From what I read on Wikipedia (don't knock it; it's not always wrong), outcome independence has become a mainstay of self-improvement psychology. I see that psychologist Alan Gordon recommends it for dealing with TMS. He explains it with an example from a movie where a student with a crush on a girl finally works up the courage to ask her out. She says no, and her boyfriend punches him in the eye. But he is really happy because he had the courage to ask. Perhaps not coincidentally, outcome independence is reportedly part of the repertoire of the PUA (pick-up artist) who boldly asks out every woman he sees in a bar or at a social gathering. I guess the theory is that if you don't care whether they say no, you will have the courage to ask and won't tense up and get tongue tied. Perhaps the theory as to TMS is that if you don't care if you are in pain, you won't get the muscle tension that causes TMS. I have no experience with that because I don't try to practice outcome independence. I have my doubts about it as a way to overcome TMS based on recent neuroscience research I have read, but that is not the point I want to make here.
The point I want to make is that I don't think Sarno teaches outcome independence as a way to treat TMS. Consider, for example, the twelve Daily Reminders on page 82 of
Healing Back Pain. Reminders 6 through 9 are:
- Since my back is basically normal there is nothing to fear.
- Therefore, physical activity is not dangerous.
- And I must resume all normal physical activity.
- I will not be concerned or intimidated by the pain.
In short, don't fear physical activity and don't fear pain from resuming normal physical activity. But that is far different from not caring whether you have TMS pain. The whole point of Sarno's daily reminders is to prevent TMS pain from occurring and to stop it if it does occur. When Sarno says not to fear that physical activity will result in TMS pain, I think he is referring mainly to conditioning--which leads me to my next point.
While Sarno writes at length about the role of repressed emotions in causing TMS pain, he also recognizes the important role of conditioning. For example, on pages 21-23 of
Healing Back Pain, he illustrates conditioning with the famous example of Pavlov's dogs that were conditioned to associate the sound of a bell with being fed, so whenever he rang the bell they began to salivate. Sarno goes on to explain that if a person has (mis)learned to associate sitting in a car seat or bending over at the waist with back pain, she will get back pain whenever she sits in a car seat or bends at the waist. Sarno says on page 22: "One cannot overemphasize the importance of conditioning in TMS for it explains many of the reactions that patients don't understand." Similarly, he writes in
The Divided Mind at page 127: "One of the prime characteristics of TMS is that the pattern of symptoms will develop as a result of Pavlovian conditioning. People will experience the kind of symptoms they have learned to expect to experience, just as Pavlov's dogs learned to associate the presentation of food with the ringing of a bell. . . .[T]hese are programmed responses that bear
no relationship to anything beyond what the patient is conditioned to expect." (Emphasis added.) In short, TMS pain can occur that bears no relationship to a currently repressed emotion; it is simply a product of conditioning.
When I overcame more than two decades of low back pain with the help of
Healing Back Pain, I first had to learn to become aware of repressing anger (usually at my spouse), but to fully rid myself of back pain I also had to learn to overcome the effects of conditioning so that I did not get pain when I sat in a car seat, slept on a soft mattress, etc.
