So who's right - Alan or Dr Sarno?

Oh yeah definitely... I forgot to add, I too entered menopause at right about THE SAME time as my pain issues began.. I did injure my right hamstring 3 yrs ago and THAT was the beginning of the end for me, a very active happy lifestyle... I worked with kids, ran around with them on the playground everyday, played basketball and ran with them in the gym, shopped regularly, cleaned my house with zero limits or pain... With the exception of trying to be reasonable and avoid obviously "too heavy" lifting or improper lifting... I had back surgery 22 yrs ago and was FINE until last year with my back.. I now have chronic pain in my right leg and back... Had the "usual" TERRORIZING MRI and it has stuck with me, those "incidental" findings (as Sarno calls them...) actually give me nightmares and a crippling phobia of movement and increased pain or further injury... And I worry ALL the time, "how will I be in just 5 more years? 10? 20?"..the idea of being incapacitated even more with time and age makes me feel more fear than I ever have about anything in my life!! How do I handle it all??

 

Oh God, this sounds like me as well. So so worried about the future, as if it's this bad now, how will it be in 10 or 20 years?! I was absolutely fine, doing everything and never had back pain until 9 years ago, when it started. Then a bad back operation left me incapacitated (so I think I have a mixture of TMS plus something physical). I get extremely jealous of everyone else I know being able to do whatever they want - even when my boyfriend complains about having to go to work - I wish I could complain about such things! How not to be jealous? It's really hard. I too, feel isolated as my boyfriend goes and does things without me, and I feel like he's always coming or going and I'm always home! It's so difficult not to compare ourselves with others, but I wonder if that's part of what got me into this mess in the first place - too much pressure I put on myself to 'succeed', and too many comparisons with others.
And the fears we have - of our futures and 'what if the pain is still there in 10 years, or worse, even?' These fears can't be helping us get better. I think I'm having trouble with the self-sooothing, as part of me keeps questioning how I can say 'don't worry, it'll be ok' when rationally, I find this hard to believe. How to convince ourselves that it will be ok when we are programmed not to believe such things? Seems an uphill struggle, but still worth attempting

 

You sound just like my twin... Just a couple of yrs ago, I could ride on the back of a motorcyle... (see my avatar).. And now it's a struggle just getting up and down stairs or even getting dressed..
I had back surgery too, 22 yrs ago, never had a problem til last year... One of the members on here mentioned menopause playing into it, plus severe trauma in the past 3 yrs(and also a real physical injury) and it was all the perfect storm for crippling TMS..

 

I used to ride a motorcyle too! Even though I can't walk now, I've found that I can ride a bike (if the seat's quite low, so leaning forward, arms taking the weight of my back) which is amazing, and doesn't aggravate my pain.
Interesting that menopause can play a part in this. I'm heading towards that myself soon, so hopefully won't make the pain worse!

 

I'm about a quarter of the way through Alan Gordon's new book, The Way Out. While it's wonderfully smart and accessible, so far it seems like a fundamentally different approach than Dr. Sarno's. To massively oversimplify: Sarno taught that pain is a defense mechanism to distract from unconscious thoughts perceived to be threats. Gordon's approach (so far) seems more about a fear-pain feedback loop, and not anything about distraction or the subconscious (or is unconscious the preferred term?).

Do I need to unlearn Sarno's lessons to incorporate Gordon's? Like so many, Sarno saved my life when I read HBP many years ago, so I'm reticent to switch horses in midstream. But as a chronic relapser after 12+ years of Sarno I'm open to new approaches. It may be time to unlearn my approach to unlearning my pain (to borrow from Dr. Schubiner) ...maybe Gordon ties it all together with Sarno later in the book, but right now it feels like the more I read the more I'm undermining what has worked for me in the past.

There's a few posts earlier in this old thread that try, but fail (imo), to reconcile the two approaches for me. There must be posts from Alan Gordon or others that address the Gordon v Sarno topic directly - and posts that reject that characterization, now that The Way Out is out, but I can't find any. Thank you!

@Alan Gordon LCSW

 

Bumping this.

Alan Gordon's The Way Out is really muddying the water for me. In the first chapter Gordon mentions that his mother gave him a book that set him on his path to being a pain therapist, but doesn't mention the name of the book (Healing Back Pain presumably). The book goes on to outline many ideas that set squarely against what Dr. Sarno might recommend, and what has worked for me and so many others in the past.

Did I miss a memo? Is Dr. Sarno's approach no longer in favor in the mind-body chronic pain community? As I mentioned in my previous post I'm looking for new ideas to deal with my chronic relapses, but didn't anticipate having to incorporate such a different approach when I picked up The Way Out. Does Dr. Gordon explain or reconcile his approach with Dr. Sarno's anywhere?

Signed,

Very Confused

 

People heal via Sarno and I knew someone who succeeded with more of Alan Gordon’s approach mixed with some Sarno..
Don’t get hung up. You don’t HAVE to do Alan Gordon’s approach. You just read the book, maybe it didn’t resinate with you.
The basic gyst with Alan is to deal with fear, like Sarno he uses pain science to point out that pain alone can not hurt you.
Sarno found it was rage and anger, but I think he also asks you not to fear emotions by directing the reader to journal. He asks you not to fear because the pain is benign.

I find that getting stuck on issues like this and having difficulty seeing details makes me avoid the real task of getting out of my head and into my body and emotions.

 

When I first started learning about TMS, I struggled to connect Sarno's theories to my own experience. After going through his ideas and then those of Schubiner, Hanscom, Dan Buglio, and onto Alan, what all came together for me--and really helped--was truly accepting that my pain was brain induced, not structurally induced. The extent of my unconsciously suppressed emotions--rage, anxiety, fear--all of it, made my pain worse because what I could not release consciously was being expressed in my body as habitual pain, and it became the cycle that feeds itself (pain>fear>more pain>more fear) as everyone talks about here.

Again, the big thing for me was finally getting to a point where I could accept that the pain was NOT structural. When I stopped addressing it as such--giving up the stretching, PT, etc--that action (or non-action) sent a big message to something in me, and I began to improve. But to get there I had to do the reading and stumble around. I think that everyone's path is the path. It all adds up--the work we do accrues--even if it doesn't seem like it is. Keep at it with as much self-kindness as you can bring to the process.

A couple of years ago, I would go through period where walking around the block was an accomplishment. These days, I can walk ten miles without pain. I still have my moments, but I have experience and tools to help keep me on point. My current, favorite tool is Alan's recent book, The Way Out. I read a little bit of it every day. It works for me. And a part of the reason it works is that other books and blogs I've read (including Sarno) provide reinforcement/contrast/nuance to what Alan writes, so the effort I put into learning about TMS amps up the utility of the advice I take from Alan's book. Good luck to you!

 

I don't know that anyone's going to be able to totally reconcile the two approaches - although, as a TMS 'struggler', I do hope someone is able to do so. I haven't read Gordon's book, but I have read the stuff he's posted on here and I am told there isn't much, if anything, extra in his book, so I think your summary of Gordon's approach is likely to be correct.

What occurs to me is that with both approaches/explanations of what's going on to cause symptoms, it seems to be that the brain/mind is essentially 'perturbed' (for want of a better word)...with Sarno the brain/mind is perturbed by what it perceives to be threats and with Gordon the brain/mind is perturbed due to fear. Could it be that we 'simply' need to recognise that, for whatever reason, the brain/mind is being perturbed and work on 'unperturbing' it in as many ways as we can?

I am also coming to the conclusion that the reason I've not yet got fully better is that my brain/mind has been unremittingly perturbed since childhood and this is 'etched' into the neuro pathways of my brain and to get better it will probably involve changing my brain through neuro-plasticity -- by repeatedly and consistently doing things to 'unperturb' it...but then that's another theory.

Anyway, whether I'm talking a load of old tosh or not I don't know, but I'm grateful to have seen your two postings on this thread as they have got me recognising again that my brain/mind is perturbed on a daily basis, numerous times a day and I need to keep realising that in order to have any chance of becoming totally symptom free for good.

 

I have been lurking for a year and have not posted my story.
This is true for me as well. I was 'perturbed' pretty much 100% of the time from the age of seven (family discord/trauma) until beginning meditation practice five years ago. It is a long journey from constant pain/illness and the approaches of Sarno and Gordon have both helped me. Thanks to all of you for your honesty and support, even to people like me who are not active on the discussion boards.

 

Some good thoughts here on this 'conflict'. Thank you - especially the point by Cactusflower about me getting out of my head. The only time I ever post on this forum may be when I'm indulging in that behavior! Regardless, I'm still looking for some kind of way to bring these approaches together if possible. A third book may be needed for ppl that have used the time honored tools Dr. Sarno gave us to make sense of Dr. Gordon's bold new ideas. Ideas that don't acknowledge 'distraction' as the key purpose for chronic TMS symptoms.

This may demonstrate what I'm talking about: there is an example in Gordon's book where, presumably after he was aware of Sarno's approach, his back pain grows worse and worse during a drive to San Francisco. Anyone familiar with TMS would say "duh, there was something in his subconscious, probably triggered somehow by going to SF, trying to assert itself". But at no point does he refer to anything like that. Instead he uses the example to explain the fear-feedback approach he's trying to get across. I guess a diversion in TWO to detail Sarno's approach (whom readers may not even be aware of) and then Alan's journey away from it, would have been unwieldy. And possibly, not germane to understanding Gordon's approach. It many ways I think The Way Out would be a much easier sell to those who have never heard of Dr. Sarno. There's a quite a few other things in the book that would seem to make it impossible to mix-and-match, or do a little of both, as people have suggested.

Per my OP in this thread. Does Alan Gordon discuss, or even acknowledge his journey from Sarno to this new approach, and how they're related (or not)in article or video? I'd love to read or hear about that process. It might help me understand my conundrum better and offer me a foothold out of this rabbit hole.

 

Hi there Bagofwater,
Without going into discussion too much... I did some searching on the forum as in the back of my mind Alan did make some statements about the "difference in approach" between him and Sarno. This link is all I could find, but I am quite certain there must be one that is more to the point... just can't find it:
https://www.tmswiki.org/forum/threads/why-do-some-people-get-better-from-reading-sarno-and-some-dont.8429/ (Alan G. - Why do some people get better from reading Sarno and some don't?)

 

Sarno emphasized repressed emotions, especially anger, while Alan emphasizes the role of fear. I will argue first that this difference is less than might appear and second that Sarno and Alan actually agree on the bedrock principle regarding what is required to stop TMS/neuroplastic pain--and that is what’s important.

I became a follower of Sarno in 1991 when he published Healing Back Pain. By doing what he prescribed, I was able within six weeks to end more than two decades of chronic low back pain. What did he prescribe? Two elements as I saw it. The first is to buy into his succinct “list of twelve key thoughts,” which he also called “the Daily Reminders.” The second is not stated as succinctly in Healing Back Pain as Sarno would put it three years later in an interview, so I will use that formulation: "Know about the anger [you are repressing], and know why it’s there. And if you do those two things, your pain will go away.”

It is notable that no less than five of Sarno’s twelve Daily Reminders concern the role of fear in causing TMS pain:

• The pain is due to TMS, not to a structural abnormality. (Meaning don’t fear you have damaged or defective body tissue that will get worse if you are physically active.)
• TMS is a harmless condition, caused by my repressed emotions. (Meaning don’t fear you have damaged or defective body tissue that will get worse if you are physically active.)
• Since my back is basically normal there is nothing to fear. (“Nothing” means don’t fear you have damaged or defective body tissue that will get worse if you are physically active, and don’t have any subsidiary fears that the pain will prevent you from earning a living, from being a good parent to your children, from having a good social life, and so on and on and on.)
• Therefore physical activity is not dangerous. (Meaning there is no reason to fear physical activity.)
• I will not be concerned or intimidated by the pain. (Meaning don’t fear the pain or any subsidiary adverse consequences of being in pain like not being able to earn a living, etc.)

What I see as Sarno’s bedrock principle is implicit in the Daily Reminders, but he made it explicit in his later two books. In The Mindbody Prescription, he wrote: “The pain will not stop unless you are able to say, ‘I have normal back; I now know that the pain is due to a basically harmless condition, initiated by the brain to serve a pychological purpose, and that the structural abnormalities that have been found on X-ray, CT scam or MRI are normal changes associated with activity and aging.” (Emphasis by me.) In The Divided Mind, he wrote that to recover “the person must not only understand the [TMS] process but be able to fully accept it as well. . . . This was clear in the early days [of his TMS practice] since only the patients who understood and accepted got better . . . .” (Emphasis by me.)

Turning now to Alan Gordon’s new book, The Way Out, he wrote on on page 51 about being in a car accident:

“After the accident I developed pain . . . which led to fear, which led to more pain. . . . But I didn’t just have fear of the pain. I had a very specific fear--that the pain was caused by a physical problem in my back. I was scared of the pain because I thought it meant that something was broken, or ruptured, or otherwise damaged in my body. And this is the exact fear that fuels neuroplastic pain."​

Alan calls his therapy model Pain Reprocessing Therapy. What has to be reprocessed? The pain, of course. How does it have to be reprocessed? You have to quit viewing it as being caused by damaged or defective body tissue and instead view it as created by your brain by mistake, i.e., as being only what he calls neuroplastic pain.

Alan’s bedrock principle is essentially the same as Sarno’s. It is true that they rely on different theoretical explanations of why you can have pain that feels exactly like it is due to damaged or defective body tissue but in fact is not. Sarno’s explanation was Freudian; Alan’s is not. But it makes no difference which theory, or something else entirely, helps you to quit viewing your pain as caused by damaged or defective body tissue. The whole focus has to be on rejecting the notion that the cause is damaged or defective body tissue. (I’m not sure somatic tracking, a technique Alan highlights in his book, is necessarily the best way to get there, but that’s a topic for another time.)

 

Thank you all for taking the time to write these thoughtful responses! It's appreciated. Duggit, Quite a bit of what you wrote makes sense to me.

One more question: What book would you now recommend to someone suffering from chronic back pain? ...say, to a stranger whom you've been chatting with on an airplane.

 

Good question, bagofwater. If a person gets into book-hopping, it is easy get befuddled and wonder, “So who's right?”

My short answer to your question is whatever book will help its reader quit viewing his or her chronic pain as caused by damaged or defective body tissue and instead view it as created by his or her brain for some reason that has nothing to do with the condition of his or her body tissue. A particular book that helps one person get there might not help another. In turn, a book that does not help one person might help another.

Here is my long answer. Dr. Schubiner said one of the most insightful things I have ever seen or heard regarding what a person suffering from chronic pain needs in order to recover. It was in a video presentation he gave to the Commonwealth Club of California, and he was speaking from the perspective of a practitioner who treats such patients. He said these patients need (1) a practitioner they trust, (2) an explanation for what’s wrong with them, (3) a technique they can use to fix it, and (4) hope and optimism. It is the trusted practitioner, of course, who provides the explanation and the technique and who inspires the patient to be hopeful and optimistic. Trust in the practitioner is essential to success. If you are trying to recover by reading a book, you need to trust its author enough to accept his or her explanation of what is wrong and technique to use to fix it, and to gain hope and optimism.

If had to recommend a book, I think it would be Alan’s The Way Out. As I said previously, the crucial step in recovering is to reject the notion that your pain is caused by damaged or defective body tissue. To use Alan’s terminology, you have to reprocess your pain. An appendix at the back of his book lists twelve (unnumbered) indicators that your pain is neuroplastic rather than caused by defective or damaged body tissue. Then Alan says: “Even if none of these guidelines applies to you, you could still have neuroplastic pain. Neuroplastic pain is very good at mimicking structurally caused pain. . . . Often patients start seeing evidence that their pain is neuroplastic as they apply the lessons of Pain Reprocessing Therapy.” (Emphasis by me.) This is the goal: to find evidence--evidence credible to you--that your pain is not caused by damaged or defective body tissue.

I'll give you a personal example. As I wrote in my first post in this thread, Healing Back Pain enabled me to overcome chronic low back pain. After about six weeks of attending to Sarno’s twelve Daily Reminders, I got the credible evidence I needed. It happened one day when I was at work. I was confronted by an obnoxious person who made me angry. I knew I was angry, but I also knew I had to suppress it in dealing with him. When the confrontation finally ended and he left, I noticed I had low back pain in the same place I always got it and with the same intensity. I then had a eureka moment that went something like this: “My consciously suppressed anger caused this pain, so anger that I don’t know I have because I am repressing it can do the same. Sarno is right about the cause of my recurring back pain, and he is right about the technique to fix it. I need to become aware of when I am repressing anger and why I’m angry.” Sarno wrote the following in Healing Back Pain about his recurring heartburn: “I have learned that heartburn means that I’m angry about something and don’t know it. So I think about what might be causing the condition, and when I come up with the answer the heartburn disappears.” I was hopeful and optimistic I would be able to do the same, and I was.

I’ll give you another personal example. Several years after my back pain stopped, I developed tooth pain that persisted. My dentist wanted to do a root canal. I declined because with my history of TMS, I thought the pain might be TMS. But I had lingering doubts, and the pain persisted for nearly two decades. When I moved to another city, I needed to find a new dentist. After I saw him a few times and trusted that he knew what he was doing, I asked him to look into my persisting tooth pain. After careful examination, his diagnosis was atypical ondontalgia. I knew “odontalgia” is just a fancy word for toothache. I also knew dentists are trained to fix structural problems, and that is what they do all day. So if he called my pain “atypical,” that meant it was not what he typically saw, i.e., it was not structural. My eureka moment, while still in the dental chair, was that my tooth pain is TMS after all. By the end of the day my tooth pain was gone. That was more than a decade ago, and it has never come back. The pain was what Sarno called conditioning; it had nothing to do with repressed anger. (To digress for a moment, I now think that the role of repressed anger in TMS comes down to conditioning, too. That is how I reconcile Sarno with the modern pain science focus on predictive coding, aka conditioning.)

I could give more personal examples, but there would be little point in that. What has been credible evidence for me will not necessarily be credible evidence for someone else. Each of us has to find our own credible evidence that his or her persisting pain in a particular body part is not caused by damaged or defective tissue.

Since I just recommended Alan’s book, I should explain my reservation about somatic tracking that I expressed in my first post above. If you watch videos of Alan doing somatic tracking with patients you will see that (1) he is a master at getting a patient to trust him and (2) during the session he repeatedly assures the patient that his or her pain is not due to damaged or defective body tissue. Similarly, in The Way Out at page 67, he told his patient during a somatic tracking exercise: “As you explore this tight, pulsing feeling in your back, remember there is nothing to fear here. Neuroplastic pain is actually a safe sensation. It is just your brain overreacting to neutral, safe signals from your body.” And on page 68: “These are completely safe sensations. Your brain may misinterpret them as pain sometimes, but they are safe.”

I have no reservation about the effectiveness of somatic tracking if Alan is sitting beside you while you do it, and he repeatedly tells you that you are safe, i.e., that your pain is neuroplastic rather than due to damaged or defective body tissue. But what if you are doing somatic tracking on a self-help basis, and you are telling yourself that you are safe? Are you going to believe you? The answer might be yes for some people. Good for them. But if most people are like me, the answer will be no. I have always needed credible evidence that my persisting pain, whatever it was, was not due to damaged or defective body tissue. If I were still troubled by chronic pain and using Alan’s book, I think I would not put much, if any, effort into somatic tracking. If you already accept that your pain is not due to damaged or defective body tissue, you don’t need somatic tracking. If you don’t already accept that, a self-help effort at somatic tracking might well fail, and failure is likely to reinforce the natural inclination we all have to think that all pain is due to damaged or defective body tissue. Instead of somatic tracking, I would focus on what Alan says in the appendix about how to determine if you have neuroplastic pain (and also on what he says about making that determination in earlier parts of the book).

 

That's a lota insight!

So, The Way Out would be your recommendation then. At this point I'm starting to agree with you. Over the years I've sent or recommended Healing Back Pain to about a dozen people - including total strangers I overheard complaining about back pain. As far as I know it only helped two of them (both book-cures!). Although I think Gordon's approach represents a fork in the road of chronic pain approaches, rather than a dovetail as some attempt to characterize it, it’s starting to look like the logical route. I have to believe that Dr. Gordon had all the same info we do about Sarno's work as he wrote the book, and deliberately chose what to leave in or out based on his own experience, newer brain science, the Bolder Pain Study etc. among other things.

I guess everyone reads into each of the two approaches and spins out what they need. While both Sarno and Gordon share the view that the pain sufferer needs to be convinced that the body is not damaged in order to be rid of the pain, they diverge distinctly beyond that. A great deal of HBP and The Divided Mind is devoted to explaining how distraction from perceived threatening unconscious emotions is the reason for TMS symptoms. I’m not familiar enough with Alan Gordon’s approach to give a thumbnail description, but it is not that. His is about fear. Not distraction.

As a chronic relapser I feel like I need to try new and different approaches (see: the definition of insanity), but I don’t know what to do with all this work I’ve done around ‘distraction from unconscious emotions'. If it needs to go, it needs to go. Fear is actually a lot more accessible to me than my anger anyway (which I always have to go looking for). I’m far more fearful than I am angry.

The Way Out also recommends physical remedies to help get control of the fear (not the pain), which as a TMSer seems insane. But again, if it works, it works. I’m ready and open to a new approach….”new” as I see it anyway. I still can’t see how TWO can be considered anything else.

 

Playing devil's advocate - could it be that the two things are going on in the same person, in some cases, I wonder? (It might explain why some people using Sarno's 'method' - for want of a better way of putting it - lose some symptoms for good but don't fully lose them all and others who recover and then relapse, but don't fully recover again.)

 

My two cents.
Both Alan Gordon (focusing on fear) and John Sarno (focusing on rage) are right.
In some cases of mild TMS the solution of pain comes from losing our fear of being seriously "ill".
In other cases, not so mild, the solution of pain comes, apart from losing our fear of being seriously "ill", from being aware on our intense anger (against a criminal, a raper, our abusive boss, our stupid neighbor, Kim Jong-Il, Boko Haram,....).
BUT.... in the extreme, recalcitrant cases of TMS the solution of pain comes, also apart from losing our fear of being seriously "ill", from being aware on our intense anger/rage/fury against our most beloved people (spouse/husband, sister/brother, daughter/son, mother/father,...). In such cases one part (civilized, ethical, moral, rational,...) of our mind is not just feared but terrified of the practical, irreparable consequences from feeling that rage (initially repressed in our subconscious). Our brain detects the "bad intentions" of the other part (selfish, narcisistic, primitive, irrational, wild,...) of our mind and decides create pain as a distraction.
Dr. Sarno relates than between thousands of his patients only two carried out criminal acts once they discovered and felt intense repressed rage.

Fear and rage working toghether in the genesi of TMS pain. Thanks Alan Gordon, thanks John Sarno.
M.

 

Hello! I thought I had "just" anxiety and fears at the beginning of my therapy. I couldn't connect with what was underneath. And then, I understood that it was rage. Suppressed rage. So, I do think that my panic is and was so connected with rage, but also with fear. And it can happen that my rage comes from fear. Of loss, for example. Hope this could help.