Do Dr. Schubiner ('Unlearn your pain') and Dr. Sarno disagree on TMS?

I'm reading Dr. Schubiner's book/program 'Unlearn your pain' which I expected to be in keeping with Dr. Sarno's concept on TMS but I find that Dr. Schubiner differs in explanation of what he believes to be cause of chronic pain e.g.

"Back pain will often develop in people who are experiencing severe difficulties in their jobs but cannot quit them. Their subconscious mind will often try to 'protect' them by causing pain to get them out of the distressing situation." (p.40).

He also talks a lot about stress causing over-sensitisation of nerves and pain pathways being learned after healing has occurred, as the reason for chronic pain, rather than a direction emotional cause.

Does he disagree with Dr. Sarno as pain being used as a distraction?

Thanks

 

Hi. I may be interpreting things a little differently, but I don't think Dr Schubiner is saying that there is a structural cause for the pain. Its just that with chronic pain, we do develop neuropathways that create sensitivity and a propensity to feel pain. Fortunately, our brains are neuroplastic and we can train and develop new pathways that do not support the pain sensitivity. But the old pathways are still there. I forget which book I read that gave the analogy of a ski slope. When you go sledding it is easiest to hop on the pathway you have already laid. You can go in a different direction and carve a new path, but the old one is still there. What does this mean for our TMS recovery? Well, for me, I had occipital neuralgia and right sided neck/head/shoulder pain for many years. Just three years ago local neurologists recommended cervical surgery. I showed my MRI results via email to Dr. Schubiner. He was very helpful in supporting my TMS diagnosis and recommending that I did not need surgery. And it turns out I did not. But this area is my weakness, it is my pain default mode so to speak. If I am really stressed, not getting enough sleep, and allowing myself to fall back into my old patterns, this is where I feel it first. I now see it as a signal. It does not cause the fear and panic it used to. I realize that I have to stop, take better care of my self, and explore what is going on emotionally. I do not think Dr Schubiner disagrees that TMS pain is a mental distraction from emotional causes.

 

Hi Anne,

Thanks for your reply

He doesn't say that the pain is structural, he agrees it's caused by the mindbody (he says by stress and the way emotions are 'suppressed'), but he seems to be saying that your subconscious doesn't create pain as a distraction, like Dr. Sarno says, to distract you away from 'repressed' emotions it doesn't want you to feel, but instead that it is creating pain to get you out of things you don't want to do e.g. your job to allow you to remove yourself from the situation, like it is providing an excuse, which is a very different explanation. In the case of injury e.g. a pain pathway doesn't disappear after an accident, his ideas seem to fit more with Dr. Sarno. I'm just a little confused because I see this book recommended by a lot of people on this site and then I find that it seems to have a different premise! Dr. Sarno stresses how important it is to accept his explanation of TMS which is why I think this 'other' idea is bothering me.

 

I read "Unlearn Your Pain" and did not really see the contradiction you are speaking of. I'm not sure he was saying that people create pain to get out of things they don't want to do, but rather sometimes people have a hard time facing the emotional reality that they are unhappy in their job, marriage etc. and they don't feel like they have any other options. In other words, they are stuck and this can cause a lot of emotional pain and distress. Rather than focus on that and feel it fully, pain is created as a distraction. Sometimes that pain is so severe that they can no longer function in their job, marriage etc. but they are still in pain. They are not functionally living a full life, they are limping along in pain. They are distracted by the pain and not focusing on the true cause, the emotional distress. The solution is to recognize why the pain is there and to feel the emotional distress.

 

Hi Sara and Anne,

I am enjoying this discussion.

I think that in this fine point: Is there secondary gain in "causing/maintaining TMS?" Dr. Sarno has clearly said "not one in a hundred/or thousand [I forget the number and exact quote, but almost never.]. And that, indeed, as I read, and listen to Dr. Schubiner, he sees this as one factor.

https://en.wikipedia.org/wiki/Primary_and_secondary_gain

Secondary gain can also be a component of any disease, but is an external motivator. If a patient's disease allows him/her to miss work, avoid military duty, obtain financial compensation, obtain drugs, or avoid a jail sentence, these would be examples of secondary gain. These may, but need not be, recognized by the patient. If he/she is deliberately exaggerating symptoms for personal gain, then he/she is malingering. However, secondary gain may simply be an unconscious psychological component of symptoms and other personalities. In the context of a person with a significant mental or psychiatric disability, this effect is sometimes called secondary handicap.[1]

Let us suppose, since we don't have Dr. Schubiner or Dr. Sarno to answer our question, that it is true that "secondary gain" underlies a significant number of TMS cases. What then?

When first read Dr. Sarno's assurance that secondary gain is not a factor, the main impact it had on me was that I didn't feel as "guilty" about that I might have TMS. I felt like I was not a "sneaking participant" and I also felt less that I "did this TMS to myself." This was a great help for me because it undermined some of my Inner Critic activity that arose as I contemplated the TMS theory. It was very important for me to read this from Sarno, at the time. The Inner Critic activity about "why I might actually have this terrible, baffling, weird TMS" interfered with me accepting my own TMS diagnosis, so Dr. Sarno's assurance on this particular point was very helpful for me to contemplate and believe I had TMS. I don't know how this would have been different had my introduction been been by Dr. Schubiner's work.

So, Sara, what if there is secondary gain? What comes up for you? I think ultimately it does not matter whether Dr. Sarno or Dr. Schubiner is correct. Both agree it is a mind-body dynamic, and agree on the outlines of treatment. So I am curious how this "conflict" impacts you, Sara. Not as a criticism of you, but as a support for you to inquire into why this piece is important to you, and therefore hopefully clear the way for you. I suppose this is why you brought this up?

Andy B.

 

Hi Andy,

Thanks for your message

They way you explained it is how I interpreted the difference too.

I gave secondary gain a lot of thought back when I was first learning about psychological perspectives on pain, which is how I discovered TMS. For me, I really don't believe there is a secondary gain component. My TMS manifests as pelvic pain, which while painful and tiring, doesn't get me out of anything as I still have to carry on caring for my children and running the house just as before, just with a lot more difficulty. Because of the 'personal' nature of the pain, I don't discuss it with friends and family (outside my immediate household) so I don't gain any sympathy or additional help etc. Additionally, I'm missing out on a lot of fun actives in which I really want to participate. I thought hard on this issue and really don't think it is involved which is why I was a little disappointed after ordering and starting Dr. Schubiner's book, to encounter this difference between his view and Dr. Sarno's view. I think this "conflict" or the reason I am troubled by this variation in the theories of the two doctors so much is that I am trying so hard to build up 100% confidence in my symptoms being TMS and the perfectionist in me is trying (far too hard) to find the 'one perfect method' of TMS healing (and I suppose I had hoped Dr. S's work book would be it). Also, I know my inner-skeptic is looking for discrepancies in TMS (the little voice asking "Is this really real? Does it really work?") so it would be easier if there was just a universally agreed understand of TMS. I realise that the fact I have made an issue of the discrepancy tells me a lot about myself and where I am at with this process, which is probably more important than any differences in versions of mindbody healing.

Sara

 

Hi Sara,

The way I read Dr. Schubiner is that he feels this "gain" can be a factor. Not "usually is." The fact that you are clear on this factor in your own case can, perhaps, help clear the air for you, and you can move into where both Dr.s agree. From what I have seen, every practitioner related to Dr. Sarno brings their own propensities, insights, additions, emphases.

The desire for "solid ground" or certainty is something we all have. It is especially acute when it comes to pain and suffering. So I can understand why you want agreement. This tendency in me is why I tend to stick with the very core Sarno work (which for me, does include Dr. Schubiner) and not go too far afield into many of the great books and teachers that folks recommend here. I can see my rigidity, and it is based on that I personally know Dr. Sarno's method works. I can see my desire for solid ground.

Andy B.

 

Thanks Andy. That makes a lot of sense.

 

Hi Andy. I think it is really interesting what you say about secondary gain and our inner critic. I now remember acutely that I really struggled with that at the beginning of my recovery. The faulty thinking was that if we have the ability through belief, knowledge, and action to alleviate our pain, then we are then somehow responsible for creating it to begin with. It was difficult from me to get past this and I remember sobbing to my TMS therapist at the time that I had some dark need to punish myself. Recognizing and batting down my inner critic is what saved me here. Having spent over 20 years in chronic pain I explored many, many different kinds of therapies and for a while got sucked into the theories of secondary gain and woundology, for instance in workshops with Caroline Myss on why people don't heal. It really did provide me with a lot of fuel for being hard on myself, and did not get me any closer to healing. Embracing TMS recovery is what finally did it for me. I can finally say that I feel good in my body most of the time. That is so incredible to me. I personally believe the majority of people would prefer to feel this way.

 

Hi Sara,

I also suffered from severe pelvic pain and I know there a few women here who also have pelvic pain. It was just a few years ago I had to cancel a birthday week-end getaway because I had such bad pelvic pain. I just stayed in bed crying in desperation the whole week-end. Most of the time I managed things much better than that, but sometimes it really got me. I had lots of testing done and the best my doctor and urologists could come up with was bladder spasms. Most of the time it felt like a bad UTI that wouldn't go away and then sometimes it was burning or strange uncomfortable sensation in my urethra. Sometimes it would go away for months at a time and then suddenly return. I couldn't figure out any real patterns. In any case, I completely understand about not wanting to share it with anyone. I would talk with my husband but he was really at a loss as to what to do or say. I can have a very over-active mind and one of the things that helped me the most was working with a somatic experiencing therapist. It got me out of my head and back into truly experiencing and accepting what was going on in my body in a loving, forgiving way. Also, we would work on bringing mental attention to a part of the body not in pain. It took a lot of work but was very helpful in not obsessing and focusing on the pain too much. This allowed me to focus on the emotional work more effectively.

 

Anna,
Thank you for your comments.
Andy B.

 

Psychology has three major schools of thought. Psychoanalytic psychology looks at unconscious conflict and repression. Cognitive Behavioral psychology looks at maladaptive beliefs ways of thinking. Humanistic psychology looks at existential anxiety &meaning making. Within those major schools, there are many sub-theories. This is very general, but "thinking psychological" doesn't necessarily mean that repression is the root of pain. It's a theory.