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Congratulations on being familiar not only with Sarno but also with the Australian researchers (Lorimer Mosely, David Butler, and Mark Hutchinson). Most readers of this forum are not familiar with the latter.

I was a Sarno purist and devotee for two decades. That enabled me to completely and permanently overcome 24 years of debilitating low back pain. But then I struggled for many years with persistent right knee pain (for which I had three failed surgeries over the years for structural defects) and left foot pain (for which I had two failed surgeries for structural defects). Then about a decade ago, I discovered the three Australian researchers and what Moseley calls contemporary pain science. I am happy to say that I have been completely free of any kind of chronic pain for the last half dozen years or so because of what I have learned from assiduous study of the contemporary pain science method.

I don’t see “lots of contradictions” between the Sarno and contemporary pain science methods that can’t be harmonized. I think each approach gets a lot right. At the same time, however, each approach overlooks or mistakes a thing or two that the other approach gets right. For example, Sarno said we habitually and unknowingly repress emotions that we have learned are dangerous to experience, and we do that by using standard defense mechanisms, e.g., denial, intellectualization, projection, externalization, etc. That is classic Freud and is widely accepted as correct. But then Sarno did what Freud never did. He regarded TMS as a fail-safe defense mechanism to ensure that repressed emotions stay repressed. Sarno said this fail-safe function is why your brain creates TMS, and therefore the way stop TMS is to become aware of your repressed emotions. In contrast, Moseley & Butler say your brain creates pain when it has more credible evidence that you are in danger than it has credible evidence you are safe (and Moseley, with his neuroscience training, explains the biology of this in molecular detail in chapter 3 of his and Butler’s Explain Pain Supercharged). Moseley & Butler say the way to stop chronic pain is to have more SIMs (Safety In Me) than DIMs (Danger In Me) in your life. In my opinion, Moseley & Butler do not fully appreciate the role of repressed emotions as super strong DIMs. Importantly, however, Sarno and Moseley & Butler are easily harmonized. Sarno says: Repressed emotions = Pain. Moseley & Butler say Danger = Pain. The two equations are harmonized by adding a third one: Repressed emotions = Danger.

This harmonization might seem incomplete because repressed emotions are not the only kind of danger to a person’s well-being. But Sarno did not limit his explanation of TMS to repressed emotions. Although he said repressed emotions are the major cause of it, he recognized another cause that he called Pavlovian conditioning (also known as associative learning). E.g., if you have learned for whatever reason to expect that bending over to tie your shoes will make your back hurt, then your back will hurt when you bend over to tie your shoes solely because of what you expect, not because of any repressed emotion. Stated differently, you have been conditioned to associate bending over to tie your shoes with the danger of being in pain. In Moseley & Butler’s terms, Pavlovian danger conditioning is a DIM. Sarno and Moseley & Butler are talking about the same thing as the cause of chronic pain, namely, danger to your well-being. (In my opinion, Sarno overlooked that the repressed emotion cause of TMS is subsumed under, i.e., is just an instance of, Pavlovian danger conditioning. To explain why would require a long digression that is not worth getting into here.)

Perhaps the hardest to reconcile difference I see between Sarno and Moseley & Butler is Sarno’s reservoir of rage in the unconscious, to which we can never gain true access. Moseley & Butler have no reservoir of rage. For them, however, there are stored memories of what is dangerous to our well-being, i.e., a reservoir of what is dangerous. If I recall correctly, some danger memories are stored in the hippocampus and retrievable to working memory, i.e., consciousness, while most of them are stored in a subcortical part of the brain called the amygdala, which is not directly accessible to consciousness.

Most important of all, though, both Sarno and Moseley & Butler stress the absolute necessity of understanding and accepting that the cause of your chronic pain is NOT a damaged or defective body part. Instead you must understand and accept that the cause is something “psychological”--to use Sarno’s term when he said it is necessary to “think psychological not physical.” To understand and accept all this at an intellectual level is one thing. It is a wholly different thing to understand and accept it at a deeper level, and that is what is essential. I don’t know how to describe the deeper level, except to say that for me it has always required an epiphany of some sort supported by what I regarded as credible evidence. Moseley & Butler once described the process as follows: “Even if no problems whatsoever exist in your body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. It is as simple and as difficult as that.” (I added the italics for emphasis.)

The difficulty in succeeding arises, I think, because it is not just the conscious but also the subcortical nonconscious part of your brain that must conclude you are not in danger. My experience has been that I stopped persistent pain only when (a) I understood and accepted that the pain was not due to something wrong with my body tissues, nervous system, or immune system and (b) I identified the exact psychological cause i.e., exact danger to my well-being whether it be a repressed emotion or some other conditioned expectation of danger. The difficult part was accomplishing (a). Once I did that, accomplishing (b) was relatively easy.