Differences in approach between Sarno and Clarke (?)

I have nearly finished reading 'They can't find anything wrong!' by David D. Clarke.
It strikes me that where Sarno approaches Anxiety and Depression as symptoms of brewing, suppressed emotions, just like physical symptoms, Clarke treats them as causes for symptoms. Although I see a lot of overlap between this book and Sarno's , this seems to be a fundamental difference between the two. Also I can't remember Sarno propagating the use of anti-depressants or anti-anxiety medication (?), where Clarke has no difficulty in prescribing any.
I think it is pretty impossible to prove which causation is true. Anxiety and depression could be the result of upcoming suppressed emotions, but you can also say that it is the other way round.
Any thoughts?

 

Hi Gigalos,

I haven't read Dr. Clarke's book, so I can't speak directly to his theories. But if he states that anxiety and depression cause chronic pain and other symptoms, then to me that begs the question "What causes the depression and anxiety?" I read Dr. Schubiner's book Unlearn Your Anxiety and Depression awhile back. He states that anxiety and depression are forms of mindbody syndrome (TMS) and should be treated the same way as physical symptoms. He states that the old theories of low serotonin or other neurotransmitters is not a proven theory, and that anti-depressants do not "fix" a neurotransmitter problem. Since reading his book I've worked on weaning myself off an anti-depressant that I took for half my life. I'm down from 150mg to 50mg daily, but I've had mild to moderate depression and anxiety ever since lowering the dose. Dr. Schubiner talks about a rebound effect when trying to come off of anti-depressants so I was expecting to have these symptoms. But it has been months now. I'm trying to treat these symptoms as TMS but it is difficult, and I've not had much success yet.

It's an interesting question. I look forward to seeing others' responses.

 

I read a sample of the book and he makes sense, he has a website and has helped people. But people w/fibromyalgia are non trusting of everything. Fibromyalgia is a ridiculous name,which has slowed down research and progress. I haven't read the book, but he does say modern day stresses are causing pain,and maybe other unseen forces. Also he feels,if I understand him, saying the pain is from repressed memories,is like blaming the patient.
I did cut and paste his (well its on his website) what I believe is a refutation of Dr. Sarno's distraction theory.



Psychophysiologic Disorders: Distracted by Theory

Psychophysiologic Disorders (PPD) consist of pain or other physical symptoms that are partly or completely relieved when underlying psychosocial issues are uncovered and treated. The process that produces this form of illness is an area of active investigation.

One theory you will see written about regularly is that the brain creates these symptoms to distract the patient from underlying emotions. As John Sarno, MD, put it: ” to divert people’s attention to the body, so that they can avoid the awareness of or confrontation with certain unconscious (repressed) feelings.” (1)

There are a number of problems with this model, however. First, the only evidence I can find to support it is that a psychoanalyst named Stanley Coen suggested it. Second, for this theory to be true you must assume there is a cognitively sophisticated but subconscious process deciding when the physical symptoms need to be created. Third, any attempt by a health care professional to uncover the emotions underlying a patient’s PPD should, according to this theory, increase the intensity of the symptoms as the mind tries ever harder to distract the patient. (In my practice, the reverse is usually the case: uncovering powerful unrecognized emotions leads to improvement of symptoms for a large majority of patients.) Fourth, this theory is not intuitive for patients, health care professionals or the public to comprehend. Fifth, Dr Sarno claims that once the Distraction Theory is “accepted by the patient, the knowledge of what is going on destroys the brains’s strategy.” (1) This implies patients can achieve lasting relief without addressing the underlying emotions. Though some do experience improvement simply by accepting that their symptoms derive from emotions and not from an organ disease or structural problem, in my patients unless the emotions are recognized and treated, the risk for a relapse is substantial.

Is there an alternative concept? Absolutely. Most of us have had the experience of a “knot” sensation in our abdomen when we find ourselves in a tense situation. Most have blushed with embarrassment a few times. These are physical manifestations of emotions of which we are consciously aware. Because of that awareness we can cope with these situations using cognitive and verbal skills.

What about emotions of which we are not consciously aware? Is there any reason why they could not also cause physical manifestations using normal nerve pathways analogous to those that cause abdominal “knots” or facial blushes? Our lack of awareness of the emotions would make them inaccessible to our cognitive and verbal skills, perhaps enabling them to grow in severity over time. Enabling the patient to access these feelings would not, under this model, ratchet up the mind’s attempts to distract with ever more severe symptoms. Instead, it would enable the emotion to be expressed verbally instead of somatically. This is what I have observed in over 7000 patients.

The Distraction Theory and the Somatic Expression of Emotion Theory will tend to produce similar outcomes for patients under care of experienced PPD practitioners. The principal virtue of the latter theory is its intuitive simplicity which is of great importance. Despite the success of treatment for PPD, physicians and many patients struggle to accept the PPD concept. A straightforward explanation of the physiology, grounded in universal human experience, will greatly facilitate building acceptance among patients and colleagues.

1. Sarno JE. The Mindbody Prescription. Warner Books, 1998, p xxvii.

Tags: Distraction Theory, psychophysiologic disorders

This entry was posted on Sunday, March 15th, 2015 at 11:16 pm and is filed under Changing the System, Stress Illness Causes. You can follow any responses to this entry through the RSS 2.0feed.

Interesting read.

www.stressillness.com

 

Interesting read Mark, thanks for your investigation. He brings some strong arguments to the table.
I also agree with Ellen that there is a lack of explanation about what depression and anxiety really are. The unbalance of neurotransmitters could be true, but in my opinion it is poorly proven and still doesn't give an answer to why it happens.
I'll need to let my mind digest all of this.

 

hi, he has a website and does acknowledge the book MINDBODY Prescription as one of the recommended books to read so,he doesn't completely ignore Dr Sarno, but unlike Dr Sarno it appears he thinks one should bring up memories uncover them as it were. I just watched his video which is about 27 minutes long on YouTube and he's an interesting person.but I don't know I think this it's going to be a long before it's understood why people have chronic pain. There are many theories out there (even conspiritorial ones), one thing for sure it's a lucrative business but "they" need to get it together and start helping people.

 

I've been able to recover from chronic pain with Sarno's distraction theory as my paradigm. I realize it is theory and can't be proven, but many of us have fully recovered or made significant progress using that theory as a guide. That's good enough for me. But I think it is interesting to look at the different theories. The other one being the learned neural pathways model.

 

I think as long as we see ourselves in a book by a physician we can heal. This Dr. Is for bringing to light all memories that cause anxiety or trauma. I think we will have to decide what methods work. If anyone has healed under Dr. Sarno,I wouldn't be willing to go to another bunch of theories.

 

I agree with you, markus. Reading Sarno will heal TMS. Why try anyone else's philosophy.

I have also found a great way to relieve stress and anger.
Shut off the computer and disconnect the telephone.
I am going to do that as much as I can this Memorial Day weekend.
I am tired of phone calls from businesses and strangers. I want peace and quiet and
by God, I will get it if I avoid electronics.

 

I need to get back into Sarno but I'm distracted easily, I even can convince myself I need to be distracted, but, when I first discovered his methods, I was certain he could help.

 

I think this is an interesting quote. I am thinking more and more that there may be a very simple way that pain is addressed that is embedded in Dr. Sarno's work. I will use the analogy of The Wizard of Oz. The wizard at the end tells Dorothy that she simply needs to use her shoes, which she has had all along! This is also the way I feel about spiritual development. That our Being is in us all along, but needs to be seen clearly and appreciated. I don't think this is the whole story with Dr. Sarno's work, but a powerful core piece.

 

Markus, I'm a huge fan of Dr. Sarno --- with his help, I overcame back pain and other issues that defied conventional treatment. I'm a little confused as to whether you agreed with what you called Clarke's "refutation of Dr. Sarno's distraction theory", or if you were just posting it for people to see. Regardless, I'd like to address Clarke's points, because I don't think they refute Dr. Sarno's beliefs at all.

----

"First, the only evidence I can find to support it is that a psychoanalyst named Stanley Coen suggested it."

"The only evidence"? Is Dr. Clarke not aware that Dr. Sarno has treated thousands successfully for decades, all while working within the transparency of the New York University School of Medicine system? (Sarno didn't exactly practice in back-alley hideaways.) Is Dr. Clarke also not aware that several follow-up studies involving well over 300 patients, plus a random check of 20 of his patients by ABC's 20/20 program, all showed a strong rate of success with Sarno's approach?

----

"Second, for this theory to be true you must assume there is a cognitively sophisticated but subconscious process deciding when the physical symptoms need to be created."

Is that assumption really that implausible, given how much still isn't known about the workings of the human brain? And ultimately, isn't the proof in the pudding? In other words, how does Dr. Clarke explain Sarno's high success rate with thousands of patients using that exact same approach?

----

"Third, any attempt by a health care professional to uncover the emotions underlying a patient’s PPD should, according to this theory, increase the intensity of the symptoms as the mind tries ever harder to distract the patient."

Has Dr. Clarke not read any of Dr. Sarno's books? Actually, most patients achieve a quick and permanent release from their pain, with little if any resistance from their subconscious mind along the way. As Sarno describes, there will be a smaller number of patients, who have much more emotional trauma built up and will experience some increase in intensity during treatment. But even in those cases, the patient can still ultimately achieve permanent success by following the protocol (although they may need assistance from a professional).

----

"Fourth, this theory is not intuitive for patients, health care professionals or the public to comprehend."

So what? Columbus saying the world was round wasn't intuitive for many people, either, but that doesn't change the fact that he was right, and everyone else was wrong. And if you conducted a public survey, most people would make the exact same argument about Dr. Clarke's system.

Ignaz Semmelweis was a 19th-century obstetician who demonstrated convincingly that hand-washing could prevent the vast majority of deaths in maternity wards. Why did other doctors still refuse to believe him for many years afterward, and continued working without disinfecting their hands and while wearing dirty clothing, causing countless more unnecessary deaths? Apparently, they didn't find that great man's argument "intuitive".

----

"Fifth, Dr Sarno claims that once the Distraction Theory is “accepted by the patient, the knowledge of what is going on destroys the brains’s strategy.” (1) This implies patients can achieve lasting relief without addressing the underlying emotions. Though some do experience improvement simply by accepting that their symptoms derive from emotions and not from an organ disease or structural problem, in my patients unless the emotions are recognized and treated, the risk for a relapse is substantial."

Again, has Dr. Clark even read any of Dr. Sarno's books? Sarno has said that in the most stubborn cases of TMS, more and more individual issues WILL have to be addressed before finally achieving resolution. In other words, many, but NOT ALL, patients will can become healed without addressing specific underlying emotions.

----

In summary: I haven't read Clarke's book, but if your copy-and-paste is accurate, I'm not particularly impressed with his thoughts on Sarno. He puts words in Dr. Sarno's mouth, and I'm not at all convinced that he ever really understood what Sarno argues, or that he ever read much of anything that Sarno wrote.

For all I know, Clarke's system may be quite decent; whether it's better than --- or for that matter, even as good as --- Dr. Sarno's, might only be proven down the road. I'm always glad to have another doctor around who pushes the conventional health care system to take a harder look at the emotional causes of health issues. We certainly need more doctors doing that. But Clarke should NOT be criticizing another professional if he doesn't particularly understand what that person advocates.

 

[This post has been edited so that it stays on the topic of the thread, which is comparison of Clarke's and Sarno's views.]

[Regarding the topic of comparing Sarno and Clarke, as] of now I don't have an opinion because I'm doing something called the THE PRESENCE PROCESS. I did a quick review on Amazon reviews and he is WELL liked.

 

I've also had tremendous success using Dr. Sarno's distraction theory. It makes sense to me and has worked beautifully for me, so I see no reason (personally) to quibble or nit-pick at it.

 

Agreed, there's an enormous amount of judgment of members who discuss different mindy/body practitioners other than Sarno! I do not think that this forum is for that. Everyone should be more concerned about someone's welfare than whom they saw. Sarno no longer practices,so, people have to see those who are. "Quibbling and nit-picking" are immature, showing lack of respect for all opinions. I hardly think that is the purpose of this forum.

 

I feel pretty much the same way that Gigalos does in the original post. Anxiety and depression could cause TMS or repressed emotions could cause anxiety and depression. How would we know? It's so hard to establish what causes what. Also, with the way that Freud set it up, there is no way to observe what is going on in someone's unconscious mind. It's just a big mystery, which makes it hard to really know anything.

I've had depression before and medications really do work. They aren't a panacea, but they are life changing. Cognitive-Behavioral Therapy also works and can be life changing, and it doesn't touch unconscious emotions at all. I'm sure that some people need to go into unconscious emotions, but study after study shows that Cognitive Behavioral Therapy and medications work for others.

Whatever works... Depression sucks.

 

Phaedrus, i believe that we are just beginning to understand some of what the brain is capable of. 6 months after my Mother passed away I woke up and was crying profusely! I remember having to urinate and I didn’t have the energy to get out if bed. Fortunately I summoned that energy because it's not acceptable for a grown man to wet the bed. I made coffee and called in sick to work (night shift). I had just enough energy to go back to bed. All the time I was crying. I called my therapist and made an appointment. I cried through the entire session! So, he prescribed paxil,and rather quickly it brought me out of it (and week maybe).
So, I can't believe that tms was a culprit, but I also know that without that medication I was a very sick,sad, exhausted person. I have never felt that way sinse. But I have to agree that anti-depressants do work, and are necessary! Probably looking back, I was fairly together during my Mother's illness and passing, but I lost control over my own mood. I don't know which came first, the chicken or the egg. Not to mention it was over 16 years ago

 

General TMS Subforums (in honor of Dr. John Sarno)

 

I find this an interesting conversation. I myself have tried nearly everything out there to help with TMS, anxiety, depression and trauma recovery. There are days where I feel that this is all TMS and days when I find out some of it has been hormonal imbalance. I do believe in the power of belief. When I am buying into something, I start to feel better and I start to feel hope and safety. For some the power of belief in the treatment/cure is enough to cure. Placebo effect or not it works and if it works GREAT!I have tried many things that did not work for me (most things). Would I tell someone not to do a process that didn't work for me? Maybe bee sting therapy, that was not fun... but not because it didn't work but because the experience was unpleasant and it didn't work for me. It is helping others tho... that is why I tried it. In trying it I had a shot at it helping. So hearing others positive experiences with something brings me into try it. I was brought to Sarno's work by a friend who recovered upon reading the book. Perhaps I am a slow learner but that was not the case for me. I value all approaches because they help someone. Be it by placebo, belief, efficacy or whatever. I want to know what is out there to help. If my friend had not shared her success story I would not be here today connected to this cool forum with interesting view points and people to share thoughts support and conversation.

I am so happy that there are people (physicians and practitioners) out there looking for ways to help. Thank God for them (or whoever/whatever) because TMS sucks. Depression sucks. Anxiety sucks. I would give anything not to have this crap in my life but it is here and maybe I am supposed to learn something from all of this. But it has been a crappy existence for a long time. Now, with the variety of methods I find here with TMSers, I feel I have a good recipe. I love that Dr. Sarno figured this out. It is miraculous when you think of it. Because some of how the practice of medicine functions today with treating symptoms rather than getting to the root keeps the focus off pioneering, Dr. Sarno and these other TMS specialists are trying to find the root cause and treat that. Years ago we didn't know the brain could be healed or re patterned come to find out it can? Cool! These practitioners are smart and I am glad they are out there and inspired to find a method or methods that work. It cant be easy to go against the "system" but they are helping people heal and that is good stuff. I don't care how I heal or how you all heal, I just care that we heal.

 

I could not identify more with this, its incredible and we owe the man a lot that he stood by his findings. important to distinguish these are not his beliefs but replicable findings over many many years. being someone who has an Engineering degree the evidence clinically isn't that robust but when you understand the nature of the treatment coupled with the evidence based model of medicine currently it is easy to see why he has been ignored.

it is really sad because Doctors are harming their patients. I have tried to explain this concept to three GPs(family physicians) and three hospital doctors(including two relatives) and have been met with blank stares on most occasions. some minor interest but then its business as usual.
you truly have to have experienced this to really believe it is possible which is a real shame.
hopefully some intrepid researchers find ways of validating this stuff further, it truly could revolutionise the way we think about health.

 

I did read Dr. Clark's book (more than once actually ) and I have to admit the part about depression did confuse me a little. I started wondering if maybe anti-depressants would be the answer to all my problems. But then I remembered what Dr. Sarno said and I just kept on doing my tms work.

I nevertheless got a lot out of Dr. Clark's book. What I loved most was all the success stories he shares. Most of his patients came from very dysfunctional families with abuse and neglect, much like my own. He tells their stories in such a compassionate way. I find it extremely soothing and that's not something I've found in other books. Whatever works to calm the nervous system, right!