Book Review: The Divided Mind

This is an overview of the book The Divided Mind by John Sarno

Sarno's bio: Dr. Sarno is a graduate of the Columbia University College of Physicians and Surgeons. Currently Sarno is Professor of Clinical Rehabilitation Medicine at the New York University School of Medicine.

Key point: The vast majority of chronic pain disorders are psychosomatic in nature. Stated differently, most afflictions that cause persistent physical pain are caused by the mind. They are mind/body disorders.

Webster's dictionary defines psychosomatic as, “Of, relating to, involving, or concerned with bodily symptoms caused by mental or emotional disturbance.”

Now, that key point is quite the claim! And a lot of people have a problem with it. But this post, and this book, are for the big boys and girls out there. Sarno's main area of study is on a condition he calls tension myositis syndrome or TMS. Included in the category of TMS are chronic back, neck, and limb pain which are not relieved by standard medical treatments. Sarno includes other ailments such as GI problems, dermatological disorders, and repetitive strain injuries under the label of TMS.

While Dr. Sarno works at a very prestigious institution, his work is considered outside the mainstream. Sarno states clearly, and up front, that he does not have hard data. But what he does have is years of clinical studies and mountains of case work to support his thesis. The mind is very complex and we are barely scratching its surface through scientific analysis. A lot of people disregard with Sarno’s conclusions because the conclusions cannot be directly quantified. But, difficulty measuring things inside the brain is a product of the inadequacy of our instrumentation. It is not a disproving of the phenomenon.

Sarno claims that knowledge about what is happening inside the mind/brain is all that is necessary to cure TMS. In particular, Sarno says that TMS is the result of unconscious rage. The book clearly states that Sarno is building off the work of Sigmund Freud. Freud is arguably the most famous psychologist of all time, I'm sure you have heard of him. The phrase “Freudian slip” is used in everyday language.

To make sense of all this TMS stuff, we need a little discuss of the architecture of the brain. Though far from perfect, Freud did lay an amazing foundation for psychology. Freud said that the mind is made up of three components the: Id, Ego, and Superego. Somehow modern language has made the Ego a bad thing. But for Freud, the Ego was the part of the brain that keeps the Id in check. Keeping the Id in check is very important if we hope to exist, even thrive, living in societal structures.

You see, the Id is the child-like part of the brain. It is selfish and dependent. The Id creates the primitive desire to have what it wants when it wants it. The Ego evolved, according to Freud, to keep those desires in check. The reality for humans is that we are, and must be, social creatures. No society of people dominated by the Id would last very long. The Ego keeps the Id subdued.

Briefly, the Superego is concerned with the loftier concepts of being a good person, altruism and the like. The Superego does not play much of a role in Sarno’s book. So I will not spend any time on it.

Freud contended that humans suppress many undesirable thoughts, inclinations, and emotions. The Id is the domain of such thoughts. Sarno comments that the unconscious mind believes it would be too painful for the conscious mind to reflect on such deep, dark territory. So, in an attempt at self-preservation, the mind deflects attention by creating the various forms of TMS. Sarno says it is the Ego which is responsible for the psychosomatic illnesses that have become so prevalent in our society. If we are focused on our back pain, we have little attention left to consider deep, repressed, emotional turmoil. In particular, Sarno points to the role of unconscious rage and anger.

When a patient addresses their physical disorder, with medication and/or surgery, the pain may go away. But an interesting effect, called the symptom imperative, usually kicks in. The symptom imperative occurs when a person addresses a psychosomatic illness with mechanical (as opposed to psychological) techniques. The results of such an intervention is that the mind will simply create another ailment in the body. So, maybe a person has back surgery to deal with a herniated disk. But before long, that person develops Carpal Tunnel Syndrome, or something else.

This is an interesting idea and it might allow you to test Sarno’s theory. If you had chronic pain and treated it with pills or surgery did another, possibly unrelated, symptom pop up? The people I have spoken with say yes!

Many people have a hard time accepting that their problem is psychosomatic. Because to do so means you must accept that you, or at least your thinking, are the cause of the problem. That thoughts and feelings in the brain can elicit a physical reaction is without doubt. Get scared and your heart will probably race or you may feel sick to your stomach. Those are psychosomatic reactions. When we get embarrassed our cheeks turn red. Again, this is a mind-body interaction. And, it is not a conscious decision. It is automatic.

Another reason people are hesitant to keep an open mind, with Sarno, is because it can be hard to accept the premise, that simply acknowledging a phenomenon's existence, is sufficient to fix it. And, that is precisely what Sarno is suggesting.

Sarno says that all it takes, to heal your chronic pain, is to internalize the knowledge he is putting forth. This is where things get really interesting, deep, and complicated. If you were to believe the argument, as it has been constructed, then consider the following. If chronic pain is the mind’s way of keeping you from consciously experiencing and addressing repressed thoughts and feelings, then wouldn't it make sense for the mind to keep you in doubt about a book such as Sarno’s, which endeavors to reveal what the mind is subconsciously doing? Tricky stuff, isn't it? But, I think we all know the person who most needs to hear a message, often strongly resists that very message.

So the solution, according to Sarno, is quite simple. Knowing what our subconscious is up to is sufficient to gain relief from our psychosomatic disorders. All of our negative emotions can cause TMS. A lot of people recognize that their back hurts more when they're stressed out. But, Sarno points to anger as the emotion most responsible for psychosomatic illnesses. If Sarno is correct then we should be able to make a prediction. Here is the prediction. If you know somebody who has fibromyalgia, carpal tunnel, sciatica, or anything like that, chances are that person has a temper or other emotional turmoil. Think about it. Is Sarno correct?

Let me end by being very clear about one thing. The diagnosis, of TMS, is NOT blaming the victim. The patient, in no way, chose to develop the symptoms. As I said earlier (with the scared reaction) the brain generates automatic, unconscious reactions to things. It is definitely not the patient's fault. But, there are things the patient can do to get relief.