Confuse in tms Dr sanro approach

The more I am reading about TMS, the more I am getting confused. At one place, doctor John Sanro says that various types of anxiety, stress, pressure, fear, sadness, anger etc. increase the pain of TMS, meaning they activate danger signals in the brain, but all these emotions are a part of life and in today's life we cannot run away from them. This is my question, this is question1. That we have to fear these things; that stress, work pressure, anxiety, fear, anger should not come in our life; or while feeling these things without worrying whether stress will come or not, whether there will be anxiety or not, whether there will be worry or not, whether there will be anger or not, we just have to feel these things and keep ourselves safe while feeling them? 2nd question: At one place doctor John Prabh says that we only have to work with these things, for example to activate calm signal along with pain, which is difficult because it always frustrates and it is natural, pain will definitely frustrate you, so how do we keep ourselves calm with pain and in another paragraph when a woman says that I always remain calm with all this but still you are not improving then Sanro says that the personality of keeping calm activates pressure within you due to which you are not improving, then we have to keep working or are not able to understand anything no, both the statements are contrary to yours

 

Hi there, the way I see it:

1- Feeling anxiety, stress, anger, sadness etc is pretty normal and we should allow ourselves to feel it. The problem is we are socially trained to repress these feelings, and that's the issue here. Usually you won't be allowed to be angry in a public place, for example, so the therapeutic way of dealing with this would be, when you are in a safe place you try to identify what's stuck inside of you and let this feeling emerge whithout controlling it. Then you let this feeling be and eventually run out of its energy. And by no means you should use the symptoms as the metric if you've done that right, because symptoms might be caused for lots of different reasons, and neuroplasticity is a slow process (for modern standards at least).

2- It's hard to feel calm when the symptoms are screaming in your head. I don't try to force calmness during these periods. Doing this definitely frustrates me and causes more stress. There's a Jim Prussack's success story where the patient tells about "embracing the suckness" of these moments. I like this strategy because it's honest. So what I usually do is a message of safety that'd go like this "yeah ok symptoms are acting up now, I know it sucks but that's when neuroplastic healing really happens". Of couse, to think this you gotta believe you'll in fact heal eventually.

I'd also say there are a lot of contradictions in the methods you'll come across. Brain MRI is somewhat new and expensive. Sarno did his discoveries without it, so of course there are some contradictions with modern approaches. We still have a lot to learn on the matter. Anyway, I like the way Australian researchers are tackling this, specially the works of Dr. Lorimer Moseley.

 

Congratulations on being familiar not only with Sarno but also with the Australian researchers (Lorimer Mosely, David Butler, and Mark Hutchinson). Most readers of this forum are not familiar with the latter.

I was a Sarno purist and devotee for two decades. That enabled me to completely and permanently overcome 24 years of debilitating low back pain. But then I struggled for many years with persistent right knee pain (for which I had three failed surgeries over the years for structural defects) and left foot pain (for which I had two failed surgeries for structural defects). Then about a decade ago, I discovered the three Australian researchers and what Moseley calls contemporary pain science. I am happy to say that I have been completely free of any kind of chronic pain for the last half dozen years or so because of what I have learned from assiduous study of the contemporary pain science method.

I don’t see “lots of contradictions” between the Sarno and contemporary pain science methods that can’t be harmonized. I think each approach gets a lot right. At the same time, however, each approach overlooks or mistakes a thing or two that the other approach gets right. For example, Sarno said we habitually and unknowingly repress emotions that we have learned are dangerous to experience, and we do that by using standard defense mechanisms, e.g., denial, intellectualization, projection, externalization, etc. That is classic Freud and is widely accepted as correct. But then Sarno did what Freud never did. He regarded TMS as a fail-safe defense mechanism to ensure that repressed emotions stay repressed. Sarno said this fail-safe function is why your brain creates TMS, and therefore the way stop TMS is to become aware of your repressed emotions. In contrast, Moseley & Butler say your brain creates pain when it has more credible evidence that you are in danger than it has credible evidence you are safe (and Moseley, with his neuroscience training, explains the biology of this in molecular detail in chapter 3 of his and Butler’s Explain Pain Supercharged). Moseley & Butler say the way to stop chronic pain is to have more SIMs (Safety In Me) than DIMs (Danger In Me) in your life. In my opinion, Moseley & Butler do not fully appreciate the role of repressed emotions as super strong DIMs. Importantly, however, Sarno and Moseley & Butler are easily harmonized. Sarno says: Repressed emotions = Pain. Moseley & Butler say Danger = Pain. The two equations are harmonized by adding a third one: Repressed emotions = Danger.

This harmonization might seem incomplete because repressed emotions are not the only kind of danger to a person’s well-being. But Sarno did not limit his explanation of TMS to repressed emotions. Although he said repressed emotions are the major cause of it, he recognized another cause that he called Pavlovian conditioning (also known as associative learning). E.g., if you have learned for whatever reason to expect that bending over to tie your shoes will make your back hurt, then your back will hurt when you bend over to tie your shoes solely because of what you expect, not because of any repressed emotion. Stated differently, you have been conditioned to associate bending over to tie your shoes with the danger of being in pain. In Moseley & Butler’s terms, Pavlovian danger conditioning is a DIM. Sarno and Moseley & Butler are talking about the same thing as the cause of chronic pain, namely, danger to your well-being. (In my opinion, Sarno overlooked that the repressed emotion cause of TMS is subsumed under, i.e., is just an instance of, Pavlovian danger conditioning. To explain why would require a long digression that is not worth getting into here.)

Perhaps the hardest to reconcile difference I see between Sarno and Moseley & Butler is Sarno’s reservoir of rage in the unconscious, to which we can never gain true access. Moseley & Butler have no reservoir of rage. For them, however, there are stored memories of what is dangerous to our well-being, i.e., a reservoir of what is dangerous. If I recall correctly, some danger memories are stored in the hippocampus and retrievable to working memory, i.e., consciousness, while most of them are stored in a subcortical part of the brain called the amygdala, which is not directly accessible to consciousness.

Most important of all, though, both Sarno and Moseley & Butler stress the absolute necessity of understanding and accepting that the cause of your chronic pain is NOT a damaged or defective body part. Instead you must understand and accept that the cause is something “psychological”--to use Sarno’s term when he said it is necessary to “think psychological not physical.” To understand and accept all this at an intellectual level is one thing. It is a wholly different thing to understand and accept it at a deeper level, and that is what is essential. I don’t know how to describe the deeper level, except to say that for me it has always required an epiphany of some sort supported by what I regarded as credible evidence. Moseley & Butler once described the process as follows: “Even if no problems whatsoever exist in your body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. It is as simple and as difficult as that.” (I added the italics for emphasis.)

The difficulty in succeeding arises, I think, because it is not just the conscious but also the subcortical nonconscious part of your brain that must conclude you are not in danger. My experience has been that I stopped persistent pain only when (a) I understood and accepted that the pain was not due to something wrong with my body tissues, nervous system, or immune system and (b) I identified the exact psychological cause i.e., exact danger to my well-being whether it be a repressed emotion or some other conditioned expectation of danger. The difficult part was accomplishing (a). Once I did that, accomplishing (b) was relatively easy.

 

@Duggit you always write so well about TMS. The quotes above perfectly describe my recovery process from TMS. Thank you for taking the time to share your knowledge of TMS theory with us.

 

I second what @Ellen said. Your posts have helped me so much, and this one is a goal mine! As simple and as difficult as that. Wow, that’s it in a nutshell.

Related to this I do have a question for you. I know that experts have said it’s possible to heal despite being in a “perceived” dangerous environment. For example, having family members whose behavior is perceived as dangerous to one’s emotions and well-being. Is it possible to gain healing in this situation and if so, how?

 

Thanks Duggit, great clarification!
My own TMS coach (I just posted about her Australian pain educational bike tour led by Mosley etc) utilizes pain science education (which is exactly what Sarno used for his patients in the lectures he gave) along with many current TMS theorists to blend clear, concise messages for her clients based on their experiences and thoughts about pain and emotions. Sarno was pretty clear, without going into unnecessary detail that fear and feelings of lack of safety were about the psychological past as well as present pain situation and it all causes rage (as do many other emotions we suppress or repress). Conversely, a lack of safety and the need for control in an attempt to feel safer can induce an outward rage, anger, resentment that we are conscious of but stuck in. Sarno was a basics guy, the fewer things you need to do or know, the faster it is to success.
I too was very confused at first, so much new info and overthinking it all, my TmS brain needed to know and dissect it all - just another distraction from really doing the work. Now I’ve been at this for awhile, I can easily see how it all fits together and eventually you will too. You will see how triggers could possibly be enraging and be able to experience the emotions and thoughts that tend to challenge your safety comfort zone. Later you can work on expanding your mental and emotional constraints of safety.

 

Duggit, thanks for the amazing explanation. I found it interesting you said (a) was the hard part. I thought I was kinda done with (a) but struggling with (b), but maybe there's something in (a) that hasn't clicked yet.

 

I guess just because @Duggit found b) to be relatively easy compared to a) doesn't mean that others will necessarily find b) easy or relatively easy. (You might not be done with a) but if whenever a new or old symptom rears its ugly head you immediately think "TMS" and not something along the lines of "What did I do to cause myself this back pain; did I walk 5 minutes more than I should have done?" imo, I think it's sign that you are likely done with a).)

With b) I wonder whether it's always actually necessary to identified the exact psychological cause i.e., the exact danger to our well-being whether it be a repressed emotion or some other conditioned expectation of danger. It might be a case of that what we need to do is to show (rather than tell) the brain that we're not in danger, that we're safe. I recently came across this podcast by Alan Gordon regarding this and I like what I heard; it's entitled "How Can I Heal My Pain by Making My Brain Feel Safe?":

https://www.curablehealth.com/podcast/make-your-brain-feel-safe (How Can I Heal My Pain by Making My Brain Feel Safe?)

Brilliant! This really socked it to me with realization! Thanks, for this @Duggit!

 

Yes, but it was a good reminder that I might be trying to speed up my recovery too much, and it wouldn't hurt to check the foundation every now and then.
Thanks for the podcast, I listened to a couple of episodes and subscribed to it. I like how Gordon's approach isn't exactly as grounded on trauma investigation as Schubbiner's, being somewhat lighter and sometimes funny.

 

Of course!

However, in checking the foundations and being able to tell whether or not a) has actually fully "clicked" can be difficult.

I didn't know how to tell whether I hadn't lost all of my TMS symptoms because of lack of a) or lack of b) or combination of both.

Then eventually (but perhaps it would be obvious to others) it occurred to me that a really good indication re a) (but I'm not claiming it to be failsafe) would be if my instant reaction to a new symptom appearing or old symptom reappearing was that it was TMS (whereas in the past, before doing lots of TMS work, my immediate reaction tended to be that I had probably overdone things and caused myself some structural strain or damage or suchlike, and only after that might I have thought "perhaps it's TMS").

Anyway, it was just something I thought I'd mention in case it might be of help to you in trying to tell whether a) has fully "clicked" with you or not.

 

Ah no worries, even if it applies or not to my recovery, I really like the subject