So who's right - Alan or Dr Sarno?

I like it. In other words, for some people Dr. Sarno's method only goes so far, at which point Dr. Gordon's methods could takeover. In that sense the two approaches would dovetail, rather than split off. Food for thought, BloodMoon. Thx.

Well, Dr. Sarno includes fear as a component of TMS as well. It's 'pain as distraction from unconscious rage/shame/guilt etc.', the cornerstone of Sarno's work I think, that Gordon leaves out of his approach entirely. That is the essential thrust of my conundrum.

 

IMHO Sarno puts the spotlight on "fear of being enraged". Our protective brain exchanges rage for pain. We feel pain because/but don't feel rage. That's a distractive maneuver.
Unfelt rage rests buried in our subconscious. So we can feel fear of being seriously ill...but not fear of being enraged.
When we can feel, courageously, our rage without fear .... the pain loses its purpose and dissapears. Tricky ....but understable.

 

Yes, Gordon does leave out Sarno's Freudian defense-mechanism explanation for why your brain creates pain. But I do not see a conundrum because I don’t think that explanation is the cornerstone of Sarno’s approach. I think the cornerstone is that one must reject the notion that the cause of your his or her pain is structural.

More specifically, I don’t think the Freudian defense-mechanism explanation is all that critical to Sarno’s approach because of what he wrote in Healing Back Pain:

“For many years I was under the impression that TMS was a kind of physical expression or discharge of the repressed emotions just described. In fact, this is what I suggested in the first edition of this book. . . . It was a psychoanalyst colleague, Dr. Stanley Cohen, who suggested . . . that the role of the pain syndrome not to express the hidden emotions but to prevent them from becoming conscious. This he explained is what is referred to as a defense. In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created [by the brain] in order to distract the attention of the sufferer from what is going on in the emotional realm.”
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Sarno’s treatment technique remained constant over the years. As I described it earlier in this thread, it had two prongs. The patient needed (1) to reject the notion that the pain is structural and (2) to “[k]now about the [repressed] anger, and know why it’s there. And if you do those two things, your pain will go away.” He knew from clinical observation that this two-pronged treatment worked for a high percentage of his patients, and unsurprisingly he wondered why. He thought “[f]or many years” that the theoretical reason was that if a patient could know he or she was angry and why, that would discharge the anger. After talking with Cohen, the theoretical reason that appealed to him was that if a patient could know he or she was angry and why, the anger was no longer repressed and hence the brain no longer had any reason to create pain as a distraction to keep the anger repressed. Sarno's theoretical explanation changed but not his treatment technique. The frosting on the cake changed, but the cake stayed the same.

With Sarno’s two-pronged approach, it is not enough to know about your repressed anger and why it’s there. You also need to reject the notion that your pain is structural, i.e., that the pain means you have damaged or defective body tissue. As far as I can tell, Sarno thought that assiduous attention to his twelve Daily Reminders and his explanation of how TMS works would convince his patients/book readers that their pain was not structural. Its worked for me more than thirty years ago, as I described earlier in this thread.

Sarno wrote in his books that he would do a telephone interview of people who called for an appointment with him in an effort to screen out those he thought would be unable to reject the notion that their pain was structural. In contrast, Gordon and Howard Schubiner, who are friends occasional collaborators, take a different approach from Sarno. They are not bothered by patients who think the cause of their pain is due to damaged or defective body tissue. They just ask these patients to keep an open mind while they work with them, and then they undertake to present them with credible evidence that their particular pain is due to misfiring neural brain circuitry. Gordon’s The Way Out seeks to teach a reader how to find credible evidence by himself or herself that the pain is due to misfiring brain circuitry rather than damaged or defection body tissue. Even if you are wedded, bagofwater, to the view that you have to uncover repressed anger to stop chronic pain, doing that is only the second of Sarno’s two prongs. I think Gordon’s pain reprocessing approach could help you with the first prong.

I'll end by referring to a book Schubiner co-authored with Allan Abbass, a psychiatrist who specializes in ISTDP (Intensive Short-Term Dynamic Psychotherapy). They say that patients with TMS and its equivalents, which they call it PPD, differ across a wide spectrum. Many of them will be able to recover from chronic pain by using only cognitive-behavioral techniques, which are basically the same as Gordon’s pain reprocessing therapy. But others will need to deal at a deep level with repressed anger, sadness/grief, and guilt about the anger. For those patients they advocate ISTDP . Sarno’s chief psychologist, Arlene Feinblatt, had training in ISTDP. In Healing Back Pain, Sarno indicated that about 5% of his patients needed psychotherapy. By the end his career, however, Sarno wrote in the Foreword for a book written by two of his psychologists, namely, Anderson & Sherman: “In about one quarter of our patients, psychotherapy is essential for success. These patients harbor feelings that are deeply repressed in the unconscious and can only be brought to consciousness with the help of appropriately trained psychotherapists [meaning trained in dynamic therapy rather than cognitive-behavioral therapy].” I recommended Gordon’s book in an earlier post in this thread because I thought that if Sarno’s approach was not working, maybe Gordon’s pain reprocessing approach would work by it itself. If so great. If not, his approach should help meet the first prong of Sarno’s two-pronged approach. My conclusion is that no one book on treatment (except maybe Schubiner & Abbass, but that is written for clinician's not patients) is going to be right for every person with TMS and its equivalents, and for some people no book exists that will help them because they need dynamic psychotherapy.

 

This is what I can't make out...I believe that my symptoms aren't structural and I am now fully aware that the other part of my brain has "bad intentions", e.g. some of the things my elderly Dad says to me enrage me and I want to, in no uncertain terms, bite his head off and 'tell him his fortune' and I have felt the associated intense rage...yet my symptoms don't go away. Any thoughts/suggestions on this would be greatly appreciated.

 

Accepting that the basis of my pain isn't structural was the easy part for me. I suspected this even before I stumbled on Healing Back Pain. So for me the 'distraction' concepts were the revelations in that book.

As I pointed out before, people will read different things into the same material. The quote from HBP that Duggit presents to make the point that the defense-mechanism isn't key to Sarno's approach is exactly the same one I'd present to say that it is. I couldn't have found a better one frankly. "...In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created [by the brain] in order to distract the attention of the sufferer from what is going on in the emotional realm.” This concept, the concept that leapt out at me when I read HBP, is not part of Gordon's approach, and why I'm so conflicted about embracing it.

It's a real possibility, that while I accept that the pain isn't structural intellectually, I don't know it on a deeper, emotional level. That's where the The Way Out might be able to pick up where HBP leaves off. Gordon's approach seems to cut to that chase (of knowing more deeply the pain isn't structural) without digressing into the 'distraction' concept that I've been organized around. I feel like I may be putting too much emphasis on that concept at this point. ....which was perhaps your point Duggit.