There is no greater agony than bearing an untold story inside you.
-Zora Neale Hurston
It says here:
The average unmarried female
Due to some long frustration may react
With psychosomatic symptoms
Difficult to endure
Affecting the upper respiratory tract.
In other words, just from waiting around for that plain little band of gold
A person can develop a cold.
You can spray her wherever you figure the streptococci lurk.
You can give her a shot for whatever’s she’s got, but it just won’t work.
If she’s tired of getting the fish-eye from the hotel clerk
A person can develop a cold.
-“Adelaide’s Lament,” Guys and Dolls (1955)
John E. Sarno, MD, former Clinical Professor of Rehabilitation Medicine at the New York University Langone Medical Center, pioneered the idea that a wide variety of pain disorders are psychophysiologic in origin. He initially identified certain presentations of pain symptomatology as Tension Myoneural Syndrome (TMS), now called PPD (Psychophysiologic Disorder). A therapist familiar with TMS, or PPD, conceptualizes the individual’s pain symptomatology as a desperate, self-protective measure to deflect awareness away from unbearable feelings. Such therapists do not exclusively view pain symptomatology as the unfortunate result of illness or accident which is then exacerbated by emotional distress. Whether musculoskeletal pain is conceptualized as a psychophysiological condition or not determines its fate as a symptom, a complaint, or a communication in the treatment situation.
Numerous studies over the past twenty-five years have consistently demonstrated that the relationship between MRI findings and back pain is coincidental. Nevertheless, physicians who treat pain, psychotherapists, and even people struggling with musculoskeletal pain attribute physical problems exclusively to anatomical defects, thereby “medicalizing” them. The failure to recognize the crucial role disavowed emotions play in the development of persistent musculoskeletal pain undermines the effectiveness of clinicians and inadvertently deprives people of beneficial treatment. When a structural or anatomical defect is diagnosed as the cause of someone’s pain and disability, a psychophysiological disorder can be misdiagnosed and physical treatments not only fail but may serve to intensify the symptomatology. Appropriate treatment may be delayed or denied. It is essential that physicians establish the diagnosis of a psychophysiologic disorder.
Both medical and mental health clinicians would agree, of course, that emotional distress must accompany any experience of physical pain and its associated losses and limitations in activity. In fact, when people deny such reactions, we generally become suspicious. It is widely recognized that anxiety and depression will exacerbate an individual’s experience of pain. Nevertheless, for many psychotherapists and physicians, pain symptomatology remains essentially a medical event which can be favorably or unfavorably influenced by psychological factors. For these health care providers, it is neither caused nor resolved by elucidating these very same emotional factors.
When my colleague Frances Sommer Anderson, PhD, SEP, and I treat people suffering from musculoskeletal pain, in contrast to mainstream thinking about its diagnosis and treatment, our approach is guided by the idea that pain symptomatology develops in response to intolerable emotional experiences, not the other way around. Obviously, such profound differences in ways of thinking about pain symptomatology influence the approach for treating people with psychophysiological disorders.
If the mental health professional regards the person’s pain symptomatology as the result of a herniated disc, for example, then the thrust of the work must be directed towards understanding the various ways that someone mourns his or her loss or struggles against accepting it. If someone exercises, then the behavior is branded as self-defeating and non-compliant, a defiant expression of their refusal to mourn and accept the losses that accompany the medical condition. Or, the patient is viewed as masochistic and passive when he or she doesn’t exhaustively pursue every medical option, including contradictory and illogical ones.
When someone grieves and accepts the permanence of their physical losses, the treatment is proceeding smoothly. However, if the individual complains incessantly about his pain, then the person is trying to make the therapist feel useless. Of course, the therapist is useless. He or she can’t fix structurally damaged bodies. In this model, the therapist can only help someone come to terms with their losses, but the individual’s demands relocate their relationship into an arena which is not within the scope of clinical practice.
Once a therapist recognizes musculoskeletal pain as a MindBody disorder, then the goals of treatment change. Complaints of pain are no longer disregarded as static in the background, but are appreciated instead as distress signals originating from the person’s inner life. The emphasis in therapy shifts from mourning the physical losses associated with pain symptomatology to developing a richer and more extensive emotional vocabulary to translate the body language of suffering into the heartache that first produced it.
Eric Sherman, PsyD, is in full time private practice treating adults with psychophysiologic pain disorders and other MindBody conditions. He also treats individuals coping with the aftermath of serious medical illness and disability, as well as training physicians and mental health professionals in these areas.
Dr. Sherman trained under the aegis of the late John Sarno, MD, at the NYU Langone Medical Center and collaborated with him on treating pain patients until Dr. Sarno’s retirement from private practice in 2012. Dr. Sherman received his postdoctoral certificate in psychotherapy and psychoanalysis from NYU and is guest faculty at the Manhattan Institute for Psychoanalysis. He was a founding member of the PPDA (Psychophysiologic Disorders Association), and is co-chair of the Committee for Psychoanalysis and Healthcare of Division 39 (Psychoanalysis) of the American Psychological Association. He is the co-author with Dr. Frances Sommer Anderson of the book Pathways to Pain Relief.