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The Mindbody Prescription: Healing the Body, Healing the Pain Paperback – October 1, 1999
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Dr. John Sarno caused quite a ruckus back in 1990 when he suggested that back pain is all in the head. In his bestselling book, Healing Back Pain: The Mind-Body Connection, he claimed that backaches, slipped discs, headaches, and other chronic pains are due to suppressed anger, and that once the cause of the anger is addressed, the pain will vanish. Relieved Amazon.com readers call this book "liberating" and say "it sounds too good to be true, but it is true." Sarno has returned with The Mindbody Prescription, in which he explains how emotions including guilt, anxiety, depression, and low self-esteem can stimulate the brain to manufacture physical symptoms including fibromyalgia, repetitive strain injuries, migraine headaches, hay fever, colitis, ulcers, and even acne. If these psychosomatic problems all sound a little Freudian, what with the repression of emotions in the unconscious, it's because Sarno unapologetically borrows from Freud for the basis of his theory and cites childhood trauma as a major source of emotional problems. He also says that his program is a "talking cure" of sorts, since patients must be convinced their pain is rooted in their emotions before healing can begin.
The book reads a bit like psychology text, with Sarno quoting from psychoanalytic theorists including Heinz Kohut and Graeme Taylor and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Sarno walks through the neurophysiology of mindbody disorders, lists the symptoms of dozens of disorders that he believes are emotion-based, and offers a basic program for overcoming psychosomatic pain and illness. His recovery plan includes meditation and sometimes psychotherapy, including behavior modification, and stopping any medication or physical therapy. While Sarno's ideas seem radical, they were commonly implemented earlier in the 20th century, when psychoanalysis was at its peak of popularity, and they promise to become more accepted in our current era of alternative medical therapies and anger management. --Erica Jorgensen --This text refers to an out of print or unavailable edition of this title.
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Top Customer Reviews
Everyone, EVERYONE, who has had long-term back pain needs to read this book and try it out.
I had a back injury in 1993. It hurt off and on ever since. It disrupted my life and cost me a lot -- in stress, in worry, in wasted time, not to mention in money (for doctors, pain meds, massage therapists, etc.). This pain was a significant part of my life -- will I make it through okay on a long plane trip? Will it be okay to mop the floor? If I lie on my back to read a book for half an hour in bed, will I be miserable all day tomorrow? It affected my decisions every day.
A friend mentioned this book to me, and said she totally got rid of excruciating back pain. She is not a fan of "woo" either, so I took her seriously -- and well, I'd tried everything else already. What would it hurt to buy a $10 book?
As it turns out, I'm one of those people -- a not insignificant minority, it seems -- who read the book and their back pain goes away (my friend said it took her a few months of dedicated work, and that's pretty common too--but 80-some percent of people seem to get significant, lasting relief).
I read the book about three weeks ago, and have been pain-free ever since. You might be saying "big deal" ...but I haven't had a three-week pain-free stretch in 20 years. Also, even on days when my back didn't actively hurt, certain places -- such as my shoulders -- were always stiff and sore if you touched them. That's gone too. I keep pressing on my shoulders to show myself, "Wow this doesn't hurt a bit." This thing that plagued me for 20 years is gone.
Here's what I think is good in the book:
1. Everyone knows that "stress" can affect you negatively. For example, people who suffer from chronic back pain or headaches often feel worse under stress. What I never considered, however, is that your own nervous system _creates_ physical responses. For example, when some people are embarrassed, they blush. Their blush is real -- it's not "in their head" -- and they're not blushing deliberately or in order to gain anything. Chronic back pain -- real pain, which is not "in your head" and not something you're exaggerating or fabricating -- can arise from your nervous system in the same way as a blush, whether or not there's anything "wrong" with your back. Just as a blush can arise in some people when they're embarrassed, back pain can arise in some people when they're "stressed" -- and everyone is stressed every day. If you're not stressed, you're dead, right? Not everyone blushes, and not everyone has back pain, but people's nervous systems can create physical responses from emotions.
2. Sarno points out that injuries do heal. People break a bone, it heals, and they're fine. People sprain an ankle, it heals and they're fine. Once my back injury healed (20 years or so ago), there was no reason for it to hurt anymore, other than my own nervous system using a familiar "route" to cause pain. Then the question is, Why?
3. The author points out that many people with chronic back pain are the "nice guys" of the world. People with chronic pain are often very conscientious, do-gooder, perfectionistic, or self-sacrificing types. If it's associated with a certain type of personality, that's a red flag right there that something other than an "injury" is going on. A lot of people with chronic back pain also have a history of having been abused as children. What do these two types of people have in common? They tend to deny or minimize or not notice their own feelings. They are the types to say, "Sure I'll help you move a piano at two a.m. on Christmas in a blizzard." They don't even notice that maybe a small part of themselves would rather not move the piano.
4. The author speculates that all this do-gooding and self-denial and ignoring-of-one's-own-feelings and needs (whether it's your personality type, or whether you were raised in an abusive home, or both) also creates a constant pool of underlying "rage" (his word, which he uses a lot) from the part of ourselves that doesn't want to move pianos. Here's where it gets speculative. Somehow your body transforms this unacknowledged feeling into pain (just as "somehow" the body transforms someone's embarrassment into a blush).
5. The author also speculates that the pain serves as a distractor. Of COURSE you aren't wild about moving the piano! Your back is killing you! That's a socially acceptable reason to admit to yourself that you don't want to move the piano. Of course, you'll probably move it anyway. (By the way, the author rejects the notion of "secondary gain" -- i.e., the idea that people with chronic pain use it to get certain benefits like attention or sympathy. He believes the pain serves both as a distraction from emotional pain, and an outlet for / substitute for emotional pain you're not feeling.)
6. Something I found interesting is that people in certain times and places seem to have certain mindbody disorders that are approved by their society as being "real" things with physical causes. In Victorian times there was a lot of mysterious paralysis, but it went out of fashion once people knew more about the body and that it didn't "really" work that way. In the 1990s there was a lot of carpal tunnel, even though computers were probably easier to use (easier on the wrists) than, say, old manual typewriters where you had to bang the keys. There's a whole lot of back pain today, which often lasts years beyond an injury, and which is remarkably unresponsive to treatments and surgeries, but the medical community supports the idea that an injury you sustained 20 years ago can be hurting you today, so everyone believes that chronic back pain has a physical cause, just as everyone once believed in the paralysis in Victorian times. Almost everyone (like me) can point to an "injury" that triggered their back pain, but unlike ever other injury we've ever had, it doesn't get better. It's pretty odd, once you think about it, but everyone -- from doctors to physical therapists to chiropractors to massage therapists to other people with back pain -- reinforce the idea that it's related to a physical injury and there's very little you can do about it. This belief is extremely powerful and helps perpetuate the pain.
7. What I like most of all: I read the book, I thought about all this stuff, I decided his description fit me perfectly (my personality, the type of pain, the length of time, etc. etc.), and once I knew there was likely nothing actually "wrong" with my back, it's like the game was up. My brain gave up trying to use that as a strategy. The back pain went away, including the permanent tightness in my neck and shoulders, including the shooting excruciating nerve pain down my leg for which I was being medicated.
It. Went. Away. I'm off the medication. I'm doing whatever I want. I'm lying on my back for hours every night reading my books. I'm bending however I want. Etc. No problem.
I can never do this book justice. There's a lot more, about MRIs, about people with and without bulging discs, arthritis etc., about people who are told they have to do this or that with physical therapy, "or else" (which is pretty much reinforcing the notion that there's something terribly wrong, although plenty of people have bulging discs and arthritic changes and never have a day of back pain). You just have to read it, to see whether it fits you too. If you've had back pain for years, it probably does.
Here's what I'm not wild about.
1. The book seems very psychoanalytic to me -- to me, needlessly so. It talks a lot about "rage" and you might not be a person who really perceives that you're feeling "rage" (I'm not). But on the other hand, the book "works" so I'm not sure that anyone necessarily needs to accept a psycholanalytic explanation. I'm a nice-guy self-denier who probably, if I'm really honest with myself, truly loves to help people but doesn't enjoy moving pianos at 2 a.m.
For me, all I had to do is, every time my back started to twinge, ask myself to think hard about what I'm feeling, what's bothering me. I say it to myself -- I don't even have to go around refusing to move people's pianos. I just have to say to myself something like "I really don't like getting up at 2 a.m. to move pianos. I would rather stay in bed. I wish there was some other time -- not on Christmas, not during a blizzard -- when we could move the damn piano." I just acknowledge to myself that a part of me feels that way. I also ask my brain to stop my back from hurting, and it does. Then I go about my business. But there's no need for a psychoanalytic explanation, in my opinion, any more than there's a need for a psychoanalytic explanation for a blush or a phantom limb pain.
We don't have to understand it for it to work. Gravity always "worked" whether or not we understood it. Apparently checking in with your own emotions, acknowledging them, and asking your brain to stop sending pain messages also works. I don't quite understand it, but -- like gravity -- it's very powerful.
So -- like every other idea you encounter in life: Take what works for you, and leave the rest. I've read a bunch of other good books on this topic now too, by this author and others. My favorite so far is Unlearn Your Pain by Howard Schubiner. Only the first five chapters is available on Kindle, though, and I've ordered a hard copy of the rest of the book, so I can't review the whole thing yet.
I wish every doctor who sees patients with back pain would read this book. I wish everyone with persistent back pain would read this book and give the ideas a try. I wish tons of research were being done on this phenomenon. I wish I had come across this book 20 years ago.
Sarno argues persuasively that almost everyone has various structural abnormalities in their bodies from head to toe. But to conclude these are symptomatic of pain is not science, but "faith" on the part of mainstream medicine. In fact, as Sarno points out, what is scientifically shown to be correlated with pain in a specific area of the body is oxygen deprivation via blood-flow to particular parts of the body, which is directed by the autonomic nervous system, which in turn is directed by the brain. In other words, the mind, without consulting us, can actually restrict proper oxygen via the bloodstream to a particular part of the body. The further evidence that this is true is that Sarno cites many people's long term chronic pain ceasing almost immediately when they call to mind certain emotional issues and recognize the fact that their brain has been employing this little trick. After all, if only structural abnormalities were the cause of chronic pain, then how could people who have had chronic back pain for 20 years see it vanish almost immediately? The body's structure does not suddenly change, but the oxygen of blood flow to a particular part of your body can indeed change "on command" --by way of the brain's control over the nervous system. In the mysterious realm of mindbody interaction, your recognition that your brain is conducting this little trick, is the key that turns the lock, and disarms the brain's strategy. Unfortunately, the only way that you "unlock" the chronic pain is to endeavor to call to mind various things that your brain (you) is bothered by or anxious about, which you have not been consciously thinking about or willing to recognize. Many people have a good deal of anger, fears, anxieties etc that they've basically "stuffed into the basement" of the mind, so to speak. You can "clean it out" by being willing to at least recognize certain things, and Sarno's questions about common worries, anger, etc. are helpful in this process. But this is a key point: you don't have to solve the problems, per se, but you do have to be aware that they are there. So, in effect, Sarno does not offer a "free lunch". Take your pick: you can either be mentally aware of things that are uncomfortable to think about or process, or you can ignore them and experience chronic pain somewhere in your body. Thanks to Dr. Sarno, it's your choice. Obviously, the healthiest thing over time is to try to redress the emotional stuff, but thankfully, mere willingness to recognize these things can actually liberate the body for good.
It's not to say I haven't had pain or a flare up since (I read this book about 8 months ago), but when I feel something coming on, I readjust my thinking based on Sarno's teachings and remember the cause is emotionally based and it eventually goes away. The mind-body approach can take time to really get a handle on, but it's a cure.
To anyone debating reading this book: It can't make your pain worse, but it can help it go away, so just try it. There is hope! (Also, check out his recorded lecture online and other helpful resources!)