Back Pain and Tension Myositis Syndrome (TMS)

The article below was written by Kim Ruby, a yoga instructor from Los Angeles, California, who recovered from her own TMS and subsequently went to medical school to become a TMS physician (I haven't heard from her since). The article was subsequently reposted by Dr. Howard Schubiner at the website for his Mind Body Medicine clinic in St. John Providence Hospital of Southfield, Michigan.

We use this article in Day 2 of the Structured Educational Program, but the link is obsolete. I am reposting it here for nonprofit and educational uses. It has been archived from what is now an obsolete link. The original source was http://www.stjohnprovidence.org/mindbodymedicine/backpaintms/ (Page Not Found - St. John Providence) (another archived version)

See below the article for discussion. Feel free to add your questions or comments!

Back Pain and Tension Myositis Syndrome (TMS)

It's no secret that back pain (and other chronic symptoms) have reached near epidemic proportions in the US. But you may be surprised to find out that back pain is often (though not always) caused by emotional stress. Dr. John Sarno has written several excellent books on this syndrome, which he has named "Tension Myositis Syndrome." Dr. John Sarno's books obviously go into more detail than I do, and I suggest that you read them. But in the meantime, here's a condensed explanation of how TMS works and how to cure it, based on Dr. Sarno's books and my own experience.

In a nutshell, Tension Myositis Syndrome symptoms (such as back pain) are initiated by our fear of "not being good enough." And no, you're not crazy if you are suffering from TMS.

I am a strong supporter of Dr. Sarno and his approach, and I think everyone can benefit by understanding his theory. However, it is possible that your back pain (or other symptoms) is caused by something serious, like a tumor, an infection, or severe osteoporosis. If you are suffering from severe back pain, it's important to get it checked out by a physician, preferably one that is familiar with TMS.

Over the years, in accordance with our beliefs about good and bad people, we create a long list of requirements for ourselves. If we have a belief that a good kid only gets straight A's in school, then we have to get straight A's. If we believe that only losers are fat, then we have to be thin. We feel like we need to prove our worth--we need to be the best at work, to have the perfect body, to drive the perfect car, to be the perfect spouse, or to raise the perfect child. There's always an underlying fear that if we're not meeting all our requirements (and we usually have ridiculously high standards for ourselves), then we won't be loved. We're afraid other people will reject us, because they'll discover just how flawed and gross we really are. And even though we may know on an intellectual level that this notion is silly, we all still believe it deep down in our guts because that's what we've been believing all our lives.

When we're in our comfort zone--when it feels like we're measuring up--things seem OK. But inevitably, situations arise that make us feel like we're not quite living up to expectations. Say, for example, that I'm a new mother. I love the baby with all my heart, but since the baby's been born, I haven't had a decent night's sleep. My husband and I don't get to spend any time alone together. My mother-in-law keeps dropping by the house. I don't have time to hang out with friends. I miss my work, and I miss interacting with adults. Deep down, I resent the baby for making my life so different and so difficult. It's really not bad to have those thoughts because they're just thoughts. But let's say I have a deeply-conditioned belief that a good mother would never resent her baby. And I believe that if I admit to myself or anyone else that I resent my baby, I'm basically admitting that I'm a horrible, selfish mother. Admitting and experiencing the fear of being a horrible mother is the absolute last thing I want to do, so I manage to find ways to avoid it.

Distractions come in a variety of flavors, and here are just a few examples:

• We try harder. "I'll just manage my time better. I'll get all the household tasks finished early and then I'll have more time to spend with my husband. Then everything will be great."
• We blame others and get angry at them. "If my husband's annoying mother wasn't around here so much, I'd have a lot more time to myself."
• We eat too much, shop too much, drink, smoke, or engage in other addictive behavior.
• We take on other projects to occupy our time.
• We develop TMS.

TMS is actually our brain and body's way of helping us out. It's a way of taking attention away from the negative feelings and directing it toward a physical pain or another medical symptom. Through the autonomic nervous system, the brain initiates physiological changes, and painful symptoms develop soon after. And usually the symptoms are so painful and distressing that it's impossible to focus on anything else, including the feelings of inadequacy. Of course no one wants to be in physical pain. But on a deep-down unconscious level, we usually believe that it's easier (and certainly more socially acceptable) to deal with physical pain than it is to experience the horrible feelings of unworthiness. This is a very important point to understand about TMS--the pain serves a purpose. It works as a distraction.

A common response to this explanation is "But this doesn't apply to me because I'm not upset about anything." Or "Maybe some people have emotionally-induced pain, but my pain is caused by a real medical condition. The doctor said so."

Let's address that last comment first. It's certainly possible that the pain is being caused by a serious medical condition, like a tumor or an infection, so it's very important for anyone with serious pain to be examined by a physician. However, many structural abnormalities (such as herniated discs or muscular imbalances) are mistakenly blamed for pain that is actually emotionally-induced. We'll talk about that more in the next section.

And back to the "I'm not upset about anything" response. Human beings are very good at finding ways to avoid discomfort. So good, in fact, we often don't even realize that's what we're doing. At the risk of sounding like a know-it-all, most people have no idea how angry and/or scared they really are. After watching the TMS pattern in myself and my clients for many years, I've learned something. If a person's immediate reaction is "I'm not upset about anything," it means one of two things: a) they know what's

bothering them, and they just don't want to talk about it with me or b) it's something too uncomfortable to even admit to themselves.

Dr. Sarno makes an important point in his books--the feelings that trigger TMS symptoms are not conscious, perceived feelings of anger or fear. The troublemakers are the negative feelings that are simmering below the surface, which is why they're so hard to pinpoint. Say, for example, that my boss criticizes me at work. I'm fully aware that I'm angry about being criticized. But there may be other feelings underneath that anger. Perhaps I'm afraid that my boss is actually right, and that I'm really not doing a good enough job. Or perhaps I'm afraid that my opinions aren't being taken seriously. Or maybe I'm ashamed that I can't handle a little criticism without getting upset. These subtle feelings of "not being good enough" are the ones that need our attention.

Even happy events can trigger TMS symptoms because they can also create feelings of pressure and fear. For example, a wedding is a wonderful event, but it comes with all kinds of expectations--the dress has to be perfect, the ceremony needs to be perfect, the guests all need to have a great time. And once again, it's the fear of not meeting expectations that initiates the TMS process.

Understanding how we try to avoid feeling unworthy is crucial to curing TMS symptoms because this avoidance is what starts the whole syndrome. To eliminate TMS symptoms, the sufferer needs to become aware of the very feelings he's trying to avoid. And he needs to know--deep down in his gut, not just intellectually--that it's completely OK to experience those feelings. I'll talk about this more in the How to Cure TMS section, but for now I want to emphasize the fact that the sufferer doesn't need to eliminate stress from his life, nor does he need to learn how to "manage" stress through relaxation or breathing techniques. He simply needs to identify and experience the feelings he's trying to avoid.

And once again--you're not crazy or mentally unstable if you are suffering from TMS. All human beings are products of conditioning, we all want to avoid discomfort, and we all develop some type of TMS symptoms at some point in our lives. And there's certainly no need to feel ashamed or to blame yourself for developing symptoms. I'm rather surprised at the number of people I've met who believe that Dr. Sarno is "blaming the patient." He's not doing that at all, and neither am I. Anyway, I'll talk about that a bit more in a later section.

The basic premise of TMS is that the unconscious fear and anger can actually induce physiological changes. This is a pretty hard pill for some people to swallow. On the whole, conventional western medicine tends to pooh-pooh the idea of psychosomatic illness. There is, however, growing scientific evidence to support the relationship between emotions and illness. I'll discuss that shortly.

Dr. Sarno developed his TMS theory as a result of working with patients suffering from back and joint pain. He noticed that a large majority (88 percent) of his patients had a previous history of tension-induced conditions such as heartburn, pre-ulcer symptoms, hiatus hernia, irritable bowel syndrome, colitis, spastic colon, tension headache, migraine, eczema, and frequent urination. Not all doctors agree that these disorders are emotionally-induced, but based on his own medical history and his clinical observations at the time, Dr. Sarno felt confident that indeed they were. This correlation between back pain and tension-induced disorders, and the failure of conventional back pain treatments, led him to believe that back pain may be caused by emotional tension.

He noticed that heating pads, massage, and physical therapy, (all of which increase circulation to the applied area) seemed to temporarily alleviate the pain. He hypothesized that the real cause of the pain may be a reduction of blood flow to the soft tissues in the affected area. A reduction in blood flow would mean a reduction of oxygen available to the tissues, and that mildly ischemic state could certainly cause pain. Think of what happens during a heart attack--blood flow to the heart muscle is completely blocked, and the patient compares the resulting pain to an elephant sitting on his/her chest. In the case of back and joint pain, however, there is no permanent damage to the soft tissues because there is only a minor reduction in blood flow. As a matter of fact, Dr. Sarno noticed that once his patients understood and accepted the fact that they were suffering from a tension-induced disorder, their pain quickly went away, and they were able to resume their previous activities. Good as new.

This brings us back to the problem presented at the top of the page--just how does emotional tension actually induce physiological changes throughout the body? Well, here's what we know so far:

• 
  The limbic system in the brain has historically been considered the "seat of emotions." It's been thought to be the area of the brain that produces those nasty feelings from Step 1: fear, anger, etc. Some researchers like Dr. Candace Pert, however, believe that emotions originate in both the head and the body. For our purposes here, it doesn't really matter where they originate. The important point in Dr. Pert's work is this: "Neuropeptides and their receptors thus join the brain, glands, and immune system in a network of communication between brain and body, probably representing the biochemical substrate of emotion." Her work has proven that emotions absolutely have a physiological effect on all parts of our bodies.
• Let's see what happens when emotions lead to dysfunction in the immune system. If the immune system does not react strongly enough to foreign invaders, the result is susceptibility to infections: frequent colds, yeast infections, urinary tract infections. Overstimulation of the immune system can cause allergic reactions.
• How about the autonomic nervous system? This system, controlled by the hypothalamus, is responsible for the "fight or flight" response. It can instantaneously direct blood flow to or from various areas of the body. This process can cause tension headaches, migraine, back pain, joint pain, nerve dysfunction.
• The immune system and the autonomic nervous system are just two examples. Remember that emotions affect all parts of the body. They can certainly affect the endocrine system and its subsequent release of hormones. And TMS theory suggests that emotions also affect the chemistry of the brain itself--meaning that several psychological disorders (depression, anxiety, obsessive-compulsive disorder) are also manifestations of TMS. In the next section, I'll list off many of the known physical and psychological TMS conditions that can be cured simply by identifying the unacceptable, repressed feelings.

Dr. Sarno’s Model for TMS

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Here's what we don't know: We're not sure exactly how the mind/body decides which physiological alterations to make in response to unacceptable emotions. We don't know why some people get back pain, others develop a spastic colon, and still others get migraines. Some alternative medicine practitioners suggest that specific emotions can cause specific symptoms (financial worry causes knee pain, for example), but I really don't think that's the case. I think that you develop the symptoms that will work as the best distraction for you--the ones that you are least likely to attribute to emotional tension. I'll discuss that more in the next section.

You may have noticed that I have not mentioned structural abnormalities like herniated discs, degenerated discs, osteoarthritis, spinal stenosis, scoliosis, pinched nerve, spina bifida occulta, spondylolysis, weak or inflexible torso muscles, minor cartilage tears, calcium deposits, minor rotator cuff tears, or soft tissue inflammation (tendonitis, bursitis, fasciitis). That's because none of these are responsible for the pain.

This is another tough idea for pain sufferers to swallow. People with joint pain have usually been to see an orthopedist, a chiropractor, a physical therapist, or a podiatrist to find out what was causing their pain. So they're often told that there are some muscular imbalances surrounding the joint, or perhaps some soft tissue inflammation. None of those are responsible for the pain. Poor posture and muscular imbalances can lead to poorer posture and a reduction in range of motion, but not intense pain. And what is often diagnosed as tendonitis, bursitis, fasciitis, metatarsalgia, shin splints, tennis elbow, sciatica, or carpal tunnel syndrome is, in reality, just an area of soft tissues suffering from mild oxygen deprivation.

Patients usually have x-rays or MRIs that show some whacked out abnormality in their joints or spine. Now I'm not denying the fact that they have some weird-looking joint abnormalities. I'm saying that the abnormalities don't cause pain. Lots of people, who have no pain at all, have all kinds of structural irregularities in their spine. Lots of people who have excruciating pain have no irregularities at all. And some people even have irregularities and pain, but the irregularity is in such an area that it couldn't possibly be responsible for the pain. (There are many research studies that show there is no correlation between disc bulges and back pain.)

Now it is certainly logical to blame the pain on the abnormality that is spotted on the x-ray or MRI, especially when that's the only thing the doctor is taking into consideration. And of course, that's what the practitioner has been trained to do. But after twenty-some years of observing TMS patients, Dr. Sarno has noticed that his patients only permanently eliminate their symptoms when they accept the fact that the structural abnormalities are not causing the problem. He has realized that many of these abnormalities (like osteoarthritis, degenerated discs, minor rotator cuff tears, minor cartilage tears) are simply part of the aging process. Humans have been painlessly developing them with age for eons, but we have only recently acquired the technology to view them with x-ray and MRI machines. As long as a patient believes that there is something "wrong" with their back or other joint, the pain will hang around. Why? Because it's still working as a distraction. It is still successfully keeping the focus away from the unpleasant emotions in the unconscious mind.

Here are a couple other points to remember. The human body has a marvelous capacity to heal. I mean marvelous. If you snap your thigh bone in half, it's as good as new in six weeks. So why in the world would a fall you took ten years ago still cause your back to flare up and cause you pain? Or even the surgery you had a few years ago? Don't you think that the area should have healed by now? And the idea that a minor activity, like bending over to tie your shoes or sleeping on a soft mattress, could possibly "throw your back out" is ridiculous. I'll discuss this fear issue more later.

Very often, if a patient has faith in a particular treatment, he or she will get better, regardless of the true effectiveness of the treatment. It's called the placebo effect. The relief is usually temporary, unfortunately, and the symptoms eventually come back. That's essentially what is happening when you undergo the conventional treatments for back and joint pain. Chiropractic, deep massage, physical therapy, cortisone injections, surgery, and all of those retarded products sold at Relax the Back are barking up the wrong tree. They assume that there is something physically wrong with your back. Many of these modalities are good at temporarily relieving the symptoms--because they either temporarily increase circulation in the area, or you have enough faith in the procedure to enjoy the placebo effect. But if you only treat the symptoms, and not the root cause, the symptoms will eventually come back. Or you may develop another version of TMS. It's very common for back pain to suddenly disappear, only to have shoulder pain or migraine or irritable bowel syndrome show up in its place. So now let us observe the various manifestations of TMS...

Dr. Sarno originally came up with the name "Tension Myositis Syndrome" to describe the pain syndrome he saw in his patients: "tension," referring to the emotional tension that causes the syndrome; "myositis," referring to the involvement of the skeletal muscles; "syndrome" referring to the multitude of symptoms present. But he soon discovered that TMS is not just limited to musculoskeletal manifestations. There are a number of other conditions that serve the same purpose. The common ones are listed below. They also are emotionally induced, work as a distraction, and can be cured through education and awareness.

Once again, this website is not meant to make any diagnoses. If you have any of these symptoms, be sure to see a capable health provider to rule out any serious disease.

Musculoskeletal disorders. Affected by the autonomic nervous system.

• Low back pain, diagnosed with one or more of the following:
  • Sciatica
  • Osteoarthritis
  • Spinal stenosis
  • Herniated/bulging/degenerated lumbar disc
  • Scoliosis
  • Spondylolysthesis
  • Piriformis syndrome
  • Weak/inflexible torso or hip muscles
  • Spina bifida occulta
  • Spondylolysis
  • Transitional vertebra
• Neck/shoulder pain, diagnosed with one or more of the following:
  • Osteoarthritis
  • Pinched nerve
  • Herniated/bulging/degenerated cervical disc
  • Whiplash
  • Thoracic outlet syndrome
  • Weak/inflexible neck, shoulder girdle, or rotator cuff muscles
  • Rotator cuff tears
  • Bursitis
  • Tendonitis
• Knee pain, diagnosed with one or more of the following:
  • Tendonitis
  • Torn meniscus
  • Chondromalacia
  • Unstable patella
  • Muscular imbalances around the knee joint
  • Osteoarthritis
• Elbow pain, diagnosed with one or more of the following:
  • Tennis elbow
  • Tendonitis
  • Muscular imbalances around the elbow joint
  • Osteoarthritis
• Foot/lower leg pain, diagnosed with one or more of the following:
  • Tendonitis
  • Plantar fasciitis
  • Plantar metatarsalgia
  • Neuroma
  • Flat feet
  • Calcium deposit/heel spur
  • Shin splints
  • Muscular imbalances around the ankle or foot joints
  • Osteoarthritis
• Wrist/hand pain, diagnosed with one or more of the following:
  • Carpal tunnel syndrome/repetitive stress injury
  • Tendonitis
  • Muscular imbalances around the wrist or hand joints
  • Osteoarthritis
• Nerve dysfunction
  • Sciatica
  • Carpal tunnel syndrome/repetitive stress injury
  • Trigeminal neuralgia/tic douloureux
  • Bell's palsy
• Temporal mandibular joint syndrome (TMJ)
• Fibromyalgia
• Myofascial pain syndrome
• Tension myalgia
• Chronic pain

Gastrointestinal disorders. Also affected by the autonomic nervous system.

• Heartburn/acid reflux
• Hiatus hernia
• Gastritis
• Ulcer (Yes, h. pylori bacteria may be present and may even cause ulcers. That would mean the ulcer is the result of an infectious agent. Frequent infections are also a manifestation of TMS.)
• Nervous stomach
• Spastic colon
• Irritable bowel syndrome
• Colitis

Circulatory disorders. Also affected by the autonomic nervous system.

• Tension headache
• Migraine
• Raynaud's phenomenon (excessively cold hands/feet)

Genitourinary disorders. Also affected by the autonomic nervous system.

• Frequent urination
• Urinary tract infections
• Prostatitis

Cardiac disorders. Also affected by the autonomic nervous system.

• Rapid pounding heartbeat (paroxysmal auricular tachycardia)
• Extra (ectopic) heartbeats

Immune system disorders.

• Allergies
• Asthma attacks
• Frequent infections
  • Colds
  • Urinary tract infections
  • Yeast infections
  • Recurrent herpes simplex
• Skin disorders
  • Acne
  • Hives
  • Psoriasis
  • Eczema
• Epstein-Barr syndrome

Psychological disorders.

• Depression
• Anxiety
• Panic attacks
• Obsessive-compulsive disorder

Miscellaneous disorders.

• Dizziness/vertigo
• Tinnitus (ringing in the ears)
• Chronic fatigue syndrome
• Laryngitis/spasmodic dysphonia

Ask anyone who suffers from severe back pain how it's affected their life. They'll probably tell you that their life is now all about their back. They're afraid to overexert themselves, afraid to sit for long periods of time, afraid to sleep on a soft mattress. They no longer engage in their usual activities with friends, co-workers, family members. They've spent thousands of dollars in medical expenses. They have to take strong pain relievers just to get through the day. They're completely fed up with doctors and unsuccessful medical procedures.

Now tell one of those sufferers that the pain is caused by something in their head. If they don't kick your teeth in, they'll probably tell you to go have intercourse with yourself. (Plenty of people have said it to me.)

The whole purpose of TMS is to divert attention away from the unacceptable emotions and to keep attention focused on the physical symptoms. This syndrome is very good at its job. The symptoms are distressing enough by themselves, but TMS literally adds insult to injury. Psychological and social factors add to the whole mess, leaving sufferers completely exasperated. But ta-dah! Mission accomplished! Sufferers may be exasperated...but they're certainly not thinking about those unacceptable emotions anymore....

Blaming the patient/secondary gain. Let's get something cleared up right now. Just because I'm saying that all of the previously mentioned symptoms are tension-induced, it doesn't mean that I'm "blaming" anyone. If you're a TMS sufferer, you've probably been through the wringer with doctors, co-workers, friends, family members. At some point, someone has certainly suggested to you that your pain is "all in your head," which is just about the most insulting thing you can say to someone who's miserable. I'm not saying that. I'm saying that the pain and symptoms are most definitely real, but the original cause is in your head. And the good news is, there most definitely is a way to eliminate all the symptoms.

TMS sufferers are often mistakenly accused of getting some kind of "secondary gain" out of their condition. They're accused of prolonging it, faking it, or using it as an excuse to weasel out of their responsibilities. That's really not what's going on. Yes, sometimes the symptoms are so intense that you do wind up missing work or school, but that's not the primary reason for the symptoms. The real benefit is avoiding the unacceptable emotions simmering below the surface.

These accusations add all kinds of guilt and frustration, which in turn just reinforce the hold TMS has on your attention. You're no longer just in pain--now you're beating yourself up for being in pain and not being able to make it go away.

Choosing the most "acceptable" distraction. Your brain starts this whole mess in order to protect you from feelings that seem to threaten your self-image. To your brain, those are the scariest things imaginable because those feelings threatenyou, all the qualities that make you you, the very essence that is you. Nothing could make you feel more vulnerable. So to your brain, anything is a better alternative. Even excruciating pain. Logically, you'd think that it would be a whole lot easier to just deal with some unpleasant feelings, but that's not how your brain works. It's programmed to protect you at all costs.

All versions of TMS from the long list above serve the exact same purpose, so it's quite common for one set of symptoms to disappear, only to have another set take their place. Why then, do some people develop back pain, while others get a spastic colon, and others develop obsessive-compulsive disorder? I don't have a definite answer. But I do know that your brain chooses the handiest, most acceptable distraction. The one that you are least likely to recognize as tension-induced. It's very common to have pain at the site of an old injury because your brain knows that you probably won't associate the pain with emotional tension. You'll almost certainly attribute the pain to the injury, even if it was a minor injury that occurred years ago. (Of course it's possible to be seriously injured by violent trauma, so you should always be checked out by a doctor.)

Ulcers have become much less common over the years, probably because the public has become aware that they are associated with emotional tension. They don't work as well as a distraction anymore. At the same time, the incidence of back and joint pain has skyrocketed, probably because the public has been led to believe that the back and joints are very delicate and easily injured. (Which is ridiculous! Think of all the pain-free manual labor our ancestors performed!) This misinformation is coming from several sources--orthopedists, physical therapists, chiropractors, podiatrists--all who have been trained to treat structural abnormalities and completely disregard the involvement of the mind. And don't forget the media attention that repetitive stress injuries and "mysterious" ailments like chronic fatigue syndrome receive. In today's society, it's perfectly acceptable to have a "real" medical condition. But if someone has a stress-induced disorder, they're immediately tossed into the "crackpot" category.

Fear and conditioning. Fear plays a significant role in prolonging symptoms. Current medical wisdom says that you can't arch your back, you can't lift anything heavy, you can't sleep on a soft mattress, you can't sit for too long, you can't slouch, you can't sit in a non-ergonomically-correct chair, you can't run on pavement, blah blah blah. So if you experience pain after running on pavement, for example, you're probably going to blame the pain on the activity of running on pavement. It's Pavlovian conditioning. You're probably going to be afraid to run on pavement from that point on, because you know how miserable the pain is and you'll do anything to prevent an attack. So you start to gradually change your life, to the point where you're no longer able to do the majority of your favorite activities. You have to completely accept and understand the TMS diagnosis in order to undo this conditioning. It's crucial to resume your normal activities, to prove to yourself that there is nothing physically "wrong" with your back or neck or elbow or whatever.

If you're pain free, but are still afraid to resume your normal activities, you're not yet "cured." Living in constant fear of hurting yourself keeps your attention focused on the physical symptoms, and the symptoms will eventually return because you still haven't accepted the fact that there is an emotional root cause.

Sometimes the pain comes back. The pain can recur for a number of reasons. First of all, since all forms of TMS serve the same purpose, it's not unusual for one set of symptoms to substitute for another. It's common for your neck pain to go away, only to have knee pain develop in its place. Or for the pain in one shoulder to disappear, only for it to mysteriously reappear in the other shoulder. Or for your back pain to disappear, only to begin to experience panic attacks. To be on the safe side, you need to rule out any serious illness as the cause of the new symptoms, but chances are, the new symptoms are just another manifestation of TMS. They're there to keep diverting your attention away from the underlying emotions.

If the symptoms keep coming back, whether they're in the original location or not, it means that you haven't yet identified the unconscious emotions that are causing the whole syndrome. Or you might not be aware of just how deep and intense those emotions are. Or you might not have completely accepted the TMS diagnosis. Be sure to read the How to Cure Back Pain and TMS symptoms section for more info.

Keep in mind, however, that just because it's possible for symptoms to return, that doesn't mean that this treatment approach is just another placebo. Experience with TMS sufferers has shown that many people can immediately and permanently eradicate their symptoms, once they understand what's going on.

Support groups. (Certainly there are medical conditions that are not easily reversed in the same way that TMS and its equivalents are. In this section, I'm only talking about support groups designed for the tension-induced symptoms listed above. If you’re reading this, you obviously know how to research information on the internet. Chances are you've visited one or more of the support newsgroups available through Usenet. Just like any other support group, these have both pros and cons.

The great thing about a support group is the feeling of relief that washes over you when you first discover it. "Oh thank God! I'm not crazy! I'm not the only one who feels this way!" It gives you the chance to swap stories and exchange information without feeling like a self-conscious fruitcake. Unfortunately, a support group quickly becomes like an exclusive club. There's "us" (the folks who all have the same problems or symptoms), and "them" (everyone else). You can be in the club as long as you're suffering as badly as the other members, but if you're not, you're out. Which means there's essentially no incentive to get better. Like I said before, no one consciously wants to suffer with their symptoms, but it's important to recognize that you're fighting an uphill battle against your unconscious mind. All of the positive qualities about a support group unconsciously reinforce the idea that it's acceptable, or even normal, to have physical symptoms. And learning about another sufferer's tension-induced symptoms absolutely increases the chance of developing them yourself, because once again, it seems acceptable to do so.

If your life has already begun to revolve around your particular symptoms, support groups tend to make it worse. The group gives you a label, or a new identity for yourself. "I am a back pain sufferer." "I am a fibromyalgia sufferer." "I am a depressed person." "I am a chronic fatigue sufferer." And if your particular illness is relatively new or "mysterious," with no known origin, well now you don't just have a medical condition--now you've got yourself a cause. You've got to join the crusade to bring more public awareness to the problem! You've got to get more funding for research and testing! You've got to get Oprah to talk about it on her show! It's very easy to get self-righteous about suffering. I'm just as guilty of it as anyone. Whenever anyone told me that I was bringing my symptoms on myself or that I should just snap out of it, my answer was always the same: "F--- you. If you were suffering the way I'm suffering right now, you certainly wouldn't be telling me what to do."

So I'm not saying that support groups are bad and should be avoided. I'm saying that it's important not to wear your ailment like a badge of honor. You'll never get any better that way. Use a support group to exchange information, but always remember that it is possible to eliminate your symptoms through education and awareness, regardless of the nay sayers in the newsgroups.

How to Cure TMS

In order to cure this syndrome, you must go as far back in the chain of events as possible and treat the root cause. Conventional treatments might go back a step or two--pain relievers treat the physical symptoms, massage or ultrasound treatments address the physiological changes--but they don't address the root cause.

In order to completely eliminate all symptoms, you must identify which unacceptable emotions are threatening your self-image. The physical symptoms are present for a reason: They distract your attention away from the unacceptable emotions. Once you acknowledge the threatening emotions, the symptoms no longer work as a distraction, and they go away. Quite dramatically, I might add. You don't even need to eliminate the source of the stress--you just have to become aware of it.

Since we're talking about unconscious emotions, they might not immediately be apparent. Recognizing them might take some work. A daily meditation period, during which you take time to notice all the thoughts and feelings that float through your head, is a very beneficial practice. And try making a list of expectations, or requirements, that you have for yourself, and see which of those requirements are being threatened by your current situation. Very often, we require life to be fair. "I'm a good person, I deserve good things to happen to me." Unfortunately, life is rarely fair, and it can become a source of intense anger.

You also have to completely believe in the TMS diagnosis. That means that you have to completely accept the fact that your symptoms are emotionally induced. If you still believe that there may be something physically or structurally "wrong" with you, you're not yet "cured." You're not paying attention to the underlying emotions, which means that the symptoms can still work as a distraction, and it's likely that they will return.

It's also important to completely resume your normal activities. If you're still afraid to sit in a soft chair or pick up your kids or bend over to tie your shoes, you're not "cured" yet, either. As long as you're living in fear of another attack, the physical symptoms still have your attention, and chances are good that they'll return.

Many people can eliminate their symptoms simply by reading one of Dr. Sarno's books. Some people need a little more help. If reading his book doesn't "cure" you, there are a few other options:

• Check out other information resources. Understanding and completely accepting the TMS diagnosis and treatment approach is crucial. It helps to have these ideas reinforced by several sources. You can listen to the RealAudio samples we have on our site. You can purchase The MindBody Workbook from Dr. David Schechter's website or from Amazon.com.
• If possible, see an MD who is trained to diagnose and treat TMS. If you live in the New York area, see Dr. Sarno. If you live in the Los Angeles area, see Dr. Schechter. Check out the Directory for TMS physicians in your area. In Michigan, Dr. Howard Schubiner is the only physician trained to treat TMS.
• Sometimes it's necessary to meet with a psychotherapist. As I mentioned before, it's not always easy to make unconscious emotions become conscious. A skilled therapist can be a big help. When looking for a therapist, try to find someone who is analytically trained, since they are specifically trained to deal with the unconscious mind.
• Feel free to discuss your experiences with others on our message board.
• Be patient, be persistent, and be kind to yourself. Nosing around in your unconscious mind can be very uncomfortable. Some people are not quite ready for this approach, which is understandable, considering the current state of western medicine. Don't beat yourself up if you don't immediately find relief. But please don't throw in the towel. I assure you that Dr. Sarno's method works.

Additional responses to this article may be found at the following link:
http://search.tmswiki.org/results.html?q=kim+ruby (TMS Search Engine)

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Absolutely. I believe that Kim was referring to non-TMS support groups because of the way that they lead people to focus on their symptoms so that their symptoms become their identity. In a well-run TMS group you are protected from this, to some degree, by the fact that most people know that the goal of the TMS is to get you to focus on the body. You overcome TMS by losing your fear about your body and re-immersing yourself in your life. At least, that's the approach that I advocate.

I even don't like the idea of a "support" group. I think of it the same way that I think about therapy. The goal of a good therapist is to work themselves out of a job by giving the client the skills to take care of themselves. It's a bit like "give a man a fish" vs. "teach a man to fish." On this site, I similarly want people to develop self-care skills so that they don't need the support that the site provides any more. My hope is that once they do that, their life will have been so transformed that they will want to come back to help others overcome their own TMS. Luckily, we have a lot of absolutely wonderful people who have chosen to do exactly that. But the big picture is that I want people to come here for the support, find the strength and confidence inside of themselves so they can be givers of support rather than receivers, and then stick around because either:

1. they enjoy the intellectual discussion of discussing TMS in the General Discussion Subforum or
2. they find that their lives are much richer when they help others through experiences that they know to be terrible in the SEP and Support Subforums.

The bottom line is that I basically agree with you. We don't want to become dependent or addicted. I think we're quite good at avoiding that, but it always bears repeating so we stay good at it.