Debunking Dr John Sarno / TMS / Healing Back Pain
June 25, 2016 6:43 AM   Subscribe

Can someone help me understand or explain why there seem to be so many people (including many on the green) who have claimed to have been helped by Dr Sarno's books and his whole 'TMS' diagnosis? I just read the book, and it seems like complete quackery, especially in his advice around herniated lumbar discs. What gives?

Personally, I absolutely believe there is an uncanny mind-body relationship that we don't fully understand yet as a race. The placebo effect makes compete sense, and I'm not arguing with any of that.

I had a microdiscectomy for a herniated lumbar disc in September, and after recovery and intensive rehab, had a bit of a setback. Someone who I trust recommended his book, saying it cured their back pain and spasms (pain that kept them in bed for days) so I took a punt and read it in an afternoon. I thought it was absolutely crazy, so I looked his name up here on the green, only to see some people also singing its praises.

Now, I understand the first thing he says in the book is to ensure you get yourself checked out properly, and he also explains that his method is not a placebo effect, so what explains these masses of people claiming to be healed or helped by a diagnosis that has never been formally accepted by modern science?

The real thing that baffles me is his comments on herniated discs. He says that even when a disc bulges or even herniates, that it's not likely that it can touch the nerve and/or cause pain? My quackery siren was in full alert mode when he was going through every spinal condition and basically saying that it's only your repressed emotions manifesting itself physically. When I was crawling on the floor to use the bathroom for two months because I couldn't feel my left leg, I'm pretty sure that had a physical cause.

A part of me wants to believe theres a kernel of truth in this, that there may be something else I can explore to help me with my back pain, but honestly the whole book has gotten me so worked up I would love to try to get a better understanding of how something so seemingly crazy could be so positively received by the public (seemingly), and backed up by actual success stories. The mind boggles at the moment. Thank you!
posted by sxtrumpeto to Health & Fitness (10 answers total) 4 users marked this as a favorite
can't answer most of this (except "people are complicated"), but i know that i have some messed up discs in my spine that cause no problem at all (i know of them because i have frequent MRIs for other reasons). and i suspect that this is true in general - doctors (in my experience) tend to be very reluctant to go on "fishing expeditions" to look for problems unless they already suspect something is wrong. presumably because bodies are often messy / broken in ways that don't affect people. all of which may mean that it is true that most disk bulges don't cause problems.

(at the risk of being bland, i believe the best you can do is care for yourself in mind and body (exercise, therapy, whatever) and then add a good doctor to bring in the heavy weapons where that fails).
posted by andrewcooke at 6:54 AM on June 25, 2016

The book sounds like quackery to me. I haven't read it or heard about it until now.

But I see a couple of flaws in your logic. One is that you are ruling out a placebo effect, on the basis that "he says it's not a placebo effect." If you don't believe anything else he says, I'm not sure why you believe this. He can say it's not a placebo effect and it's still a placebo effect.

Second, you seem to think "but my pain is really Really REALLY bad" somehow means there cannot be an emotional cause. I'm not sure why you think that only less severe pain can be emotionally caused. Maybe because you're thinking of the emotional cause causing one to imagine the pain and this pain is too severe to imagine? Anyway, emotional causes can cause very severe symptoms.

One mechanism though which I could imagine emotional causes bringing about severe pain is from the way one holds one's muscles when stressed. Someone once pointed out to me, and I discovered that it's true for me also, that RSI pain from typing too much doesn't happen just from typing too much -- it's increased typing during times of severe stress that seems to do it. I assume that I'm more likely to be typing while holding my muscles tense when I'm stressed than when I'm not. Fortunately, this has never caused fully debilitating pain for me, but it does for some people. There are lots of other examples of emotional causes having severe physical effects, including pain. And of course Freud famously found many examples of emotional causes bringing about even paralysis.

Finally (ok, three flaws in your logic), you seem to think that if something has an emotional cause that means it doesn't have a physical cause. Hence you're saying that the cause isn't emotional because you're pretty sure there's a physical cause. Physical and emotional causes are inter-related and can interact just like different physical causes can interact. If you take tylenol and alcohol your liver will fail. Saying "I'm pretty sure it's the alcohol so it's not the tylenol" makes no sense. It can be both (even though both tylenol and alcohol by themselves can also cause your liver to fail). In this case, where it's both, removing one cause or the other can cure the liver failure. The same can be true for physical and emotional causes: Remove the stress OR remove the typing and the RSI pain will be avoided, in the example above.

So yeah, it can be quackery because there's no evidence it's true. But your logic is flawed.
posted by If only I had a penguin... at 7:00 AM on June 25, 2016 [2 favorites]

Best answer: I am not familiar with TMS but based on some quick reading, it seems like the very first requirement for a diagnosis of TMS is that it not be associated with a structural issue (e.g. something that can be seen on MRI). There are a lot of similar diagnoses in mainstream medicine that lean heavily on the "mind body" connection for theories of their etiology and require ruling out structural issues first -- irritable bowel syndrome (IBS) is the one that comes to mind most readily.

Given that a presumably responsible surgeon performed your lumbar surgery already, I am guessing that you do have a structural defect, which suggests that TMS is not necessarily the best diagnosis for you. It also jibes with your intuition that crawling to the bathroom is more likely a sign of a physical injury, not a psychosomatic one.

That said, it's very possible for the mind-body connection to be involved in exacerbating the severity of symptoms associated with a structural injury -- while TMS and its associated treatments may not be supported by the medical establishment, many similar approaches to pain management -- e.g. cognitive behavioral therapy, mindfulness meditation, and biofeedback -- have very good evidence supporting their use in chronic pain conditions.

I am a highly skeptical scientist type person but I think if there's any area where it's worth being more open minded than your intuition allows, it's in pain management. The experience of pain is entirely subjective and therefore an "effective placebo" is actually a totally valid treatment, as long as it isn't harming your health in other ways or bankrupting you.

Like I said, there are other approaches that are accepted by the medical mainstream (although insurance coverage has been slower to come around), so if this guy is setting off your alarm bells, I would encourage you to explore those other similar but peer-reviewed approaches.
posted by telegraph at 7:05 AM on June 25, 2016 [7 favorites]

Response by poster: Penguin - Thank you for the detailed reply. I won't respond as such, but I perhaps wanted to offer some clarification to my question, (and it will be my final post as not to threadsit here)

Let's specifically talk Herniated Lumbar Discs then.

As Andrew pointed out above (and as I fully recognise) - one can have a herniated lumbar disc without having it cause pain. In my initial research before my surgery, I was told that most all people have bulging or herniated discs, but it never becomes an issue.

In some ways I am also not talking about my particular case, which I do agree was structural, but more about some specific assertions made in his book on almost every documented spinal condition, and with the level of confidence that he spoke on them, basically saying that the majority of those cases are simply cases of TMS, and not the medically diagnosed condition.

If you then take as a given that most people with severe lower back pain get MRI's done to diagnose the pain, and those MRIs clearly show nerves that are impinged by bulging disc material, how does one reconcile those facts with the diagnoses made in the book or the mind-body connection in general?
posted by sxtrumpeto at 7:19 AM on June 25, 2016

I consider myself a very rational and skeptical person. That said, his book helped me, could say cured me of debilitating shoulder pain.
I'd say to you, be very skeptical of Sarno. Examine his ideas and break them down scientifically why they are false. You haven't done that. You're response has been purely emotional. 'It's quackery because it's quackery!!'
posted by Lucky Bobo at 8:23 AM on June 25, 2016 [1 favorite]

This is a really valuable type of discussion to have.

"specific assertions made in his book on almost every documented spinal condition"

"he was going through every spinal condition and basically saying that it's only your repressed emotions manifesting itself physically."

Would you be willing to include actual quotations from the book? I haven't read it, but the fact that many people here have, and that there are a lot of books out there purporting to help when traditional Western medicine doesn't, makes me hope that breaking this down into specifics could be helpful. If there were a model for people to use in trying to decide whether to trust something like this, it could be very useful.
posted by amtho at 8:33 AM on June 25, 2016

You ask why do people like him? People like all kinds of things. People are willing to attribute symptom improvement to any thing. You don't like him or his book. Throw it away and move on. He is not worth the space in your head.
Sorry for your pain.
posted by SyraCarol at 9:43 AM on June 25, 2016

Before there was Sarno, there were many "bodywork" therapies that related the emotions to how one held one's body, most famously Wilhelm Reich's Character Analysis from which many of the later ones were derived. My experience is that there is a core of truth in the theories and techniques but for various reasons, mostly cultural, it never got integrated with modern Western medicine.

What this means in practice is that most doctors know nothing about it and the "practitioners" of the various varieties of body work have their own ways of explaining what they do, often with lots of woo woo. Sarno himself (in the one conversation I had with him--on line in the mid 90s when he was promoting one of his books) wasn't interested in how his work related to anyone else's and talked about it as his private discovery.

I have found many of the various bodywork techniques useful for myself and others and I believe they can help people even with structural problems but they aren't magic and won't help everyone with everything. Some of the theoretical ways of thinking about them make sense while others are just marketing and/or quackery. In the end you have to figure out for yourself what will be of use to you.
posted by Obscure Reference at 10:17 AM on June 25, 2016

Modern science just hasn't been very successful when it comes to back pain, and surgery doesn't have a great track record. Working in medical publishing has made me much more aware of how much money plays a part in what is ultimately researched and published. Consequently, I've become much more skeptical of the idea that seems to underlie your question, that if a treatment is legit, scientists will have studied it extensively and decided whether it's worthwhile. Controlled studies cost enormous amounts of money. Sarno's treatment is not going to yield much money for practitioners or researchers and none for drug companies, so it doesn't surprise me at all that it hasn't been adequately researched. That doesn't make it quackery. The researchers who found that ulcers are caused by bacteria were unable to get adequate funding for years because those holding the purse strings found the whole idea absurd. When they did have proof, they could not get their work published. In the meantime, patients were advised to eat bland food, take antacids, and reduce their stress. Some had their stomachs removed. Even after the research was done, it took twelve years for the NIH to change their recommendations and it took even longer for doctors to change their treatment. You can read more about the whole disturbing history here and here.

Now imagine that they hadn't gotten funding or been able to publish their research in medical journals - remember, they were turned down multiple times. Instead, they try it on a few patients. It works, so they publish a book saying that ulcers are caused by bacteria and can be cured with antibiotics. And people convince their doctors to let them try and it works, and they sing the praises of the authors. And then other people read the book and say, well, this is quackery because there's no proof. That easily could have happened.

When medical science doesn't have a good answer, and it often doesn't, desperate people turn to alternative treatments. Some of these treatments don't work and are quackery, but some do work and are ignored for reasons that have nothing to do with science and everything to do with money and skepticism based on preconceived beliefs. Pain is subjective and hard to measure, but in the case of back pain, that is what is making people miserable. If I were in pain and Sarno's methods helped me, I would not care if it was because he's right or because it was a placebo. In the end, it was yoga that seems to have ended my debilitating back pain. Are there studies showing it works? Frankly, I don't care.
posted by FencingGal at 11:28 AM on June 25, 2016 [9 favorites]

Best answer: Slate Star Codex just published a great, thorough article on this topic that addresses the claims of the mind-body advocates with a great deal of rigor and, in many cases, more seriousness than they deserve. I highly recommend checking it out.
posted by phoenixy at 10:35 PM on June 25, 2016 [3 favorites]

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