"Every age, every generation has its built-in assumptions; that the world is flat, that the world is round, etc. There are hundreds of hidden assumptions, things that we take for granted that may or may not be true. Of course, in the vast majority of cases historically, these things aren't true. So presumably, if history is any guide, much of what we take for granted about the world simply isn't true. But we're locked into these precepts without even knowing it, often times. That's a paradigm."

John Hagelin, Ph.D., physicist, (1954 - )

Chapter 1: Minding My Own Business

I was minding my own business as a psychiatrist in private practice when I innocently Googled “John Sarno, M.D.” Now I can’t mind my own business anymore. What follows is the story of the dramatic impact of a simple idea on an unsuspecting psychiatrist. There is more to the story than just the work of Dr. Sarno, though John’s work served as the tipping point that caused my medical worldview to unravel starting on a cold morning in February 2006.

It was a day like any other and I was seeing a woman for a routine follow-up visit. I've since forgotten the particular patient but I remember that she was in her forties; her depression was doing well; but, she was complaining of pain, as many patients do. That day I remembered the name, John Sarno.

I had heard Dr. Sarno’s name in the early 1990’s when I was a psychiatry resident at a large private medical center in New York City. I was listening to Howard Stern on WXRK and he said, “I went to one of Dr. Sarno’s seminars and he cured my back pain.” I thought that was very strange and I’ve never forgot it. But, I didn’t look into it for 16 years.

I was startled to find that Dr. Sarno cures chronic pain in most of his patients. Even more startling, he does it with a two to three hour lecture and daily homework. He does personally screen his patients. All potential patients must have had a more serious cause of back pain ruled out (cancer, infection, acute fracture, etc.) before he screens them over the phone. In this telephone screening, he screens out the patients that cannot accept a significant psychological component to their pain, saving his and the patients’ time. As I understand it, only about 15% of chronic pain patients can accept that their own mind is at play in their pain. Of that 15%, he cures most, often within a month. In the case of ABC News correspondent, John Stossel, within one week of seeing Dr. Sarno he was freed of 20 years of back pain.

If you are wondering how Dr. Sarno defines a cure, the bar is high:

  1. Little or no pain
  2. No functional limitations (which means you can do anything)
  3. No fear of any physical activity (often the most disabling feature of chronic pain syndromes)
  4. All physical treatments have been discontinued

How is this possible? It isn’t within the current medical model. That’s why his work is ignored by the world of modern medicine. But let’s look at some interesting facts, as I understand them.

Fifty years ago, back pain was uncommon in the U.S.

What were common were ulcers. Then, the incidence of ulcers began dropping and an epidemic of chronic regional musculoskeletal pain, two thirds of it low back pain, exploded. The back pain epidemic grew 14 times faster than the population for decades. Almost nonexistent 50 years ago, back pain is now a huge public health issue. It has been estimated that in 2005 low back pain alone cost the U.S. economy over 100 billion dollars. And, this is just the tip of the iceberg, as our story will show.

Epidemiology is the study of the patterns and prevalence of diseases in populations. It can be very useful in finding the source or cause of a disease. A decline of ulcers coinciding with the explosive epidemic of back, neck, limb, and trunk pain can be explained by a single, unthinkable idea. The pain is caused by the mind.

The pain is real, not imaginary.

It is caused by mild oxygen deprivation, which the unconscious mind deliberately produces, using the autonomic nervous system. What is the purpose of the pain? Why would your own mind hurt you? To distract you.

The pain serves as a distraction from powerful emotions in the unconscious that are threatening to become conscious. These hidden emotions are so frightening, the unconscious mind thinks, like Jack Nicholson in “A Few Good Men,” “You can’t handle the truth!”

The theory: these powerful, hidden emotions have three main sources: childhood experiences, current life stress, and your personality style. When the reservoir of powerful, painful, frightening emotions builds up enough that the unconscious mind fears their escape, your mind hurts you to distract you. The pain helps the unconscious mind to keep that nasty stuff hidden in the basement... beneath the surface.

What happened fifty years ago? It got to the point if you told someone you had an ulcer they said, “Ah.... stressed, ay?” Ulcers failed as a distraction and began pointing out stress and emotional issues. Ulcers began declining and the epidemic of back, neck, limb, and trunk pain began. Musculoskeletal pain is a much better distraction than belly pain because it is obviously physical. It’s fascinating the evidence doesn’t support this obvious truth.

What physically happened in the U.S. about fifty years ago to cause back pain to explode, growing 14 times faster than the population? What physical explanation could there possibly be?

Did something terrible happen to the American back?

Here's another troubling fact:

Imaging studies of the spine (CT scans and MRI’s) and pain don't correlate.

To me that spells trouble for the theoretical cause and effect relationship between structural “abnormalities” of the spine and pain. If back pain is caused by injury, damage, and structural problems of the spine (like herniated discs) then why is there no correlation between imaging studies of the spine and pain?

Here's another troubling fact:

Modern medical treatments for back pain are ineffective.

When a treatment is ineffective it suggests that the diagnosis is incorrect.

Here's another troubling fact:

Dr. Sarno's treatment for back pain produces a cure in most of his patients, often in less than a month.

When a treatment is highly effective it is suggestive that the diagnosis is correct.

There are many other facts that correlate with the strange picture that's emerging here, but these are the most troubling observations to explain using the current medical model. Is it starting to look like the emperor has no clothes, or is it just me? As a psychiatrist, I may not know fine fabric, but I know no fabric.