Mindbody Prescription: Healing the Body, Healing the Pain, The

The Mindbody Prescription: Healing the Body, Healing the Pain. John E. Sarno. New York: Warner Books (1998). xxviii + 210 pages, $ 14.00 Reviewed by Donald F. Lynch, Jr., M.D.

The Mindbody Prescription: Healing the Body, Healing the Pain is the sequel to Dr. John Sarno's earlier Healing Back Pain: The Mind-Body Connection. Sarno, who is a specialist in rehabilitation medicine at The Institute of Rehabilitation Medicine, New York University Medical Center, has blended psychoanalytic theory with physical medicine in describing the Tension Myositis Syndrome (TMS), which he proposes is the major cause of back and musculoskeletal pain in his practice.

As originally described, TMS is a condition of deep muscular pain which has its origin, Sarno postulates, in repressed emotions or "rage." The pain is theoretically caused by "a reduction in blood flow to the involved tissues...mediated through the autonomic system" [p.xx] as a stress response to these repressed emotions. Sarno identifies the pain as a defense mechanism, intended to divert the conscious mind from dealing with repressed rage or other intolerable emotional conflicts. In The Mindbody Prescription, Sarno extends his TMS theory beyond back and muscle pain to encompass a broad range of disorders ranging from migraine headaches to such disparate diagnoses as post-polio syndrome, peptic ulcer disease, colitis, skin disorders, infections, and more exotic conditions, such as the chronic pain associated with Lyme disease.

The Mindbody Prescription: Healing the Body, Healing the Pain is divided into three parts which follow a lengthy preface. There is also a detailed appendix with citations to support Dr. Sarno's conclusions, as well as a bibliography of articles related to both physical and psychoanalytic aspects of chronic pain and its management. While intended primarily for a lay audience, the book makes worthy reading for the practitioner interested in the emotional aspects of illness and the relation of stress to chronic pain problems.

The preface and introduction sections recapitulate Dr. Sarno's theories and earlier work with back pain and other chronic musculoskeletal disorders, stressing the emotional basis for the pain. In the book's first section, he discusses the concept of mind-body medicine, and reviews the role which physical and mental stress, guilt, personality disorder, anxiety, and depression may play in the symptoms experienced by the TMS patient. Sarno leans heavily not only on Freud, but also Franz Alexander, Heinz Kohut, and Stanley Coen-all proponents of psychoanalytic theory-to support his thesis that the symptom of chronic pain is a diversion or defense mechanism against deep-seated anger or emotion. Also included in this first section is a clear, well-organized description of the concepts of mind-body medicine, which touches on the neurophysiology of psychogenic disorders, conversion reactions, and psychosomatic problems. Sarno also briefly cites the work of Candace Pert, which has done much to tie the biochemical activities of the brain to physiological processes. While some of his concepts will seem radical to practitioners trained in classical pathophysiology, his presentation is articulate and certainly intriguing.

The second section of the book discusses in detail Sarno's original work in TMS, and then proposes extending the TMS concept to other disease states. Many of these clinical problems are already recognized as being rooted in, or exacerbated by, stress; it is Sarno's association of these disease entities with repressed rage that makes his theory unique. It is unsettling that he discounts many physical findings, such as herniated vertebral discs and osteoarthritic changes, as being coincidental findings and not the actual etiology of the pain. While he makes a case for conservative management of lumbar disc disease and associated skeletal pain, and supports this by citing a number of back and spine specialists, such treatment is a major departure from conventional management of these disorders.

Dr. Sarno also identifies TMS "equivalents"-illnesses of the gastrointestinal, genitourinary, integumentary, circulatory, and immune systems-which he postulates, like TMS disorders of the musculoskeletal system, are primarily the result of unresolved and repressed emotional concerns which can be managed in a manner similar to his management of classic TMS problems. A discussion of disorders "in which emotions may play a role," e.g. hypertension, mitral valve prolapse, atherosclerosis, and cancer, is also included in this section.

The third and final section of the book discusses treatment of TMS and TMS-- related illness. In simple terms, the patient must identify which unacceptable emotions or elements of unconscious rage are threatening his or her self-image. It is stressed that recognition of the emotional concern in itself is often enough; correcting the issue involved is often not required for significant clinical improvement to occur. Identifying the problem is usually achieved through careful self-examination, often combining meditation and self-affirmation. For cure, it is also essential that the patient believe completely in the TMS diagnosis and accept the psychosomatic nature of his or her pain as the basis for the problem. Sarno notes that on occasion formal psychotherapy may be helpful, but is usually not required. He notes that many cures have occurred in patients who have simply read his book and subscribed to the recommendations within. It is also important for the patient to return to full activities of daily life, including exercise.

The concept of stress and emotions as important contributors to illness is now fairly widely accepted, but the degree to which Dr. Sarno invokes the psychological will make many clinicians uncomfortable. One is always leery of practitioners who decry the "conventional medical establishment" as being outmoded or out-of-synch, and there is too much of such stridency in this book. It abounds with phrases such as: "Modern medical science studies the details of maladies but rejects unconscious emotional processes as the cause..."(p. 117), and, "All of these admonitions and prohibitions (by doctors and physical therapists) enhanced by poor medical advice, keep your attention riveted on your body, which is your brain's intention"(p. 147).

It seems that Dr. Sarno envisions himself on a crusade: "The disorders just described under the headings of TMS and its equivalents are without doubt responsible for a substantial proportion of the Western world's medical ills. Their proper management would alleviate much suffering and reduce the enormous cost of medical care that now burdens modern society" (p. 126).

While some of what Dr. Sarno propounds in this volume would be considered unconventional treatment, it is a treatment program which enjoys many adherents. Consequently, this book will be of most use to the clinician who is involved in the management of chronic pain or physical rehabilitation patients. The book is articulately written and presents the concepts of mind-body medicine and stress management clearly and simply. Those who need to be familiar with TMS and Sarno's protocol for its treatment will find it a useful summary of that program and a valuable addition to their libraries.

Copyright American Society of Clinical Hypnosis Apr 2003
Provided by ProQuest Information and Learning Company. All rights Reserved