John E. Sarno: The Divided Mind

I mentioned a few weeks ago that I had noticed that Dr John Sarno had a new book out, and that I had every intention of reading it. Well, now I have.

Sarno's latest is entitled The Divided Mind -- the Epidemic of Mindbody Disorders. And it's about health.

Let me say at once that this is not a book that everyone is going to appreciate. Some will find it, almost literally, a lifesaver. Others will regard it as offensive, insulting, and a complete waste of time. My own opinion is that it is a valuable book, and possibly an important one; but all I can do here is try to give you the flavour of it and allow you to make up your own mind as to whether it's worth buying/reading.

Dr Sarno was born in 1923. He trained in medicine at Columbia and seems to have had a successful early career as a practitioner of orthodox, non-controversial medicine. Even today he is still a Professor of Clinical Rehabilitation Medicine at New York University Medical Center, and is still treating patients.

Somewhere along the line, Sarno became interested in patients with back pain. He noticed that many of these patients had pain which did not respond to standard medical treatments, and that their pain was in any case was not related to any demonstrable injury. He came to the conclusion that, in many instances, this pain had a psychological and emotional basis, and he found that, when such patients were educated in the true cause of their pain, a large proportion of them recovered their health.

Now immediately, if the above paragraph were read by, say, a hundred patients with severe back pain, a large number of those patients would become very annoyed. So, they would mutter to themselves, this **** Sarno is saying that back pain is all in the mind. Well my ***ing back pain isn't in my ****ing mind, it ****ing well hurts, and any ****ing **** who says otherwise is....

And so on.

Sarno is not saying that back pain -- anybody's back pain -- is 'all in the mind'. Far from it. It's real pain. What Sarno argues, in essence, is that in cases where there is no injury to account for the pain, then there must be some other cause. One possible cause is what he calls tension myositis syndrome (TMS). What happens in those cases is that various powerful emotions, largely unconscious, bring about a tension in the muscles of the back. This tension causes real (not imaginary) pain, because the muscles are deprived of oxygen. And Sarno's major contribution to medicine is that he has found a way to treat such patients with a high degree of success.

To oversimplify greatly, the treatment consists of explaining to the patient the physiological basis for TMS, and inviting the patient to consider, with or without professional assistance, the possible unconscious emotions which might be the underlying cause.

In previous books, such as Healing Back Pain (1991) Sarno dealt more or less exclusively with pain in the shoulders, neck, and lower back. In his 2006 book, however, he has included the results of his more recent research, which indicate that TMS may underlie a much wider range of disorders.

The Divided Mind falls into two parts. In the first part, Dr Sarno himself gives us a discussion of psychosomatic medicine in general. He defines the term, and then provides a history of the practice of such medicine; this is followed by a discussion of the psychology of psychosomatic disorders, and finally there is an account of his treatment for them.

The second half of the book is made up of six essays by other medical specialists, all of whom have largely accepted Dr Sarno's theories and have incorporated them into their treatment of patients. There are chapters, for instance, by specialists on hypertension and rheumatology.

I ought, perhaps, to make a number of points clear. First, Sarno himself tells us, as he has done in previous books, that his theories and the treatments that he has developed are not acceptable in the world of orthodox medicine. Medical science accepts as 'fact' only that which can be demonstrated through the gold standard of double-blind tests, such as those used to test new drugs. Sarno's work does not lend itself to validation of that kind.

The second thing that needs to be said is that patients themselves are quite amazingly resistant to any idea that there might be a link between their physical health problems and their past and present emotions. Patients, like most orthodox doctors, believe in the separation of mind and body.

For example, in one of the essays in the second part of the book, Douglas Hoffman describes giving a talk to 400 patients with fibromyalgia. You may not yet have heard of fibromyalgia, but you will soon, because it is being increasingly diagnosed. Jerome Groopman, a professor of medicine at Harvard, has estimated that there are six million Americans, mostly women, with this disorder.

In the 1980s the American College of Rheumatology decided that fibromyalgia could be diagnosed if patients exhibited pain in 11 of a potential 18 locations. Frequently, such patients have other symptoms, such as headache and irritable bowel syndrome, anxiety, depression, and sleep disorders. Rheumatologists have not been able to explain these disorders, but they can 'diagnose' them and label them as fibromyalgia.

As far as Dr Sarno and his colleagues are concerned, fibromyalgia is a severe form of TMS, and is best treated like any other form of TMS, i.e. by providing knowledge and understanding of the true source of the pain. The core of this treatment is a lecture presentation in which Dr. Sarno (or a colleague) leads the patients through a process of realisation of the relationship between emotions and physical symptoms and explains to them the importance of understanding what is going on as the basis for curing many common pain syndromes.

However -- if we go back to Dr Hoffman and his experience of trying to put this explanation to a group of 400 fibromyalgia patients, what he found was that not one of those present would accept the possibility that Dr Sarno's theories might be correct. (Mention of 10,000 or so happily cured patients carried no weight.) No no. Sarno couldn't possibly be right. All they needed was the right pill. And if the drug companies haven't found one yet, hey, maybe the government should fund the research. Quick.

For many people there is, apparently, something deeply insulting and offensive about the idea that unconscious emotions are the source of their physical pain. They feel as if they are accused of being feeble-minded. In fact, quite the reverse is true. As Sarno says (page 103), 'We do not think our patients are neurotic. The psychosomatic reactions they are experiencing are both normal and universal.'

Dr Hoffman also points out that patients may come to the conclusion, consciously or unconsciously, that it is better to have the pain than to face up to the horrifying and frightening emotions which have brought it about. And we do not, by the way, have to go into theories of repressed memories of child abuse and extreme situations of that sort, to identify the source of powerful emotions. Just everyday life, work, family situations, reading the newspapers, all that stuff will generate more than enough powerful emotions in most of us to explain quite a lot of pain which cannot otherwise be explained.

Because of this massive patient resistance, trying to treat patients with TMS -- whether it is diagnosed as fibromyalgia or anything else -- is a mighty frustrating business for the physicians involved. Many years of experience have taught Sarno and his colleagues that only 10% to 15% of the population are likely to accept a pyschosomatic diagnosis. In Dr Sarno's case, he doesn't even try to treat those who are implacably resistant. Before accepting a patient on to his programme, he talks to them first, to see whether they are likely to be open to his ideas. This eliminates a number of people who have come to him, perhaps reluctantly, at the urging of someone else.

In a 1999 outcome study, of those who were treated by Dr Sarno and his colleagues, 44% reported, six months after completing treatment, that they now had little or no pain, and the rest showed varying degrees of improvement.

By the way, do I need to point out that writers seem to me to be particularly at risk here? Trying to cope with the pressures of writing books on top of everything else, plus the powerful emotions generated by the inevitable rejection and frustration, will generate more than enough conscious or unconscious rage to damage anyone. Furthermore, Sarno has found that the drive to be perfect and good is also a big help if you want to suffer lots of TMS. Hard-working, conscientious, responsible, driven, success-orientated people are just queueing up at Sarno's door.

Finally, I can only tell you that, when I first came across Dr Sarno's work, some fifteen years or so ago, it was an enormous help to me in coping with various forms of pain in my back and shoulders, plus frequent headaches. I am quite certain, in retrospect, that these were 99% caused by TMS. And, like many other potential patients, I found that simply reading Dr Sarno's books effected a great improvement.

If you value your own health and wellbeing, or those of the people around you, I can only suggest that you acquaint yourself with what Dr Sarno has to say. And if, at the end of the day, like Dr Hoffman's 400 fibromyalgia sufferers, you decide that it's all a load of nonsense, then so be it.

The Divided Mind is published by Regan Books . There is also an audio version.

Later note: If you are interested in learning more about TMS there is now a wiki-type site which contains a great deal of useful information. In particular, it contains many first-hand reports by former pain sufferers who explain how Dr Sarno's ideas, and his practical suggestions for treatment, have helped them to feel better. I warmly recommend it. The web address is tmswiki.org.