Tuesday, November 22, 2022

Back Pain and the Mind-Body Problem

From the NY Times, here's another testimonial to the curative power of John Sarno's psychological approach to back pain:

For more than a decade, I had a near-constant throbbing in my left piriformis, a small muscle deep in the butt. I tried treating it with physical therapy, ultrasound and Botox injections. At one point, I even considered surgery to cut the muscle in half in order to decompress the sciatic nerve that runs underneath.

Then, in 2011, I picked up a library copy of the 1991 best seller “Healing Back Pain: The Mind-Body Connection.” It claimed that, in order to distract the sufferer from repressed anxiety, anger or feelings of inferiority, the brain creates pain in the neck, shoulders, back and butt by decreasing blood flow to the muscles and nerves.

The book’s author, Dr. John Sarno, was a rehabilitation physician at New York University and something of an evangelist, touting a methodology bolstered by anecdotes from his practice and passionate testimonials from patients like Howard Stern or Larry David, who described his recovery from back pain as “the closest thing that I’ve ever had in my life to a religious experience.”

According to Dr. Sarno, nearly all chronic pain is caused by repressed emotions. By undergoing psychotherapy or journaling about them, he said, you could drag them out of your unconscious — and cure yourself without drugs, surgery or special exercises. I chose journaling and began writing pages-long lists of everything I was angry, insecure or worried about.

I appreciated the tidy logic of Dr. Sarno’s theory: emotional pain causes physical pain. And I liked the reassurance it gave me that even though my pain didn’t stem from a wonky gait or my sleeping position, it was real. I didn’t like that no one in the medical community seemed to side with Dr. Sarno, or that he had no studies to back up his program.

But I couldn’t deny it worked for me. After exorcising a diary’s worth of negative feelings over four months, I was — in spite of my incredulousness — cured.

Of course this doesn't mean Sarno's method really cured our author; believing that if you get better, the last thing you tried must have cured you, is medieval medical thinking. Sometimes chronic conditions get better on their own.

But then this is equally true of surgery. As I have mentioned here before, I have two acquaintances who swear that disk repair surgery magically cured them from years of terrible back pain. But since large-scale studies show that, on average, disk repair surgery does little good, who knows?

Back pain is really complicated. It is much more common among people who have experienced a trauma in their lives like divorce or job loss. It is more common in economically depressed areas. And yet it strikes some happy people whose lives seem as good as anyone else's. It is, as some people say, a "bio-social-psychological" condition.

But to deny that pain has a psychological component, to believe that even mentioning psychological factors is some kind of insult, is unhelpful. Our brains are part of our bodies, exquisitely connected to every other part of us, bound together in ways that sometimes mystify us but are very much real.


David said...


On the insult front, I think it depends on how one phrases it. Your statements here contain no insult: your idea seems to be "this may help with this kind of distress," which is what medicine is supposed to be. But, referencing the previous discussion you link to: yes, I would continue to insist that there was animus behind DeBoer's response to Douthat (his line that in his experience, long Lyme was characteristic of a certain kind of upper middle class person; how is that not hostile, especially coming from the leftist DeBoer, whether "true" or not?).

Saying physical symptoms have a psychological cause is in itself in no way insulting. But there are plenty of ways to put a hostile accent on that simple statement. Suggesting that the complainant is just that kind of annoying person is a classic example. I doubt Sarno said to a patient, "Everyone around you is in luck. I can help you stop complaining."

On a different front, I wonder if "if you get better, the last thing you tried is what cured you"--essentially post hoc, ergo propter hoc--is particularly medieval. If some source like the Salernitan Questions or whatever says "the physician must learn to think this way," then yes, we're on our way to an argument that it is. But provisionally, it strikes me that the Standford Encyclopedia of Philosophy (I've got an authority!) is closer to the mark when it says that this sort of thinking is "a common fallacy of the human mind." Moderns engage in it all the time, and my physician father (another authority! whee!) described to me how he and his comrades had to be trained out of it.

Anonymous said...

The last time I heard somebody boosting Dr. John Sarno was Howard Stern in 1994. It's still a running joke among fans. Anytime somebody has cancer or something, a "Sarno says it's all in your head!" comment will be made.

John said...

@David- I once did some research on miracle collections, and there are hundreds of medieval miracle stories that go like, "I prayed to St. Dunstan, and stayed sick, so I prayed to St. Kevin, and stayed sick, and finally I prayed to St. Wulfstan and got better, so I known he cured me and I am here to make a donation to his shrine."

That's what I had in mind. Obviously it is a widespread human weakness.

G. Verloren said...

John, if you're not familiar with it already, I think you might enjoy reading up a bit on "Mirror Therapy" for people who have phantom limb pains - it clearly demonstrates a powerful innate connection between the 'physical' sensation of pain and the mind.

David said...

It occurs to me that a doctor saying, "Everyone around you is in luck. I can help you stop complaining" is just the sort of thing Larry David would have put in Curb Your Enthusiasm.

John said...

@G-I had heard of phantom limb pain and mirror therapy, but not read much about it. So I did. I had no idea phantom limb pain was so common; up to 80% of amputees suffer from it to some degree, and many find it debilitating. And how cool that the simple trick of watching what seems to be your missing limb move in a mirror for 25 minutes a day can stop the pain for many patients.