Conscious Choice: Pain's Dirty Little Secret: The Unconscious Connection

February 2000

Pain's Dirty Little Secret: The Unconscious Connection

by Jerry E. Wesch, Ph.D.

John E. Sarno, M.D., professor of clinical rehabilitation medicine, New York University School of Medicine, has been treating pain for many years. His 1984 book Mind Over Back Pain (New York: William Morrow) outlined more than ten years of investigation and treatment of musculoskeletal pain syndromes using psychological concepts and techniques. In 1991, he updated his findings in Healing Back Pain (New York: Warner Books). His recent The Mindbody Prescription: Healing the Body, Healing the Pain (Warner Books, 1998) extends his approach to a variety of common health problems he calls pain equivalents. These include such ailments as gastrointestinal disorders, circulatory problems, headache, allergies, fibromyalgia, infections, chronic fatigue syndrome, and hives.

Dr. Sarno says, in short, that pain (like the other disorders on his list) often has a deep dark secret. The body complains via pain, localized spasm, and ischemia (local decreases in circulation) to control our awareness of powerful unconscious emotional tension. He calls the resulting multifaceted, often disabling, variable symptom picture tension myositis syndrome (TMS). Symptoms can manifest in any body system but are most often focused around previous injuries. Like a complex and painful smoke screen, the body takes the heat for hidden unacceptable emotional loads.

He particularly targets unconscious rage, shame, and emotional trauma from psychological and emotional wounds that threaten to overwhelm our psychological equilibrium. These feelings are protected from conscious awareness by the use of pain and bodily symptoms as a distraction. His solution is to assume that the body is complaining about something psychological (after appropriate medical evaluation to rule out the physical) and go find it via introspection and knowledge. Understanding and awareness undoes the unconscious secret. His reported track record (more than 80 percent recovery) is hard to argue with.

His model is not news. Psychiatry and health psychology have been outlining the connection between the unconscious mind and body since Freud outlined the basics of the unconscious in the 1890s and, the beginning of the psychosomatic revolution of the 1930s.

In recent decades, the psychopharmacology revolution moved psychiatry away from intrapsychic phenomena toward biology. Psychology embraced behaviorism and, more recently, conscious, cognitive factors in behavior and health. These new ways of understanding and treatment have not stopped the unconscious from doing its best to keep our emotional dirty laundry out of sight, often at very great personal cost. The research finding that many chronic pain patients (50 to 60 percent in many surveys) often have histories of trauma, loss, and/or abuse has usually been treated as a mystery and not followed up or explained.

What does Dr. Sarno recommend? First, repudiate the general assumption that your pain or other symptoms have a primarily physical, structural cause (after you have had a good medical diagnostic evaluation). He mounts an extensive and well-documented assault on the common ideas about ruptured discs, pinched nerves, and the other usual medical diagnostic suspects for pain. Second, acknowledge the psychological basis of the symptoms and follow the hide-and-seek process he outlines for finding the truth.

This program does not use physical therapy, injections, pain medications, or surgery, just knowledge and patience in uncovering the personal stories behind the pain. If the hidden, previously unconscious emotions are no longer secret, the ruse doesn’t work and the symptoms recede, sometimes going away too quickly to be explained by ordinary healing processes. For complex traumatic backgrounds like sexual abuse and other major emotional trauma, Sarno does use psychotherapists as coaches. He also outlines how to overcome the fear of pain and to accept the ramifications of having a mind/body problem, just like everybody else.

When a person’s life is being disrupted by pain, the last thing he or she wants to hear is "It’s all in your head." Yet, as these books clearly indicate, all too often that is the easiest and most effective place to find relief. I used to ask chronic pain patients "Would you rather have a physically based pain or a psychologically caused pain?" The almost universal answer was a physical pain, based generally on fear of shame and weakness. The "right" answer, though, was psychogenic pain, since these disorders, like Dr. Sarno’s TMS, can be cured completely by counseling and psychological interventions, without drugs or surgery, while hard-core physical pain often can be managed only partially, with the usual medical interventions.

As a pain psychologist for almost thirty years, I know Dr. Sarno is onto something. I don’t always agree with him completely, but I can recommend his books highly to the person with chronic pain or the other chronic health problems on his list of TMS equivalents. His ideas have power to relieve suffering and return personal control to a beleaguered self. Give the references a look. They aren’t for everybody, but they’re cheap and often startlingly effective.

Resources

Sarno, John E., The Mindbody Prescription: Healing the Body, Healing the Pain (Warner Books, 1998).

Sarno, John E., Healing Back Pain (Warner Books, 1991).

Sarno, John E., Mind Over Back Pain (William Morrow, 1984).

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