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I think fear of abandonment is a really common and critically important factor in TMS, which unfortunately is too often overlooked. My purpose here is to explain why I think that.

My view is based on attachment theory, which was pioneered by the late psychiatrist and psychoanalyst John Bowlby. The core idea of attachment theory is that we have an innate drive for physical and emotional connection with other people. This drive is hard-wired in our brains as a result of--take your pick--evolution or Intelligent Design.

Gabor Maté concisely explained the effect of this drive on our lives in his latest book The Myth of Normal. He noted that for mammals, and even birds, this drive is indispensable for survival.

“Its primary purpose is to facilitate either caretaking or being taken care of. For the human infant especially—at birth among the most immature, dependent, and helpless animals, and remaining that way for by far the longest period of time—the need for attachment is mandatory. Without reliable adults moved to take care of us, and without our impulse to be close to these caregivers, we simply could not survive—not for a day. . . .​

“In infancy our dependence is an obligatory and long-haul proposition. Everything from crying to cuteness--two unignorable cues babies transmit--is an inbuilt behavior tailored by Nature to keep our caregivers giving and caring. But the need for attachment does not expire once we are out of diapers; it continues to motivate us throughout our lifespan. . . . What distinguishes our earliest attachment relationships—and, crucially, the coping styles we develop to maintain them—is that they form the template for how we approach all our significant relationships, long after we have grown out of the do-or-die phase. We carry them into interactions with spouses, partners, employers, friends, colleagues: into all aspects of our personal, professional, social and even political lives.”​

Bearing this in mind, now consider what Sarno wrote three decades earlier in Healing Back Pain:

“I remember a mother telling me proudly how she had stopped the temper tantrums in her little fifteen month old. The ‘wise’ family doctor suggested that she splash ice water in the child’s face when he started to take a tantrum. It worked beautifully—he never had another tantrum. At the ripe age of fifteen months he had learned the technique of repression. He had been programmed to repress anger because it produced vary unpleasant consequences, and he would carry that dubious talent with him throughout his life.”​

The ice water on his face might have been unpleasant in itself, but the really unpleasant consequence was that his loving and caring mother was suddenly and violently anything but loving and caring. His all-important caregiver abandoned him in a time of need, i.e., whatever unmet need he had that prompted his tantrum. He learned that his anger at his mother significantly damaged his attachment relationship with her. Stated differently, the fifteen month old learned that his anger at his mother was too dangerous to his well-being to experience, so he coped by learning the dubious talent of repression. As Sarno has noted, we repress emotions that we discover are too dangerous to experience. In my view, not much can be more dangerous to one's well-being that an emotion that frustrates his or her hard-wired drive for secure attachments in significant relationships.

I have another story about abandonment that involved Sarno. It concerns a woman he had successfully treated for low back pain that had persistent for many years. She remained completely free of low back pain (or any other form of TMS) for many years thereafter. But then the back pain returned, seemingly out of the blue. She was unable to figure out why, so she telephoned Sarno.

He successfully treated her in a 10 minute phone call. He first asked her what was going on in her life currently. She said her husband had just been diagnosed with cancer. Her worry, dread, and anguish that the cancer would be fatal was obvious in the conversation. Sarno knew from having treated her years earlier that she had been sexually abused by a family member as a child, and when she sought help from her primary caregiver, that person did not believe her and did not support her at all--in other words, abandoned her. Sarno said that her childish, narcissistic id was angry at her husband because of fear he would abandon her by dying from cancer, and she was repressing her anger at him. To her unconscious, childish, narcissistic id, her fear that he would abandonment her by dying was equivalent to her childhood abandonment trauma. Her back pain was gone when the phone call ended and never returned.

Sarno never wrote about this, so how do I know about it. Her husband told me. He did not die from the cancer, which was in one of his thumbs. That thumb had to be amputated so the cancer could not spread. The amputation ended his career as a heart surgeon. I have no doubt that financially he could have retired, but he was inspired to became a mindbody physician. His training for that included spending some time learning from Sarno in his clinic.

So how did I hear the story from the husband? Fourteen years ago, several months after I retired, I got neck pain that persisted. At that time, I was a Sarno disciple because years earlier I had ended more than two decades of persistent low back pain by following his advice in Healing Back Pain. However, I was unable to get rid of the neck pain, so I consulted the husband about my neck pain. After probably the second or third time that I told him that something he had just said was contrary to what Sarno wrote, he blurted out that Sarno did not go deep enough. I figured he was referring to ISTDP since Sarno’s chief clinic psychologist was trained in that, so I undertook serious self-study of ISTDP. Attachment theory is the foundation of ISTDP.