The Mind-Body Connection to Chronic Pain and other Physical Symptoms
"Unconscious emotions are a potent factor in virtually all physical, non-traumatic ills," states Dr. Sarno in his book, "The Divided Mind."
In 1991, Dr. Sarno published "Healing Back Pain," a New York Times bestseller that was in time translated to 20 languages. A quick browse through some of the thousands of amazon.com reviews and 4.5 rating shows that, although his theory at the time was controversial within the medical community, it proved immensely popular and ultimately therapeutic to many who suffered from chronic pain. There has since been much research that supports the mind-body pain relationship, but little implementation of that research into medical care.
1. The unconscious mind can cause chronic pain as a distraction from unresolved trauma/stress and repressed emotions.
2. The pain can resolve if you can correlate the pain with the unconscious's attempt to distract from trauma/stress.
3. We are not consciously aware of these mechanisms and therefore have no choice in the process.
4. Faulty movement patterns caused by injuries can persist long after the damage has resolved.
5. Faulty movement patterns are a resource the unconscious can tap into to cause pain.
6. The symptom imperative is when the unconscious causes new chronic pain when the link between trauma/stress has been identified and resolved from an old pain site.
7. People who are conscientious, hardworking, very responsible, great caregivers, often perfectionists are disproportionately prone to mind-body symptoms.
What is Dr Sarno's basic theory?
Years ago, I read Dr. Sarno's last book (he passed in 2017), "The Divided Mind," it greatly influenced my therapeutic approach; I will try to summarize his powerful book below…
Dr. Sarno believed repressed emotions that lurk in the dark recesses of our unconscious mind could directly induce chronic pain symptoms, gastrointestinal conditions, skin disorders, depression, common headaches, dizziness, and tinnitus.
Further, he believed these unconscious emotions might play a fluctuating role along with genetics and environmental factors in other disorders such as autoimmune disorders and hypertension.
Dr. Sarno reinterpreted Freud's work that identified the mind as composed of three separate identities/traits. The id (child-primitive), the ego, and the superego.
The id (I'll use the more descriptive term "child-primitive") is the product of the ancient (paleomammalian) mind. Its characteristics are that of our primitive, non-social ancient ancestors. The child-primitive is self-centered, bestial, childish, narcissistic, irresponsible, and wants to be dependent on others' care. It inhabits only the unconscious mind; we have no conscious knowledge of the child-primitive's state within us, yet it is considered the fundamental person inside each of us.
The ego and superego came later in the evolutionary timeline and are the product of the evolving mind adapting to the formation of social structures and the creation of society. Both have access to the unconscious and conscious minds. They harbor in our newer (neomammalian) brain and facilitate reason, higher intelligence, communication, and morality.
The ego is considered the chief executive, the decision-maker of the mind; its primary role is to protect the child-primitive. It interprets the outer world for the child-primitive and is rational and logical, but is also aware of the child-primitives demands and reactions.
The superego is the moral compass of the mind. Further than just survival, it wants you to succeed and pushes for perfectionism and goodism. The ideals of the superego are in direct conflict with the needs of the child-primitive.
So why do we potentially suffer from chronic pain and other symptoms because of these three traits of the mind?
In short, the unconscious child-primitive harbors feelings of sadness, emotional pain, and rage. When triggered it wants to push these emotions into the conscious realm to be expressed, as would have been the norm in primitive times. The ego is aware of this urge for expression and wants to prevent the explosion of sadness, pain, and rage into consciousness. It believes the pain and sorrow would be too dangerous for the person to experience or the anger to be too socially unacceptable to express. Instead, it represses these unconscious emotions by distracting the conscious mind with pain. It decides that physical pain is less threatening than expressing repressed emotions. We are not consciously aware of this decision and do not have any influence over it.
How do repressed emotions specifically cause pain?
According to Dr. Sarno, the brain has two potential mechanisms: via "stimulation of specific brain nuclei or by reducing the blood flow to particular muscles, nerves or tendons." Considering clinical findings in SensoriMotor Repatterning (SMR), I propose a third mechanism involving dysfunctional movement patterns learned from injuries.
What causes unconscious emotional pain and rage?
" When conscious anger is suppressed, it will become part of the reservoir of rage in the unconscious." Further, the child-primitive has no concept of time. Pain is felt as strongly 30 years later in the unconscious as when the initial trauma occurred. The reservoir of rage has been gradually added to through the passing of time, and all that life throws at us. Below are eight potential contributors to this reservoir of rage:
1. Physical, sexual, or emotional abuse causes large amounts of pain and sadness to the child-primitive, especially if anger was never permitted to be expressed.
2. Not receiving emotional support, enough warmth, and love will result in anger, sorrow and pain.
3. Excessive discipline or unreasonable expectations by parents or caregivers.
4. "If you expect a great deal of yourself, if you drive yourself to be perfect, to achieve, to succeed, if you are your own severest critic, if you are very conscientious, these are likely to make you angry inside. Sensitivity to criticism and deep-down feelings of inferiority are common and also contribute to inner anger."
5. "If you have a strong need to please people, to want them to like you, or if you tend to be very helpful to everyone and anyone, if you are the caretaker type and are always worrying about your family, friends, and relatives, these drives will also make you furious inside, because that's the way the mind works. The child in our unconscious doesn't care about anyone but itself and gets angry at the pressure to be perfect and good."
6. We are all getting older and closer to death. Consciously, we rationalize the demise of our health and the nearing of our death; unconsciously, we are enraged by it.
7. The inner mind resents any kind of life pressure. Thus, pressures from your job, spouse, children, parents, etc., can further enrage the child-primitive and add to the reservoir of pain.
8. "Close personal relationships, no matter how good they are, are often the source of unconscious anger, because it's very hard to be consciously angry at a parent, a spouse, or a child." However, self-denial enrages the inner child-primitive.
It is important to note, "Everybody is under pressure from themselves or from life circumstances - and everybody has some degree of rage in the unconscious."
People who are conscientious, hardworking, very responsible, great caregivers, often perfectionists are disproportionately prone to mind-body symptoms. In a survey of 104 of Dr. Sarno's patients, he found that the "perfect-good" drive was either the predominant factor or a very significant factor in 94% of the cases, with life pressures being the second most common factor.
So how does one stop these symptoms from occurring?
Dr. Sarno believes that knowledge is power; once you realize that the ego creates pain as a protective mechanism from painful/dangerous unconscious emotions, the distraction mechanism no longer serves its purpose. By acknowledging the relationship of chronic pain to past trauma/stress every time pain spikes, the pain brings a conscious awareness of the rage instead of a distraction away from it. The pain no longer serves the purpose it was created to perform. This is why so many people get better just from reading Dr. Sarno's book. He found that only 20% of his clients needed referrals to psychotherapists to further dissect the mind's mechanisms.
However, there is a catch, and he called it the "symptom imperative." If you realize that lower back pain is genuinely just a distraction from repressed emotions, the back pain will resolve. Still, the ego searches for a new way to distract you, and it will choose something that you will naturally assume not to be a distraction. For instance, an acute muscle strain in the shoulder should repair to normal function in about six weeks, but the ego may piggyback onto the original injury, preventing movement patterns from returning to optimal function. The muscle is repaired, but the pain continues as a distraction. You accept the theory that the initial muscle injury creates ongoing chronic pain; however, the pain persists long past a western medical perspective's timeline. The ego has successfully tricked the conscious mind and distracted it from the repressed emotions again; this is the symptom imperative, a new symptom in a different place, its root cause is still inner emotional angst.
How Does Dr. Sarno's theory fit into SMR?
For years I've noticed a link between the mind-body connections in clinical practice, so I am a massive advocate of Dr. Sarno's theory or similar theories such as Internal Family Systems (IFS).
SensoriMotor Repatterning (SMR) finds faulty compensation patterns caused by previous injuries and changes them to more functional movement patterns. These patterns are objective findings. There is no question if the dysfunctional patterns exist, as muscle function changes are immediately and notably improved once a pattern has been identified and corrected.
I have always assumed the brain creates these compensation patterns in response to an injury so as to not further damage the injured tissue. E.g., causing a limp so you can get from A to B without further tissue damage. Once healed, the movement patterns should revert to the more functional, original patterns, but sometimes they don't! I used to assume this to be an oversight of the nervous system. However, if Dr. Sarno was still around, he might conclude that the ego deliberately chooses not to correct these movement patterns. The subsequent chronic pain serves as an excellent distraction from the turmoil of the unconscious mind.
Can SensoriMotor Repatterning (SMR) help?
Yes, if the unconscious mind is causing pain through holding onto, or switching between faulty and functional patterns, then these patterns can be found and removed. SMR bridges the gap between the evolutionally older part of our mammalian brain (limbic - which focuses on survival) and the newer part (Neocortex - cognitive function). The older part of the brain holds onto dysfunctional patterns as a safety mechanism, and the more contemporary part wants to be as functional as possible. Nobody at a conscious level would choose to live with chronic pain over protecting trauma/stress from the past. The unconscious (limbic) brain chooses pain; consciously, we don't get to choose. As the SMR therapist, it is my job to identify dysfunctional movement patterns from past injuries to the newer part of the brain and facilitate correcting the dysfunction. Gentle manipulation at specific points on the body's soft tissue is all it takes. The Neocortex "repatterns" the faulty neural patterns when it is made aware of them and has been given enough information to correct them.
I have also spent much time developing techniques to release stress stored in the body. Traditional Chinese Medicine (TCM) does not see the mind and body as two separate entities but as a complex whole system. TCM considers stress as being stored in the systems and organs of the body and seeks to balance or remove this stress using the meridian system. This system and the related acupoints have been very effectively integrated into SMR therapy along with neural feedback to direct the specifics of the treatment.
You should know that I do not "fix" stress or trauma. I remove the faulty movement patterns the limbic brain holds onto as a distraction mechanism (that's causing pain). I also consider working with a psychotherapist or psychologist a critical aspect of dealing with trauma if a client has not already done so.
Dr. Sarno coined the term Tension Myositis Syndrome (TMS) to refer to actual physical symptoms caused by psychological stress. I'm not a big fan of the term; the mind-body syndrome is more self-explanatory.
If this theory resonates with you, I highly recommend watching the documentary "All the rage" about Dr. Sarno's theory and work, it's an uplifting watch, and I get lots of good feedback about the documentary:
If you would like to know more about SensoriMotor Repatterning and if you could benefit from some sessions, check out this link...
Free online video about mind-body syndrome
Free online video "The role the brain plays in pain
The Divided Mind" Dr. Sarno
Healing Back Pain, Dr. Sarno
The Body Keeps the Score, Dr. Bessel Van Der Kol
When the Body Says No: The cost of hidden Stress, Dr. Gabor Maté