Alan G. Getting to the heart of TMS

This question was submitted via our Ask a TMS Therapist program. To submit your question, click here.

Question

I would like to ask a question that I have only seen touched on on this forum in a roundabout way. I am currently re-reading the excellent book, "Phantom Illness." My question is - How does TMS relate to the more generalized hypochondria? In this book, general hypochondria is broken down into several different types, one of which is called "pain disorder." I take this to possibly mean that TMS is maybe a subset of hypochondria. I have observed that a lot of TMS'ers are also hypochondriacs. What is the nature of the relationship between the two?

I ask because I have always been a hypochondriac, defined as a greatly exaggerated focus on the body and all of it's meaningless noise, to the point of obsession and misinterpretation. I seem to have largely recovered from TMS, that is, I don't experience much pain anymore and outbreaks are usually short. However, I have seemingly replaced it with more generalized hypochondria, by which I feel compelled to focus almost constant attention on body noise that I misinterpret as catastrophic disease. In my worst moments, I think that all I have accomplished is going from one type of hypochondria to another and that the "real" issues have not been addressed. For example, I recently easily recovered from a bout of sciatic pain, only to have become obsessed with a short bout of painless constipation and imagining terrible illness. Or is this my subconscious, realizing it is "so busted", just throwing everything including the kitchen sink at me in a desperate attempt to regain it's hold over me?

 

Answer

I've been waiting awhile for someone to ask this question.

Physical pain is just one manifestation of TMS. At its heart, TMS is anything that can preoccupy you with fear.

The purpose of the pain is to scare you. It’s for this reason that runners often get leg pain and screenwriters often get wrist pain (and not the other way around.) It’s for this reason that pain often manifests in a place where you know you’re structurally vulnerable. And it’s for this reason that some TMSers can eliminate their symptoms simply by reading one of Dr. Sarno’s books (as it can neutralize the fear associated with the pain).

Pain is not special. Pain is not unique. All pain is is a particularly powerful way of scaring the shit out of you.

Pain is just one of the fear outlets that is under the umbrella of TMS. Hypochondria is another. It serves the same purpose. You are constantly worried about something bad happening to you.

I've had patients where the pain goes away and they develop obsessive-compulsive tendencies. OCD is TMS, it serves as a vessel for fear.

I've had patients where the pain dissipates and they develop certain phobias; fear of open spaces, fear of closed spaces, fear of having a panic attack. These phobias are TMS. They serve as a vessel for fear and preoccupation.

Eating disorders are TMS. I've worked with patients with anorexia and bulimia, there's an obsessive preoccupation with how many calories they consume each day and they'll look in the mirror several times an hour to assess their body.

It's too narrow to define TMS as applying specifically to pain. TMS is anything that the mind uses to preoccupy or scare you: persistent fear of financial collapse, fear of earthquakes, fear of your skin breaking out, fear of losing your hair, fear of gluten, fear of Twitter, fear of nuclear annihilation, fear of contracting Ebola (at this point at least...)

You're not trying to get rid of the pain, or overcome hypochondria, or beat an eating disorder, or eliminate OCD, or bounce from one of these preoccupations to another. Your ultimate goal is to alter your relationship with fear and preoccupation as a whole, to connect with yourself, and to connect with the emotions that are underneath these defense mechanisms.

Alan

---

Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

Questions may be edited for brevity and/or readability.

 

I agree, Forest. Alan Gordon's reply is very helpful in understanding the cause(s) of TMS pain.
The Phantom Illness book sounds excellent (and I like that it's available for a penny plus shipping).
I guess once someone reads a book they like, they want others to read it, so they almost give it away.

 

This is fascinating, and I feel like now I make so much more sense to me! And framing hypochondria as TMS just makes me realize that I've "had' this for years. Just recently that it's been in the form of pain. Makes it increasingly easier to accept the diagnosis and act accordingly (WITHOUT FEAR!).

Thanks for this thread.

 

I think we're living in an age with so much media focus on health issues
that we tend to worry that we have everything being discussed or written about.
That's why I don't watch ANY network television and am very selective about what I read.

I like Youtube... I find good documentary and movie videos that lift my spirits and
don't make me think I have every ailment in the news.

 

Thanks so much, Alan, for your answer. I guess I never thought about it in this way before. Yes, I do think that the basis of the problem is fearful thoughts, no matter in what way they manifest. They just keep bouncing around inside of my consciousness. I have had issues with panic attacks in the past. I have been working hard at trying to just let fearful thoughts pass. I know they will not completely go away, but I use mindfulness meditation to be aware of them in a way that is more healthy than reacting to them. I am definitely making progress, but slowly. I like your advice of the importance of focusing on the "real" issue, which is fear. Otherwise, we just lurch from one neurotic state to another without making any real progress.

Forrest, I will do a review on the book, "Phantom Illness" by Carla Cantor and Brian Fallon. I found it extremely helpful and well written.

 

Excellent response Alan, just realized I am full of anxiety over the littlest thing.
distraction mechanism

 

What I don't understand is people who aren't anxious. What's the matter with them? I've never felt secure in my life. In fact, none of us are secure. That's just not the way of the world. I can (almost) imagine someone moving past worrying too much about this dangerous world we live in. Perhaps a cognitive decision not to bother with the dark side, or some kind of philisophical stance like acceptance or stoicism, or a belief that while this world sucks that can and will change. But just think,ing "Hey, I'm safe" is basically nonsense because nobody is safe. Anxiety may be uncomfortable but at least it's realistic.

I like what Alan said earlier: "When the thing you're anxious about is a higher priority to you than the fact that you're anxious about it, the anxiety will persist. When the fact that you're living in a constant state of fight or flight becomes more distressing to you than the thing you're anxious about, that's when change occurs."

That's a bit beyond me so I've provisionally translated it as: when you get sick of being anxious you'll find a way to stop.

 

WOW njoy, Alan really hit the nail on the head. I have often noticed that, whenever I have been having symptoms which I don't find all that scary, my mind must decide that I am not worried and distracted enough and substitutes a symptom that will really scare me. Until recently, I have not had a really scary one. I define a "scary" symptom as one that I have not had for a long time and that takes me by surprise.

I agree with you that the world is scary, at least to anyone who watches television. You know, about 6 years ago, I had a really spiritual experience and did not watch television for about 6 months. That was probably the most peaceful time in my life. I really think that, a lot of us (and by "us", I mean those of us who worry for the world) are sensing that we have had things too good for too long. We have squandered our inheritance. Especially in the area of economics and that always leads to war and other upheaval. But I don't seem to be able to tell the difference between "personal" security and "world" security. I know a lot of bloggers who write constantly about the ills of our government and society and yet are able to keep personal equanimity. In other words, I want to be able to be interested in the bad stuff going on in the world, but not be driven crazy by it. I guess I am just too sensitive, but I guess that is a TMS trait.

 

Excellent answer Alan, one of the best I've seen.

I'll tell you one that I'm seeing quite often, food intake. When they heal from TMS pain or whatever, many folks begin to shift their obsession to a perfect diet. They read, and study, and worry about the types of food they're taking in--for fear they aren't being perfect with what they're putting into their body. Their new worry is that they aren't eating perfectly, and anything they may eat may be harming them. I've seen all kinds of new shifting fears but this one seems common. Of course they deny it's TMS, just like they first denied their new knee pain was, until they can see that it is indeed a new way of TMSing. At first, they felt it was just a way of being healthy, until they realize it's a new compulsion. They feared eating the wrong thing, where they never cared before they healed from their pain. The SI-shift.

Of course there are the good old standbys like people building bunkers, germa-phobianacs, new phobias, eating disorders, and two folks that I've seen shift into PPD (paranoid psychological disorder), one of which was aimed at me. They heal from their physical symptom, but the core work wasn't accomplished, so they turn to paranoia, a psychological defense mechanism. Their fear comes through the window instead of the door.

Fear is the driver of all of life, if it's used correctly it helps us grow and expand light, to light the road to peace. If it's used for self destruction then we get TMS, and self-imposed punishment. The direction depends on self-worth.

Fear is the factor to overcome. But remember the good doctor's statement, "The brain will not be denied!" If a symptom is removed by artificial means, or by placebo, the fear will simply find another way to dim your light. Michael Marshall said, "you can't stop being afraid just by pretending that everything that scares you isn't there." So, face your fear by accepting it, and then using it to expand your light. Consciousness doesn't fear, it knows.

Steve

 

Chickenbone, we had a power outage in our neighborhood a few summers ago that left everyone without electricity
for about four days and nights. I didn't miss television at all. I read books, took more walks with my dog, and
at night listened to my favorite music on a battery operated Sony Walkman. They were four wonderful, peaceful
days and nights. Since then, I watch almost no television. I play good movies on my DVD player at night
and watch good movies and nature documentaries on YouTube. We can find peace and not bombard our minds
with worrying about this violent world.

Steve, learning about TMS has led me not to become obsessed with diet, but I am more regular about eating fresh
fruits and veggies and instead of meat, I like chicken and fish.

 

Good comments, everyone. Just a few thoughts.

First to respond to Walt. It sounds to me like you are sensible to be living a very peaceful life and it really shows. We really need to be aware of the things in life that we can change to help us live happier and more peacefully. That is something I have not worked at hard enough yet. One problem I have is that my husband, a retired physician, likes to watch Fox News. In the past, I only found it mildly annoying and some of the stuff is interesting. NOW, however, with the war drums beating ever louder and the constant talk of Ebola, it has been freaking me out and I am prone to fear anyway. So we recently, after much discussion during which time I managed to convince him that most assuredly my TMS would get much worse, we agreed that he gets only 1 hour per night. I just don't see how the commentators on that station can sleep at night. They are probably thinking about how much money they will make if the world turns to shit.

I also liked Steve's post. It helps me to read about therapist's experiences with TMSers. I can easily relate to how the fear just keeps reinventing itself. To illustrate how I can relate what Steve is saying, I want to give a brief account of my recent experience. About 3 weeks ago, I was thinking about writing my recovery story. It is a good thing I did not. (I do think I am mostly recovered or at least have learned how to be recovered). Before that I had, for about a year and a half, rapidly cycling symptoms that I was usually able to handle. However, this time, all hell broke loose. I suddenly had probably the worst back and sciatic pain I had ever had. I could hardly even sit in a chair. It really took me by surprise. But I got my act together and the pain just as suddenly mostly went away. The very next day, I had lower left, intermittent stomach pain that hurt after I ate. This really took me by surprise because I had not had a problem with my stomach in over 6 years. To give some background, I was diagnosed with diverticulosis 6 years ago on an X-ray after having the same stomach pains, only worse, but I was also going through one of the most stressful periods in my life. The medical report said that I had the condition of diverticulosis (which is the fact of having diverticula, which is usually a painless condition), but that I may have had a mild episode of diverticulitis (which is the painful and possibly life-threatening condition when the diverticula in one's colon become infected), thus accounting for my symptoms. The vast majority of people with diverticulosis never develop diverticulitis. I have always suspected that this episode had a large dollop of TMS associated with it. Anyway, my doctor husband, who is painfully aware that 98% of my constant physical complaints are TMS, usually does not want me to see a doctor because he is well aware of how this practice of constantly running to doctors can lead to unnecessary and often risky medical procedures that can REALLY damage a person's health. But this time, he wanted me to go to a Gastrointestinal specialist just to be sure I was not developing the potentially serious condition called diverticulitis. In other words, he wanted me to get checked for signs of infection. So I went and the specialist thought I was ok and gave me some medicine which has helped a lot and I am better. But he reminded me about the importance of eating a diet rich in fiber to prevent this sort of problem. I had been eating a lot of sweets and processed food which I don't normally do. Although I do believe the recently bad diet and the presence of diverticula helped trigger my symptoms, I do believe there is a lot of TMS, fueled by fear of something bad happening. My husband believes that, even when there is some physical basis for my symptoms, TMS/hypochondria is always at work making everything more of a problem that it needs to be. But it can be difficult because we all need to be wary of serious physical illness developing.

In fact, I have given up the idea of immediately thinking mental when a symptom develops. It is better just to stop thinking, because when I become aware of what I have been thinking about, I also become aware of why the symptom has occurred. Most of the time, most of us are lost in thought, having almost no awareness of what our mind has been doing. Our thoughts can quickly become dangerous to our mental and physical health. Then, BANG, this darkness shows up in our body as a symptom and most of us make no connection between our "out-of-control thoughts" and our unpleasant symptoms. We literally have no idea what has happened. More fear sets in, the symptoms worsen, causing even more fear. Each feeds on the other and still, we have no idea what has happened. Then resistance sets in toward both the fear and the pain, creating an even tighter feedback loop. I am learning, through mindfulness meditation, and to a lesser extent, somatic experiencing, to break this loop or sometimes even to stop it before it happens. I do this by taking back my attention for my own and controlling my own mind so that it doesn't get away with terrorizing me. Mindfulness works for the attention and awareness issues and somatic experiencing works well for the resistance issues that drive the fear. However, although I understand this very well in an intellectual sense, I still have not fully internalized the understanding so that it becomes an automatic reaction. This takes a long, long time because I have spent most of my life NOT understanding my own mind and how it defeats me.

 

What a powerful thread! Chickenbone, thank you for asking such a great question and launching this discussion. My understanding of the saying "What you resist persists" has deepened after reading this. Changing my relationship with fear and its ever ending faces is at the crux of the TMS matter.

Steve, your comment on the food thing made me think about the gluten free craze. I had read Wheat Belly and went wheat free for the better part of the year. My initial impressions were "Wow! This has taken care of the GERD that has been making appearances." I even did a wheat challenge after several weeks of being gluten free and BOOM! Heartburn within 30 minutes.

That is no longer the case. I eat wheat with no noticeable effects whatsoever. And while I aim to keep our diet free from processed crap, I bought some processed rice in box from the Dollar Store the other day. (Gasp!) It was quite tasty, thank you very much.

So. Is Dr. Davis' assertion that wheat today, being hybridized and having been tinkered with genetically, just another collective paranoia? I have wondered about this. Especially because I know that kids on the autism spectrum truly do better with out dairy or gluten. Also, the incidence of auto-immune diseases and frankenfood seem to be linked.

Thoughts? Or is this just another hypochondriac musing?

 

Yes, North Star, we really need to avoid even reading this food freakishness. I think most of this is just attempts to make money and scare tactics. People like us are prone to fear anyway, so this sort of thing is definitely to avoid. However, and this addresses your last point, I think we do need to take care to eat a generally healthy diet. It is hard because of all the processed food, chemicals in food and GMO stuff. Not to say, you have to avoid all of it, just make sure you balance it with good wholesome, unprocessed food.

 

Perhaps some calming activities--meditation and prayer, exercise, TRE (trauma release exercises) etc.-- are most necessary when we realize that the situation around us is dangerous. I remember years ago reading about Beruit being under fire and thousands of young people going to the beach and dancing madly all through the night while bombs fell on their city. At the time, I thought "Tsk! They should be doing something useful" but now I wonder if it wasn't a pretty good idea. When the shooting stopped and the rebuilding began, they may well have been healthier emotionally than those who worried the whole time.

Worry is only useful as a motivator to do something. If there is really nothing you can do, worry is pointless. Still, that's consciousness talking, the tip of the iceberg.

 

Thanks Alan G. For your post. I had come to this conclusion regarding myself and TMS quite a while ago. It can be difficult when your mind throws symptom after symptom at you. Sometimes I just create a list of day to day symptoms and issues just to show myself how much it fluctuates. I am a virtuoso of symptoms, sometimes running through 20 or more different ones in a day. Which, obviously, precludes getting things checked out by an MD. Learning to think psychological every single time helps. And becoming more and more active (that leap of inspired action that tells me 'I am well.' Is essential.) Thanks again for covering this.