I am an osteopathic physician and surgeon who has seen thousands of people in the last 30 years. One day, many years ago, I had a dance teacher come to me as a patient. She happened to mention that for many years she had debilitating low back pain.
“Do you still have it?” I asked.
“No, I haven’t had it for years thanks to John Sarno.”
I had never heard of him so I asked her to explain further.
“Well, I had heard that he helped people like me just by talking so I took the train from Washington, DC to NYC and went to one of his public lectures.”
“I never had any more back pain since.”
As a doctor I found this story unbelievable but since I respected her I decided to investigate further.
I learned that Sarno, a former GP from upstate New York, decided in the early 70s to get trained in Physical Medicine and Rehabilitation at the Rusk Institute for Rehabilitation at New York University. One day, while working in the out patient pain clinic, it dawned on him that many of the same patients were coming back again and again for the same complaint.
What was going on?
If they were correctly diagnosed and the treatment (physical therapy) was effective then why were they returning with the same complaints?
It turns out, as he discovered, they were not being correctly diagnosed. They were being diagnosed with physical problems when, in fact, they had psychosomatic problems.
Even though their pain was real, and for such patients it is real including muscle spasm and other physical symptoms, the cause was not physical. The cause was from the mind, not the body.
For many years physicians have known that the mind has an effect on the physical body but they really had no idea how to help such patients. There are many textbooks and articles on these things but as far as I know no medical school teaches what to do with these people when training doctors.
Sarno, who had lifelong headaches, worked with psychologists and therapists at NYU to learn about the mind and its effect on the body. What he finally emerged with not only cured his own headaches but also made him famous with patients with such symptoms.
He calls these problems TMS (tension myoneural syndrome). I read his books (5) and researched him. Then I wrote him a letter and he said that I could spend time with him seeing patients.
So I got on a train and went to NYC where I subsequently spent a day seeing patients with him.
Sarno was a very small man. He wore a white doctor’s coat and had a tiny office in the NYU Rehabilitation Institute. When I came there he told me, Well, I have to get permission from the patients for you to come in. You know, these people are paying a lot of money to see me.
At the time he was on a salary but NYU charged $1,400 for a consultation with him.
I noticed that the patients varied from those who were very quiet and reserved to one man who angrily said, “Who made you and expert? You are not a psychologist. You have no academic training in these matters.”
He was very hostile.
Sarno just pulled himself up and looked directly into his eyes and said, “I have a brain and I can read.”
That shut the patient up.
Then Dr. Sarno told him, I have looked at your records and examined you. There is nothing physically causing your pain symptoms. Here is the program I advise. When you feel the pain, which you will, you must tell yourself: “There is nothing wrong with my body. All of these symptoms are being caused by my unconscious mind which is trying to send me a message. It believes that I need the message because it is afraid that I haven’t realized that my way of being with stress is making my life hell. It is using my body to get my attention.”
“You are not crazy. You are simply one of a subset of people who has these psychosomatic reactions to internalized stress and refusal to recognize your feelings and to do something about them.”
I went back to my practice in Maryland and began to apply these teachings to my own TMS patients and got success. Over the years I have learned a lot more from helping these patients and gotten even greater success.
One of the most important things I have learned, which I want to share with you, is that without a thorough physical examination done by a physician who can actually put their hands on the patient and figure out the difference between normal tissue (musculoskeletal) findings and those which indicate a physical origin, we cannot ever know if indeed the patient has TMS.
I am an osteopathic physician who went to medical school, took years of courses designed to help me make such a exam, and who has treated thousands of people over the years who indeed do and did have pain caused by physical problems. I treat them and their pain goes away.
Most DOs (osteopathic physicians) do not have such a practice. They are family doctors, internists, surgeons, obstetricians and do not specialize in these types of exams. I do and have for 30 years. I know very soon whether a patient has a physical or a non-physical cause of their pain.
Most of my patients do not have TMS but some do and with them I must use Dr. Sarno’s approach to get results.
Incidentally, and this is written with great respect, few physicians especially MDs like Sarno have these skills.
Sarno did the same exam with the same result on every patient during the time I spent with him. I asked him why he did this sham exam. He told me, I have already figured out they have TMS from the interview (he would interview new patients by phone before the consultation) so the exam is simply to let them know that I have examined them.
As an osteopathic physician who regularly makes such exams I understood that we had very different training and that it was useless to mention this to him. There was no way he could relate and, honestly, what he was doing worked well for him so why would I want to upset the apple cart.
Dr. Sarno was well known in the TMS community to not welcome challenges of any type. One MD told me that he was aware of another physician who was permanently on Sarno’s list of those whom he wouldn’t talk to because this man had questioned him in a way that he didn’t welcome.
So I kept my peace and went home.
Many practitioners in the TMS community do not touch patients at all. Some who do, physicians, cannot do the exam which I have used on all my patients.
I believe that without such exam validation one cannot have a confirmed TMS diagnosis.