Brilliant piece,
@Duggit — I always look forward to reading your postings.
I understand the distinction you're making between uncovering repressed emotions and inferring a nondeclarative conditioned response, and I'm not questioning that distinction. I'm wondering about something a little narrower:
does the conditioning necessarily have to begin with pain being experienced while sitting?
Could the initial association instead be between sitting and a particular emotional or physiological state—say, prolonged stress, threat, frustration, or emotional conflict—with pain becoming part of the response later?
I ask because of my own experience. When I first started a very stressful job, my office chair was completely comfortable. I actually liked it enough that I considered buying one for home. But I was sitting in that chair while dealing with an increasingly stressful environment involving the public, office politics, and backstabbing. After a few months, that same chair had become unbearably uncomfortable, and eventually sitting in general became associated with considerable discomfort and pain.
I also remember when my back pain first came on away from that office chair. I was sitting having dinner at a restaurant with someone I considered a friend, but was increasingly beginning to realise didn't really respect me. At the time, I didn't make any connection between those feelings and the pain; I simply assumed it was the chair I was sitting on that wasn't very ergonomic.
This is partly why I wonder whether Schubiner's discussion of triggers might leave open a slightly different sequence from the particular example Sarno gives. Schubiner describes stressful events and emotional states as helping to activate or reinforce the relevant pathways, and then discusses various situations, movements, places and other cues becoming conditioned triggers for symptoms. I'm not sure he specifically proposes the sequence I'm describing, but it seems to leave the question open.
Perhaps the sequence could potentially be something like:
sitting + repeated stress/threat → association between sitting and that state → sitting becomes a conditioned cue → pain/discomfort subsequently becomes part of the response.
That would be a little different from Sarno's example, where pain occurs while sitting and sitting subsequently becomes conditioned as a cue for pain. But perhaps the two aren't mutually exclusive possibilities.
So my narrower question is really whether, within Sarno's model, the
thing initially being conditioned necessarily has to be pain—or whether an emotionally or physiologically threatening context could itself become associated with the activity first, with the pain response developing subsequently.
I'm not presenting my own experience as proof of the mechanism, just as something that made me wonder whether the emotional context and the conditioning process might sometimes interact in that direction. It seems to me that this could fit reasonably well with the broader way Schubiner talks about emotional processes and conditioned triggers, even if he doesn't specifically describe this particular sequence.