One of the pioneers in the field of chronic pain treatment was Dr. John Sarno. He was a physician who specialized in treating pain at a rehabilitation hospital in New York, and treated tens of thousands of patients suffering from chronic pain. The term he used to describe physical pain that isn’t caused by a structural/physical problem was TMS — Tension Myoneural/Myositis Syndrome. In essence, this is an earlier term for what was later called neuroplastic pain or MBS Syndrome.Sarno was a pioneer and a guiding light for the doctors and therapists who came after, and his ideas continue to form the foundations of therapeutic interventions that have enjoyed research-based validation (for example, EAET — Emotional Awareness and Expression Therapy). It’s impossible to speak of treating MBS-based symptoms without mentioning Dr. Sarno and understanding his unique perspective on the connection between the brain/emotions and the body. In this section, you’ll learn about his ideas in a nutshell.
Like every paradigm shift, this one started with a frustration with the low recovery rates among patients who came to Dr. Sarno for pain treatment. Dr. Sarno started asking questions and taking the time to talk with his patients about what was happening in their lives aside from the pain. He took an interest in what was happening close to the appearance of the pain, whether they had experienced similar symptoms in the past, if they had experienced significant trauma, and what pressures they were dealing with in the present. Based on the information he encountered and the clinical experience he was accumulating, he concluded that certain types of physical pain (that did not have a structural cause) were caused by repressed negative emotions, mostly unexpressed rage and frustration.
“My heart is broken,” “My knees are shaking,” “I have butterflies in my stomach” — our linguistic expressions easily and clearly reflect this idea that feelings are expressed through the body. Who among us hasn’t experienced a headache after a stressful day at work, or a stomachache before an exam? Most of us wouldn’t relate to these physical sensations as a “problem” and we wouldn’t immediately seek medical treatment for them. And yet, when we experience ongoing pain, for example in our backs or an arm or leg, increased urinary frequency (without an infection), frequent headaches, chronic fatigue — we tend to dismiss the emotional factor. Most of us will look for a “medical” reason for these symptoms and we won’t connect them to feelings or stress we are experiencing.Dr. Sarno’s theory focuses on this point. His revolutionary idea was that there are certain types of pain (without a physical-structural cause) that appear as the result of a need to distract ourselves from negative subconscious emotions welling up within us. In these cases, feelings and stress are not only connected to the pain; they are the hidden cause. In order to treat them, we must understand this conversion mechanism and turn our focus towards what’s going on in our emotional world rather than a direct treatment of the organ experiencing the pain.
Raw, powerful negative emotions (such as rage, despair, helplessness, guilt, shame) are identified by the brain and nervous system as intolerable and dangerous. That’s why most of them will be kept at a distance and repressed throughout our lives, pushed into our subconscious minds. The subconscious is a sort of “secret basement” used as a shelter for that emotional baggage, which will build up over time, layer after layer, unbeknownst to our conscious mind.
Any powerful emotion, or emotional conflict, that is perceived by the nervous system as “forbidden,” “intolerable,” or that “you must not ever think about or say.” Usually, the contents of these thoughts or feelings will somehow clash with the way we perceive ourselves, with societal or familial expectations that we internalized over the years, or an opinion that we formed over time about what it means to be a “good,” “mature,” “responsible,” “in-control” person.
According to Dr. Sarno, repressed emotion comes from a collection of experiences and life events that contain three layers:
experiences from our infancy or early childhood, negative experiences (death of a loved one, separation/divorce, financial crisis, a parent who isn’t functioning, exposure to violence, addiction in the family, etc.) and sometimes traumas (childhood physical/sexual/emotional abuse etc.). Though we likely won’t remember these experiences directly, they don’t disappear; they are engrained in our brains and our nervous systems.
The second layer includes everyday stress factors in our lives as adults (for example: a breakup, an illness in the family, stress at work, being fired, a global pandemic, discrimination, etc.). These stress factors can often make us feel a sense of being trapped, lack of control, helpless, anger, fear, and other feelings perceived as “unsolvable” or “inappropriate” or “exaggerated,” and they build up within us.
The third layer is connected to emotional conflicts caused by certain personality traits, mostly an increased need to be “good” and to please others, a tendency towards harsh self-criticism, and perfectionism.
The layers of repressed emotion build up over the years. However, by their nature, these emotions can’t be stored silently, and they are constantly striving to breach the barrier into our awareness. At a certain point in life, the layers that have been building up inside us are bound to overflow the “basement,” and there’s a threat that they will “leak out” and become apparent to us. Often, the danger of a “leak” will be connected to current triggers that fundamentally remind us of previous experiences and “awaken old emotional demons.” When the threat of a “leak” grows and becomes imminent, our mind-body system will do everything it can to prevent this. This is exactly when the process of converting the emotional material into a physical symptom takes place. Think about it: what could distract us and focus our attention better than physical pain?
This was essentially Dr. Sarno’s most central and revolutionary argument. Physical pain is a type of defense mechanism, whose purpose is to distract us from the repressed emotional information that is threatening to overwhelm us. Dealing with a powerful negative emotion or emotional conflict is perceived as much scarier to our brain and nervous system than dealing with physical pain (which in theory you can do something about). It’s important to understand that this process occurs subconsciously; it is not voluntary or under our control, and that gives it enormous power.
The conversion of an emotional threat into a physical symptom is managed by the autonomous nervous system (the sympathetic branch), which is responsible for preparing our bodies for a potential attack. This system has great influence on a variety of physiological functions, and practically speaking, it innervates every organ in our bodies. Therefore, its activation can be expressed through symptoms or pain in any of the systems in our bodies (respiratory, digestive, urinary, muscular, etc.). Since these chemical and physiological changes are responding to an emotional threat and not actual damage to tissue in the body, they are, by nature, temporary, reversible, and not dangerous!
Raw, powerful, subconscious emotions such as rage, shame, guilt, and helplessness are experienced by the brain and nervous system as dangerous, threatening, and intolerable.
These emotions build up over the course of our lives (resulting from negative experiences in childhood, trauma, current stresses, or certain personality traits) and are stored in our subconscious mind.
At a certain point in our lives (usually following some kind of trigger), a sort of “overflow” occurs, and the repressed information reaches a “boiling point” and threatens to burst into the conscious mind.
At this point, involuntarily and subconsciously, our brains recruit our autonomous nervous system to “defend” us by creating physical symptoms. It’s a “distraction” method. From their perspective, it’s “preferable” for us to deal with a physical symptom than to experience a kind of emotion that makes us feel trapped and that our minds can’t tolerate.
Since the source of the symptom is emotions and stress, trying to “fix” the body doesn’t solve the problem. Our attention must be turned away from the body and towards what is threatening us emotionally.
