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Somatization

Discussion in 'General Discussion Subforum' started by eskimoeskimo, Jul 9, 2018.

  1. eskimoeskimo

    eskimoeskimo Well known member

    I’m a little confused. It seems like “Somatization” is TMS, but it’s a relatively mainstream diagnosis in the DSM manual. Why all the controversy about TMS then? Could it be that we are just suffering from somatization, but never encountered the right psychologist or doctor who recognized that diagnosis and so instead ended up in this fringe TMS world? Maybe we are the patients who were so focused on physical pain that we went to pain doctors and got physical diagnoses, but if we had gone to therapists we would have received this relatively mainstream diagnosis “Somatization” and avoided all the difficulties of subscribing to a fringe theory? In TMS world we hear constantly about how physical pain being psychologically caused is not a mainstream idea, and Sarno was ostracized by the medical community, but Somatization is a diagnosis right there in the manual sitting on every therapist’s/psychiatrist’s desk. I’m so confused; is it mainstream or not?
     
  2. Time2be

    Time2be Well known member

    https://en.m.wikipedia.org/wiki/Somatization_disorder (Somatization disorder - Wikipedia)

    Here an introduction to somatization, Wikipedia is not always reliable but this one seems ok to me. The diagnostic codes used in DSM and ICD are only descriptive. There is no theory about the nature of the diseases behind that. The diagnosis can be used by different medical and psychological subdisciplines. A psychiatrist will surely use somatoform disorder as an diagnosis. An gynecologist will not. In my book, Dr. Sarno developed a theory from his practice. He was well aware of the psychoanalytic tradition and psychiatric approaches. But he felt the need to use a different name and to use a particular approach for treatment. In a way you are right that TMS is not a esoteric diagnosis. But in reality psychosomatic diseases are not well accepted in the medical system. Simply because a comprehensive theory of the psyche-soma entity is lacking.
     
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  3. eskimoeskimo

    eskimoeskimo Well known member

    I do wonder if that was prudent or not. Might it have been better to just advocate for the legitimacy of a somatization diagnosis, rather than invent a whole new and separate modality? I find it particularly strange that in all the TMS literature I've read, somatization is not even mentioned. The TMS literature really strongly gives the impression that this is a theory well outside the mainstream, but I have yet to meet a therapist, psychiatrist, or GP who wasn't at least open to - if not downright convinced of - the idea that psychological distress can cause physical symptoms, despite having never heard of TMS (maybe others have had a different experience).

    You mentioned that the DSM is only descriptive, and doesn't explain the mechanisms behind a diagnosis. But I think at this stage we don't really understand the mechanisms behind any mental health diagnoses yet - even 'simpler' diagnoses like anxiety or major depression. Also, it seems to me Sarno's explanation of the mechanism behind TMS is the least tenable component of his theory ... the repressed emotions and oxygen deprivation stuff doesn't even seem to be widely accepted in the TMS community any more; Alan Gordon and Howard Schubiner really deemphasize the freudian repressed emotions line, and essentially replace oxygen deprivation with learned neural pathways; basically, at this point, who the hell knows what the mechanism is. As you say, a comprehensive theory of the mind-body connection is lacking. I do think it's the Freudian repressed emotions stuff in Sarno that throws up a lot of red flags for layman and medical expert alike.

    This may all seem like nitpicking, but for me it's an important consideration. The idea that TMS is a fringe theory has made it so much harder for me to believe in the diagnosis, and I'm sure this has been the case for many other people. I'm always worried that I'm just trying to convince myself that some hippie-dippie, alternative pain theory is true just because I want someone to tell me that the pain can stop. But maybe the idea that psychological distress can cause chronic physical symptoms is not so fringe as the TMS literature indicates; maybe there's just another parallel term(s) that's more palatable in the mainstream for the same phenomenon.
     
  4. Time2be

    Time2be Well known member

    Hi, you have serious considerations here. This is how I see this: traditional medicine follows the naturalistic paradigm that hold that only bottom up processes happen. That means that emotions are the result of cells, neural pathways, chemical processes etc. A top down process where consciousness or emotions (understood in a very broad sense) initiate something happening on the material level is not possible in this paradigm. That’s called causal closure. But neuroscientists like Antonio Damasio give us an understanding of the interwinement between emotions and the body and how consciousness and a self is the result of these interactions within the body and in interaction with the environment. Here emotions are directly coupled with the body and consciousness and the self can change bodily reactions.
    I think Sarno tried to give a hypothesis for the back pain his patients were dealing with. Oxygen deprivation might play a role in some of the TMS cases (muscle tension causes oxygen deprivation) but I also think this is not the general mechanism. In this sense Alan Gordon and Howard Schubiner are much more on the forefront of neuroscience research. The theory they are working on is not fringe at all.

    On the background of the research of Damasio and others I can’t see why there shouldn’t be a process where emotions cause bodily reactions and that the brain is the control and steering mechanism. It seems difficult to understand for the medical establishment but I know many doctors who have a sort of provisional model of psychosomatics because this is what they see in their patients. And I also need to mention that in Europe the psychoanalytic tradition of looking at disease is much more accepted.

    The big question for the future is whether the naturalistic paradigm in its reductive way will win and we will try to simply manipulate the brain with medicine or other treatments. Then the approach that TMS is part of who you are, your self and identity, will be not necessary anymore. I doubt that this will be successful. Philosophically speaking our self understanding is bound to being a self and not just a mental entity that can be manipulated. In this sense I find it liberating that it is my responsibility and free will to make my life better.

    I have absolutely no problem with the fact that TMS is not theorized in a fully satisfying way. Simply because other more naturalistic explanation are also not able to fully account for many medical conditions either. I looked into the history of defining Interstitial Cystitis/Bladder Pain Syndrome and it is filled with hypothized emtities for which no empirical evidence exists. Some urologists now recognize this. But the amount of women that had been diagnosed wrongly with is tremendous.

    I don’t know if this is a useful answer for you. When I stopped doubting the diagnosis I almost immediately got better. Not 100% perfect, but much better, let’s say 85%. And now I really see the patterns and feel that I am much more in control of things.

    So, yes, one could use somatization or another term from DSM. But I think that Sarno, Schubiner and the others don’t want to turn all patients with pain into psychiatric cases. Therefore a new diagnosis that could be part of general medicine.
     
  5. EileenS

    EileenS Well known member

    Hi Eskimoeskimo,
    I am not familiar with the term 'somatization' at all, but read the wiki entry that Time2be posted. It wouldn't have been enough for Sarno to just advocate for legitimacy of the somatization diagnosis because there are many of us who have diagnosis from doctors of a real physical problem, but have still gotten better with Sarno's work. I have several things in my neck that showed up on MRI's and nerve damage in my neck from an operation. From reading Sarno's books and Steve O's book and being on this website, I know that the MRI was only showing normal aging wear and tear and people with more stuff on their MRI's have also gotten 100% better. There are many people in this world who have chronic pain with similar or more minor issues on their MRI's that would never consider entertaining the idea that their emotions are causing or even contributing to their pain. They would definitely not consider somatization disorder.

    You're right about the oxygen dep, who really cares at this point? I think Sarno talks about it as his theory because, a) people always ask what the cause is, and b) it reminds people that nothing serious is going on. There is a lot of information about learned neural pathways, but when Sarno wrote his book, neuroscience and this sort of knowledge was in it's early stages. As well, learned neural pathways doesn't mean there's no mild oxygen deprivation going on.
    Regarding repressed emotions, I did Howard Schubiner's workbook program and Alan Gordon's program on this site, and neither one of them deemphasize repressed emotions. I don't understand what you mean about repressed emotions being deemphasized.

    Eskimoeskimo, I think your last paragraph is really the issue. I know from your previous posts that you have not really made progress. I also can empathize with this paragraph because people who recover from reading Sarno's books or take only a few months sound like as you described. It was what I initially struggled with. They sound very much like (I apologize if I offend anyone here) people who have found religion and think everything in the bible is actually true and everyone else just needs to join in and BELIEVE. I'm too much of a realist. However, you don't have to take the TMS information like it's hippie-dippie, new age, or a new religion. Take from the TMS theories and rules what your mind can consider as true and ignore the rest (for now). That's what I did. The rule I break is I used other healing modalities to get better, but I never would have gotten better without the TMS knowledge. For me, the TMS theory is my foundation and I'm still learning after 3 years to recognize when something isn't a physical defect and I'm internalizing my emotions.

    If you think that you have somatization disorder, then see a psychologist who can help you with that. We all know ourselves best.
     
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  6. Time2be

    Time2be Well known member

    Thanks Eileen! That’s a very important point make about the physical findings. I have overlooked thIs. Most patients have some sort of ‘damage’ that doctors say is the cause for the pain. But often it is just guesswork and because no other reason could be found it must be the disc, the steniosis etc. I give you an example from Interstitial Cystitis. In the 80s patients were only diagnosed with IC if they had some sort of damage visible in the bladder. Then, during the 90s urologists included all patients with bladder symptoms under the diagnosis IC and in the beginning of 2000 they decided to call it bladder pain syndrome, now including a huge amount of very diverse patient groups. Did they have any evidence for what is wrong with these patients? No, only hypotheses about defect bladder lining etc. And then all patients are admitted to the same treatment, with little success. Some of the treatments count not better than placebo. There is a change now. But this story is a very good example what happens if you stick to only one explanation: that there must be a physical and only a physical cause for the pain. One could of course say that the brain is also physical, this is true. But things are more complex, emotions, body, brain are in interconnection.
     
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  7. Time2be

    Time2be Well known member

    I want to apologize for my lecturing ... this is a topic I am so very much interested in ... that’s my excuse ...
     
  8. plum

    plum Beloved Grand Eagle

    Please don't apologise. Your contribution to this thread is fantastic. It really helps people, especially long term sufferers and lurkers, to see the theories get a good shakedown and clarification. I also love neuroscience and read it for pleasure. It's utterly fascinating to me and I really enjoy considered, informative posts like yours.

    Plum x
     
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  9. EileenS

    EileenS Well known member

    As Plum says, no apology needed since I'm assuming your lecture was not for me but for the long term sufferers and lurkers since I am someone who has gotten all better with Sarno et al's work. (My other therapies, after learning about Sarno's work, was to sooth the mind and body. Who doesn't love a massage?)
     
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  10. Ellen

    Ellen Beloved Grand Eagle

    I learned about TMS 5 years ago now. I've read numerous books and research articles, watched many videos, listened to many podcasts, and read through this wiki backwards and forwards on the topic. Yet, I still don't understand the mechanisms behind TMS, and yes, sometimes this frustrates me. But you know what? I recovered anyway. My quality of life, physical and mental health, and spiritual well being is vastly improved. I'm not sure which of the different techniques and approaches I've used actually led to my recovery from TMS, but here I am, doing my best to encourage and support others as they try to find what works for them.

    I'm not a research scientist and my life is not a research project. I'm curious about TMS theory, and would like to understand it better. But not understanding it hasn't held me back from trying different approaches. If I feel better after doing something, and am able to maintain that better state over a reasonable period of time, than I assume it worked beyond just the placebo effect. I'm happy to share what worked for me with others in case it just may help them.

    This is more than satisfactory to me. As I've said many times on this Forum, my recovery still seems like a miracle. Maybe that is the best explanation. I'm filled with gratitude.
     
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  11. EileenS

    EileenS Well known member

    Ellen,
    You have said exactly what I would say for myself. Well put. Nothing more to add. Thank you.
     
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  12. eskimoeskimo

    eskimoeskimo Well known member

    This whole conversation is interesting. Thanks everyone.

    Ellen, I guess I’m just kind of in the opposite position. I’ve been attempting TMS treatment for 8 years, with absolutely zero success. If it works, the details of why it works don’t matter so much. I get that. But, as it hasn’t worked for me, the details - to whatever extent they are decipherable at this stage - might help clarify why. Then again, maybe this myopia just keeps me stuck. Who knows? I’m lost.
     
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  13. Ellen

    Ellen Beloved Grand Eagle

    I get this, dear Eskimo. I hope you know how much I wish recovery for you. Steven Ozanich has written eloquently on this Forum about his belief that constant searching for a theory of TMS that contains no contradictions or ambiguity is a manifestation of the TMS personality. I experienced this at first. I wanted it to be perfectly clear and straight forward. Just tell me what works and why it works and I'll happily buy in. But I had to move past that and proceed on faith and hope. Not my comfort zone, believe me.

    I think we've had this conversation before. I'm sorry that you are still experiencing pain. I'm glad you keep coming here and posting your thoughts and concerns. I still have hope that you will post a Success Story someday.

    I know I'm one of the lucky ones. I wish this for you and all the lovely people who come to this Forum.
     
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  14. Time2be

    Time2be Well known member

    But I had to move past that and proceed on faith and hope. Not my comfort zone, believe me.
    [/QUOTE]
    LOL, exactly!! Mine neither - but, that turned out to be the only way that helped me out of this labyrinth of pain, doubt, fear, self-loathing etc.!
    The Danish philosopher Soeren Kierkegaard says: "To dare is to lose one's footing momentarily. Not to dare is to lose oneself!"
     
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  15. eskimoeskimo

    eskimoeskimo Well known member

    [/QUOTE]

    This really resonated with me as well, I forgot to mention. It is as if self-scrutinizing TMS, and always finding the symptoms there, has become my comfort zone.

    On a related note, it made a lot of sense to see that Alan emphasized hyper-vigilance as a strong factor in the development of TMS. I have such a strong urge to examine TMS, to check what it's doing, like holding in my hand and looking at every angle. And I know that I've always been hyper-vigilant, about everything. The past year suddenly I've developed this concern about clothes moths getting to my woolens, despite having never once seen a clothes moth in my apartment, nor having discovered any damage to my clothes. A normal person might take a few precautions, but I've waged a completely over the top war on moths. I've checked my clothes over and over again, checked the screens in my windows over and over again, gone through boxes of moth balls, shined a flashlight in the dark corners of my closets every day ... Jeeze, this even sounds crazy to me. I have all sorts of examples of things like this going back long before pain. I just need to check things over and over again, to make sure they're right, and no amount of checking ever resolves my anxiety. So yea, vigilance. I know I do this with my neck.

    A "labyrinth of pain, doubt, fear, self-loathing" is precisely how I would describe it as well. I'm 'glad' that you mentioned self-loathing in there (though of course not glad you experienced it), because more and more I'm realizing how prominent this is for me. The constant self-loathing is searing. And I also notice a dramatic drop off in pain symptoms if somehow the stars align and I feel somehow more confident in the midst of a conversation.
     
  16. Time2be

    Time2be Well known member

    What you describe Eskimoeskimo is obsesssive behavior. And the reason is usually fear of not being in control. I also projected inner insecurity on the outer world. It’s a sign of a deep insecurity and a wish to avoid anxiety. I listened a lot to Claire Weekes and used her technique to walk through anxiety, not to avoid it and act out. It worked. Took me about half a year. Whenever I feel anxiety I use the technique. I am not afraid of anxiety anymore and when reached that, anxiety has lost its threat. But you really need to do it! It takes some discipline. If you fail, don’t bother. Next time you try again!
     
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  17. plum

    plum Beloved Grand Eagle

    My dear eskimo, this is a brave post and I am half surprised, half not surprised that it hasn't garnered more responses. I think this maybe because it is too close to the bone and this can be unnerving, however this is the very vulnerability that I find so human, so beautiful and so truly redemptive.

    God alone knows I have lost myself in the examination of my tms-inducing minutiae. I pass through phases when I am seduced by it again, which I follow with a searing rejection. These are the inner conflicts from which tms is born. Mostly I rest in a peaceful state of ambivalence with them but every now and then something, someone sparks against me and the battle, the self-loathing, the whole shebang is as visceral and cruel as it ever was.

    This is perplexing but it does dramatically highlight for me the self-destructive chinks through which tms insinuates itself. This madness thrives on self-criticism and whether it has us hunting for moths or engaging in equally bizarre or fruitless ventures (of which everyone here can stake a claim), it is nothing more than the machinery of perfection. We can call it vigilence, anxiety, control, pain, that huge catalogue of woes we all know so well but it remains the same; brutal, uncompromising, unkind, crushing and indefatigable.

    For me these emotional storms come less and less. They are triggered by stress, mostly malevolent stress directed our way by my in laws, but also by those rare people who are able to stoke dreams and desires that we all do our best to lay peacefully to rest. Unmet dreams, especially those we vested huge belief and energy into have their own cycles of recurrance and poignancy as we age, and they possess an uncanny ability to appear as real and vital as they once did. It is these losses, heartbreaks and betrayals that derail us and generate the various coping strategies that eventually devolve into tms.

    The way out is to begin to recognise that our lives possess seasons and that we honour ourselves and others by living each season well, by lending a tender appreciation to the age, the time, the season we are living in right now. I am in my late Summer (middle-age), haunted sometimes by the loss of Spring yet enchanted by the beauty of the coming Autumn. TMS comes when I unmoor from my place in Nature and want life to be anything that it is not (comparison being the thief of joy). It recedes when I remember there is a time and a season for everything. No more fighting, only flowing. That is the 'somehow' behind the stars that align, they are in harmony, letting life be lived like a poem.

    I've said before that you are an artistic soul. You just need to care for this sensitive part of yourself and no longer let it lead you down bruising avenues of pain and torment. The how is different for each of us, but essentially it entails seeing those moments of ease and embracing them, while denying the moments of madness. And we keep doing this until it becomes ingrained as the new way of being.
     
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  18. westb

    westb Peer Supporter

    @eskimoeskimo thank you for being so honest. Hyper-vigilance haunts me. I'm now retired but I used to have a job where I had to plan events, large and small and I was pretty good at it. Now checking the details, timings etc is a good idea, but I carried it to the extreme. I would print out a copy of the particular timetable at work and take it home with me to study the details time after time (not that I could do anything about anything at home). I would lose sleep and live in increasing and acute anxiety (tight chest, difficulty breathing etc etc) as the date of the event drew nearer. 99 times out of 100 of course everything went smoothly and if it didn't it generally wasn't down to anything I had done. Year later as I look back I can almost taste the sheer terror - this is not too strong a word - and anxiety of the perfectionism and fear of letting others down. Like you, this was before TMS symptoms set in.

    You are not alone here. Many of us are alongside you and understand. This is a journey we are are all on that requires us to dig deep. But I have faith (that word again) that the rewards will be there as well. Some days I even get a sense of what those rewards might feel like.
     
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  19. Ellen

    Ellen Beloved Grand Eagle

    I remember Steven Ozanich writing about how OCD is TMS. Seems like both involve the brain's negativity bias going into overdrive. In OCD the brain scans the environment for something wrong, in TMS the brain scans the body for something wrong, in Social Phobia the brain scans relationships for something wrong. Combine this overactive negativity bias with a tendency to catastrophize about what it finds, and well.....you have TMS, OCD, and Social Phobia.
     
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  20. Lainey

    Lainey Well known member

    Amen to that. All of this thread has been good reading and thought provoking.
    Lainey
     

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