I first learned of Dr. John E. Sarno when he was a guest on Larry King's television show a few years ago. The author is professor of Clinical Rehabilitation Medicine at the New York University School of Medicine and an attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at New York University Medical Center. His theories seemed to be related to primal therapy so I had intended to eventually read what he had to say about the cause and cure of back ailments. Then recently while surfing the internet I ran across a website with book reviews of both Sarno's book and Janov's The Primal Scream. I thought that perhaps Sarno's theories were closer related to Janov's primal theory than I had originally surmised so I decided to read his book, The Mindbody Prescription.
Dr. Sarno's theory can be stated simply: Most muscular/ skeletel pain is usually the result of early infantile and childhood trauma which has been repressed. The emotion involved is invariably that of profound anger and rage. Our mind plays tricks and confuses us into focusing our attention on physical pain while the real problem is in our not facing and uncovering our repressed emotions, particular deep rage. Sarno's thesis is quite different from Janov's in that the cure to Sarno's Tension Myositis Syndrome (TMS) is simply to come to realize that the origin of the pain is from the unconscious mind and not from any bodily abnormality. Janov's primal theory, on the other hand, emphasizes that this insightful knowledge is not curative; that what is needed for cure is a full re-living of the original repressed trauma.
The disorders which are encompassed by this syndrome include, low back and leg pain, most neck and shoulder pain, fibromyalgia, and chronic fatigue syndrome. The author believes that anxiety and depression are both TMS equivalents.
Dr. Sarno writes:|
Even when there are structural abnormalities found in the back and in arthritic joints, many with such pathology have no symptoms; others have pain symptoms disproportionate to the actual pathology of the normal aging process. Even after surgeries to correct these "abnormalities" the pain continues.
The author surmises that the source of the pain in TMS is mild oxygen deprivation to the involved tissues and organ systems. At a very deep unconscious level repressed rage is the cause of the pain. Sarno takes issue with the medical profession since most physicians do not accept that the primary cause of many such chronic pain syndromes are psychological problems. Most physicians recognize that emotions play a role in such problems but are quick to find an inconsequential abnormality which they believe to be the cause of the TMS symptoms.
If the cause of the pain is oftentimes repressed rage, what is the role of psychotherapy in the elimination of the chronic pains of TMS? After giving his patient a physical exam to eliminate any gross physical abnormality from consideration, Dr. Sarno primarily uses education to explain the operation and power of repressed feelings. He believes that the pain, weakness, stiffness, burning pressure and numbness caused by a reduced a blood flow causes no permanent damage to the tissues.
Unless the patient can become convinced that his back or neck is normal, the pain will continue. They must be reassured and then really come to believe that ". . . structural abnormalities that have been found on X ray, CT scan or MRI are normal changes associated with activity and aging."
This newly acquired belief, Dr. Sarno writes, will thwart the strategy of the brain to make one become fixated on the body and instead begin to understand that the problem is an unfelt trauma stored in one's unconscious. It is as though the mind fears the release of the repressed rage. To make the pain go away the patient must acknowledge and accept the true basis of the pain. Think psychologically and talk to your brain! This will divert attention from the body. Insight, knowledge, and understanding are the cures for the TMS symdrome.
Psychotherapy is rarely used. Dr. Sarno explains its role:
"In a survey done in 1975 it was found that 88 per cent of patients with TMS had histories of up to five common mindbody disorders, including a variety of stomach symptoms, such as, heartburn, acid indigestion, gastritis and hiatal hernia; problems lower in the intestinal tract, such as spastic colon, irritable bowel syndrome and chronic constipation; common allergic conditions, such as hay fever and asthma; a variety of skin disorders, such as ecema, acne, hives and psoriasis; tension or migraine headache; frequent urinary tract or respiratory infections; and dizziness or ringing in the ears. . . ." p. 29
On page 13 one of his patients described what seems to have been a primal regression encouraged by her husband's support:
". . . insight oriented therapy is the choice for people with TMS or its equivalents. The therapists to whom I refer patients are trained to help them explore the unconscious and become aware of feelings that are buried there, usually because they are frightening, embarrassing or in some way unacceptable. These feelings, and the rage to which they often give rise, are responsible for the many mindbody symptoms I have described. When we become aware of these feelings, in some cases by gradually becoming able to feel them, the physical symptoms because unnecessary and go away." p. 161
"And then, in an instant, I started to cry. Not little tears, not sad, quiet oh-my-back-hurts-so-much tears, but the deepest, hardest tears I've ever cried. Out of control tears, anger, rage, desperate tears. And I heard myself saying things like, Please take care of me, I don't ever want to have to come out from under the covers, I'm so afraid, please take care of me, don't hurt me, I want to cut my wrists, please let me die, I have to run away, I feel sick-and on and on, I couldn't stop and R--, bless him, just held me. And as I cried, and as I voiced these feelings, it was, literally, as if there was a channel, a pipeline, from my back and out through my eyes. I FELT the pain almost pour out as I cried. It was weird and strange and transfixing. I knew--really knew--that what I was feeling at that moment was what I felt as a child, when no one would or could take care of me, the scaredness, the grief, the loneliness, the shame, the horror. As I cried, I was that child again and I recognized the feelings I have felt all my life which I thought were crazy or at the very best, bizarre. Maybe I removed myself from my body and never even allowed myself to feel when I was young. But the feelings were there and they poured over me and out of me."
This was a patient, who at first despite knowing and accepting the source of her back pain, did not improve. Instead, the author writes, this patient's pain became worse. He believes that her symptoms were exacerbated in a desperate attempt by the body to prevent their being released into consciousness -- into her knowing their actual source. "The feelings would not be denied expression," he wrote, "and when they exploded into consciousness the pain disappeared. It no longer had a purpose; it had failed in its mission." (The author's emphasis.) It is the unconscious repressed rage which is the source of the chronic pain, not the anger and rage which is consciously known by the patient.
There is an inexorable press by the unconscious to release and reveal its past traumas. When the patient understands the repressed presence of rage the feelings will stop trying to become conscious and "removal of that threat eliminates the need for physical distraction, and the pain stops."
Sarno claims the rate of "cure" is between 90 and 95 per cent and yet his practice is comprised mostly of sufferers who have gone to him as a last resort -- those who have been suffering for decades. He has treated over 10,000 patients and will only accept a patient who he believes can accept the psychological explanation as the cause of their distress. Being convinced and coming to believe that the pain has its origins in repressed feelings is essential for the treatment to be successful. This is a maxim of the treatment and is repeated throughout the book. It is not a form of denial of the existence of the pain but only an affirmation and acceptance of its true origin.
Dr. Sarno writes that one must accept the emotional explanation in order to get well.
An extensive bibliography is contained in The Mindbody Prescription. Sections of the book include discussions of the the psychosomatic theories of Walter B. Canon, Heinz Kohut, Franz Alexander, Stanley Coen, Candace Pert, Sigmund Freud, Graeme Taylor, and others. A technical appendix with more indepth studies is included.
- "Increasingly, we discussed the pain with the patient, where it came from and why it would go away once the psychological poison was revealed." p. 105
- "He (the patient) understood and accepted the principle of psychological causation as applicable to his symptoms -- and he got better." p. 111
- "In many cases merely acknowledging that a symptom may be emotional in origin is enough to stop it." p. 113.
- "I would tell patients their backaches were induced by stress and tension, and if they were open to that idea, they got better." p. 113
- "The pain will not stop unless you are able to say, "I have a normal back; I now know that the pain is due to a basically harmless condition, initiated by my brain to serve a psychological purpose. . . ." p. 142
- "The brain tries desperately to divert our attention from rage in the unconscious. . . . So we must bring reason to the process! This is the heart of the very important concept. . . ." p. 144
- "I tell my patients that they must consciously think about repressed rage and the reasons for it whenever they are aware of the pain." p. 145
- "Remember, the purpose of the pain is to divert attention from what's going on emotionally and to keep you focused on the body." p. 148
- "For some people simply shifting attention from the physical to the psychological will do the trick. Others need more information on how the strategy works, and still others require psychotherapy." p. 149
The author has also written:
- Healing Back Pain: The Mind-Body Connection
- Mind over Back Pain : A Radically New Approach to the Diagnosis and Treatment of Back Pain