Official Thread Section 2.1 Accepting the Diagnosis

This is the official thread for Section 2.1 of the TMS Recovery Program donated by Alan Gordon of the Pain Psychology Center (PPC). This section is entitled "Accepting the Diagnosis." Neither Alan nor the PPC necessarily endorses this thread or any of the viewpoints presented in it.

Please keep these official threads on topic and put your best thoughts down, as these threads will be read by many people. All posts in this thread should all relate to section 2.1 of the TMS Recovery Program:
http://www.tmswiki.org/ppd/TMS_Recovery_Program#Accepting_the_Diagnosis

In section 2.1, Alan writes the following:

Accepting the Diagnosis

It all starts with acceptance. Accepting the TMS diagnosis (believing that the pain is psychologically caused as opposed to structurally or physically caused) is a very important component of recovery. But as many of you have probably found, that’s easier said than done. Even after reading the books, seeing yourself on every page, and even possibly getting confirmation from a physician, some of you may still be struggling to fully accept (both intellectually and on a gut level) that your pain is generated psychologically.

The following clip is a talk I gave at the 2012 TMS conference. It addresses why it can be so hard to fully accept the TMS diagnosis and what you can do to overcome these barriers. As you watch, see if any of the concepts mentioned apply to you. (Do you have any conditioned responses? What counter-evidence can you compile? Have you had any “exceptions”? Etc.)

(The talk was geared toward psychologists, so feel free to disregard any terms you’re unfamiliar with. Also, don’t be confused by the term PPD, it’s just a fancy way of saying TMS.)

​

See if you can identify your conditioned responses. Do you have pain when you sit? Stand? Type? Walk? Run? Swim? Read a book? Drive your car? Shampoo your hair? Go to the dentist?

The majority of TMS sufferers have at least one physical position or activity that’s linked with their pain. And it’s these conditioned responses that makes acceptance so difficult.

Below is Patricia’s evidence sheet, as discussed in the video above:

Evidence Sheet
Sat for 2 hours watching NCAA basketball tournament with no pain.
Had a therapy session where pain went from 4 out of 10 to 1 out of 10 while sitting the whole time.
Pain gets worse when husband stresses me out.
Was diagnosed with PPD by respected physician.​

Spend some time compiling your own evidence sheet. Have physicians told you that there’s nothing wrong with you? Have there been inconsistencies with your pain? Do you possess the personality traits that are common with TMS? Did a stressful event precede the onset of your symptoms?

These all belong on your evidence sheet. You can add more evidence as you discover it.

Look at this evidence sheet often. Repeat these pieces of evidence to yourself throughout the day (especially when your mind starts injecting doubt).

Accepting the diagnosis is generally an ongoing process, so don’t feel like you have to achieve 100% acceptance before moving on. It’s true, acceptance can lead to a reduction of symptoms, but even truer is that a reduction of symptoms can lead to acceptance.​

The video in this section of the TMS Recovery Program is “Working Toward Acceptance” (of TMS). This may be the hardest for many people to accept because they may have been told by doctors or others that they have a slipped disc or other structural damage. Alan Gordon says this belief may be reinforced by “associated learning.” He cites the case of a client, a 70-year-old woman, who said she was in pain when sitting. She became conditioned to expect pain when she sat even for short periods of time. Other clients said they felt pain when they walked, ran, or just bent down. Pain became a conditioned reflex to certain activities for different people, but Gordon, like Dr. Sarno and others, maintain that the pain is psychological, not structural.

Gordon says, “Acceptance that the symptom is TMS-caused takes the power out of the pain.” For me, at age 82, my severe back and shoulder pain went away about 90 percent after reading Dr. Sarno’s Healing Back Pain and accepting that it was from TMS and not structural. The rest of the pain held on because I withheld about 10 percent in that belief.

I thought that because of my age, I could expect pain from aging bones or muscles or if I lifted something the wrong way, as I had. It took me a while to further accept that as Dr. Sarno said, pains in older people are just “gray hairs of the spine.”

I had discovered repressed emotions going back to my childhood that caused my psychological pain, but needed to believe my remaining pain was not from a normal aging process. It came from not believing 100 percent in TMS. When I finally did that, the pain went away.

 

"Accepting the diagnosis is generally an ongoing process, so don’t feel like you have to achieve 100% acceptance before moving on. It’s true, acceptance can lead to a reduction of symptoms, but even truer is that a reduction of symptoms can lead to acceptance."

I think this statement by Alan Gordon is so true. We tend to emphasize how critical it is to have 100% belief that your pain is caused by TMS but this is really difficult for a lot of people in the beginning. Then having doubt is used as a stumbling block or another way to beat ourselves up for not being able to heal from TMS. I personally believe that the difficulty in accepting the TMS diagnosis is not only a big part of what gives TMS so much power but it is also part of the overall strategy of distraction. Very few people come to explore the possibility of their pain being caused by TMS without already having spent considerable time examining structural and physical causes. It would be rare to find someone who had not seen a doctor about their pain, and most have seen multiples doctors, had numerous tests and treatments. We stumble upon TMS theory because we are still looking for answers, a way out of the pain. And although intuitively it makes sense and we recognize ourselves in so much of what has been written and the personal stories, we cling to our doubt. The structural diagnosis, treatments and explanations have failed us, left us in pain and hopeless and yet we still have so much difficulty believing the cause is TMS. Allan Gordon said something very interesting in this clip, he said that the inability to accept the TMS diagnosis is not caused by resistance as many psychologists believe but by "needing to embrace a reality in which your senses are lying to you". That is at the heart of it, isn't it? We are naturally conditioned to look for a physical cause and effect when it comes to pain. The psychological cause and effect of our pain is much more complex and mysterious. Especially since the pain is just a smoke screen, a mental distraction, from the true cause. Maintaining an evidence sheet and looking for all the cracks and inconsistencies in a structural cause for the pain is an important first step toward acceptance. Also, questioning when you have doubt, just as you might try and become aware of when you are worrying, monitoring symptoms, beating yourself up, being a goodist, and all the other things we typically do too much of when we have TMS, is another good step. Having doubt doesn't really get you anywhere. It is no more a protection than having anxiety. Most of us here know that we are dealing with pain, not something life threatening. We are not deciding whether to forgo chemo and so we should feel confident in embracing the TMS diagnosis. We have everything to gain and only pain to loose.

 

Like education, accepting the diagnosis, to me, is both the beginning and the end of the process of healing with Dr. Sarno's approach. It opens the way in the beginning, and ultimately it is the 'answer' to all symptoms, so that we can not be re-triggered when symptoms come back or are slow to leave. For that to happen, the acceptance has to go very very deep.


And it is not easy, at least for me. Dr. Sopher, the TMS physician wrote me, after seeing my detailed history, that he was sure I had TMS. He went on to say brilliantly that after I had seen 14 doctors who had all these diagnoses based on physical explanations of my pain, that my accepting the TMS diagnosis would not be easy. He said it would not be easy, and at the same time it was critical.


I loved that he held both of these pieces at the same time, to support me. It helped me have compassion for myself that there was only one way forward, acceptance, and that it would take courage and a new way of thinking to develop this.


Somehow, in successfully working through TMS we traverse that gap between “physical” and TMS explanations. It almost seems like Grace or a miracle, spanning that gap.


A huge part of what helped convince me of my TMS diagnosis were the “exceptions,” as expressed by Alan's evidence sheet. I remember the first time I took a “pleasure walk,” only about 80 ft, yet it was the first time I chose to go somewhere, risking pain, just for fun, in about two years. I wanted to sit on a beautiful rock, by a canyon rim. When I did this, setting aside my fears for a moment, and I found very little pain, it blew my mind. The healing began...

 

I was in a pretty desperate state in 2012 with RSI when I stumbled upon Dr Sarno. For me I accepted TMS 100% almost immediately, for several reasons:

· I had been on the medical merry-go-round for 24 years with chronic pain, and had lost faith and interest in the medical and alternative health profession;

· With the help of Sarno’s book “Mindbody prescription” I listed all my conditions, and identified what was going on in my life prior to the onset and reduction of pain, in some cases pinpointing exactly what life events could have triggered my pain;

· I realised I was a typical TMSer - being a worrier, people-pleaser and perfectionist;

· I understood that just as being nervous can induce butterflies and embarrassment a red face, the concept that our bodies also respond to fear, stress, guilt, tension, shame, and so on made sense to me;

· At a very deep level TMS concepts resonated with me, as I realised I had spent the last 25 years running away from my angry Dad who I never connected with, while at the same time missing my Mother terribly, being thousands of miles from home... the combination of the two weighing me down like a ton of lead.

Once I unveiled all of this, I thought about what specific stress might have triggered my RSI. I knew it was the demands of a difficult client at work, so I resolved to return to work with some new boundaries, and start some relaxation exercises to calm my mind.

Feeling a renewed sense of hope I took a quick vacation to see relatives in Perth. After two days in Perth while enjoying some family time I noticed my pain had vanished. That was the moment I realised it was indeed TMS - as was my pain of 24 years.

Acceptance was however challenged in February this year, when I started getting symptoms I hadn’t had before. I started getting severe groin pain. Despite my previous epiphany, here I was with that little nagging voice of doubt. After leaving the doctor’s rooms after a check-up thinking “phew it’s just TMS”, I confess, I still had the Jiminy Criket voice in my head saying “hmmm yeeees but what if she’s WRONG”!

In the early days and weeks of my recent relapse I had to work hard at accepting TMS despite getting the all clear. I have now overcome my recent relapse, but acceptance was a big hurdle I certainly wasn’t expecting, and yet was so essential to my recovery.

TMS will always throw in the curve ball to challenge this belief, so Anne is spot on – acceptance is an ongoing process.

 

I so agree! I recovered so quickly from over 20 years pain, I was working again and doing everything I wanted and then pulled my elbow badly whilst skiing (yes skiing moi! - never thought I'd see the day...) It seemed ok that I would pull a muscle - it was the tow-rope up the side of the kids slope - I was trying to squat down to the size of a 4 year old, not easy for a dumpy lass in her late 40s! It was several weeks before I thought -'hold on a minute' - this might not be a pulled muscle it could be TMS.... I have been TMSing it since with success for a few days, then a flare-up. As I am working (landscaping - so hard physical graft) I keep thinking 'it could be a pulled muscle' then I get real and think 'its TMS' I am at the stage now where it has been more than long enough for it to gradually get better if it was a muscle strain - so it is TMS and I have to accept that and deal with it. I feel that I was doing so well and had done sooo much work on myself - it felt unfair to be 'hit' again. But that is the point - my personality, my past and being faced with traumatic memories from the past, don't just go away. I have to find ways to deal with them and accept the reality of who and what I am. I feel humbled by this, which is probably something else I need to learn...!

 

I have in the past and even sometimes now get rapid-cycling symptoms. I just get wise to one symptom and then another starts and so on to the next and the next. There is always that little bit of doubt that goes something like this "What if this time is really different?" I think this is normal. It is almost like the part of my consciousness that generates TMS is trying to keep this doubt alive. Dealing with the doubt is part of the recovery process.

 

I've been very fortunate that no doctor has ever found a physical explanation for my symptoms. And it is still hard to accept 100% the pain is psychological! Of course I've accepted it intellectually, but there is always that gut feeling that I could be wrong. Physical activity, fatigue, and sitting bring on my pain. So at the end of the day my back is sore. It's nowhere near as bad as it was at first, and for that I'm very thankful. For example, only just earlier I was playing the piano, an act that inevitably brings on back pain within about 10-15 minutes. I know that it is psychological, but I still have to take breaks and relax it or it will just get worse and worse. The longer I sit without taking a break, the longer it takes for my back to recover. So after playing for about half an hour, my back is still very sore. So I'm not sure what the solution is. If it sit longer and try to ignore it, it only gets worse, and I get more discouraged as it takes longer for it to subside. If I understand TMS correctly, my brain is programmed to bring on pain from sitting, even though intellectually I know it is psychological. So, this brings me to the conclusion that I have to reprogram my brain. I guess that is the part I'm having trouble with.

 

I really like how Alan really understands and describes the difficulties in accepting TMS. It is counter intuitive, and tricky.

Being told you must accept TMS 100% or you won't heal can create another pressure to do something perfectly. It's a little like being told not to think about a monkey for the next 15 minutes. The mind doesn't cooperate just because it's told it "must" do something.

I have found the evidence sheet very helpful. Not too long ago I was at a social function sitting across from a physical therapist. I realized that if I had any thought about going back to physical therapy (which I don't!!), it would sound crazy to describe the ever changing and moving symptoms I get. Which symptom would he treat? And on the next day it would move or change.

I do wonder if I fall into the category of Alan's older patient who understands intellectually but maybe doesn't accept on a deeper level.

I guess where I feel frustrated these days is that I've followed directions to the best of my ability and still have symptoms cycling through, even though overall there has been progress. I do think the expectation for quick healing that did occur for many of Dr. Sarno's patients, and for some here on the forum, leads me to compare myself and feel like I'm not doing something right.

If this were anything else, like learning to play music, or even traditional psychotherapy trying to do it quickly wouldn't be a goal, so I'm just extending compassion to myself as much as possible, and trusting that this is a healing process, and it's okay to be a slow healer.

 

I have to say that when I read Sarno's book Healing Back Pain, I saw myself on many of the pages. My thought was, "How does he know so much about me?!" I had no trouble accepting the diagnosis because I had tried a myriad of doctors, techniques, and procedures, and nothing eliminated the knife-like pain in my lower back.

When TMS struck me a second time, I needed a little more convincing. I find the evidence sheet to be helpful because 1. I'm a list-maker, and 2. I'm a scientist and tend to look at things analytically. It helps me to see things spelled out.

Accepting the diagnosis brought me incredible freedom. I feel bad that my subconscious responds to stress in unhealthy ways, but I choose to focus on the fact that now I have the tools to live in a healthy manner. Working on TMS is not easy, but it is simple. It's also a minute-by-minute choice to "live clean" with regard to emotions.

 

I have seen many come through the forums and report that they once did heal from their symptoms after reading Dr Sarno's books but they were battling a new symptom. They weren't quite as successful with healing this time around. Cue some pretty major doubt. I endured a few short term bouts of sciatica but it wasn't until I was hit hard with 'please, shoot me now' pain that I had to start again at the beginning and see the process through. I am still working through that process like a lot of you. I sometimes wonder if my unconscious mind is still undecided even though my conscious mind is totally on board with it all. Recently I have spoken to quite a few people with pain syndromes and I am well aware of their backgrounds, personality traits and current stressors. So it isn't just my own experiences that I load onto my evidence sheet. I include the experiences of my close family and friends. It was uncanny and very sad how many of my nearest and dearest are suffering.

 

After posting yesterday I took myself in hand and started a zero tolerance on my elbow pain. It worked remarkably well and I didn't have pain in the night or even this morning when doing a lot of shovelling in the garden. But - later I got pain - when doing the washing up. I knew that wasn't a pain-causing activity and then 'lightbulb' moment! I realised that I was musing on a past incident that hurt me badly- while I was washing up. I hadn't really noticed what I was thinking. So it was the emotional pain from that incident and my still clinging to it and giving it time in my head that caused the pain. The answer was there all along - I had used a Loiuise Hay meditation cd in the morning before I got up - and the main thrust of it was to let go of the past and embrace the moment! So I did the complete opposite within hours of the meditation! A timely lesson to me - that REPETITION -play that cd again and again - will help, and BLOOMIN' WELL LISTEN! Oh and it helped with that humbling stuff too...

 

What do you mean?

 

Even with the benefit of medical proof that a dramatic change in symptoms, from bad to unbearable, were not caused by a change in my disc, still in the same place before the change, accepting the diagnosis was one of the most challenging parts of the process for me. Like several others, acceptance for me had more than one stage or factor that pushed it to the point where I was able to move forward with the process.

The first was an acceptance that was based on logic and real medical evidence mentioned abore. A real blessing that not everyone will necessarily experience.

The second key to my acceptance was reading Dr. Hanscomb and Dr Schubiner's books. Real medical doctors. Real experience, real data. I come from a medical family and am analytical by nature. These were key contributors.

These only took me so far. The third key was an unexpected benefit of trying hard to deepen my conviction in the diagnosis and being accepting of it. I started telling people that my pain was psychosomatic. I was very nervous about how people would respond. Would they think less of me? Think I was crazy or weak? I did this anyway because if you don't say it to someone else then its just an idea in your head. For the most part responses I got were something something like "I totally believe stress could do that." And in a few cases people asked, "Do you know about Dr. Sarno?" or said, "I had it too." I even have one friend who didn't know anything about TMS but figured out on his own that his chronic back pain was caused by stressed and taught himself to get rid of it. Knowing that people I had known for years actually had recovered from TMS, in some cases with more "abnormalities" in their spine than me helped me feel not crazy, alone or weak. I felt, human. Knowing other had done it gave me the strength to know that I could to.

 

I am very touched to read the comments. In a way, we are in a battle for clarity. And for each of our personalities, we must persevere and attune to what works for ourselves, including accepting that our progress is not perfect. Thank you all for the heartfelt inquiry.

 

"After posting yesterday I took myself in hand and started a zero tolerance on my elbow pain."

"What do you mean?"
I mean that every time I feel any pain in my elbow I say to myself (out loud unless other people are about!) 'This is not physical pain. This is TMS, it is a lack of oxygen in my muscles caused by my autonomic system in order to distract myself from repressing emotion or from some stress of my personality traits." It is long-winded and I sometimes shorten it to "TMS demon - begone!" But I do it for EVERY pain, or twinge I get. It works...!

 

Chickenbone:

Awesome, glad to hear. I have tried similar tactics myself. Sadly, they haven't been as affective. I don't know if that means I'm strong minded or weak minded, lol. Maybe it means I still have things psychologically to work out. For example, I still have depression because my psychological issues that brought on the depression, ie. low self esteem, have not been resolved. I know Dr. Sarno says that merely acknowledging the repressed emotions is enough, but he also says that a certain percentage will need psychotherapy. So, why would they need psychotherapy? Obviously to resolve the issues that are causing the symptoms, be it pain/depression/etc. So perhaps I'm part of the group that needs therapy. I have gone to a good psychologist in my area, but all he knows is cognitive behavior therpay, and while this helps to an extent, Dr Sarno, and others, have stressed that Freudian insight therapy approach is what is truly needed. To my luck, one of the TMS psychologists on my site is within 30 minutes of me. But she charges $175 and hour and doesn't take insurance. I can't afford that; that's more than half my paycheck. This is pretty upsetting.

 

It is annoying that therapy can be so expensive, it's a shame it isn't like tax and go on a sliding scale! But don't give up - if you think the Freudian insight therapy is what you need - get books on it, read as much as you can. (I hope in the US you have free libraries like in the UK?) look online and find any info/resources you can. There may be centres that are training therapists and need 'guinea pigs' - I know it isn';t ideal, but we have work with what we got... I have tried a few psychotherapists over the years and found some help, like you, with CBT, but I haven't actually healed any of the childhood wounds with it. I still feel - even when I have got rid of pain - that I still have stuff to process/solve - there are some situations that just creep back at me and stress me out. I know that will cause the pain to return. I don't want to live my life constantly having to deal with this stuff - I want freedom and peace of mind! So I too am still looking for how to solve those last situations that have stuck with me. I saw a post on here about the Presence Process so am going to try that. I know there will be a solution - I have managed to cure myself from SO much stress from childhood to now and my life is incomparably different because of it. So it is just dealing with those stubborn bits that remain....

 

For many people, accepting on a gut level that the pain is psychologically caused is essentially overcoming an addiction. Many TMS sufferers literally become addicted to the fear generated by the pain. Even though it doesn't feel good consciously, entering a fight or flight state releases endorphins that light up the pleasure center of the brain.

This is one of the primary reasons that we're so prone to thinking physically. It scares the hell out of us, and there's actually a neurological reward for that fear.

Sometimes recognizing what our brains are up to can help us circumvent this pattern.

You wake up one day and your left calf is hurting. You start racking your brain for instances the day before where you could have pulled a muscle. You start obsessing, "is this real or is this TMS?"

This is where you can intervene. "What a minute! I know what my brain is up to. It's using the pain to try and scare me because it wants that endorphin payoff. I know what you're doing brain, and I know why you're doing it. Do your worst, I'm not going to buy into this fear and reinforce you..."

 

I think Alan might also agree that holding onto your pain psychologically, while consciously noxious, serves an ulterior TMS motive, which is to say that feeling bad almost feels good (I think this is what he is saying in the above post). It becomes a defense mechanism, which is exactly what your deeper mind wants to do instead of "pulling the curtain back." It wouldn't be a good defense mechanism, would it, if it couldn't cause you to reject the diagnosis out of hand? Defense mechanisms operate on your own un-awareness of them to protect you from insights your deeper mind doesn't think you can handle

What to do about that, I think, depends upon the individual. Some people can expose the sham by journalling. Some of us need a little extra help.