Chronic Pain Syndrome and Other Psychosomatic Illness

What is the nature of psychosomatic illness? Long before Descartes said that the mind and body were separate, there existed in Western medicine a philosophical dichotomy between mind and body, while Eastern tradition had the wisdom to view the mind and body as coming from the same energy or source. This disconnect has directed how Western medicine evolved, and

has had a powerfully negative effect on how patients are perceived and treated, based on the assumption that there is mental pain and there is physical pain and never the twain shall meet. “These two types of pain, so the myth goes, are as different as land and sea. You feel physical pain if your arm breaks, and you feel mental pain if your heart breaks. Between these two different events we seem to imagine a gulf so wide and deep that it might as well be filled by a sea that is impossible to navigate” (Morris 1991, p. 9).

Psychosomatic disorders may appear to be purely physical but they originate in emotions that are unconscious or dissociated from consciousness.There are hundreds of illnesses and disorders that are purely psychosomatic or have a psychosomatic component, yet it is quite astonishing that despite the prevalence of these disorders, the medical community remains in the dark about this. . . When physicians are confronted with a psychosomatic disorder they do not recognize it, or if they do, they tell the patient that it is all in the mind.

Loss and isolation can cut like a knife. Grief or anger can be stored in the muscles of the neck, head, back, or gastrointestinal tract, and can cause allergies to flare. The waiting rooms of primary care physicians are filled with people in very real physical distress for which no medical cause may be found. . . . Their pain may well originate in the mind or psychic pain might greatly exacerbate the pain of a physical disorder. But in any case, it is not all in the mind. It is in the mindbrainbody. It is psychosomatic (Farber 2013, pp. 166-7).

A number of years ago I got a call from Kay, a friend and neighbor. She was miserable, in almost constant pain—her back, neck, shoulders. Consultations with three orthopedic surgeons told her that she needed to have orthopedic surgery. She was instructed to go on complete bed rest and that is how she’d been living for the past several weeks. She hired a high school senior girl to come over at lunch time to prepare and serve her lunch and empty her bed pan. Surgery was scheduled for three weeks later.

What a terrible way to live, I said, and asked her if she had ever heard of the work of a physician named John Sarno, a pioneer in psychosomatic medicine and head of the Outpatient Department at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center. I told her that I had worked there years ago and learned a great deal about chronic pain syndrome, how the mind can produce or exacerbate physical symptoms.

At a time when few physicians understood that the mind and body are connected and that there is such a thing as an unconscious mind, Sarno developed the theory that many painful symptoms, whether they are skeleto-muscular, gastrointestinal or other, are an unconscious distraction to aid in the repression of deep unconscious emotional issues. In other words, it is preferable to feel physical pain than to experience deep emotional pain. Sarno believes that when patients can begin to think about what may be unconsciously upsetting them, they can defeat their minds' strategy to repress these powerful emotions; when the symptoms are seen for what they are, the symptoms then serve no purpose, and they go away. Sometimes this can happen when the patient receives this kind of psychoeducation and exercises through the pain; sometimes the patient needs the help of psychotherapy to do this. Sarno is one of a handful of physicians who works collaboratively with psychoanalytically-oriented psychotherapists who understand the nature of psychosomatic disorders. Sarno has said

The enormity of this miscarriage of medical practice may be compared to what would exist if medicine refused to acknowledge the existence of bacteria and viruses. Perhaps the most heinous manifestation of this scientific medievalism has been the elimination of the term psychosomatic from recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official publication of the American Psychiatric Association. One might as well eliminate the word infection from medical dictionaries (Sarno 2006, p. 3).

I urged Kay to make an appointment to see him and referred her to his books, Healing Back Pain: The Mind-Body Connection (1991), Mind Over Back Pain (1999). The Mindbody Prescription: Healing the Body, Healing the Pain (1999) ,and The Divided Mind: The Epidemic of Mindbody Disorders (2006), featuring chapters by six other doctors and addressing the entire spectrum of psychosomatic disorders and the history of psychosomatic medicine.

Kay was eager to hear what Sarno had to say and made the appointment. Her husband had to put down the back seat of their station wagon so that she could lie down for the ride. That evening I got a phone call from her, eager to tell me what had happened. It felt like a miracle. After her exam by Dr. Sarno, she attended a psychoeducational lecture on the nature of chronic pain syndrome and learned that the brain actually induces physical changes in the body for the purpose of preventing the conscious brain from becoming aware of unconscious feelings like rage or other emotional pain. She heard that chronic pain should always be approached as a symptom closely associated with emotional disturbances. She attended an exercise class that afternoon and actually stood up and moved. She rode home sitting upright. For her, the psychoeducation and continuing in the exercise class were enough for her to make what seemed to be a full recovery. She laughed as she told me that she had cancelled the appointment for surgery.