I think that this TMS program is probably on a word by word basis the best content in this wiki. However the challenge is that because it's so concise and distills so much wisdom down into a short space, that there's temptation to read it like a magazine article. I think this is especially true with this section and I'd like to talk a little about why.
I had the pleasure of speaking for an hour last Thursday with Dr. Dave Clarke, author of They Can't Find Anything Wrong, and Dr. Eric Sherman, co-author of Pathways to Pain Relief and one of Dr. Sarno's most trusted psychologists. I asked Dr. Sherman about something that I had been wondering about for years: Dr. Sarno is clear that 80% of his patients don't need psychotherapy and they get better just by reading the books and going to his lectures. Dr. Sherman affirmed this.
Back when I was first learning about TMS, what I will call the "reading and rereading approach" was very prominent within the online TMS community, much more prominent than it is today. I think that this approach needs to come back because it works very well for a lot of people (though everyone is different of course). Dr. Sarno describes how knowledge is the penicillin for TMS: "The most important factor in recovery is that the person must be made aware of what is going on; in other words, that the information provided is the “penicillin” for this disorder" (p. 71 in Healing Back Pain).
Dr. Sarno described the process that he used at the Rusk Institute in all of his books. In the Divided Mind, in the treatment program section, he wrote the following:
- If you have not already done so, read the entire book you are using a bit at a time (Healing Back Pain or The Mind-body Prescription). After that, read the psychology or treatment chapter every day. Pay close attention to what you read, especially when you see things that remind you of yourself.
- Set aside time every day, possibly fifteen minutes in the morning and thirty minutes in the evening, to review the material I am about to suggest.
- Unconscious painful and threatening feelings are what necessitates the pain. They are inside you; you don’t feel them.
- Make a list of all the things that may be contributing to those feelings.
- Write an essay, the longer the better, about each item on your list. This will force you to focus in depth on the emotional things of importance in your life.(p. 142-143 in The Divided Mind. Some text boldfaced by me for emphasis.)With Dr. Sarno being the consummate hospital physician, I suspect that he didn't feel comfortable telling people how to treat themselves at home. Rather, he wanted people to be under the care of highly trained physicians and therapists. While this may be frustrating to us, because we want step by step instructions, I think it is a testament to the respect that he has for medical science. The closest that he ever got to describing a home treatment program for people who weren't at Rusk was in The Mindbody Prescription. In it, rather than describing his prescription for home treatment, he reproduced a letter in which one of his patients, Jim Campobello, described what he recommended to his friends. I think that this is as close as we will ever get to Dr. Sarno of an at-home treatment protocol.
So what did the Campobello program involve? It involved reading and rereading (and some other things). Here is his handout:
First, you must decide that you will make a serious attempt at Dr. Sarno’s technique. The technique only works for people who make a strong effort to apply it. You must either believe that it can work for you, or you must be so desperate that you will try very hard to do it even if you don’t believe in it.
I did not believe in it when I first read the book. My nature is very skeptical; I didn’t believe in mental powers of any kind, and I had given up on the miracles. However, I was desperate. I was in constant pain. My life consisted of standing up to do what little work I could, and lying on a mat on the floor at home the rest of the day. So even though I didn’t think it could help, my wife convinced me to try it. You can do the same thing.
So first you must make a commitment to try the book’s approach. It costs nothing, but you must be willing to spend some time on it every day for at least a month. You might as well try—what have you got to lose?
I don’t think there is one exact way to do it, but I will tell you what worked for me and recommend that you try it.
1. Read about 30 pages of the book every day. Don’t just go over the words—think about them! Pay attention to what he says, and think about how it applies to you. It’s very easy to be inattentive, so force yourself to concentrate on the ideas. When you see parts that remind you of yourself, be especially attentive. Also, keep reminding yourself that the people described in the book had problems similar to yours, and they were cured. When you finish reading the book, start it again the next day. You must read it continuously for a month or more. And you must pay attention every time you read it.
2. Set aside time every day to think about what problems might be bothering you, what might be in your life and in your mind that is causing your back trouble. Spend at least 30 minutes every day thinking about this. I used to take 15 minutes in the morning, when I first got up, and then 30 minutes in the evening. Use this time for the following:
Think about everything that might possibly bother you—work or school pressure, family responsibility, financial matters, etc. Be as specific as possible. You cannot simply say, “I’m worried about work”—that isn’t enough. You must try to identify every specific item you can think of. I found it useful to write lists to keep track of it. (When you are very specific you can think of quite a few things.) Pay attention to all areas of your life, big and little. Consider not only the obvious problems, but try to speculate about hidden things too. Consider both the real and imagined things that might be troubling you.
Once you have identified your problems, divide them into two categories: those that you can do something about, and those that are beyond your control. Be realistic about where each one fits. The ones you can do something about, start taking action on. Do whatever you can to correct them, or try to at least. The ones you have no control over, tell yourself that you know they bother you, but you must accept them—and most important, you will not let them cause you any more back pain. Remember, you don’t have to eliminate your problems for the cure to work, you just have to be aware of the process.
Think about what you are like—what is it in you that lets these problems create such pain. I am a typical Sarno type—perfectionist, easily angered, highly motivated, high achiever, somewhat compulsive and impatient with other people. Those are the part of my personality that led my mind to develop back pain. However, there are other types that get it. One of my co-workers is a happy, easygoing, very pleasant woman, but she got back pain as bad as mine, and the book cured her, too. (It took her about three months, by the way, but she is perfectly healthy now.) Try to learn what is inside you that needs that distraction. What permits the pain to develop and persist? Be honest about yourself. Again, remember that you don’t have to change your personality for the cure to work—you just have to understand and fight it.
3. All day long, keep reminding yourself of the whole process. Whenever a problem occurs, think, “Okay, I don’t like that, but I’m not going to let it go to my back and cause pain.” Whenever you feel back pain (or if you are like I was and it hurts all the time, whenever it feels especially bad), think, “My back is acting up. What is going on in my life or in my mind to make it hurt?”
4. After you have worked on the above for three or four weeks, start to take small steps to test your progress. Don’t do too much too soon. Just look for tiny improvements, find something you can do that doesn’t hurt quite as much as it used to. Go very slowly, but after a few more weeks you will notice your back is a little better. Build on the small steps—the slightest improvement is a sign that the process is working, and that should encourage you to stick with it.
5. Don’t give up. Believe me, I know how depressing and discouraging it is. Yet there is hope. But in order for it to work, you must put in the time and effort to make it work.
(p. 152-155 in The Mindbody Prescription. Some text boldfaced by me for emphasis.)
For anyone who is curious, Jim participated in our Thank You, Dr. Sarno project. His thank-you, with photo, can be found here:
So why is all of this reading and rereading so important? Dr. Sarno provides us with a quote from Edna St Vincent Millay: "Pity me that the heart is slow to learn / What the swift mind beholds at every turn" (p. 78 in Healing Back Pain). While we may read a book a single time and get it on a purely intellectual level, it takes a long time and a great deal of repetition for a lot of people for us to truly accept the diagnosis. It can take a great deal of repetition to deeply, deeply understand what Dr. Sarno is saying and internalize how it applies to us. Dr. David Schechter has the following to say about how to read a TMS book: "focus on how the concepts apply to you personally. It's not enough to just have a general understanding of the theory. It's crucial to reflect on the similarities to your own symptoms and personality and delve deeper...even if your problem is tension headaches, irritable bowel syndrome, or TMJ, rather than the one described in a particular book, these books can be helpful to you if you try to apply the concepts to yourself" (p. 20 in Dr. Schechter's MindBody Workbook).
All of the time on the forum we see people who post questions that are actually answered in books that they have already read. As I see it, in when this happens we can help them by teaching them how to read TMS books better, as described above. We can let them know about how important it is to reread and apply the material to their lives, or perhaps even point them to this post. It is natural and completely human for newcomers to need to be taught how to read a TMS book well.
Bearing this in mind, remember how I opened this post by describing how there can be a tendency to read the TMS Recovery Program donated by Alan Gordon as if it were a magazine article? My hope in having an official thread for each section of the program is to give people something to read that may help them see how various people applied the ideas in their own lives. So if you are reading these threads and are trying to heal, please take heed of the advice from Dr. Sarno, Jim Campobello, Dr. Schechter and myself about how to read TMS materials. Read these posts written by other people and think hard about how and whether they apply to you.
And don't hesitate to reread your TMS books. Each time we reread, we get a deeper and more nuanced understanding. TMS audiobooks can help with this. See http://www.tmswiki.org/ppd/TMS_Audiobooks for options. Dr. Sarno reads the abridged version of Healing Back Pain, and for some, hearing his voice can be very powerful.
Of course the downside of all of this repetition is that while we may come to fervently believe what we read, we need to accept as when we come together on the forum may have different perspectives. This is simply part of the respectful discussion that needs to take place for us to have a healthy community.
Note that this is how Steve Ozanich healed and how I healed. It took a huge amount of persistence, but it got the job done. We did not do deep psychological work as part of our cure. If this surprises you, remember that 80% of Dr. Sarno's success stories did not do this sort of work as well. (Some, of course, did.) Dr. Paul Gwozdz, a notable TMS doctor in New Jersey, is said to have remarked, "I've known a great number of people with very thick journals who are still in pain." To me, this suggests that journaling isn't necessarily a cure-all.
Rather, I took a very simple healing approach, perhaps best articulated in Healing Back Pain. In that book, Dr. Sarno writes that the treatment program rests on these two pillars: 1. The acquisition of knowledge, of insight into the nature of the disorder 2. The ability to act on that knowledge and thereby change the brain’s behavior. The treatment chapter of Healing Back Pain is divided into 5 subsections. They are very simple, and they explain how knowledge therapy works:
1. Think Psychological
2. Talk to Your Brain
3. Resume Physical Activity
4. Discontinue All Physical Treatment
5. Review the Daily Reminders
While it is the third-oldest of his books, Healing Back Pain is still Dr. Sarno's best-selling book, and I think that's a testament to the power of the simple and empowering steps enumerated above. It is knowledge therapy, pure and simple. I don't want to speak for Steve, but I think that he took a similar, Healing Back Pain type of "pure knowledge therapy" approach as well.
In closing, I confess to feeling a bit apologetic for bringing all of this up. Today's zeitgeist – the fashion of the times – seems to focus heavily on journaling and I know that everyone here who is still in pain wants a nice, simple formula. However, having read many thousands of posts on the forum and written many thousands myself, one conclusion I have found to be unshakably clear is that different things work for different people and so you may have to try different things to see what works for you. See the wiki page about Be a Scientist for more on this.
The moral of this section, and of my commentary on it, I think, is don't rule out pure knowledge therapy. Like everything else, it takes time. But for many people, it gets results.