All of my patients’ case histories are interesting, but some are more interesting than others. I particularly remember the twenty-eight-year-old engineer who arrived at my office one morning and told me the story of his low back and leg pain. He had been suffering with it for over eight months. His condition was extremely painful, and he had gone the usual route of seeing a variety of doctors, trying a number of treatments, all without improvement. His MRI showed a herniated disk, which his doctors presumed to be the cause of his pain. Inevitably, the persistence of the pain after the failure of conservative treatment brought the usual recommendation for surgery. He might have gone that route, but it was around that time that he read my book, Healing Back Pain, and decided that the disorder described in the book, TMS (tension myositis syndrome), might be the cause of his pain, so he made an appointment to see me.
One of the things he told me during the consultation was that he had an extremely responsible job, one in which he supervised four people, a couple of them older than himself, and that he found the job very burdensome. He then said that about two weeks before our scheduled appointment, the leg pain got so bad that he would have gone looking for a surgeon had he not already made the appointment to see me. He agonized over the severity of the pain, recalling the things he had read in my book about the psychological basis for it. Then, out of the blue, he found himself saying something like, ‘I don’t want that job of mine. It’s too hard, and there’s too much responsibility. I want a job where somebody will tell me what to do.’
Knowledge is power
And, he told me, as this revelation flashed through his mind, the severe leg pain simply... disappeared! Over the next few days he continued to have some mild low back pain, so he decided to keep the appointment with me and go through the full therapeutic program. As it turned out, he did well and became totally pain free in a few weeks.
As an attorney might say, I rest my case.
This young man received no treatment, he simply learned something by reading my book, and through a mental process managed to eradicate severe physical pain. Knowledge is power. Let us see what his experience tells us about the psychosomatic process.
Distraction tactics
Years of experience treating thousands of patients have taught me that the physical process resulting in the pain of TMS is initiated in the unconscious by the brain’s decision maker, which Freud called the ego. The ego is aware of the rage, emotional pain, and sadness and concludes that – since they have the potential to ruin the person’s life – it must do something to prevent the explosion of the rage into the consciousness and keep the person from experiencing the pain and sadness.
And what does it do? It creates pain as a distraction because it knows that will prevent the rage from coming out and spare the individual from feeling the pain and sadness.
In the case of the young engineer, his pain was a reaction to an unconscious emotion – rage – and its purpose was to assist repression and make certain that the rage did not reach consciousness. Multiple factors contribute to the reservoir of unconscious rage across the spectrum of patients, but the one that brought it to a dangerous level in this patient, the one that convinced his mind’s decision maker of the necessity for a physical symptom, was his hatred of his job. And then there was the remarkable phenomenon that occurred when he became consciously aware of that unconscious reaction: the pain went away!
But why should the symptoms take the form of pain, or stomach trouble, or an intractable rash, or sever allergies or, for that matter, anxiety or depression? It would appear that all such disorders are meant to distract, to keep one’s attention focused on the physical, on the body. Even anxiety and depression, clearly psychological phenomena, are states of discomfort that can serve just as well as physical symptoms to distract us from what the brain-mind considers more dangerous or problematic phenomena. The more intense or threatening the unconscious feelings are, the more severe the psychosomatic reaction is likely to be.
So here’s a seeming paradox: the symptoms created by the brain-mind, which we deplore as evils, are in fact generated for our protection.
Now let’s take stock. Thus far, our young engineer has taught us three important things about the psychosomatic process: 1. That physical symptoms (in his case, back and leg pains) can be a reaction to unconscious mental/emotional phenomena. 2. That these unconsciously generated feelings are repressed as a matter of self-preservation. 3. That becoming aware of them can lead to a ‘cure’.
I remember the time I was explaining this to a particularly intelligent but somewhat sceptical patient. At one point she looked at me with the faintest hint of a smile and a wry twinkle in her eye. ‘And the pain is supposed to go away?’ she asked. ‘Just like that? I’d like to believe you, Dr. Sarno, but I’m not sure I can manage that great leap of faith.’
She didn’t understand. ‘What you need in order to get better, my friend,’ I said, ‘is not a leap of faith but a leap of understanding.’ That is the heart of treating psychosomatic disorders.
From The Divided Mind, © 2008 by John E Sarno, MD, published in the UK by Duckworth.
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