John E. Sarno, M.D., is a professor of Rehabilitation Medicine at the New York University School of Medicine. He has been practicing medicine since 1950. He is the acclaimed author of three earlier books on musculoskeletal pain.

The Divided Mind

ReganBooks

Chapter One

What is Psychosomatic Medicine?

I remember the first time John R came into my clinic in 1996. He was a successful businessman in his early forties, well dressed and fit, radiating confidence. He seemed altogether at ease and self-assured -- until he bent to sit down. Abruptly, his movements slowed and he became so cautious, so fragile, so tentative that he was suddenly a caricature of the driving, confident man who strode through my door only moments before. His body language made it clear that he was either experiencing excruciating pain or feared the pain would strike him if he made the slightest wrong move.

As a medical doctor, I could empathize with his suffering. My specialty is mindbody disorders, and I see cases like this every working day. I hoped I could help him, which meant helping him to help himself, because with mindbody disorders, a doctor cannot "cure" a patient. It is the suffering patient who must come to understand his malady . . . and by understanding it, banish it.

As we went over John R's history, a picture began to emerge of an interesting and satisfying life. Married, three children. His own business, which probably took up too much of his time, but was doing well. I also heard a familiar litany of suffering and pain -- a chronic bad back of mysterious origins, sometimes inducing such severe pain that he could not get out of bed in the morning. His long and unsuccessful search for relief -- experiments with alternative medicine, prescription drugs, and finally, in desperation, surgery -- immensely expensive and only temporarily successful. Then the sudden onset of brand-new ailments: sciatica, migraine headaches, acid reflux -- the list of maladies went on and on.

As a physician, my heart went out to him. It was my job to help him. But I could only lead. Would John R follow? Would he understand the profound interconnectedness of mind and body? Would he grasp the awesome power of buried rage?

To the uninitiated, there is often something mysterious about mindbody medicine. In truth, the relationship of the mind to the body is no more mysterious than the relationship of the heart to the circulation of the blood, or that of any other organ to the workings of the human body. My first interview with John R indicated he would be open to the idea of mindbody medicine. Within a month of beginning treatment, his pains, which had tortured him for much of his adult life, simply disappeared, without the use of drugs or radical procedures. I still get an annual Christmas card from him. In his most recent one he reported that he continues playing tennis and skiing. Last summer he and his oldest boy walked the entire Appalachian Trail. The pain and the equally unexplained other disorders have not returned.

Many of my patients have an initial difficulty grasping the full dynamics of the mindbody syndrome. It is one thing to accept the concept that the mind has great power over the body, but quite another to internalize that knowledge, and to understand it on a deeply personal basis. Even when my patients come to fully appreciate the central element of the equation -- that it is their mind that contains the root cause of their physical distress -- they may continue to stumble over the secondary details, unable to accept the reality of their own buried rage, and remain puzzled over the fact that their own mind can make decisions of which they are unaware.

Sometimes it helps my patients to understand the mindbody connection if they step back and look at it from a broader perspective. Psychosomatic disorders belong to a larger group of entities known as psychogenic disorders, which can be defined as any physical disorders induced or modified by the brain for psychological reasons.

Some of these manifestations are commonplace and familiar to all, such as the act of blushing, or the feeling of butterflies in the stomach, or perspiring when in the spotlight. But these are harmless and temporary phenomena, persisting only as long as the unusual stimulus remains.

A second group of psychogenic disorders includes those cases in which the pain of a physical disorder is intensified by anxieties and concerns not directly related to the unusual condition. An example would be someone recently involved in a serious automobile accident whose pain may be significantly worsened by concerns about his or her family, job, and so on, not about the injuries. While mainstream medicine tends to ignore almost all psychogenic manifestations, it generally acknowledges this type, recognizing that symptoms may worsen if the patient is anxious. Doctors may refer to this as emotional overlay. In my practice, patients have reported that their pain became much more severe when they were informed of the results of a magnetic resonance imaging (MRI) scan that described an abnormality, such as a herniated disk, particularly if surgery was suggested as a possible treatment.

The third psychogenic group is the exact opposite of the second: it covers cases in which there is a reduction of physical symptoms in an existing disorder. In one of the earliest studies of pain, Henry Beecher of Harvard reported that in a group of severely wounded soldiers in World War II, it was found that despite the severity of their injuries they often required little or no analgesic medication because their pain was substantially lessened by their becoming aware that they were still alive, being cared for and removed from the dangers of deprivation, hardship, and sudden death.

By far the most important psychogenic categories are the fourth and fifth groups, hysterical disorders and psychosomatic disorders. Hysterical disorders are mostly of historical interest, although the psychology of both is identical. My experience has been primarily with psychosomatic disorders.

The symptoms of hysterical disorders are often quite bizarre. The patient may experience a wide variety of highly debilitating maladies, including muscle weakness or paralysis, feelings of numbness or tingling, total absence of sensation, blindness, inability to use their vocal cords, and many others, all without any physical abnormalities in the body to account for such symptoms.