Dr. Alexander Beyond Sarno !!

I have been a student of neurophysiology for many years. TMS has provided me with many new questions as has the whole field of neuroplasticity or the ability to alter the structure and process of the brain with out invasive measures.

I know and have spoken to Dr. Joseph LeDoux who is one of the worlds premier brain researchers and cited in this article.I would like to open for discussion the possibility that Sarno had it partly right and missed a major part. There is no doubt that his conclusion that pain can be generated by the mind is profound. His work also occurred before many advances we have now in neuroscience.

My question, and it is a question, is whether the pain is a blocking mechanism for unwanted emotions and the process of going back to explore these emotions is beneficial.

In this article Dr. LeDoux describes the process of precognitive emotions that are not and never will be available for inspection by the mind. Many of these were formed in the first years of life or are genetically programmed and contain the raw data to keep us alive and safe. Our rational brain does not have an opportunity to sort these out before we feel them....snake...JUMP!!

How we respond to them either makes them more powerful or lessens them which is called extinction. If you see a snake and jump then start a story: oh God I hate snakes, I might die, I hope there aren't any more, I remember reading that red snakes kill people....OH GOD!!!

You have just etched the “Snake Fear” neural track in your brain deeper which means next time it will be more hair triggered and go off with more intensity.

When we do psycho-archeology and go back and dig through all the old memories of trauma, pain and suffering we are causing new electrical energy in the brain to etch these neural tracks deeper and if we tell ourselves a story about our history that is fear or trauma based we have just created more internal suffering potential.

I am not advocating that we gloss over our past traumas and put lipstick on that pig. For me I need to know where I came from and how it may have altered me in ways that I am not self-supportive or productive. Literally whos voice am I haring when I think and have emotions.

So here is where I question the full Sarno program. Anyone who has been wounded as a child was not provided the emotional growth stages of self-soothing, self-support, positive outcomes, trust and safety. Revisiting these places and writing long pages of painful memories will never teach us to provide our own internal safety which leads to letting go into lowered tension and anxiety. In fact each time we revisit an emotion it recharges the neural pathways.

The way to cause these painful emotions to have less power is to through our thoughts, beliefs and words. Example: if you look back over you life and see how much trauma you have endured and come to believe you are a severely wounded person you are going to suffer.

However if you re-write your story and tell yourself that you are a tough, rugged survivor and if you came through all that crap the rest is small stuff, anxiety will drop. If you are dumped by a date you can create a woe-is-me story or reframe it into: Good – that means a better person needed me to be free to find them.

So from my perspective the only reason to revisit the old painful places is to learn to reframe them into a positive outlook – not to make them positive. Example: I ran away at the age of 15 – I was alone, hungry and scared –so do I conclude that I am still a scared, wounded boy....hell NO!

I am a survivor that learned to scrap and take care of my self in horrible circumstances...a choice to see myself as sad or victorious.

The next step is to reprogram the negative bias that is a survival mechanism – boy this is a major challenge for me.

So from having read 7 TMS books and looking a this through my personal filters I am coming to believe that Sarno gave us a gift of recognizing that body pain in the absence of physical damage but the greatest step in TMS recovery may be accepting our power to create a new reality and to know that what we think and believe becomes who we are!! Remember that every behavior stems from a thought and a belief: if we push ourselves too hard it is because we have a story, conclusion and thought that needs to be changed.

And to come to understand that wounded children turn off emotional awareness and therefore lose the guiding power of emotions and that we need to learn how to listen to this deep inner wisdom again.

Working with old emotions, especially these pre-cognitive ones is like catching fog or heading cats – being mindful of our internal milieu of thoughts, beliefs and stories is tangible and the real work in my belief!!

cognitive neurobiology
http://www.nytimes.com/1989/08/15/science/brain-s-design-emerges-as-a-key-to-emotions.html?pagewanted=all&src=pm

 

So here is where I question the full Sarno program. Anyone who has been wounded as a child was not provided the emotional growth stages of self-soothing, self-support, positive outcomes, trust and safety. Revisiting these places and writing long pages of painful memories will never teach us to provide our own internal safety which leads to letting go into lowered tension and anxiety. In fact each time we revisit an emotion it recharges the neural pathways. From RikR above


Your post is so insightful, RikR. As a handwriting analyst, I know that our developed neural pathways are the reason why handwriting analysis shows one's personality - handwriting is "brain writing." I , too, am very grateful to Dr. Sarno - can't say enough about his findings and his life's work! I would be in terrible pain if it weren't for him.

I also question that perhaps the journaling process is lacking something; feedback is probably what I'm getting back to here - some sort of feedback loop. As a handwriting analyst, I can see the subconscious mind's beliefs and emotions in the handwritten notes. What is really neat is that if you change your handwriting with specific goals, you can change your behaviors; this is called "grapho-therapy." In short, you are re-wiring your brain's neural pathways in order to change your behavior patterns and the belief systems that underlie those behaviors.

This is essentially what you are saying above. Given your medical background in the neuro-programming of the mind, I thought I would confirm your findings from my vantage point. Interestingly enough, we view the same issue differently but are both stating the same concern about "...each time we revisit an emotion it recharges the neural pathways." Yes, this is so accurate and as a result, profound for us TMSers!

The most fascinating thing is that by changing your handwriting, you actually change the neural pathways of the mind, thus creating new beliefs and resulting behaviors. And it does work - I've seen it work with me.

For instance, if you've not satisfied with your money situation, you change your "g's", "y's" and "j's" in the way you form the lower loops. If you are feeling less than confident with work, you change your "t's" in your script in a certain manner. But, it must be done for three weeks straight, every day and in a specific manner; it doesn't change anything if you change the handwriting once in a while Interesting that it needs repeating to create the new neural pathway.

Anyway, I don't want this to be about me but I wanted to explain how this change happens and confirm your statement with another science. Interesting stuff.

The feedback loop with the journalling is something that I am working on developing (www.writeaboutu.com is being developed as I write, so it's not done, but you can see where I'm going with this concept). I think these wonderful Dr's on this site are making excellent strides for all of us; there is the additional question you pose of "what if we considered there's another piece to helping clients/patients cure their TMS?" Many of us may not have the self-supportive systems for uncovering old emotions and yes, we can be inadvertently recharging those very emotions we're trying to forgive. That might explain the symptom imperative whereby symptoms move to yet another body site.

Hope this has been informative and confirming for you. You know, with your medical background you can be the next physician who helps others on this site when you self-heal and thereafter write your own book In the interim, we are all lucky to gain your medical expertise as part of this process of healing.

Thanks, RikR

 

Hi Lianne

I was only "half" a physician. I was a medical psychologist trained in the body and mind and nothing about TMS. I am long retired but still leaning. I went through a huge trauma 23 years ago at the age of 42 and my handwriting changed. I can not tell you the science behind it only that it did!

 

I certainly noticed as a child of 11 or 12 during the period when my parents were trying to get a divorce for the second time that I adopted a tight, rigid formal style of handwriting and later, as I became even more perfectionist in grad school, that I loved writing out my Classical Greek assignments in a close, tight script: almost like calligraphy. Now, I'm much looser and lazier about my signature and penmanship, but do notice that my handwriting gets even worse when I have to write out checks to pay bills. Unconscious avoidance?

I have noticed that by going back and reliving old unconscious emotions using Howard Schuber's ISTDP techniques that those unpleasant emotions, by being brought into conscious awareness, seem to have less power over me. Sort of a process like Aristotelean catharsis where by viewing a tragic character's downfall you are purged of those unpleasant emotions that keep you from achieving psychological balance. Of course, Aristotle thought that process applied to all the citizens of the Athenian polis so that by collectively viewing a tragic play, the whole body politic was purged of unbalanced emotions, thus achieving the classical Golden Mean in the individual and the state. Then, there were the Romans, who believed that if citizens watched wild beasts devouring criminals in the arena, they would be toughened up for the blood and gore of the ancient battlefield where killing was up close and personal. Hard to say how these observations apply to modern Post-Freudian man, but Aristotelean catharsis seems to have been based on the ancient medical concept of purging strong emotions, which the ancient Greeks believed resulted in an unbalanced internal state of consciousness that was injurious to the whole state and its citizens. They thought that watching a tragic hero self-destruct on stage allowed the audience to vicariously participate in his emotional life and thereby safely purge those unbalanced emotions from their psyches while teaching the Athenian citizens how not to behave if they didn't want to invite the wrath of the gods, who always struck down anyone who was getting too big for their britches.

 

The term catharsis was adopted by Freudian psychoanalysis, to describe the act of expressing, or more accurately, experiencing the deep emotions often associated with events in the individual's past which had originally been repressed or ignored, and had never been adequately addressed or experienced.

With the a advent of SPECT scans it was found that regurgitating these emotions and revisiting these old traumas actually strengthened the neural pathways through negative neuroplasticity. We can see the same effect with biofeedback.

If you see a snake once every 5 years and you have a fear of snakes the fear can stay at a baseline - if you move to a place where people tell you there are many snakes the thoughts alone will reinforce the original fear response and drive the nervous system into higher arousal.

Our memory system, especially those in the limbic system are impossible to erase, we can however overlay them with new reframes that will shut off the knee jerk responses and their impact. This is the basis of phobic treatments.

Simply going back and revisiting old pains and emotions only etches them into the nervous system. Now if you go back and overlay them with new, positive data then there can be limited benefit.

Psychodynamics and catharsis therapy really worked...for the therapist. It kept people sick and coming back for years so it worked to make the therapists payment on the Mercedes and vacation homes.

Here is the real caveat...if you believe that Sarno type excavation of emotions is working then you probably have the placebo effect...which alone is powerful

And by the way look how it worked for Rome - and Aristotle had to promote the benefits of cathartic tragedy to keep the proletariat from rebelling against constant wars and trauma

 

No, no, no. Greek tragedy was not designed to be viewed by the proletariat, only by Athenian citizens, who had already gone through a process of emotional purgation while participating in the Dionysian mysteries, the contents of which have not been passed on to us moderns. But I don't think it was any accident that the ancient Greek theaters also had altar to Dionysus at the center of the stage. Athenian democracy was definitely reserved for an elite who were waited on by a slave cast of helots. From reading the Περὶ ποιητικῆς (335 BC) during my misspent Classical youth, I know that Aristotelean catharsis was a term borrowed from ancient medicine and involved quite literally "purging" the humors in your body to keep them in balance, closer to the classical "Golden Mean" - Nothing to excess. It sounds as though the Freudians and their successors made the therapist play the role of audience, watching the patient regurgitate his repressed emotions on the psychoanalytical couch. But if, according to the IDSTP model, the patient goes from experiencing old emotions to dealing with the guilt associated with them and then moving on to forgiveness and compassion, he/she has also in the process reprogrammed his/her neural pathways, transformed them if you will. Slaying Dragons and turning them into Angels? Ask Alan Gordon at his forthcoming webinar this month.

 

Rik. Good points raised. I think we are talking about different populations. There are some people (an unknown proportion) who clearly get better from reading TMS books, and following suggestions such as journaling- many of these people are active on the forums and can testify to this reality. It appears that a combination of information and self reflection are up to the job for these people (I was one of these). And then there are some people for whom this more simple intervention is not adequate- they are also on the forum, and report to not getting better despite journaling and reading etc. I cant offer any clear suggestions as to why this difference exists- i dont think it has to do with the intensity of distress, ie. i dont think it is 'light weight' problems which resolve easily and quickly with just information (I was highly traumatised from nearly being killed; and there are people who have not been traumatised at all, but their TMS seems more indelible). Is it to do with the degree of openness to the general proposition? Perhaps. Sarno saw more than 20,000 chronic pain patients in his career- this is an enormous sample- probably more than anyone else alive. As such, while i dont think he suffers from Papal type infallibility, I think it is worth listening to him when he says that unless people accept and internalise the TMS model (or some very close variations of it), including the idea that unconscious distress necessitates chronic pain as a protective strategy, then people will not get better using these ideas. That is, to half entertain these notions is not sufficient to change the pain. Nor is hanging on to physical therapy likely to result in a resolution. Its not that people have to follow this advice, but it they want to get better from the TMS approach, these seem to be pretty central tenants. Not everyone (who is entertaining this approach) is equally committed to or convinced of the merits of these ideas- thats OK- their choice.

People who do not get better from information and self reflection will probably benefit from appropriate types of psychotherapy (again, as per Sarno's suggestions). It is not that this approach is no good for them- it is that they need additional help, beyond what information and self reflection can provide. There may be a tendency to write the approach off as it hasnt worked for them, but perhaps they need the information, self reflection and appropriate therapy? (my personal experience is that good therapy without the good information is not sufficient to resolve chronic pain though- both seem to be needed for some people, with the information being necessary but sometimes not sufficient in its own right).

There are certainly implicit memories which are laid down in our pre-verbal stage of development, and if these are from upsetting experiences, they will be evident in emotional patterns rather than in auto-biographical memory. And there is certainly a whole neurology to this, as with everything else in humans. It is not correct that these implicit memories (and their associated feeling states, cognitive patterns and schemas, physiological reactions) are indelible- they can be changed in so far as the emotional charge can be taken out of the implicit memory- this is referred to as re-consolidation, and is well researched and demonstrated in neuroscience. There may be some spontaneous experiences which aid in reconsolidation/ We do no know that this can happen in certain experimental conditions, and these are replicated in certain psychotherapeutic processes (see Bruce Eckers recent book: Unlocking the Emotional Brain). This therapeutic reconsolidation does require that people revisit the upsetting/traumatic event in vivid detail (in their imaginations, under the guidance of a therapist)- then specific procedures can be undertaken in which the emotional sting of the experience is removed from the memory (there are variations of how this can be done also with implicit memories, and those for which there is no conscious recall due to being laid down in pre-verbal ages). How much can people do this on their own? Eric offers his experience of doing it for himself (on tms help forum), and he is no doubt on his own in this. It can be done very effectively with certain approaches to therapy, e.g brief psychoanalytic approaches as used by Sarno's psychologists, Coherence Therapy, EMDR, some Gestalt practices, some NLP practices etc.

When people are journaling as part of their attempt at a 'book cure' from TMS, they are simply raising their level of awareness about the pertinent issues. This may or may not be therapeutic in terms of TMS. The simple raising of awareness may be sufficient to effect change; or it may simply trigger more distress and reinforce their distress around certain experiences- the latter would be a good indicator of the need to seek professional help. It cannot be taken for granted that revisiting past hurts will by necessity simply reinforce painful neural pathways- it is also a necessary component of the reconsolidation process, whereby the outcome is being able to recall bad events but no longer being emotionally or physiologically aroused when connecting with the memories. This outcome ties in with the treatment of TMS as it is these memories/emotions which are generally what the pain is being created about. Deal with them (as per reconsoldiation) and there will be no further need for our mind/brain to generate pain as a deflection.

 

Thank you, Dr. Alexander. This is very helpful information, and I am going to bookmark it for future use. Just your first sentence "I think we are talking about different populations" is something that many people don't understand - many of them come here looking for "the" TMS cure, as if it's a recipe than can simply be followed step by step. I recently posted that in order to recover from a mind-body disorder, one has to recognize one's behavior, accept it, and then either change the behavior or change their response to the behavior. I believe that the "book cure" comes about when an individual experiences immediate recognition and acceptance and immediately changes their response. Others need more time and effort to achieve that change in response, while still others really need to change their behavior, which is much harder to accomplish.

It always comes down to "everyone is different" but you've explained the why and the how, which I greatly appreciate.

Jan

 

Journaling is something I did a lot of when I was in pain, and still do it occasionally as I feel the need. I found that journaling about past events/traumas, etc. was absolutely worthwhile. After some sessions, or even during writing, events from childhood or teenage years that I had not recalled in many many years did come back to mind so I could FEEL the feelings as I did at the time, and be able to process them out. Wonderful a-ha moments. This was referred to as delayering the artichoke to get to the core issue. I realize my style of journaling is different in that I always look for the morsel of truth or lesson learned, thus ending every session with a positive note. I don't stay stuck in the "this happened to me and that sucks." I do believe these past feelings need to be processed out. Yes, rewriting out story is good, but the feelings that have been suppressed, repressed and buried need acknowledgement. So many of these childhood events are still alive in us currently unless processed out. So i see benefit to revisiting past issues to heal them; by finding the healing statment we are indeed rewiring the brain and the experience. Our entire perspective becomes changed and there are times when even a shift in the body is felt. There are issues I have processed out that bring up NO emotion at all anymore. Something that happened that's part of my history. That is how I know the event, etc. has healed. And it's a wonderful feeling.

I chose to view Dr. Sarno's method as the way for me to get out of bed and back to my normal life. I read stories of how it worked for others (in his books--I did not know of any online help group such as this one at the time). And I got better. And I believed in what I was doing, which I believe is key.

There is also a readiness factor. Though this method may sound appealing to some, they are not (yet) ready or willing to invest the time and work involved to get better. And that's their choice. I also think overanalyzing things can be its own issue in people's recovery.

Best wishes for healing.

 

thanks Jan. I suspect that the level of psychological sophistication seen in participants on this forum is not necessarily 'normal' in the general population (at least in Australia, anyway). This means that we cannot take it for granted that people in the general population have the level of self-awareness required to make use of the TMS approach- some people have it quite naturally, while others have never before considered their psychological life and/or histories. Such people are more likely to need journaling amongst other self-analysis processes so as to allow them to have a degree of awareness so that they can then make sense and use of the TMS approach. If their psychological histories include traumas, then there is the chance, as Rik has suggested, that they could be re-traumatised and further entrenching the distress related neural pathways just by going over and over it. I wouldnt suggest this is a good idea- if journaling brings up substantial distress, people should perhaps see this as evidence of the need for competent psychotherapy. I dont see the value in going over and over old hurts in journaling, nor in psychotherapy. I agree with Rik, in that it could just be further entrenching and strengthening distress neural pathways. But that isnt the point with journaling- it is a strategy for people to raise into awareness issues from their psychological histories, and to see the significance of them in relation to TMS. If people are already aware and see the significance of their psychological history, then perhaps repeated journaling is not what they need. If their distress increases with each time they journal, then perhaps they require competent psychotherapy (by competent, i mean transformative therapy, which results in the reconsolidation process already discussed- not counteracting therapy, which can involve just re-hashing and re-hashing the past hurts as well as attempts to minimise their impacts- the current flavour of the month in psychotherapy for the last couple of decades, CBT, is a very good example of counteractive therapies. It may help for many things, but it aint likely to help with chronic pain).

What i am saying is that i do believe raising into awareness past hurts is useful for people who have not before considered them important in the causation of chronic pain- this is merely a first step, not an end in itself for many people (although, for some it can be, ie. result in eradication of pain). This can then lead on to the possibility of pain reduction for some people, and for others could indicate a need for competent transformative therapy. I do not see it as beneficial to just go over and over past hurts once people are aware of them. If this raised awareness is not enough to shift the pain, as it often is, then perhaps the person needs to engage in transformative therapy- this does involve bringing up the emotional distress and connecting with it as part of the transformative process- other things then need to happen to allow the reconsolidation to occur (resulting in the eradication of the emotional pain associated with the experience).

Do all such people need therapy? I wrote my last post in a hurry and accidentally wrote that such a reconsolidation process does not occur when people do certain procedures on their own- this was a typo- i meant to use Eric's statement (on the tms help forum) as evidence that people can do this for themselves. The level of success may depend on a range of factors, one of which may be the amount of emotional pain associated with it? Eric might like to add more on this as he has apparently done it for himself regularly.

 

What a great thread, from cognitive neurobiology to handwriting analysis and Aristotelean catharsis! Priceless.

Then there is Dr Alexander's explanation of the two populations that inhabit the forum, those who recover with knowledge therapy and those who need more. I have no doubt I have TMS. My "degree of openness to the general proposition" is pretty high. I did have some sessions with a TMS therapist to get me to that point. When I first began I was about 95% sure. By the time I stopped going I had hit the 100% mark but that was about it. Although my symptoms improved, they didn't go away completely. They did start to morph into a whole crop of new symptoms - the ole symptom imperative. I stopped the therapy after a few months because I was feeling pressured to work to a timescale and undertake certain activities such as journalling where I felt great resistance. There was also a heavy focus on CBT techniques which didn't feel right for me at the time. Now I know why.

So I have been pretty stuck until now. I continued to resist journalling. I have also been unable to concentrate on reading over the past year or so. Is this all the result of my brain saying "hey, don't journal or read that article/book. You might find something out and get better." ??? Is this nothing more than a distraction? Perhaps I haven't the "readiness factor" Lori mentions above. I am not entirely sure. I have certainly invested time but have I actually been engaging in the best activities for me?

Over the last week or so I have undertaken a mammoth sewing project. While I am doing this I have been listening to podcasts and audios on my iPad that up until now have been saved for that proverbial rainy day. I have quite the backlog. If nothing else it will top up my knowledge therapy but I suspect it may do more. Last night I made a mental note to go back and listen to some audios again because I had heard some interesting tidbits that I wanted to jot down on paper. Perhaps this could be a breakthrough.

Lianne, my late uncle was a graphologist and I was very dismayed that he refused to analyse my handwriting. Perhaps he know too much about me already and this would influence his findings?

One of my TMS issues has been pain and weakness in my hand, wrist and arm while writing. I can type until the cows come home. It was hand-writing that brought on the symptoms which have improved over the last couple of years to the point where I no longer dread having to pick up a pen. I had originally put all this down to an injury I sustained as a teen. I nearly chopped the tip of my right forefinger off in a car door and underwent minor surgery to re-attach the bit that was cut. I remember having an X-ray after the accident and being told my fingertip was completely crushed. It was all "mush", said the doctor. Following the accident I adapted the way I held my pen to exclude my forefinger and have held my pen in this manner ever since despite all of the nerves in my fingertip having been in full working order for decades.

As a younger child I had deliberately changed my handwriting style when my father told me off for having such poor penmanship. I decided to use print letters instead of script. I still do to this day. I was embarrassed by what my father said years ago and what others have said in latter years about my handwriting even though I have tried hard to make my writing legible. I have even found myself pre-empting any comments by apologising to people in advance of them reading something I had handwritten. When it was so painful that I couldn't write, this allowed me an excuse to avoid it. However at the same time it caused me great stress. Typical TMS stuff.

One of the reasons I couldn't get to grips with journalling - note the way I just phrased that - was because I had read and got it into my head that it was somehow more theraputic to handwrite than type. So a couple of years ago journalling = handwriting = pain/weakness = inability to write = feelings of failure as far as my healing was concerned.