Can idiopathic/physically unexplained symptoms always be considered TMS?

[tag24]

(This is a question on broader TMS theory more than one for personal use)

I ask because I'm listening through the Tell Me About Your Pain podcast where this topic is partially discussed, and because I am currently being assessed for a diagnosis which definitionally fulfils 10-15 of Schubiner's 19 F.I.T (Functional, Inconsistent, Triggered) checkmarks for neuroplastic symptoms. It boggles the mind that if this condition (and many others like fibro, IBS, CFS, etc.) are such neat fits for TMS, how many people suffer being treated with the wrong methodologies if they don't stumble across the world of mindbody medicine?

Is there nuance to it? Are some conditions which fit the FIT criteria not actually TMS? Or should it always be taken as Occam's Razor that "if it walks like a TMS and quacks like a TMS, it's probably a TMS"? Interested in opinions on it; because for example, a lot of neuropathies (incl. diabetic neuropathy, etc.) would tick over half the 19 FIT criteria, but would be considered structural conditions when evidence of nerve damage is found. (Same goes for SFN which is considered by Schubiner to be 100% TMS.) Are conditions like these also TMS, or at least similiar enough despite a structural root that they will benefit from either psychological/neuroplastic treatment?

At this stage I more than believe in TMS as a whole, but struggle with the fact that some disorders meet the standard TMS criteria 100% of the time - because that would be millions of people suffering from issues that are rooted in mindbody, and could be cured from these methods, but instead often get no treatment at all. It feels both very simple and extremely bleak. But maybe that's part of the flawed medical model, and the answer really is "yes, most people with idiopathic diagnoses could be treated with mindbody work and it's a tragedy that they're not." Wondering what you all think.

 

[Cactusflower]

When people blush - it is the mind/body connection: a physical reaction to an emotion. Everyone does this.
We cry when sad - not everyone does this but it is a physical reaction to an emotion.
Why would people not have any other physical reaction to anything emotional or brain oriented?
Sarno saw most of his patients with back pain. That was "trendy" at the time.
Dr. Schubiner talks about other symptoms he has seen come in waves over time.

Sometimes people have real illnesses and issues whether triggered by a mind/body issue (as @JanAtheCPA describes her RA), or a disease. Fear, heavy emotions, panic, anxiety ... they have all been proven to make any diagnoses feel more difficult.

What I think is that it really all doesn't matter what or why. That is your brain trying to rationalize, problem solve and create issues (or thoughts) out of things that are essentially not important to your situation. I know, I've been there. Your mind will try anything to keep you from discovering exactly what it has been trying to protect you from (Sarno says it's anger/rage, Schubiner agrees and throws in sadness, I've read some posts of Steve O and in his book - he talks about any thoughts/emotions which make you feel broken/or essentially separated from self which many people describe as lonely) - they key is knowing that after getting checked out ONCE, and cleared by your Dr., that there is nothing wrong with you. Your brain/mind is convinced there is .... but your thoughts are not truth. They are merely thoughts.

Focusing on your wellness, on dealing with the anxiety and the fear and finding the confidence that is buried within you is the most important thing. The rest is just a smoke screen.

 

[miffybunny]

Idiopathic means "we have no blooming idea what the cause is" lol, so yes that's tms. It is scandalous and appalling that millions of people suffer needlessly and yes it is an epidemic of iatrogenesis and fear. This is the timeline in which we live and hopefully we are on the cusp of a revolution , but paradigm shifts tend to take centuries. In the autism world, they are not shifting in terms of school methodology. It's actually going backwards because schools depend on funding and bureaucracies that only recognize old paradigms. It's complicated but mostly financially driven. The way medicine is practiced today is driven by profit and corporations, not ethics. Private practices have been taken over by interest groups. Doctors have become employees who see the patient for 7 minutes. Specialization has led to a myopic view where the patient as a person has become invisible. On a societal level, it is indeed tragic because it doesn't just affect the sufferer, but the whole family and the community. It boggles the mind to imagine how many people and how many years of their lives and bank accounts could have been spared untold suffering and fear and misery.

 

[tag24]

When people blush - it is the mind/body connection: a physical reaction to an emotion. Everyone does this.
We cry when sad - not everyone does this but it is a physical reaction to an emotion.
Why would people not have any other physical reaction to anything emotional or brain oriented?
Sarno saw most of his patients with back pain. That was "trendy" at the time.
Dr. Schubiner talks about other symptoms he has seen come in waves over time.

Sometimes people have real illnesses and issues whether triggered by a mind/body issue (as @JanAtheCPA describes her RA), or a disease. Fear, heavy emotions, panic, anxiety ... they have all been proven to make any diagnoses feel more difficult.

What I think is that it really all doesn't matter what or why. That is your brain trying to rationalize, problem solve and create issues (or thoughts) out of things that are essentially not important to your situation. I know, I've been there. Your mind will try anything to keep you from discovering exactly what it has been trying to protect you from (Sarno says it's anger/rage, Schubiner agrees and throws in sadness, I've read some posts of Steve O and in his book - he talks about any thoughts/emotions which make you feel broken/or essentially separated from self which many people describe as lonely) - they key is knowing that after getting checked out ONCE, and cleared by your Dr., that there is nothing wrong with you. Your brain/mind is convinced there is .... but your thoughts are not truth. They are merely thoughts.

Focusing on your wellness, on dealing with the anxiety and the fear and finding the confidence that is buried within you is the most important thing. The rest is just a smoke screen.

I appreciate what you've said here but don't worry, this isn't a "someone convince me TMS is real" post, this is a general thought on the principles of TMS as it stands. A lot of disorders that are termed as physical/structural/functional issues do fulfil most of the criteria set out by doctors like John Sarno or Howard Schubiner, which is interesting from the TMS perspective because does that indicate they would at least benefit from an ELEMENT of neuroplastic treatment, as part of a broader care package? Was just thinking about it.

 

[tag24]

Idiopathic means "we have no blooming idea what the cause is" lol, so yes that's tms. It is scandalous and appalling that millions of people suffer needlessly and yes it is an epidemic of iatrogenesis and fear. This is the timeline in which we live and hopefully we are on the cusp of a revolution , but paradigm shifts tend to take centuries. In the autism world, they are not shifting in terms of school methodology. It's actually going backwards because schools depend on funding and bureaucracies that only recognize old paradigms. It's complicated but mostly financially driven. The way medicine is practiced today is driven by profit and corporations, not ethics. Private practices have been taken over by interest groups. Doctors have become employees who see the patient for 7 minutes. Specialization has led to a myopic view where the patient as a person has become invisible. On a societal level, it is indeed tragic because it doesn't just affect the sufferer, but the whole family and the community. It boggles the mind to imagine how many people and how many years of their lives and bank accounts could have been spared untold suffering and fear and misery.

Unfortunately, I'm inclined to agree, and have nothing to add. My own experience with doctors has certainly been like what you describe, and it's difficult to understand on a human level how doctors can often feel so callous to patients. But I guess that's the result of years of desensitization and being forced to see patients as faceless numbers, it makes it difficult to appreciate the extent they may be suffering.

 

[Baseball65]

Idiopathic means "we have no blooming idea what the cause is" lol, so yes that's tms. It is scandalous and appalling that millions of people suffer needlessly and yes it is an epidemic of iatrogenesis and fear. This is the timeline in which we live and hopefully we are on the cusp of a revolution , but paradigm shifts tend to take centuries. In the autism world, they are not shifting in terms of school methodology. It's actually going backwards because schools depend on funding and bureaucracies that only recognize old paradigms. It's complicated but mostly financially driven. The way medicine is practiced today is driven by profit and corporations, not ethics. Private practices have been taken over by interest groups. Doctors have become employees who see the patient for 7 minutes. Specialization has led to a myopic view where the patient as a person has become invisible. On a societal level, it is indeed tragic because it doesn't just affect the sufferer, but the whole family and the community. It boggles the mind to imagine how many people and how many years of their lives and bank accounts could have been spared untold suffering and fear and misery.

I have told Drs. when I am paying THEM that I highly suspect something is of a psychogenic origin and they always roll their eyes. Dentist gave me the same treatment when I had pain in a tooth with no nerve.

because that would be millions of people suffering from issues that are rooted in mindbody, and could be cured from these methods, but instead often get no treatment at all.

Yep. So Glad I discovered Sarno Before I lost my health insurance. I haven't read your story, but all of us go through a sort of progression... angry at all of the stuff we were told (they didn't know any better) angry at the system for straining a gnat and swallowing a camel (What @miffybunny brought up) and feeling sort of helpless against the inertia of all of that MONEY propping up the 'conventional diagnoses'

Sarno once said (paraphrased) "If the Great Architect disabled the placebo effect, the pharmaceutical industry would crash".
Yes and No. Yes, they benefit from the Placebo effect at probably 50-60% of their gross, NO because they would find something else to scare us with. Medicine has become such an ossified construct that it has little ability to change ....even if they had lofty ideals and weren't monetarily motivated.

Blessed are the Poor.

 

[Duggit]

But maybe . . . the answer really is "yes, most people with idiopathic diagnoses could be treated with mindbody work and it's a tragedy that they're not." Wondering what you all think.

I am not so sure Dr. Sarno would agree. In The Divided Mind, he wrote: “After many years of experience, it is our impression that not more than 10 to 15 percent of the population would be willing to accept a psychosomatic diagnosis.” By psychosomatic, he meant “physical disorders of the mindbody, disorders that may appear to be purely physical, but which have their origin in unconscious emotions.” Later in the book, he added: “Because acceptance of the diagnosis is essential for a positive outcome and because so few people are open to such a diagnosis, I have a telephone conversation with all who call for an appointment. After years of experience it is not difficult to determine whether someone is a good candidate for the program, and for those who are not it is a kindness to them and to me to discourage them from making an appointment. This is not discriminatory but simply faces the reality of what is required for successful treatment. It is analogous to a surgeon’s decision not to operate on some who is not a good surgical risk."

 

[tag24]

I am not so sure Dr. Sarno would agree. In The Divided Mind, he wrote: “After many years of experience, it is our impression that not more than 10 to 15 percent of the population would be willing to accept a psychosomatic diagnosis.” By psychosomatic, he meant “physical disorders of the mindbody, disorders that may appear to be purely physical, but which have their origin in unconscious emotions.” Later in the book, he added: “Because acceptance of the diagnosis is essential for a positive outcome and because so few people are open to such a diagnosis, I have a telephone conversation with all who call for an appointment. After years of experience it is not difficult to determine whether someone is a good candidate for the program, and for those who are not it is a kindness to them and to me to discourage them from making an appointment. This is not discriminatory but simply faces the reality of what is required for successful treatment. It is analogous to a surgeon’s decision not to operate on some who is not a good surgical risk."

This is fair and yeah, reasonable enough that there'd need to be a certain level of buy-in for people to benefit from TMS/PPD/MBS or whatever treatments, but I did sort of mean "putting aside the issue of belief" because in a perfect world, there wouldn't be such an intense degree of skepticism towards a mindbody diagnosis anyway. You are right that many people would simply reject it too fundamentally to ever believe in, but I guess I'm thinking just of whether the symptom sets could be treated if belief WAS present

 

[JanAtheCPA]

which is interesting from the TMS perspective because does that indicate they would at least benefit from an ELEMENT of neuroplastic treatment, as part of a broader care package? Was just thinking about it.

@tag24, I've been telling the story of my broken hip for YEARS on this forum. I've started saving things in my OneNote app, so I don't have to re-write every time. This was a 2022 post I wrote to support a response that all pain is created by the brain, not by the pain site - but the the other side of my story is the fact that being willing to shift from fear to acceptance was integral to my positive experience and quick recovery. Mind you, this was three years before I knew anything about Dr. Sarno, so obviously I already had the ability to achieve this kind of mindset, which I undoubtedly have to credit to my parents, because it has served me well all my life in spite of lifelong low-level TMS. Post-Sarno, I went back to this inicident and was able to identify exactly what was going on in my brain at every step. Here's the post:

This (pain is in the brain, not the body part) all explains my experience when I ended up in the ER in 2008 after a bike crash, with pain in my hip that felt like an 8 to me - and I was freaking out over the thought of being totally disabled for 6 or 8 weeks. When the ER doc came back with my x-rays and said it was a simple fracture in the neck of my femur, and that they could pin it up and have me on crutches in two days, my pain level immediately plummeted. They asked if I wanted drugs, and I said that some ibuprofen would be fine, and that's all I ever took. After the surgery they kept coming by to ask about my pain level, to which I finally said "I've had cramps worse than this, you really can stop asking". Knowing what was wrong, what they could do, and what I needed to do to heal quickly, was more important than the pain at that point. I had not had surgery since my tonsils were removed at age 5, but I decided there was no reason to fear it. I utterly failed to catastrophize the situation once I knew the prognosis, and it's like the pain was optional. It was there to remind me what not to do (obviously) while recovering, but that's it. This happened three years "before Sarno" for me, by the way. I've had anxiety all my life, but this situation provided me with a lot of certainty, and a clear plan of action in which I had faith, and which I was happy to follow to the letter.
​

 

[JanAtheCPA]

There have been and I'm sure there currently are psychological studies connecting the recovery outcomes of patients with illnesses and/or injuries with their mental outlooks. There was a famous study of burn victims which showed that patients with a positive and proactive attitude recovered better and faster.

I'm reading a book right now which you would probably find interesting, and perhaps quite useful. It's called Chatter, recently published in 2021 (written during the shutdown, I think) by Ethan Kross, who is a neuroscientist, psychologist, and researcher. I'm only about 30% through it, and it seems to be a compendium of his many years of research and study on the issue of our inner chatter, its mostly-negative effect on our mental and physical health, and what we can do about it. Each section addresses different aspects of his central premise about inner chatter and includes references to tons of related studies over many decades. For example, there's a chapter all about studies which seem to consistently and conclusively show that people who are regularly exposed to green spaces experience less anxiety, and overall better mental and physical health than those who are not. Apparently, hospital recoveries have even been shown to be different depending upon the view that patients have from their rooms. This, of course, is the premise behind the recent trendy name of "forest bathing" which has been assigned to the well-known mental benefit of just taking a walk outdoors in some kind of green space.

The book has also already addressed inflammation and the connection between inflammation and health problems - and ties this to inner chatter, of course. The word "rumination" comes up a LOT, and in the current chapter he's addressing rumination as an obsessive behavior in general and how it can become full-blown OCD.

Did I mention I'm not even halfway through the book? It may be a bit over-written, but it's also easy to skim certain sections. I got the e-book from my library - although I put a hold on it almost three months ago. It is apparently a best-seller (which in itself is good news, particularly because he regularly reminds the reader about the connection between emotional and physical health - what we here call TMS).

Kross has a nice website, with TV appearances, podcast interviews, and articles under the Press tab. Ethan Kross - Author of Chatter and Acclaimed Psychologist. I took the quiz and was offered a short 10-point toolkit to download. The website is a good intro.


One final thought, @tag24: intellectualizing is interesting mental activity, as long as one is completely aware that it can easily devolve into over-thinking, which is a distraction, one which I see being deployed by TMS brains ALL THE TIME, with a goal of avoiding the emotional vulnerability which is required to do this work.

Also, IMHO, spending time trying to find a way to define a clear and consistent delineation between TMS conditions and "not TMS" conditions is an exercise in futility (and a distraction). There is no such thing, nor does there need to be if you accept the fact that our minds and bodies are inextricably linked at all times. And you should already know from your own experiences that this link is different between individuals, and it's different at different times within each individual. You can't pin it down!

the answer really is "yes, most people with idiopathic diagnoses could be treated with mindbody work and it's a tragedy that they're not."

Yes. And life is ultimately tragic when viewed from an individual level. Check out Ethan Kross's concept of "Distancing".

Ultimately, life is what it is, and not as you or I would have it. Acceptance is one of the most powerful tools we have.