Dr. John Sarno discusses his approach to treating chronic pain, emphasizing the connection between the mind and body.
During this interview, Dr. Sarno observes that a majority of his patients with back pain have a history of other mind-body related conditions, such as allergies, headaches, and stomach problems.
Dr. Sarno explains how the brain controls everything that goes on in the body and how it can cause pain as a protective mechanism to keep emotions, such as intense anger or painful memories, from surfacing. He highlights that certain personality traits, such as being responsible and hardworking, may lead to heightened pressure and contribute to chronic pain.
Dr. Sarno shares insights into working with the unconscious mind to alleviate persistent pain.
When did you start to think there’s something more going on here with people than just a bad back?
I graduated from medical school in 1950. I was asked to head up the outpatient department at the Rusk Institute of Rehabilitation Medicine in 1965 and was then exposed for the first time in my medical career to large numbers of people with back pain.
I used the conventional diagnosis and treatments for about seven or eight years with great disappointment. There was great frustration because people just didn’t get better.
I noted - and this is the important thing - that practically all of the patients I was seeing had histories of other things which I had considered mind-body for many years. Like common allergies and common headaches and common stomach problems and common colon problems and so on. And then I said, ‘Wow, wouldn’t it be amazing if this physical thing turned out to be the same sort of thing.’
That was the beginning. I began to put that into practice and obviously one always had to rule out any important structural abnormality which wasn’t difficult to do.
Little by little through the years I learned more and more about how it works - how it works physically and how it works psychologically.
How does your brain does this to your body?
Your brain does it to your body - believe it or not - to protect you. To protect you from emotions it considers to be either threatening and dangerous, like intense anger to the point of rage. Or from emotions that are too painful, too unpleasant.
So it’s focus on this pain, not on that emotion?
The strategy works. The brain knows if it gets you to focus on the pain, then all your anger will certainly not come out.
In all the years I’ve been doing this - 34 years or so - I’ve only had one patient who had an experience where some of those emotions exploded out. That was a woman who had been actually sexually abused by her father many many years ago.
Generally the emotions don’t tend to come out, so the strategy works.
How does the brain cause the pain?
The brain controls everything that goes on in the body. There are different systems involved. The system that’s most commonly involved is the autonomic nervous system that controls involuntary functions. It controls the circulation of blood which is how it produces symptoms.
The brain simply decides, ‘I’m going to reduce the blood flow to these spinal nerves down in the low back area,’ and that produces pain. It’s very simple.
Fortunately it’s very benign, very harmless because the degree of oxygen deprivation that results is quite minimal, but enough to produce pain.
The brain does the same thing by interfering with normal function in the stomach and you have reflux. It does the same thing by interfering with normal function in the bowel and so you have Irritable Bowel Syndrome and on and on and on.
So you believe Tension Myositis Syndrome isn’t just about back pain?
I call these other things equivalents. The psychology is the same. It’s fascinating. I had a telephone call from a woman today, 81 years young. There was a catastrophe in her life three years ago and she began to have symptoms for the first time.
First, it was some urinary problem and she went to the doctors and they cleared it out. Then she developed pain in the shoulder and she went to a chiropractor and he cleared that up. Then she developed sciatica and she went to someone and that was cleared up. Then she developed what she has now which is pain in her neck.
She came across my books and said, ‘I think these were all related,’ and I said, ‘They certainly are.’ She came in to be educated.
So for some people simply knowing about this works for them?
That’s why so many people have gotten better just from reading one of the books. I think why people are able to get better just by learning about it is that what’s going on psychologically is not quite as heavy as it is in others who required more than that.
Others who need to come and see me, have the diagnosis confirmed after an examination, attend the lecturers, attend my meetings. More work is needed on the unconscious mind.
How do you know what’s going on in your unconscious mind?
You can’t identify it by tests. An MRI doesn’t tell you what’s going on in the unconscious mind. You can do more sophisticated studies that neuroscientists are doing now and that doesn’t tell you.
It’s a matter of learning and observation. It’s really not terribly difficult. But you’d be amazed that every patient I’ve ever seen who has come to me has certain personality traits. It is so consistent.
They’re hardworking, conscientious, responsible. People who expect a great deal of themselves. We call that a perfect tendency. They almost invariably have a need to be very good people.
Why is this a problem? It certainly isn’t a problem in our daily lives. It’s magnificent in our daily lives.
But in the unconscious it’s a problem because it puts certain elements within us under pressure. It’s pressure from outside and pressure from inside. The pressure we put on ourselves is an even greater pressure.
And all that pressure causes pain?
Yes, all that pressure results in anger, intense anger. That’s probably the main reason for symptoms, to make sure that anger doesn’t surface, that it doesn’t become conscious.
I keep learning every day. Within the last few weeks I’ve introduced a new therapeutic idea to the people I’m working with because I think it may help.
We’re talking about chronic pain and not garden-variety pain?
We’re talking about both. You assume that you feel sore it’s because you worked too much in your garden this weekend. If this annoyed you sufficiently and you felt you had to come to see me, I’d say, ‘No, no, it’s because you’re a perfect and you’re a good - it’s not the working in your garden.’
A perfect and a good?
And I’d ask you, ‘What’s going on in your life? What pressures are there in your life?’ In other words, the pressures we put on ourselves and the pressures that life puts on us.
Or things that have happened in our past from our childhood even?
Well, that’s the most subtle one. That’s the one that a lot of people find hard to believe because they think their childhood was just beautiful. You know, the mom and the dad were great and so on.
But there are certain factors that lead me to believe that in virtually every one of us, we carry away some things from our childhood that still influence us. What made you develop these traits of the perfect and the good?
Trying to please your parents?
Exactly. And so you carry that right on into adult life.
How has the medical community dealt with you over the years?
Oh, it’s very simple. Totally ignored. Totally unaware of what I’m doing.
But you’re in New York at the Rusk Institute?
I’m a full professor here at the NYU School of Medicine.
How can they ignore that?
They don’t read my books. And it doesn’t fit with contemporary medicine. And contemporary medicine is really only since the mid-1950s. Prior to that, doctors very much had in mind the possibility that emotions could influence illnesses. And there were many papers published in peer review journals. been totally ignored now.
But since the mid-1950s, medicine has become increasingly mechanical. Let’s identify what’s wrong and then let’s fix it. Fix it with a knife, or fix it with a drug.
But the idea that the mind might be playing a role in these things is totally absent from medicine today. You realize that treating pain in the United States is a major industry. Billions of dollars are spent every year.
In fact, it was an extremely important article published in the Journal of the American Medical Association demonstrating the enormous amount of money that’s been spent over the last six or seven years. And then the statistics indicate that the problem is still as great as it ever was, that essentially we haven’t gotten very much for our money.
Do you think that maybe in the past five, 10 years there’s been a group of doctors that actually do think more about what you’re saying?
It’s a very, very small group. What you’re hearing is more talk about mind-body medicine. It’s a general recognition that stress may be important in our lives. But I have seen nothing that essentially recognizes what I’ve been talking about. That is a relationship between the mind and the body in which there are definite events occurring as a result of what’s going on emotionally.
This is really the realm of psychosomatic medicine. The word is not a good word because people don’t understand what it means. They think it means kooky or weird or strange and so on. But if you think about it technically, that’s the correct term.
Of course, this connection between the mind and the body has always been so. And the fact that it is totally ignored now is very upsetting. It’s a public health problem of major magnitude.
I have concluded after all these years that the only thing I can do to possibly make a small dent in the problem is to try to continue educating doctors, primary care physicians.
And what I would teach them is what this disorder is all about, how essentially benign it is once you have ruled out cancer or something of that sort. And that they should treat the people themselves and not send them to the specialists. Because once you send them to the specialists, they’re gone.
You do still see patients?
Oh sure, sure. I see patients three days a week and then I have my two-hour lecture every Monday evening and group meetings every Tuesday.
I have nine or ten people who are still struggling to get through. They have attended the lectures. They’re doing their homework. Doing homework is very, very important in this. I make sure the patients understand this. We find that writing can be extremely helpful.
And the latest thing I’ve introduced is talking to people about getting in touch with their inner self. Sounds almost Buddhist but the fact of the matter is I think the Buddhists are very wise.
How do you advise people to get in touch with their inner selves?
It’s kind of like meditation. Quiet time, close the eyes and imagine. Six-year-old Donna standing in front of you and saying to six-year-old Donna, ‘You know right now you had to be a good little girl and so on and that made you angry and maybe sometimes you were unhappy and sad and so on.’
You’re just sort of conversing with her. And letting her know that you, the adult mature intellectual you is her friend.
I just started to introduce that as another therapeutic strategy. You see how far away this is from conventional medicine. This is a whole other world.
And what we need to do is get more doctors recognizing that this world exists and to start trying to introduce it into their practices.
When you teach doctors do you find that they are receptive to this?
I only teach the doctors who want to be taught. There aren’t very many. I had an enthusiastic patient who wanted to help. I said, ‘Find me doctors.’
So he found a doctor in his community and he sent them and he spent some time with me here and now we’ll go back and try to put these principles to work.
I take it you’ve seen some miraculous things happen?
Oh, yeah. I mean, it’s very gratifying. Some people go from being totally disabled individuals to highly functional.
What would you advise people who can’t come to see you?
Read the books. There are four of them. They’re available online. A certain number of people will get better just from reading a book. And then others may say, ‘Well, you know, let me see if I can interest my doctor in this. Or a psychologist that might be willing to work with me.’
But just knowing about it can help some people?
Oh, yes. Oh, absolutely. Think about it as if your pain is protecting you from something. I’ve been saying lately to patients, ‘Think about your pain as your friend. It’s telling you something. It’s saying, pay attention.’
How about that? So it’s serving a double purpose - protection on the one hand and knowledge information on the other hand, about a very important part of you. What’s going on inside.
So there’s nothing that you advise people to do physically, like take yoga classes?
I tell them that those things are okay, but they’re not going to cure you.
What I say to patients as soon as they come into the program during that initial lecture, you have to get out of the physical ballpark entirely and get into the psychological ballpark.
And that’s a very, very important thing.
And very hard for some people to do?
Of course, of course. A very bright young woman made a statement at one of our meetings that denial of the syndrome is part of the syndrome.
What does that mean? It means your brain doesn’t want you to think this is psychological, it wants you to stay focused on your body.
I just talked to one of my patients today who’s been working with one of our psychologists and he said, ’It’s great. I’m 95% better. I’ve gone back to do everything. My life is great now. But I still have a little bit of pain and a little bit of doubt that it’s not entirely Tension Myositis Syndrome. What do I do?’
I said, ‘Go back to your psychologist. You’re not quite finished.’ And he’ll do it. He’ll be at the meeting tomorrow night, but he’ll do that.
The modicum of doubt means that the brain still needs to continue either your pain or your fear. Fear is the big, big factor in this whole business.
Fear of the pain. Fears we carry over from childhood.
I guess everybody still has their child inside?
Oh, yeah, we all do. I still communicate with mine at my age. It’s never too late to have a happy childhood.