by dr. john e. sarno mD
Please Note: Each book review is intended to provide an overview of the content and it’s main benefit to the reader. Though I recommend reading a book alongside following The Roadmap, I am in no way connected to the author or publisher or them to me or this website.
key elements
– Back pain, as well as other joint, and muscle pain is rarely due to physical factors
– The repression of so called negative emotions, particularly anger, is the cause of most physical pain.
– The pain itself is due to the reduction of oxygen to the affected area, not by any permanent serious problem.
– Certain personality types are prone to this
– Anyone can cure themselves of back pain and other muscle pains by acknowledging their emotional distress as the cause.
– Other conditions are likely to be caused by emotional repression.
why this book is worth reading
This book clearly sets out, with numerous well documented examples, the clear link between the mind and the body in health and particularly physical pain.
Most of us now have an understanding that mental stress in our lives can be detrimental to our physical health but often this is thought of in a vague way as stress contributing to or exacerbating already existing conditions. This book shows how the way you think can directly affect your body causing physical pain. By focusing on one area in particular – back & muscle/joint pain, Sarno drives home the message that the way you deal with the world and your thoughts about yourself & others has a profound effect on your body.
Dr. John Sarno was Professor of Rehabilitation Medicine at New York University School of Medicine for many years and treated thousands of people for back pain. His methods have influenced many others to develop and practice a Mind Body approach to medicine and particularly pain.
Testimonials to his work have been collected together at the website Thank You Dr. Sarno.
pain
Pain must be physical right, I mean it hurts!
Don’t worry, this is not a book that is going to tell you the excruciating bout of back pain, where even the slightest movement sends sharp needles up and down your legs and torso, is all in your mind. The pain is real, but it is the cause of this pain that is in question. Where the usual medical model explanation for joint and back pain is either wear and tear or a strain, Sarno, through years of practice, found this approach not just inadequate, but plain wrong.
Though Sarno always starts by ruling out a genuine physical cause of pain such as a tumour on the spine or some kind of acute breakage or rupture from an accident, these causes are rare. More often, what is thought to cause joint and muscle pain, including joint deterioration visible on x-ray is not the deterioration itself. Sarno shows in chapter five that common structural problems such as herniated disc, scoliosis, tendinitis, bursitis and a host of others are present both in people with pain and without pain.
This finding has also been borne out by studies showing how “sham” surgeries, where for example a sample of patients experiencing knee pain receive a genuine knee operation and another sample receive all the trappings of an operation, including the cuts on their skin, but no actual surgery but both groups experience the same level of recovery and report the same level of pain reduction. (see here for more info about this and more examples) How could this be if these abnormalities actually caused pain?
The answer for Sarno is that the pain is caused not by any inherent flaw in our muscles or joints or bones, but by mild oxygen deprivation at the cell level in the muscle area where the pain is located. This oxygen deprivation can affect muscles, nerves, tendons and ligaments. Sarno termed this Tension Myositis Syndrome or TMS.
This is an as yet unproven theory, but it also seems borne out by what Sarno calls the “Symptom Imperative”. This is the phenomenon where once pain is “healed” in one area (either by surgery, or physiotherapy or by Sarno’s methods) pain or other physical problems can appear in another, completely different area as if magically. For example, in my own experience I have had back pain disappear, only to be replaced days later with ankle pain, or hip pain.
The questions arising logically from all this is why does pain move around and what is causing the oxygen to be deprived from these various areas of our bodies?
Repression
Repression is a word I had always associated with Freudian psychoanalysis. For some reason this had made me think of it as hiding away some deep dark secrets, wanting to kill your father or have sex with your mother, but repression is much simpler than that and very commonplace. For a definition of repression & the difference to suppression, check out the Glossary. Simply put, repression is the act of burying feelings and thoughts that are unpleasant in some way to you (either because you have learned to think of them as unpleasant or because society agrees they are unpleasant) so that you are unaware of even having these feelings, thoughts and emotions.
Sarno saw in many patients with pain that they commonly repressed one emotion in particular – anger. The anger they refused to acknowledge to themselves was anger at their life or work situations and particularly those closest to them such as spouses, parents and children. He also saw that there was a link between this repressed anger and the pain they felt and that by acknowledging this link and acknowledging to themselves what they were angry about, his patients’s pain disappeared.
It sounds too simple to be true, but try it yourself. Read this book and if you have any unexplained pain, ask yourself what you might be angry about? You don’t have to go around telling everyone how much you hate their bad table manners or annoying parking or crap driving, or how much it pains you to have to work for them, but you do need to acknowledge those hatreds to yourself.
If someone or something annoys you, set that thought free and accept that you feel that way. Don’t bury it, or you might be burying yourself in pain, or, as we’ll see in the next two book reviews, in a grave.
And why does the pain move around? Because we always have in life new challenges, new angers to repress, and if they are repressed, then pain can be the natural consequence. Sarno saw that many of his patients had personality traits that were prone to repressing anger and hence causing pain.
personality
Personality is a tricky concept. We are taught, directly & indirectly and commonly think of ourselves as having, a certain personality. We are this or that kind of person. Though not discussed in Healing Back Pain, we will look later in The Roadmap through the lens of Internal Family Systems at how it is more useful to think of our personality as not one fixed thing but a community of often competing desires and fears.
With this in mind, when it comes to pain caused by TMS, a person is often dominated by those parts of themselves that are most associated with anger repression. These are the parts of ourselves that want to please other people, be nice and put other’s needs before our own.
If that sounds like you then you are far from alone and many people most helped by Sarno’s books, myself included, often recognised themselves on his pages while reading.
Though helping others is often a positive experience, it can go awry in some of us who see, and have learned it to be, our primary way to gain acceptance in life. This approach means you lack your own voice and your own desires are put second. This can then create a great deal of anger within yourself. As expressing this anger could lead to hurting others, we often repress it. However, we must acknowledge all our feelings.
curing yourself
This book is probably the most important out of all the guides for me personally. It gave me my life back and taught me to always look to the psychological when pain or illness struck.
In 2019, after occasional episodes of mild back pain I experienced a severe bout of back pain and bought this book after searching Amazon for some kind of insight into back pain. I was not looking for any kind of alternative solution, just any solution. I had a young family and a small but growing business, both of which were running into severe problems.
My wife and I were at war over a work-life balance that was out of proportion with me working 80 hour weeks and my business was imploding through staffing and management problems. As well as that my wonderful father had been diagnosed with terminal cancer the same year. Now, on top of all this, I could hardly walk through the pain. I was desperate.
At the same time as I bought this book I had developed a persistent cough which had been ongoing for the last six months. I will never forget hobbling into a Consultant’s surgery, coughing, and barely able to walk. It was the day of my forty-seventh birthday. He told me that my cough was likely Bronchiectasis an incurable autoimmune condition that would worsen as I got older.
This, he told me, was related to my history of Ulcerative Colitis. Even though I had had my bowel removed after acute attacks when I was thirty.
I was dumbstruck. My father was about to die, my business was on the rocks, my wife could leave me and I could hardly walk and now I was going to die a slow death of coughing.
I read Healing Back Pain. and saw myself on the pages as so many others have. I had the personality traits Sarno described as being prone to repressed anger coming out as pain.
Following his instructions, though with the occasional milder back pain setback and the odd symptom imperative challenges, I cured myself of back pain.
Sarno outlines how to treat TMS in chapter four of Haling Back Pain but what it boils down to is acknowledging that your mind can directly affect your body as a way to either distract you from repressed emotions or draw your attention towards the fact that something is not the way you want it in your life.
Knowing this and knowing that any pain or symptom is due to oxygen deprivation and so curable means you can heal yourself and don’t have to stop exercising or depriving yourself in any way.
As Sarno says, and which became a mantra for me, when pain or illness strikes – “Think Psychological ,Not Physical.”
Healing beyond pain
In the final chapter of Healing Back Pain, Sarno discusses the Mind Body interaction in a more general sense and looks at other potential illness that could be due to the lack of coherant processing of our own emotions. Illnesses such as heart disease, autoimmune conditions, ulcers & bowel disease. Here he foreshadows the work of next two guides to come, Rediger and Mate and why I was drawn to their work.
Here as well is where I began to wonder if my original, acute case of Ulcerative Colitis had been due to uncontrolled stress in the form of unacknowledged emotions. After two acute attacks within six months I was diagnosed and then had an emergency removal of my entire colon on my thirtieth birthday, leaving me with an ilesotomy, a bag atached to my abdomen.
I was early in my business then and bending over backwards, busting my guts, (see the article Mind Body Healing for more on such sayings) trying to please my clients at work, the expectations of my parents and my newly found dream girl, love of my life. Life up to this point had been difficult in many ways and now that I seemed to be finally succeeding at work and in love along came an acute physical illness.
When I thought of that and saw the parallel with my condition seventeen years later in another medical setting on my forty-seventh birthday with a supposedly incurable cough, I made the cognitive jump. After googling bronchiectasis, seeing it had no known cause I wondered if like ulcerative colitis and back pain was this my physical way of dealing with an extremely difficult emotional situation – my body saying no, telling me to stop, either distracting me from my emotions or trying to draw me into discovering them?
Healing Back Pain was the only book I had read that discussed Mind Body healing and so I applied Sarno’s reasoning and techniques to my cough telling myself it was my way of distracting myself from all the anger I felt in the different areas of my life.
I allowed myself to be pissed off and my cough resolved itself within six months. My own personal experience of curing the incurable.
where i see this book in the roadmap
Even though it is scientific in nature this book fits in Stage Two about how science doesn’t have all the answers as it is about turning current scientific thinking on its head. It also fits well in Stage Four because it teaches you about the effect of your childhood learning on your physical health. It also links to Stage Three in that it shows that if you try to fit your life to what society’s says is right, this can cause problems.
Finally I would say to ignore this work and the next two guides at your peril. There is no way to freedom if all your time is taken up with being sick.