TMS and corporate medicine

Dr. Schubiner has said that one obstacle to finding a physician who knows how to treat TMS is that most physicians don’t learn anything about it in medical school. The video below reveals another obstacle--an economic one given current standards for insurance reimbursement of medical bills versus the time a physician needs to educate patients that the cause of their pain (or other chronic symptom) is not structural but rather is psychological and how stop the symptom. The hospital where Schubiner practiced mindbody medicine for about 20 years did not renew his employment contract because he was not generating enough revenue.

 

"The video below reveals another obstacle--an economic one given current standards for insurance reimbursement of medical bills versus the time a physician needs to educate patients that the cause of their pain (or other chronic symptom) is not structural but rather is psychological and how stop the symptom."

No doubt this is true. Just look at how long a doctor typically spends with a patient. A few minutes.

I suspect it's why many psychiatrists dole out heavy duty psychotropic medications and offer little in the way of therapy.

 

I am carefully listening to this. Around 17:20 "I need this fourth step". Context? Is he speaking of the same 4th step I do, or is this part of his program? (the one from the 12 steps)

I ordered his book just to try some new stuff. It's not here yet, but I figured I'd start immersing myself now as part of the morning review.

 

It appears that the context for this has been edited out of the video. My best guess is that the first 3 steps relate to Pain Reprocessing Therapy (Alan Gordon's approach) and the 4th step relates to Emotional Awareness and Expression Therapy (Schubiner's approach). You can Google both of these for more information.

I have the 2nd edition of Schubiner's book (not sure what edition he is on now), but my edition doesn't describe these two therapies. They are fairly recent, so not sure if your book will describe them.

 

gotcha. I just ordered a book from His website direct so hopefully I'll get the updated one.

 

Both points are very true. Dr. Schubiner has been saying it all along, that he was losing money on his TMS patients. This is what I wrote on this subject 6 years ago, and our mainstream medicine still has not changed:

"There seems to be an explosion of chronic pain in our society in the recent decades. Chronic conditions seem to appear in young people and continue to accompany us through our entire lives while we all accept the inevitability of pain.

As someone who experienced those conditions since my early adulthood, I have many unanswered questions for our healthcare system:

Why is our medicine so focused on dealing with acute conditions and ignores the ones that are deemed non-life-threatening, yet very capable of destroying one’s life? How often are the acute conditions a result of the chronic conditions gone too far?

Why is it acceptable that by age of 50, an average person takes several medications on an ongoing basis? Why does our society find it acceptable that so many people now must take pills to alleviate side effects of the other pills that were prescribed to them years ago?

Has anyone studied the emotional toll of a prescription drug dependency by a human being on that human being and his/her family?

Why is it easier to get a prescription for an opioid than a referral to a physical therapy? Is it due to a perceived low cost of painkillers?

Why is preventative medicine so focused on the patient’s blood pressure or blood sugar but so negligent of the state of the nervous system, which may be in fact the cause of a high blood pressure or high blood sugar?

Why is it so easy to get a referral for a full bone scan and so hard to get a referral to a psychotherapist?

Considering that HMO is the most common format for the healthcare systems in the U.S., I wonder if they are truly committed to their stated objective of providing quality healthcare at a lower cost. I wonder if, all good intentions aside, they slip into the business of providing healthcare-related services at a lower cost. ".

 

A few years ago I went to this alternative medical practice where the doctors spent as long with you as needed. It was unrushed. They focused on alternative healing methods and also used traditional. I loved the place! After 2 years they shut it down because they couldn’t survive with the insurance model we currently have. Doesn’t surprise me this happened to Dr. Schubiner. What a loss!

 

I expect you will be getting the 4th edition of Unlearn Your Pain, though it appears a book titled Hidden from View that Dr. Schubiner coauthored with psychiatrist Dr. Allan Abbass is also available through his website. Abbass’s specialty is Intensive Short-Term Dynamic Psychotherapy (ISTDP). Like Ellen, I only have the 2nd edition of Unlearn Your Pain, so I don’t know what is new in the fourth edition. I am guessing that like the two Scubiner books I have read, the fourth edition of Unlearn Your Pain contains zero Freudianism. If so, I hope you will not be put off by that.

Several years ago, I watched an interview of Schubiner where the interviewer tried to bait him into criticizing Sarno’s distraction theory to explain why the brain creates TMS pain. Schubiner declined to take the bait. Instead he just said, without elaborating, that he preferred “a different perspective.” In Hidden from View, Schubiner expressed his reverence for Sarno because of his pioneering work in mindbody medicine. Schubiner has also said, however, that Sarno “got the big things right” about TMS but not everything. He analogized Sarno to Einstein, genius that he was, who got the big things right about relativity but not everything.

My understanding of Schubiner’s “different perspective" is that it is based on a combination of ISTDP and the new, new thing in brain science called predictive coding, aka predictive processing. Perhaps Schubiner goes into predictive processing in the fourth edition--as he did in Hidden from View, which was published after the second edition of Unlearn Your Pain. At any rate, I will focus here on ISTDP.

The founder of ISTDP, Dr. Habib Davanloo, began as a Freudian psychiatrist. However, in 1987 he concluded that Freud’s three-part structural theory of how the mind works (id, ego, and superego) “is not really a self-consistent system.” The only one of the three parts that Davanloo regarded as salvageable was a run-amok version of the superego that he initially called the punitive superego and later renamed the perpetrator of the unconscious.

Turning now to the Schubiner video interview that I linked above, Schubiner used the term “emotional processing” with regard to the fourth step about which you inquired. As Ellen noted, Schubiner has more formally called this Emotional Awareness and Expression Therapy. Schubiner’s personal emotional processing in the video had several steps:

1. Anger – he felt his anger at the hospital that employed him for many years but did not renew his contract. He expressed his anger while alone in his car by cursing the hospital management and by imagining himself blowing up the hospital building(s) with TNT.
2. Sadness – he felt his sadness about being let go by the hospital.
3. Compassion – he felt compassion for himself and for the hospital because it was losing money and needed to solve that problem.
4. Forgiveness – he forgave himself for his anger at the hospital and forgave the hospital because it needed to replace him with a physician who would generate more revenue.​

As I see it, the four steps above are an adaptation of the ISTDP formula for processing anger and related emotions. That formula has four emotion elements: rage, sadness (or grief), guilt, and love—usually to be experienced in that order though sadness and guilt are sometimes reversed. ISTDP therapists are instructed not to stop with merely helping a patient to feel his anger and “portray” it, i.e. imagine carrying out his aggressive angry impulse. The reason is that if a therapist fails in “helping the patient to experience the entire range of complex feelings (that is grief, guilt, and love in addition to rage), the results can include dropout, symptom exacerbation, and potentially serious acting out.” Nat Kuhn MD, Intensive Short-Term Dynamic Psychotherapy: A Reference 199 (2014).

Returning to Schubiner ‘s personal emotional processing in the video, the first element in the ISTDP formula is to process one’s anger. Schubiner did this by feeling his anger at his employer and then (while in his car alone) cursing the employer and imagining he blew up the hospital with TNT. The second element in the ISTDP formula is to process one’s grief. Schubiner felt his sadness over loss of his long relationship with the hospital. The third element in the ISTDP formula is to feel one’s guilt about getting angry. This is missing from what Schubiner did. The reason is that the ISTDP formula pertains to anger at a loved one (hence the fourth element, love). We instinctively feel guilty when we get angry at a person we love (it’s an evolutionarily conserved reaction). Schubiner apparently did not love the hospital administration—so no feeling guilty for him in this situation. The fourth and final element in the ISTDP formula is, of course, to feels one’s love for the person he got angry at. This element might appear to be missing from what Schubiner did, but consider the context of his anger. If you are angry at a loved one, then as part of experiencing your love for the person you will likely have compassionate understanding for his or her conduct that angered you, and you will likely forgive the person. But Schubiner was not angry in the context of a personal relationship. He was angry in the context of an employment relationship. In that relationship, compassion and forgiveness for the employer who got rid of you are about as close to love as you can get. I believe Schubiner was just using a contextually appropriate adaptation of the ISTDP formula when he felt compassion and forgiveness for not just for himself but also for the hospital. Finally, note that Schubiner said his pain ended once he did all that emotional processing.

 

That is funny. I use that analogy myself. According to the math in relativity, the universe should have been one giant clump , or singularity. Einstein came up with 'action at a distance' and basically added a Mushy addendum to an otherwise beautiful , simple idea "Well....at a long enough distance, gravity works backwards" (lol) .
Meanwhile, Hubble and Humason were working at Palomar finding the 'red shift' that is, that the Universe is expanding, and couldn't understand it...and a French Monk , George LeMaitre was postulating the 'Big Bang theory', negating the need for 'action at a distance' and explaining the red shift ...if all of them had access to each others work, they would have dovetailed nicely and understood more.....but it was the early 20th century.
Timothy Ferris wrote some great books about this period in Science.

I am glad you wrote such a good response. Believe it or not...I Paused and re-watched that piece on his job loss a few times, and took notes.
Now I am going into this with as open of a mind as I can, but one of the possible....pitfalls? We all listen to other stories with our own experience for context. I would have had ZERO problem knowing I was angry at the hospital. I would have defintely been down the TNT fantasy, and I definitely would have added fantasizing personal harm on the people who fired me...individually. But THEN, Schubiner seemed to quickly Jump to the 'compassion and forgiveness'...That sounds intellectual to me. I don't think I have ever intellectualized my symptoms away.

Generally my pattern has been to completely MISS the source of the rage and even finding it is quite a piece of work...it is something so subtle it takes me quite awhile to figure it out. I also know from doing the 4th step in AA which is:

1. With whom/what am I angry?
2. Why?
3. What did it effect?
4. WHERE was I wrong or to blame?

It's interesting that in the concrete example we are given in our book , 3 and 4 are two pages away from each other.

With TMS it might go.

1. Symptom ??? (wtf?)
2. Why?
3. Where was I wrong or to blame?
4. With whom/what am I angry?

Of course if I got fired from a Job I know who I am angry with....but Those subtle dynamics of being angry at my own sons, friends, partners etc? Those are the tough ones.

Obviously most people know I am a Sarno fundamentalist, so I watched the video pen and paper in hand looking for...an error? Something I disagreed with? Something new?
The only thing that sat out was me thinking he glossed over his emotions in the Job firing....not a lot of 'disagreement' in a 1 hour video. Maybe I am just angrier than him. Maybe I am just more sensitive.

Anyways.. I always say a little prayer to set aside what I think I know so I can have a new experience. Obviously I wouldn't be browsing if I wasn't trying to shake something loose, and many times when I have been stuck, just a word, an idea or something from this forum, a video, a podcast has helped me.

Thank you for that awesome response! Peace

 

I agree on this. Nothing I have tried has been simple and easily done. Not getting angry and not forgiving. It’s more like a long process.

 

Now that @Baseball65 and @Diana-M got me thinking, I came to the conclusion that my years of TMS training and practice have shortened my process from anger to forgiveness. What really helped me was a realization that forgiveness is not my permission for the perpetrators to do what they have done to me, it is permission for me to stop looking for an immediate act of fair justice or revenge when none of it is possible. Dr. Schubiner's story about the plunger is a great illustration. His brain was satisfied with the act of "justice" performed in his mind. It was not fair, it was not equal but it was enough for him to move on.

 

This is an interesting part of the human experience.
Part of our 12 steps was the amends process. Obviously being completely self involved for years had left a lot of damage to others.
Interestingly enough, the only people to whom I STILL harbor conscious resentment , are those where I was not able to make the amends for some reason. Three of them stick out prominently. All 3 of them basically told me "Don't want to hear it".
I totally agree that forgiveness is the only way to get free from anger... But I also can't lie to myself. For me at least, the only way for me to do that 100% 'clean' is in person.
I have been told to try and do that symbolically, but it just hasn't 'stuck' because when I think of the person for whatever reason, all sorts of anger comes in Consciously which I can only assume means there is a LOT more down there??
The best concrete example I have is my family. The only one who allowed me to make amends in person is my sister...and when I think of her I only have love & compassion.. whereas the rest of them make every TMS list.

 

Absolutely agree, 100%! Those who argue with me, who disagree with me - those are OK. But those who swatted me away like an annoying fly or ignored me - I am especially angry at them.

 

Like @Baseball65 and Schubiner, I've also likened Sarno to Einstein and for very same reasons. One of my pet peeves is the new breed of mind-body practitioners being dismissive of Sarno. Fortunately, there's not many of them.

It's interesting that interviewer brought up distraction theory. Of all the things I might quibble with Sarno over, distraction theory was not one. Maybe the latest thinking in the psychology world rejects something like distraction theory. But for me as a layman and as a practical matter, that concept was extremely helpful. I credit it, at least in part to my recovery.

Sarno use to say, "think psychological". So, whenever I felt pain, instead of thinking or worrying about the pain, I said "What am I feeling right now?" "What emotions am I experiencing?" Instead of being distracted by my symptoms, I explored my emotions. It was excellent brain re-training and it worked.

 

It’s good to know that practice can shorten this process!

What about ongoing injustices? Then, do we need ongoing acts of mental justice? I know you guys will say— then just get rid of that person. But sometimes you can’t. I think perpetual injustice is tough for TMS recovery.

I think you’re right!

I don’t see how anyone could completely reject Sarnos theories. Maybe tweak them, but never reject. It obviously works!

 

It seems like a lot of the mindbody docs are just selling training courses rather than dealing with insurance companies. The other question is when you feel your negative emotions but you could not share or express them in front of others, would that lead to suppression or repression? Or as adults we just need to find a safe solo place to let out the negative emotions, since nobody could hold others' negative emotions? But would that make one feel lonely and disconnected from others ? I would make exceptions for kids though. What are your thoughts?

 

Yep. I had formerly suffered from OCD which was a HUGE 'aha' connection for me in the text of HBP. To this day a short summary for me is "TMS is OCD of the body"...once I learned how to banish intrusive thoughts, it just moved to physical symptoms. Similarly, when I had addictions I had little pain, because all I can think of is the thing I am addicted to...how to get more, protect my source and stay 'well'.... One track mind.
All three were symptoms pretending to be something, while the real problems were ignored.....so turning our minds to a source of irritation is a very good strategy.

 

Yes. And that too is another rage inducer!
Ever since the lockdowns I have felt that way. I have also noticed that when I push myself to stay involved and around other people my symptoms diminish...and when I am lonely and feeling isolated they increase. I wish there was a magic 'formula' to follow, but I don't know it yet.

 

Something got all screwed up with the pandemic. I notice a lot of people feel like you do. (Myself included). Plus everything is weird out there.

 

The medical schools are funded by the pharmaceutical companies. That's why the doctors treat symptoms, not causes. That's why they push for medication. They don't study the body as a whole, they treat parts of it. And they never suggest a more affordable procedure, when a more expensive procedure is available. They always suggest the most expensive one. Therefore the endless useless tests that you 'have' to do. And on and on and on...