TMS diagnosis in The Crown S02E10!

Does anyone else watch The Crown? In the first five minutes of season 2's 10th episode, the osteopath doctor tells Prince Philip that his neck pain is caused by tension, emotional strain, unresolved conflict! And further, that the way to treat it, is to identify them, recognize them, and change one's lifestyle. I was amazed when I saw this!! Anyone else?

 

I wrote a post about this in the thread on Pop Culture and TMS.

Check out the thread http://www.tmswiki.org/forum/threads/tms-and-pop-culture.2420/page-5#post-93485 (Steven Ozanich - TMS and Pop Culture)

 

I saw this and it actually upset me and increased my doubt about all this stuff. Later in the series, he dismisses the Sarno-esque doctor as a quack and says he went to some other doctor who quickly fixed him. It just made me think that this repressed emotions mind over matter stuff has been around for a long time, long before Sarno, and sometimes I wonder if it’s just wishful thinking, pseudo science.

 

But the unconscious mind is very powerful. You read about the cases of hysterical neurosis chronicled by Charcot and Freud and you begin to realize how many cases of chronic pain are probably due to repressed emotions. When you notice how occurrences of chronic lower back pain are concentrated in the more advanced Westernized cultures, you also begin to wonder about the psycho-historical roots of many symptoms that appear to be purely physical. As long as pain is experienced in the brain, there are bound to be many border-line cases between the physical and the psychological.

 

Charcot and Freud have been almost entirely refuted and discredited in the intervening years. The charitable view is that they were mistaken about a number of things when the field was still nascent ... but there's a lot of evidence that much of it was fraudulence. To me, the fact that Sarno took Freud and Freudian "repression" so seriously is one of the things that has made it harder to subscribe to TMS.

 

Just to comment on your doubt eskimoeskimo: Prince Philipp in the TV series maybe had something else. Or, maybe the other treatment success was a placebo effect. We will never know. Freud and Charcot definitely had diagnosed hysteria - conversion disorder where there also was another disease in the background or even the cause. And that makes you wonder if TMS is a correct diagnosis. I am quite sure that there is much more to research about TMS and maybe a different name will be used in the future etc. I strongly believe in the progress of science. And the interesting thing is that in fields like immune-psychology, cognitive science, brain research etc. there is more and more research that investigates into the connections of emotions, body and brain. Pain can stem from psychic pressure and instability that has a consequence for the autonomous nerve system. Talk about repression is a bit simplistic, though not always wrong ... psychosomatic medicine is around for a long time, since the 1920s. There is a long European tradition, especially in France and Germany. And not all of it is psychoanalytically oriented. Today you find unfortunately a sort of esoteric version where the patient almost feels guilty if she is not able to manage to heal, change her life and live positively ever after. I find this tendency not only not fruitful but also appalling because it confounds guilt and illness. But this is not how I read Sarno and Schubiner. For me their approaches are thoroughly reasonable although there are still things that are not fully explicable with scientific methods.

 

Except that recent studies of the brain do seem to confirm the "repressive" function of the prefrontal context in relation to the paleomammalian mind, what Freud would have called the ego/superego vs. the id. Modern neuroscience, in a few important areas, is beginning to confirm what Sigismund only observed empirically. Why is it then that victims of automobile rear-enders only develop whiplash in the more advanced industrial countries? Similarly, why do incidents of LBP concentrate in the USA, Europe, and the industrialized Far East? Got to be some connection with individualistic Western culture, huh? Just go out and find an aborigine who didn't make it to work Monday morning because of his 'aching back'. Of course, it's important if you're going to diagnosis a purely mind-body disorder to eliminate any medical condition that might be causing it before you jump to conclusions and initiate treatment.

 

Time2b, I think that's a very fair and astute assessment.

 

The brain, and culture, are extremely complicated. This explosion of fMRI "findings" lately relies on so many assumptions about how the brain and consciousness work. Simply observing correlations in oxygen flow in the brain ... we are so many zillion miles short of being able to say anything higher level about what this might mean in relation to Freud's theories or western culture, etc. And even if it turns out that there is some brain function which looks like something Freud predicted doesn't mean he arrived at that theory honestly and responsibly. A broken clock is right twice a day.

 

A neo-Freudian revisionist like Peter Gay might disagree with you:

https://www.amazon.com/Freud-Life-Time-Peter-Gay/dp/0393328619

 

Well, sure ... we won't have a hard time finding biographers who are sympathetic to Freud. I don't think that really addresses the point. For a skeptic such as myself, there's a lot in Sarno which raises red flags (eg very heavy reliance on individual stories), and I suspect many others have had a similar reaction. For me, Freud is one of those red flags.

 

Interesting debate going on here! I definitely understand feeling skeptical of Sarno's heavy reliance on Freudian theory. He was not a mental health professional and had an understanding based on what he knew, which 40 years later can sound outdated. Here's the thing- Sarno made some excellent, true and very astute observations of the phenomenon of TMS, for which the science has now advanced quite a bit. Reliance on observation is how all theories begin...not with randomized controlled trials (those come later!) These things are never black and white...Freud was basically the earliest modern psychologist and certainly got a lot wrong. Obviously there is no id, ego and superego residing in our brains. Its a simplistic way to think about things that has some bits of truth to it, as far as I understand it most modern therapists take bits and pieces from his theory but basically regard it in historical context.

That being said, the idea of emotional repression is widely accepted by therapists/psychologists and well documented. People successfully repress traumatic memories and emotions all the time, and this plays a HUGE role in TMS. Understanding of this has advanced much beyond how Freud saw it. Modern TMS practitioners definitely use this idea of emotional repression, though its not the only thing contributing to TMS, just one component. @eskimoeskimo, have you read books other than Sarno to help strengthen your belief? Don't let one little TV show moment get you down!

 

Dr Sarno didn't apply Freud's theories in a cookie-cutter fashion to his theory of TMS. What he said is that the behaviors he noticed in his patients seemed to conform to Freud's theories about emotional repression. What Dr Sarno thought was that emotional repression physically manifested as a slight reduction in oxygen to the nerves, tendons and muscles in the extremities, which in turn caused pain. Howard Schubiner on the other hand suggests that emotional repression manifests in TMS patients as programmed pain pathways in the brain, resulting in chronic pain. Alan Gordon though relies on ISTDT models to deprogram programmed pain pathways. But of all these theoretical models at least Dr Sarno's has the advantage that actually lowering of oxygen has been measured in the back tissues of TMS patients. It seem to me though that what you notice in TMS patients is a phenomenon similar to PTSD, only one that evolves over the long term, rather than the short term like being exposed to an IED at a crossroads in Iraq. In TMS it seems like an incremental rather than a catastrophic process. Of course, emotional repression can play a role in the development of chronic pain, but you have to factor in traumatic life stress events too.

 

Yes, I appreciate your thoughts @MindBodyPT and @BruceMC. I think I'll leave it there for now. I hope you agree it can be constructive to air some of these doubts now and again. Luckily this is a very civil and understanding community. I also hope I didn't distract too much from @Emerald 's post!

 

Are you familiar with Pete Walker's conceptualization of Complex Post Traumatic Stress Disorder (C-PTSD)?


http://pete-walker.com/fAQsComplexPTSD.html (Pete Walker, M.A. Psychotherapy)

 

Not before now, but what Walker is saying rings true with me:

"In this vein, I believe that many substance and process addictions also begin as misguided, maladaptations to parental abuse and abandonment – early adaptations that are attempts to soothe and distract from the mental and emotional pain of complex PTSD."

I believe Gabor Maté makes the same point when he asserts that childhood trauma, especially during the first 6 years of brain development outside the womb, often leads to disease states and addictions in adults later on. What Pete Walker says about symptomatic treatment that ignores larger issues seems spot-on too. You cure the itch with cortisone cream but don't address the underlying issue driving the symptom, such as what Walker calls "complex PTSD".

 

Amen

 

Now that Walker mentions it, I realize that as a teenager I started sneaking drinks to emulate and establish a channel of communication with my father in some kind of misguided attempt on my part to heal the wound of separation between us that had occurred during my parents' unsuccessful attempt at divorce when I was 12 years old. Acting like dad did when he got drunk to link with him and heal the feeling of abandonment that followed the divorce attempt. Lots of potentially self-destructive behavior must originate in that kind of imitation by a kid of his parent.