This pales in comparison to the flagrant conflicts of interest that undergird the entire ‘refutation’ of Bessel Van Der Kolk’s work embodied by the new opinion paper in Frontiers in Systems Neuroscience lead-authored by entrepreneur and performance expert Steven Kotler.
On April 29th, Steven Kotler, a journalist and entrepreneur behind the Flow Research Collective published a provocative opinion paper in Frontiers in Systems Neuroscience. For some reason that I continue to not understand people are referring to it as a research paper. It is not a research paper. It is an opinion paper. These are not the same. A research paper must marshall evidence from somewhere- a laboratory, a clinic, experiments, etc. This paper does not do that at all.
Since that time I have heard several people assert that Bessel van der Kolk’s work has been debunked. This has all of the empirical rigor of someone telling you that they overheard someone at the gas station say Pluto is the center of our solar system. The Frontiers Journal ecosystem is increasingly a pay-to-play ecosystem (oops - did I say that out loud?). We are therefore on the threshold of releasing a paper that tears the Kotler paper apart line by line.
The Kotler paper explicitly disclaims conflicts of interest while the Flow Research Collective that employs three of the four authors is raising 50M to fund research into the topics the paper asserts define this terrain: the fourth author is cited by the Flow Research Collective as the mathematical inspiration behind their model. How that got through an ethics committee I don’t know– were they by any chance busy snorting cocaine off a bathroom toilet seat?
Join us for Dismantling Season on The Neurobiology of Connection.