by John E. Sarno

Preface

Pain, disability, misinformation, fear—that quartet has plagued the Western world for decades and the plague shows no sign of abating. Back, neck and limb pain are rampant, and statistics indicate that the epidemic is spreading. Disability in American industry from low back pain continues to increase year by year.

Industries that employ large numbers of people working at computers are experiencing great disability and health insurance problems because of a new pain disorder known as repetitive stress injury (RSI). Millions of Americans, mostly women, suffer from a painful malady of unknown cause called fibromyalgia. While gigantic medical industries have arisen to diagnose and treat these conditions, the plague continues.

This book is about that epidemic. It describes both a clinical experience that has identified the cause of the pain disorders and a method of treating them. Sadly, mainstream medicine rejects the diagnosis because it is based on the theory that the physical symptoms are initiated by emotional phenomena. Intelligent laymen in large numbers have embraced the concept, however, no doubt because they are not burdened by the bias imposed by a traditional medical education.

As if the pain epidemic were not of sufficient magnitude, a large group of physical disorders have been identified as equivalents of the pain syndrome, since they appear to stem from the same psychological process. These maladies have occurred commonly for years and, taken together with the widespread pain maladies, are universal in Western society. I refer to many of the headaches, gastrointestinal symptoms and allergies, as well as respiratory, dermatologic, genitourinary and gynecologic conditions that are the stuff of everyday life.

If most of these are psychogenic—that is, they originate in the mind (and it is my goal to demonstrate that they are)—we have a public health problem of staggering proportions. The medical, humanitarian and economic implications are obvious and will be enumerated.

This book is about emotions, illness and wellness, how they are related and what one can do to enhance good health and combat certain physical conditions. The ideas are based on twenty-four years of successfully treating an emotionally induced physical disorder known as the Tension Myositis Syndrome (TMS). Although I will provide an up-to-date description of that condition, my major focus is the impact of the emotions on bodily function.

That connection came close to being accepted by Western medicine in the first half of the twentieth century and then fell into almost total disrepute. Repudiation of psychoanalytic theory, increased interest in laboratory research and the tendency of doctors to shy away from psychological matters (they see themselves as engineers to the human body) are the likely reasons for this historical trend. As the century draws to a close, few practitioners, either in physical or psychological medicine, believe that unconscious, repressed emotions initiate physical illness. Psychoanalysts are the only clinicians who have held to that concept, but their influence in the larger fields of psychiatry and general medicine is limited. In the physical medicine specialties virtually no one adheres to the idea.

Despite the lack of interest of mainstream medicine, much has been written on the "mind-body connection." Careful studies have been conducted that relate psychological factors to pathological conditions such as coronary artery diseases and hypertension. I know of only one investigator outside the field of psychoanalysis who has identified unconscious emotions as the cause of a physical illness. One reads of stress, anger, anxiety, loneliness, depression, but they are discussed as conscious, perceived emotions. In many instances these feelings are thought to aggravate underlying structural pathological processes, such as herniated discs, fibromyalgia or repetitive stress injury.

In view of the widespread Freud bashing of recent years I may be courting disapproval to state that my concepts descend from Freud's clinical observations and theories. But I know this only in retrospect, for I did not set out to prove Freud right. My developing ideas were the consequence of clinical observations; they were not based on preconceived notions about the mindbody connection. As with Freud's patients, I found that my patients' physical symptoms were the direct result of strong feelings repressed in the unconscious. In addition, I have drawn on the concepts of three other psychoanalysts: Franz Alexander, founder of the Chicago Institute for Psychoanalysis, did pioneer work in mindbody medicine in this century; Heinz Kohut conceptualized what is known as Self Psychology and pointed out the importance of narcissistic rage; Stanley Coen suggested the crucial idea that the mindbody disorder I was studying (TMS) was a defense, an avoidance strategy designed to turn attention away from frightening repressed feelings.

This book addresses physical disorders that are caused by repressed, unconscious feelings. Because these disorders are very specific, they can be accurately diagnosed and successfully treated.

The Tension Myositis Syndrome is currently the most common emotionally induced disorder in the United States, and probably in the Western world. Since the publication of Healing Back Pain, other painful conditions of significant public health importance have emerged. They, too, are manifestations of TMS.

The book is laid out in three parts. Part I is a discussion of the psychology that induces these physical maladies, and it includes a chapter that might be called a bridge, for it describes the psychoneurophysiology of psychogenic processes: in other words, how emotions stimulate the brain to produce physical symptoms. After traversing this bridge (which sounds more formidable than it is), Part II takes up the various emotionally induced physical maladies, beginning with TMS, the disorder that introduced me to the world of mindbody medicine, and including such ailments as the common disturbances of the gastrointestinal tract, headaches, allergies and skin disorders.

Part III discusses treatment for these disorders.

For those who are interested, an appendix covers the more academic aspects of the mindbody (psychosomatic) process.

A word of caution to the reader: What follows is a description of my clinical experience and the theories derived from my work. No one should assume that his or her symptoms are psychologically caused until a physician has ruled out the possibility of serious disease.

© 1998 by John E. Sarno, M.D.

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