Dr. Sarno's 2003 article with Dr. Rashbaum

[Forest]

Hi everyone,

If you visit Dr. Sarno's web site, you will find an important article listed in his publication list. It is an article that he wrote with Dr. Rashbaum, to whom he now refers all of his patients. It was published in the Archives of Physical Medicine and Rehabilitation, the official journal of the American Congress of Rehabilitation Medicine.

I thought I'd share some quotes from the article that I found particularly interesting. The first is very helpful for understanding the type of emotions that cause TMS. In it, rather than emphasizing deeply repressed emotions from childhood, the two doctors emphasize self-imposed internal pressures such as the need to be perfect and good and external pressures such as financial, work, family or health stress. These aren't old and deeply buried, but are, rather, stresses that we either generate or live with on a day to day basis.

Of course, understanding our past can be very helpful in dealing with this internal and external pressure, but in the end, it's the way that we feel on a day to day basis that matters.

Here's how the two doctors put it. Referring to the emotions that general The Mindbody Syndrome (TMS), they write,

These emotions, mainly rage (termed “narcissistic rage” by Kohut [30]) arise from self-imposed internal pressures such as the need to be perfect and good, and external pressures that can be financial, job-, health-, and family-related, and developmental (aging, facing death), to name the most important. Some patients have psychic problems that require psychotherapy, but most merely react to the realities of life and personality. Physical symptoms occur when the mind senses that repression of emotions may fail and an emotional eruption is imminent. The conflict is between the reasonable, intelligent, moral, conscious mind and the childish, primitive, archaic mind that continues to have a strong influence in the unconscious.

I once asked Alan Gordon to summarize his TMS Recovery Program and he said that it all boiled down to learning how to be kind to yourself. I think the above quote from Dr. Sarno and Dr. Rashbaum reflects that. We put internal pressure on ourselves to be perfect and good. We have external pressure that just make us want to scream. Unconsciously, we feel rage at all of this, and this is what fuels our TMS. We need to learn how to self-monitor so that we can soothe ourselves and relax:
http://www.tmswiki.org/ppd/Self_Monitor (Self Monitor)
It's all about being kind to ourselves.

I hope you find the quote as interesting as I did. To keep this post nice and short, I'll post the next quote a bit later.

If you want to read the full article, I found it here:
https://drive.google.com/open?id=0B-5h_RNfQlfFQUp1aFMtZmVHbjQ (Rashbaum and Sarno 2003 - Psychosomatic Concepts in Chronic Pain.pdf)
It's a quick read, but it's rather heady, as is appropriate for a pioneer like Dr. Sarno.

 

[Gigi]

Good food for thought, Forest.
Where I work I've twice in the last 4 years been voted Humanitarian of the Year on my campus. One of my students one year asked, "What does that mean?" I responded that it basically meant that I was nice to people. "Oh. Well you sure are that!"
Being kind to myself is much more difficult, but I have improved in recent years!

 

[IrishSceptic]

I find myself impressed with the level of selfishness some people display...I say impressed because I just can't fathom it. No matter how hard I try I won't understand it. chronic niceness is not a good strategy in the modern world because you will be taken advantage of at some point unfortunately. Stern parents would have helped me understand this dynamic a bit better. Not to say to be on guard but certainly get your own life together before concerning yourself with the woes of others.

 

[Andy Bayliss]

Hi Forest,

Great to see the emphasis on the "moment-to-moment" way we treat ourselves. It was this part of Dr. Sarno's work that has always resonated with me, and also emphasized in parts of Monte Huffle's work.

When I read in the Divided Mind that Dr. Sarno's review of patient studies had confirmed this 'personality' component as being more important than large events or childhood history, I understood why I had TMS. I have a vicious Inner Critic. By connecting my symptoms to my inner life, I had a reason I had TMS, and it all made sense. This personal understanding made a huge difference for me, I believe, regardless of any change in the internal relationships. Just knowing the cause, believing this is the cause, and understanding this is the cause.

This understanding prevents potentially endless digging around for the "reason" that we have TMS from the past, either the recent past or in childhood. Instead it brings us into focus on the current conditions, internally, which are readily available for investigation. This investigation ---how we relate to ourselves, is the kindest thing we can ever do for ourselves, regardless of symptom relief. I am leading a local self-compassion training right now, and am reminded of this truth.

Andy B

 

[Forest]

Hi Andy,

Thanks for drawing my attention back to those pages in The Divided Mind. I don't have the book in front of me right now, but when I reviewed it, I recall that 94% of a sample of his patients had the pressure to be perfect and good as a principle or very significant source of their tension.

I tend to think that digging around in the past can be helpful for insight, just less for abreaction (by abreaction I'm here referring to a "Helen"-like lancing of the boil). However, while I think it can be tremendously helpful, I think that many people do it too much.

Here's another quote that I like a lot from the same article:

Sarno proposed that most patients with chronic pain suffer from a psychosomatic disorder, in which emotional phenomena bring about real, not factitious, physical symptoms with suffering, that he originally called the “tension myositis syndrome.” That diagnostic term became obsolete when it was observed that, in addition to muscle, peripheral nerves and tendons might be involved. Sarno now proposes that tension myositis syndrome be relabeled “the mind-body syndrome,” which includes the musculoskeletal disorder now referred to as musculoskeletal mind-body syndrome (MMS), as well as a large variety of other psychophysiologic conditions involving other systems (fig 1). Figure 2 describes the pathophysiology of MMS.

I like this quote because it explains why he prefers the name "The Mind-Body Syndrome" over the term "Tension Myositis Syndrome."

The new name also clears up some confusion because when we refer to TMS in this forum, we generally refer to other symptoms like GERD, ulcers, headache, tinnitus, and frequent infections as TMS. However, Dr. Sarno used language more carefully than us and said that those conditions weren't tension myositis syndrome but were rather TMS equivalents (p. 14 of The Divided Mind and elsewhere). To him, tension myositis syndrome only ever referred to musculoskeletal pain. On the other hand, The Mindbody Syndrome refers to both musculoskeletal complaints and their equivalents. This is more in line with how we use the term TMS here.

This whole thing can tie your mind up in knots, but in the end it simplifies things to call everything, "The Mindbody Syndrome." On a website like this, it's just about perfect, in that it immediately lets people know that they are in the right place. People immediately get what is meant by "The Mindbody Syndrome."

 

[Andy Bayliss]

I tend to think that digging around in the past can be helpful for insight, just less for abreaction (by abreaction I'm here referring to a "Helen"-like lancing of the boil). However, while I think it can be tremendously helpful, I think that many people do it too much.

Yes, to me there is a natural marriage of the past and present when we inquire into our personal condition. The past experiences help us understand the repetitive strategies, how we took them on, why we pressure ourselves today. If I investigate the pressuring Inner Critic voice, there are deep imprints from the past.

This specific understanding of old imprints can give us very guided responses to the voices inside, as demonstrated by Alan's recordings, and the superego work that I learned round-about through Diamond Heart approach. The brilliant specificity of these skillful means --reacting to the messages, tone, affect of the past relationships, is guided by tapping into the internal images we still carry today, from the past.

----Also, I appreciate this conversation about TMS, the terminology and the application/conceptual framework for this term. I'll make some changes to my educational outreach based on this.