Why did Dr. John Sarno's ideas challenge mainstream medicine?

For decades, chronic back pain was viewed primarily through a structural and biomechanical lens.

If you experienced persistent pain, the assumption was often that something in your body had been physically damaged - a disc bulge, spinal degeneration, muscle imbalance, poor posture, or joint dysfunction. Treatment focused largely on correcting, stabilizing, or repairing the affected structure.

Against this backdrop, Dr. John Sarno introduced a radically different theory. Dr. Sarno believed that many chronic pain conditions weren’t primarily caused by structural abnormalities at all, but by the brain and nervous system responding to emotional tension, stress, fear, and unconscious psychological conflict.