# Check — The Physiology of Consent

Checked 2026-10-19. 27 claims checked; 7 corrected; 0 removed. Both writer `[fixed]` corrections of the deck confirmed and kept. Length brought from ~2256 to 2049 words of read-aloud text (2149 including slide headings) by cutting connective tissue only; every slide and every verified fact remains. All 18 `[+]` and 2 `[fixed]` markers resolved and removed. Lecturer is never named. Markup intact: one `##` per slide (15), two `? ` prompts, one `> ` quotation (14 words), no lists.

## Corrections (script changed)
- Slide 9: "made for an English police force in 2015 from a blog essay" → "drawn from a blog essay in 2015 and taken up by an English police force". The animation was made by Blue Seat Studios from Emmeline May's Rockstar Dinosaur Pirate Princess post; Thames Valley Police adopted it for the #ConsentIsEverything campaign (launched late October 2015). It was not commissioned by the force. Sources: https://msmagazine.com/?p=109377 ; https://refinery29.com/en-us/2015/12/98506/sexual-consent-tea-video ; https://www.stylist.co.uk/life/sexual-consent-its-as-simple-as-tea-thames-valley-police-launch-innovative-anti-rape-compaign/62223
- Slide 15: pod-map situations "when you are hurt, when you have hurt someone, when you need to be told the truth" → "if you were harmed, if you had harmed someone, if someone you love were being harmed". The third situation was invented; BATJC's worksheet names the three as harm done to you, accountability for harm you did, and witnessing harm to or by someone you care about. Source: https://transformharm.org/?p=906 (Mingus / Bay Area Transformative Justice Collective, term in use since spring 2014, worksheet 2016)
- Slide 15: "Orcas live their whole lives in family pods" → "Resident orcas spend their whole lives in their mothers' pods". Lifelong matrilineal residence (both sexes) is documented for resident ecotypes; it is not a safe generalisation to all orcas. Sources: https://www.whaleresearch.com/post/the-amazing-grandmothers-of-the-southern-resident-orca-community ; https://www.raincoast.org/2026/05/guided-by-mom-matriarchal-world-killer-whales/
- Slide 12 (deck slide 21): "dystonia, abnormal involuntary posturing" → "dystonia, Greek for bad tension". The psychiatric term ego-dystonic (paired with ego-syntonic, Freud and successors) derives from Greek dys- + tonos, "out of tune with"; it does not derive from the movement disorder, which merely shares the root. The slide's gloss is a folk etymology. Sources: https://www.elsevier.es/en-revista-revista-colombiana-psiquiatria-english-edition--479-articulo-ego-dystonia-review-in-search-definitions-S2530312022000479 ; https://www.scielo.br/j/anp/a/Q6dYmM8cs3zRh9vXdTpKf9n/?lang=en
- Slide 14: "The American Medical Association's Code of Medical Ethics says much the same in its opinion on physician health and wellness" → "agrees, treating physician health and wellness as a professional obligation". Opinion 9.3.1 states physicians have a responsibility to maintain their own health and wellness and links it to safe care; it does not use the lecturer's "ethical responsibility for self-care" language, so "much the same" overstated it. Sources: https://code-medical-ethics.ama-assn.org/sites/amacoedb/files/2022-08/9.3.1.pdf ; https://www.ama-assn.org/about/ethics/ethics-physician-well-being-what-ama-code-says
- Slide 14: burnout definition and its drivers now attributed to the course ("The course defines burnout, or care fatigue, as a loss of self-efficacy ... and names moral injury, vicarious trauma, poor social and programmatic supports, and institutional betrayal as what feeds it"). The self-efficacy framing is the lecturer's; the standard Maslach construct is emotional exhaustion, depersonalisation and reduced personal accomplishment.
- Slide 10: beta-blocker sentence hedged on the signal rather than the perception: "may not feel the heart race, nor the fear or excitement it would have announced" → "may not feel the racing heart that would have announced fear or excitement". Beta-blockade damps the tachycardia itself; the evidence on interoceptive *accuracy* is mixed (see editor's attention). Sources: https://www.biorxiv.org/content/10.1101/2025.02.28.640776.full.pdf ; https://ir.lib.uwo.ca/etd/4700

## Verified (unchanged)
- Slide 3: sympathetic preganglionic outflow is thoracolumbar (T1–L2), with the paravertebral sympathetic chain; parasympathetic outflow is craniosacral (CN III, VII, IX, X and S2–S4). Sources: https://pmc.ncbi.nlm.nih.gov/articles/PMC10944453 ; https://link.springer.com/article/10.1007/s10286-024-01023-6
- Slide 4: vagus is cranial nerve X and the longest cranial nerve, running brainstem to abdomen, supplying heart, lungs and gut to the proximal colon. Sources: https://radiopaedia.org/articles/vagus-nerve ; https://teachmeanatomy.info/head/cranial-nerves/vagus-nerve-cn-x/ ; https://www.ncbi.nlm.nih.gov/books/NBK537171/
- Slide 4: roughly 80 percent of vagal fibres are afferent (sources give 80–90 percent; Jänig gives 85). Sources: https://en.wikipedia.org/wiki/Vagus_nerve ; https://www.cambridge.org/core/books/integrative-action-of-the-autonomic-nervous-system/interoceptive-afferent-neurons-and-autonomic-regulation-with-special-emphasis-on-the-viscera/980E6BD803ECE0E897A5E83701BDCE07
- Slide 5: Stephen (not Steven) W. Porges; polyvagal theory delivered as the 1994 SPR presidential address and published 1995, Psychophysiology 32:301–318. Writer's `[fixed]` confirmed. Sources: https://terpconnect.umd.edu/~sporges/polyvag.htm ; https://en.wikipedia.org/wiki/Stephen_Porges
- Slide 5: the theory's claims as summarised (two functionally distinct vagal outputs, nucleus ambiguus "newer"/social engagement vs dorsal motor nucleus "older"/shutdown, a hierarchy of states read from safety/threat). "Hierarchy" is the later polyvagal literature's framing but is what the theory as taught claims. Source: https://terpconnect.umd.edu/~sporges/polyvag.htm
- Slide 5: Grossman P et al., "Why the Polyvagal Theory Is Untenable: An international expert evaluation ...", Clin Neuropsychiatry 2026 Feb;23(1):100–112, doi 10.36131/cnfioritieditore20260110; 39 co-authors; concludes the theory "is untenable" on neurophysiological and evolutionary evidence. Exists exactly as the slide cites it. Script now says "thirty-nine specialists writing in Clinical Neuropsychiatry argued outright that the theory is untenable"; the course's siding with the critics is stated as the course's position. Porges replied in the same issue. Sources: https://ora.ox.ac.uk/objects/uuid:5e7a7f18-15f9-4ccc-9112-0963bd7b8028 ; https://www.clinicalneuropsychiatry.org/download/why-the-polyvagal-theory-is-untenable-an-international-expert-evaluation-of-the-polyvagal-theory-and-commentary-upon-porges-s-w-2025-polyvagal-theory-current-status-clinical-applications-and/ ; https://pmc.ncbi.nlm.nih.gov/articles/PMC12937499
- Slide 6: interoception assembled in the insula; vagal afferents reach it via the nucleus tractus solitarii and thalamus (Craig 2002, Nat Rev Neurosci 3:655–666; Craig 2009 on anterior insula). Limb position is proprioception, as the script notes. Source: https://baillement.com/interoception.html (reproduces Craig 2002)
- Slide 6: "neuroception" is Porges's coinage (Zero to Three, May 2004). Source: https://www.lausd.org/cms/lib/CA01000043/Centricity/domain/662/pdfs/Staff%20Resources/NEUROCEPTION-A-Subconscious-System-for-Detecting-Threats-and-Safety.pdf
- Slide 7: consent from Latin consentire, com- "together" + sentire "to feel". Source: https://www.etymonline.com/word/consent
- Slide 9: Consent Academy definition quoted verbatim (their parenthesis rendered as commas): "voluntary agreement (made without coercion) between those with decision-making capacity, knowledge, understanding, and autonomy." Source: https://www.consent.academy/sexual-consent.html
- Slide 10: subspace is a kink-community term for a trance-like altered state during intense play, commonly attributed to endorphin and adrenaline release; impaired ability to use safewords is widely noted, hence pre-scene negotiation. Sources are community/magazine, not peer-reviewed; the script's "usually attributed to" hedge is appropriate. Sources: https://feeld.co/magazine/how-to/what-is-subspace ; https://grindr.com/blog/subspace-bdsm
- Slide 10: benzodiazepines produce anterograde amnesia (impaired consolidation of new memory) via GABA-A. Sources: https://www.frontiersin.org/articles/10.3389/fphar.2023.1257030/full ; https://pubmed.ncbi.nlm.nih.gov/1357612/
- Slide 11: medicolegal components of informed consent — disclosure, capacity/competency, voluntariness (some frameworks add understanding and assent). Sources: https://www.encyclopedia.com/law/encyclopedias-almanacs-transcripts-and-maps/informed-consent-0 ; https://wmc.wa.gov/sites/default/files/public/1.%20Informed%20Consent%20Guidance%20Document%20approved%20by%20full%20Commission%205%2027%2022.pdf
- Slide 12: ego depletion's laboratory evidence is contested — Hagger et al. 2016 multi-lab registered replication (23 labs, n=2141) found d=0.04, CI including zero. Sources: https://research.tilburguniversity.edu/en/publications/a-multi-lab-pre-registered-replication-of-the-ego-depletion-effec/ ; https://psychologicalscience.org/?p=125699
- Slide 13: dilemma from Greek di- "two" + lemma "premise, proposition" ("double proposition"), not Latin "two truths". Writer's `[fixed]` confirmed. Source: https://www.etymonline.com/word/dilemma
- Slide 14: AMA Code of Medical Ethics Opinion 9.3.1 "Physician Health & Wellness" exists and says what the (reworded) script now attributes to it. Source: https://code-medical-ethics.ama-assn.org/sites/amacoedb/files/2022-08/9.3.1.pdf
- Slide 15: pod mapping is Mia Mingus / BATJC's transformative-justice exercise. Source: https://transformharm.org/?p=906

## Could not verify (softened or removed)
- None removed for verification reasons. Two writer additions were cut for length only, not accuracy: the "two overlapping circles" image (slide 8) and "even values that feel universal often are not" (slide 11).

## Beats changed
- None. All 15 subjects checked against the envelope: no text, labels or signage; no likeness of a real person; no nudity, restraints, blood or minors; the two human-figure beats (7, 13) are clothed and composed; anatomical beats (3, 4, 5, 6, 10, 12) depict structures, not symptoms.

## For the editor's attention
- Slide 10, beta-blockers: the slide's claim that beta-blockade "may change the interoception of physiologic responses" is clinically plausible (the tachycardia itself is damped, which is why propranolol is used for performance anxiety), but the experimental literature on interoceptive *accuracy* under beta-blockade is small and mixed; a 2025 placebo-controlled study (n=50) found bisoprolol and propranolol *improved* cardiac perceptual sensitivity, while a small propranolol crossover found a non-significant decrease. The script now claims only that the racing heart may not be felt. Alpha-blockers are grouped with them on the slide; their effect is on vascular tone and blood pressure rather than heart-rate modulation.
- Slide 5: "two functionally distinct vagal branches" is the theory's claim; the 2026 Grossman paper disputes that the nucleus ambiguus / dorsal motor nucleus split maps onto social engagement vs shutdown, and disputes the evolutionary story. The script presents the claim as the theory's and the rejection as the course's, which matches the slide. Porges's rebuttal ("When a Critique Becomes Untenable") appears in the same issue; the lecture does not mention it.
- Slide 12 (deck slide 21): the deck's "Dystonia — abnormal involuntary posturing" gloss has been replaced with the real etymology. If the lecturer wants the posturing image as a deliberate metaphor rather than a derivation, it can be restored as "the word the movement disorder also uses" without claiming descent.
- Slide 14: burnout here is the lecturer's self-efficacy framing, now attributed to the course. "Moral injury" (Shay; Dean and Talbot in medicine) and "institutional betrayal" (Freyd) are established constructs; "care fatigue" is non-standard (compassion fatigue is the usual term).
- Slide 15: the BATJC worksheet dates the term "pod" to spring 2014 and the worksheet to 2016; the script gives no date, so nothing to correct. The slide's pod-map activity presupposes the exercise was done in class; the closing `? ` prompt assumes the same.
- Slide 4: "longest cranial nerve" is standard (Radiopaedia, TeachMeAnatomy, StatPearls); Wikipedia prefers "longest nerve of the autonomic nervous system". Both are true; left as the slide has it.
- Slide 11: the three-component medicolegal list is the slide's; many jurisdictions and ethics texts list four or five (adding understanding and assent/decision). Left as the course teaches it.