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Renee,

As I said in my post above, after I overcame my low back pain I would get episodes of what Sarno calls the symptom imperative. I was not bad at dealing with those by thinking psychologically, but I wanted to get better. So I saw a physician trained by Sarno. He never mentioned ISTDP, but having read Schubiner’s Unlearned Your Pain, I knew that is what he was talking about.

That motivated me to read nearly all of the books on ISTDP written for clinicians. ISTDP has a unique lingo that is hard to penetrate. (I'm retired and had the time to learn the lingo.) There is a book on ISTDP written for lay people by a Norwegian clinician: Kristian S. Nibe, Reconnect to Your Core. It is obvious that English is not Nibe’s native language and that he did not have an editor proficient in English. Nonetheless, the book is an accessible explanation of ISTDP. Nibe gives specific advice on uncovering repressed emotions by yourself, with no therapist. The book is on Amazon.

In my post above, I quoted a passage from Healing Back Pain. Here is the same passage but with a sentence I omitted earlier that is now italicized: "I do that [repress anger] a lot. I have learned that heartburn means that I’m angry about something and don’t know it. So I think about what might be causing the condition, and when I come up with the answer the heartburn disappears. It is remarkable how well buried the anger usually is. Generally for me it is something about which I am annoyed but have no idea how much it has angered me. Sometimes it is something that is so loaded emotionally, I don’t come up with the answer for a long time."

Way back when I was suffering from back pain, it occurred to me after reading the italicized sentence that when I was having pain I should ask myself if I was “annoyed” about something. That would be the starting point to help me get at what I was unconsciously angry about. It worked. After a few times of doing that, I was permanently free of low back pain. Years later I would learn about the ISTDP concept of cover words. Cover words are words we use to cover up, i.e., defend against experiencing, a more intense unconscious emotion. Cover words for anger include annoyed, irritated, frustrated, aggravated. ISTDP regards cover words as an undesirable defense mechanism. I regard then as a helpful clue to what is going on unconsciously. Once I realize I am annoyed, frustrated, etc., then I can dig deeper.

With regard to digging deeper, my earlier post referred to Sarno's gastroesophageal reflux while on a long trip with his wife. To go into more detail, Sarno and his wife realized the distress was psychosomatic and tried to figure out what was making him unconsciously angry. They came up with several possibilities: (a) he no longer liked to travel because of its inevitable inconveniences and discomforts, (b) he found some places they visited disagreeable, (c) he wanted to be home working on a book, and (d) the trip was too long for him. But Sarno wrote: "We obviously didn’t hit on the right answer, because my symptoms continued unabated for the entire trip. It wasn’t until we got home that I realized what had been going on. I had promised the long trip to my wife, who loves to travel. I was being a good guy. I was unconsciously furious for having to do something I really didn’t want to do. My psyche wouldn’t permit me to be consciously furious at my wife, and neither would my reasonable self—so to be absolutely sure the rage remained unconscious, the brain dished up the severe gastrointestinal symptoms."

In short, Sarno’s goodism was the source of his symptoms. To be a good husband, he accompanied his wife on the trip. But unconsciously he was angry at her about having to go on the trip.

To grasp more fully what was going on with Sarno's long trip, it is useful to refer to a passage in his The Mindbody Prescription: “Bear in mind, we repress anger that violates our image of ourselves. . . . [A]nger you are aware of may be what is known as displaced anger. That is, you become overtly angry at something relatively unimportant, like a traffic tie-up or poor service in a restaurant, instead of at your spouse or a parent, because the latter is simply not allowed by your psyche.” Unlike anger at a traffic tie-up or poor restaurant service, anger at a person with whom we have an important and close relationship—such as a spouse, parent, or child—is important anger. We TMS sufferers repress it because it violates our image of ourselves and thus is not allowed by our psyche.

As I see it, Sarno’s unsuccessful initial efforts in items (a)-(d) above to figure out the cause of his gastric distress are instances of displaced anger. Some or all of the items might well have been true, but they were no more important than a traffic tie-up or poor restaurant service. He did not hit on the right answer until he focused on his relationship with his wife. If even a master of thinking psychologically like Sarno can be side-tracked by displaced anger, as he was while on the trip, that underscores the importance of focusing on one’s important and close relationships when trying to figure out the cause of a TMS episode. That is why I said in my post above that thinking psychologically takes hard work and persistence. Our psyches do not want us to hit on the answer.