Repression or Neural Pathways

Hi all, I am at the beginning of the SEP and have previously read some of Sarno's books. From reading Sarno it seems to me that emotional repression is the reason for TMS and the accompanying pain. However I can see that there is much discussion, especially from doctors who came after Sarno about learned neural pathways in the brain causing pain. Is there a mid-ground between between these two schools of thought? Or are they independent of one another? I am trying to connect the two as I try to build a bigger and clearer picture of my pain. Thanks for any input.

 

I think this merely helps to explain why long-term symptoms are harder to banish than newer ones, and knowing this can perhaps help us to tackle those older ones. I have no problem banishing some new sensation or little pain as TMS, but my unconscious expectation of a well-known symptom means that I have to be much more mindful of my thoughts.

 

Could it be that repressing emotions is a mechanism that reinforces the programming going on in programmed neural pathways? In other word, the two theories are complementary. Would be good to check with Howard Schubiner to see how he views this. I've also wondered whether programmed pain pathways could result in the slight lowering of oxygen level (ischemia) in the tissues in the shoulders and lower lumbar spine that Dr Sarno believes causes TMS pain. Now, lowered oxygen levels in those tissues has been demonstrated to exist, so Dr. Sarno's intuition may be at least partially correct.

 

Thanks guys I think I'm beginning to get my head around it. It certainly is interesting and probably is the interaction of the two. I think I'll add one of Schubiner's books to my reading list.

 

They are nothing more than different descriptions of the same thing. Here is something I wrote on another thread:

“What neuroscientists and pioneers like Schubiner and Alan Gordon are doing is simply explaining the black box that Sarno described. They have gained access and are exploring the magnificence and mystery of it and are then translating it into recovery and healing.

I view the psychological and neuroscience/behavioural approaches like this: I was born in the year the UK went metric however I quantify weight, volume and distance in Imperial Measures (such as stones, pints and miles) yet money I quantify as Metric (pounds and pence). But they are measuring the same thing in different ways. It doesn't matter whether you favour the more emotive and psychological models or if you prefer the more scientific and neurobiological ones. They are maps describing the same territory. All that matters is that you favour the one that works best for you.

Many people find the repressed emotion model incredibly confusing and messy. Other people adore the mystery, the poetry, the Old School nature of it.

Others prefer the clarity and science-backed nature of more contemporary models. They seem to make more sense. They are easier to relate to.

(You can of course pick and mix but I would suggest you need a solid grounding and understanding of both approaches to do that with confidence).

The mythologist Joseph Cambell once said the way to sainthood was to choose a path of faith and stick to it.The same may be said here. Choose the path that resonates most strongly for you, stick to your guns and come up smiling.”

Here is the thread:

http://www.tmswiki.org/forum/threads/day-2-the-nature-of-pain.16429/ (New Program - Day 2: The Nature of Pain)

Hope that helps,

Plum x

 

How do learned neuropathways explain sudden cessation of pain that some people experience though? Also what about rage?

 

grapefruit I wonder if the type of pain plays a part? For example, if their pain hasn't been present for a long time or perhaps if it is a pain that isn't constant? This might suggest the neural pathways are less deeply ingrained? I really don't know though, would be interested to see what others think.

 

Gosh, I had a strong reaction to this question, and I'm trying to figure out a way to explain it, especially as I know that you've had terrific success overcoming many debilitating TMS symptoms.

I guess what I want to say is that your question indicates a desire for a black & white explanation of this phenomenon, but I firmly believe that NOTHING in TMS is black & white.

Heck, they call it neuroscience, but I think there are still a ton of mysteries involved in figuring out the human brain, and the experience of chronic pain is just one of those.

From what we are learning, it seems that all "neuropathways" can be unlearned as well as be learned. Everyone knows that some learning is very quick, while other learning takes time. There's no reason that unlearning shouldn't be the same.

Look, our emotions are tied to our symptoms in varied and complex ways. Symptoms come and go as part of the process of initial TMS discovery and long-term recovery. We each have symptoms that are easy to banish because they are fairly meaningless to us, or perhaps because we can easily visualize existing without them. I had both types of symptoms, of varying types (pain in multiple places, GI stuff, neuro stuff) most of which disappeared or were greatly reduced shortly after I read Dr. Sarno and started doing this work. I continued to experience improvement in others, especially anxiety. But I have vague vestibular symptoms that continue to bug me, because I've had them a long long time, and to this day I can't find a way to visualize what it would feel like to live without these sensations. Ironically, I don't notice when I'm not having them, and thus can't seem to reclaim that sensation during the times they come back. But I continue to do the emotional work to this day, and I have so much of my life back that I'm really quite satisfied. And, unlike the bad old days, the fear is gone, which is huge.

@plum already said it:

What about it? One part of our brain - the part that wants to protect us from dangerous emotions, the biggest of which is rage - uses physical symptoms to distract us from those emotions. Over time, a completely different part of our brain can learn to expect one or more of those symptoms even if the reason for them no longer exists (which of course is the mechanism that explains phantom limb pain).

I'm about as far from a neuroscientist as you can get, but I'm reasonably sure that these two mechanisms are different, even if they work well together to maintain TMS symptoms over a long period of time. This probably wasn't much of an issue in the primitive world, where the TMS mechanism existed to keep us alert and in fear so we could survive just long enough to breed the next generation. It's really our long and relatively safe lives that lead to the experience of long term chronic pain.

But I digress. The point is, we have to do the emotional work, but some long-term learned symptoms may need to be unlearned, using whatever technique works for the individual.

 

Neural pathways can be unlearned, and can be rendered useless if the emotional juice that maintains them is nixed. In the case of TMS the primary emotion driving the preoccupation and obsession with the pain (or other symptom) is fear. A doctor telling you that nothing is wrong is often enough to negate the fear completely and this turns off the fight~flight response in the brain. The amygdala falls quiet, the body~mind rests in more peaceful repose.

Doubtless the minutiae of the neuroscience is incredibly complex but essentially it may be explained as some kind of neural Darwinism. Remember you can change your brain, and you can neurally prune the nest of thoughts, fears, sensations and beliefs you have about what ails you.

Again, it’s not either/or. There’s a great new field called Neuropsychology which embraces both neuroscience and psychology, and it’s generous enough to accommodate Sarno’s theories. Emotions (and your personality) are the driving force irrespective of which explanation you favour.

Rage isn’t the only emotion that can create and maintain TMS. Any strong emotion can. The basic Sarno premise prevails, if you don’t deal with your emotions, then the Symptom Imperative will arise again at some point.

There’s a common misunderstanding with TMS healing. This is that either the rage or neural pathways are intractable, that they are things to be found and laboriously dug out. This leads people to expend huge amounts of time and energy going down endless rabbit holes “trying” to heal. All this does is ramp the stress and tension in the mind~body. Once you let go of the tension, TMS goes with it. Our beliefs are a major source of tension.

 

Again, it’s the emotional intensity that is key. The type of pain, the duration, the variability may play a part in how you think about the pain and therefore may affect your emotionally-laden beliefs but the nature of the pain itself is not important.

Try to resist throwing the baby out with the bath water. The neurological models don’t dispense with emotion, they simply offer a more precise definition instead of vague notions of the unconscious.

 

I was struggling above with how to express this, but @plum has done it (again)

 

I understand what you guys are saying, and I agree that the advances in neuroscience have helped reveal the "black box" that Sarno could only speculate about. I know he himself said that future science has the potential to expand upon and flesh out his ideas. I recognize the compatibility of repressed emotions and neuroscience (particularly when it comes to conditioned pain responses), but I guess my concern is that if it's all chalked up to "neuropathways" alone it can become just another pathology for a person, that there is "something wrong with my brain," when what Sarno was really seeking after was for people to think of themselves as integrated wholes - emotions and matter together. That said, I have read very little of healing through neurscience (outside of Sarno), because I never needed too, so perhaps the literature does reflect whole-person medecine as Sarno understood it and I am making assumptions.

In my understanding it's not that there aren't other emotions other than rage that can be repressed, but that a variety of negative repressed emotions (fear, guilt, perfectionism, inferiority etc) build up into a cauldron of rage because the unconscious cannot handle so much pressure. Rage is the result. If we begin to feel too inferior or condescended all the time, eventually we will get angry. At least, if we are aware of our emotions. I experience this as a parent of little kids all the time.... I can be patient and understanding toward almost any kind of behaviour but there is always a tipping point where I've had enough as I can take and the rage boils over. I am so much more aware of this now after healing from Sarno. I know that there is a very physical component to emotions (I am so much more aware of that too - I can feel them in my body so strongly now), but I feel like whenever I tell someone about TMS and describe it as simply "neuroscience" I am not giving the full picture of whole, mind-body medicine, and that without fully embracing the emotional component they will struggle to heal. But I admit I could be totally wrong on that.

 

I think you are far from the only one who does not fully understand Dr. Schubiner's emphasis on "neural pathways," so I want to clarify his approach in relation to Sarno's. Sarno and Schubiner agree that the the brain causes TMS pain. Sarno says the brain does that by creating mild oxygen deprivation in body tissue, while Schubiner says the brain can cause any kind of pain any place in the body without needing to create any oxygen deprivation. But Schubiner also says this disagreement is of no consequence when it comes to treating TMS. I don't see any signifiant difference between Sarno and Schubiner regarding treatment.

Schubiner pays plenty of attention to emotions, including the importance of taking notice of the physiological effects they produce. And Sarno recognized, as does Schubiner, that some TMS pain is a product of Pavlovian conditioning with no emotional component. For example, if you have learned to associate lifting more than 5 pounds or sleeping on a soft mattress with back pain, then you will have back pain when you lift more than 5 pounds or sleep on a soft mattress.

Both Sarno and Schubiner say the cornerstone of treating TMS pain is to educate patients about the psychological (including emotional) basis for the pain. Both say the patient needs to understand and accept the psychological causation. Sarno did an initial screening of prospective patients to assess whether they would be able to accept that their pain was not structural. I don't know if Schubiner does any such screening, but in his recent book (Hidden from View: A Clinician’s Guide to Psychophysiologic Disorders) he stresses the absolutely critical need for the clinician to build a trusting relationship with his or her TMS patients. Of course, if a patient fully trusts the clinician, the patient is much more likely to accept the clinician's diagnosis that his or her pain is psychological not structural.

Both Sarno and Schubiner recognize that not all patients are alike, and some of them need more than education. They need psychotherapy based on Intensive Short-Term Dynamic Psychotherapy (ISTPD) in order to get in touch with their repressed emotions. Sarno’s chief psychologist developed a TMS psychotherapy program based on ISTDP and taught it to other psychologists to whom Sarno referred patients. Schubiner has long been interested in ISTDP principles as a treatment for TMS, and his Hidden from View book was c0-written with prominent ISTDP psychiatrist Allan Abbass. By the way, Schubiner and Abbass pay homage to Sarno in their book, saying they are proud to be counted among the whole generation of researchers and clinicians he influenced.

Sarno wrote in The Divided Mind: "After many years of experience it is our impression that not more than 10 to 15 percent of the population would be willing to accept a psychosomatic diagnosis." Perhaps Schubiner emphasizes neural pathways as much as he does not just because it is newly available information but also in an effort to boost the percentage of TMS sufferers who accept the diagnosis. That is, maybe a patient will react: "it's backed up by modern science, so it has to be right." My only criticism of Schubiner's discussion of neural pathways is that it is insufficiently detailed, and as result the concept is an inscrutable black box that is not as compelling as I think it could be with a more detailed explanation of the neuroscience of chronic pain--such as is provided by neuroscientist Lorimer Moseley in his Explain Pain books.

 

Hey Duggit did you post an address where people could download a copy of Explain Pain? Someone did a couple of months back and it’s worth glancing over the book to get a picture of how the pathways work, but it’s not cheap. I borrowed a copy from the hospital pain clinic. marls
PS (I still refer to your quote “how dangerous is it, really. I just sometimes put “important” or “sad” or whatever word is needed).

 

Marls, sorry but I know of no such address.

 

This is why I mentioned the new field called Neuropsychology which usually leans heavily into practices such as meditation and mindfulness and as such involves a lot of emotional work. These disciplines bring a spiritual element into the mix which is generally completely lacking in both the pure psychological or neuroscientific approaches. Are you familiar with Rick Hanson? He’s a great pioneer in this field and there is a fair bit about him on this forum.

There is a slow but gentle shift towards mind~body medicine in the more traditional sciences but mostly it seems to be coming from the ground up. By way of example my hubby has Parkinson’s and never in a month of Sunday’s will you hear his consultant talk about anything other than the medical approach, meds and neurotransmitters. Hell, the consultant before him considered neuroplasticity to be science fiction.

However his various therapists are a different kettle of fish. They are more involved in the minutiae of the condition and know it can’t be separated from the person, emotions and all. One of his therapists had a conversation with me last week about mind~body stuff but said she could only share these things with certain people. Most of the time she has to offer theory and practice that is commensurate with the current status quo.

Truth is any kind of mind~body element is going to find itself in the weeds with a lot of people. They don’t understand it and they don’t want to learn about it. To each there own. Healing is a very personal journey and a massive part of that is going into yourself alone, little wonder there is so much resistance there. The big theories give people space and overarching surety, and as a starting point, that’s ok.

Edit:I refer to @Duggit’s post on this.

 

@grapefruit

On a personal level, I believe we have a soul and the nest of troubles and woes that constellate as TMS are soul needs, that beautiful wild part of the psyche that civilisation drives deep underground. To heal this we need soul medicines. Shamans have known this forever but I shan’t hold my breath for the mainstream to reach back to this place.

 

It's really interesting and encouraging to read so many of the above responses. Thanks to all for sharing. Plenty of food for thought

 

Yes, another powerful emotion that can sustain TMS symptoms is undoubtedly great sorrow, like the death of parents or a spouse. But the separation of loss can certainly trigger rage in the abandoned child within. Seems like if you chase your tail long enough it all comes back to some variation on rage.