Summary of Dr. Sarno's approach

Copied below is some helpful information that I found on the web in a handout created by some students at Harvard and Radcliffe with Repetitive Strain Injuries (RSI). While the focus of this summary is on 'pain' or what he calls TMS (Tension Myositis Syndrome), the same principles apply to other physical manifestations that he calls 'equivalents' such as Spasmodic Dysphonia.

The basic premise of Dr. Sarno’s TMS diagnosis is that the unconscious fear and anger can actually induce physiological changes. Every single person on earth experiences unpleasant emotions such as fear, anger, guilt, anxiety, shame, sexuality conflicts, identity problems, and dependency needs. We all have a self-image that we try to protect. We all want to think of ourselves as intelligent, successful, independent, strong, likable, sexy, invincible, immortal, patient, loyal, loving, a good husband or wife, a good son or daughter, a good mother or father. When situations arise that seem to threaten that self-image, our minds do everything possible to keep us from having to face that threat. It's a built-in defense mechanism.

Your brain tries to shove any threatening emotions into your unconscious so you don't have to become aware of them. Most of the time, when the feelings aren't all that intense or threatening, your brain manages to keep them repressed. However, when the emotions are particularly strong, it's harder to keep them tucked away, so your brain needs to create a distraction. It creates real physiological changes in your body, which in turn create real symptoms. These symptoms are painful or distressing enough to take your attention away from the threatening, unacceptable feelings.

The emotions we’re talking about are unconscious. Lots of doctors and other health professionals say that stress can aggravate many medical conditions, but they're usually referring to conscious, perceived emotions such as getting a bad grade, having an argument with a close friend, losing a pet – obvious sources of stress. We're talking about the nasty, unconscious feelings that are simmering below the surface. These feelings are why even happy events like weddings and new jobs can cause the mindbody syndrome: seemingly happy events can often create pressure and fear (am I going to be a good husband, am I going to look fat in my wedding dress, am I going to be able to handle the responsibilities of my new job, etc.).

Dr. Sarno developed his theory as a result of working with patients suffering from back and joint pain. He noticed that a large majority of his patients had a previous history of tension-induced conditions such as heartburn, pre-ulcer symptoms, hiatus hernia, irritable bowel syndrome, colitis, spastic colon, tension headache, migraine, and eczema. Not all doctors agree that these disorders are emotionally-induced, but based on his own clinical observations at the time, Dr. Sarno felt confident that indeed they were. This correlation between back pain and tension-induced disorders, and the failure of conventional back pain treatments, led him to believe that back pain may be caused by emotional tension.

After noticing that heating pads, massage, and physical therapy (all of which increase circulation to the applied area) seemed to temporarily alleviate his patients’ pain, Sarno hypothesized that the real cause of the pain was a reduction of blood flow to the soft tissues in the affected area, initiated by emotional factors (his books go into greater detail as to how the limbic and autonomous nervous systems could be capable of producing such a change). In Sarno’s experience, although TMS is painful, it causes no permanent damage to the soft tissues involved. Once his patients understood and accepted the fact that they were suffering from a tension-induced disorder, their pain quickly went away and they were able to resume their activities without restriction.

To be perfectly clear: in this theory, the cause of pain is not the structural abnormalities (tendon or muscle tears, tissue inflammation, herniation, degeneration, decrepit muscles, etc) or behavioral “problems” (poor posture, a bad ergonomic setup, improper typing habits) typically identified by medical practitioners. None of them are responsible for the pain – none.

This is a tough idea for pain sufferers to swallow. People with these pain syndromes have usually been to at least one (and often several) practitioners and received structural diagnoses. However, Dr. Sarno contends that what is often diagnosed as tendonitis, bursitis, fasciitis, metatarsalgia, shin splints, tennis elbow, sciatica, carpal tunnel syndrome and so on is, in reality, just an area of soft tissues suffering from mild oxygen deprivation. Some people have structural abnormalities (such as herniated disks) which they think “prove” the structural diagnosis. You may have a structural abnormality – but abnormalities don't necessarily cause pain. Lots of people who have no pain at all have all kinds of structural irregularities. Lots of people who have excruciating pain have no structural irregularities.

How does your mind/body decide which physiological alterations to make in response to unacceptable emotions? You develop the symptoms that will work as the best distraction for you – the ones that you are least likely to attribute to emotional tension. As long as a patient believes that there is something "wrong" with their back or other joint, the pain will hang around. Why? Because it's still working as a distraction. It is still successfully keeping the focus away from the unpleasant emotions in the unconscious mind.