TMS Info\A TMS Case Study

I just want to point out that yes, I know that this is a long, self-absorbed story.  I decided to go into a lot of detail to emphasize that a) I’m a very skeptical person and it took a lot to convince me that Dr. Sarno’s theory works and b) that I’ve had a lot of ups and downs with TMS symptoms.  When people condense their TMS experiences into a couple paragraphs, they often sound like “I was skeptical at first, but I read the book, and my symptoms disappeared. Thank you Dr. Sarno.”  That’s great for them, but it doesn’t do much to help the people who read Dr. Sarno’s books, suspect that their pain is actually TMS, but then don’t have the miraculous recovery that everyone else seems to have.  I’ve had those very frustrating times when the pain doesn’t go away, and I've tried to explain here how I dealt with them.  So if you’ve got the time, crack open a beverage and enjoy my long-winded story. I hope it helps. 

Originally, I had used the name “Olive” in this TMS Case Study.  It was my thinly disguised account of my experience with depression.  I’ve never really cared who knew that it was me, but when I first posted it, I was afraid that my family might be embarrassed or hurt by the way that I described them.  So I used a bunch of fake names.  I’m still using fake names, but I’m going to tone down the griping about my family for this updated version. 

I found out about Dr. Sarno several years ago, around 1993, when I was working as an exercise instructor at the Pritikin Longevity Center in Santa Monica.  One night during class, I gave the standard 10-minute Pritikin lecture on back pain, which included the usual instructions to stretch these muscles, strengthen those muscles, lift with your legs, etc. After the lecture, one of the women in the class, Frieda, told me that she had been to see a guy named Dr. Sarno in New York about her debilitating back pain.  He had completely cured her, but he’d used a totally different approach than the one I had described.  She said that he had written a book called Healing Back Pain and she’d give me a copy of it to read. 

Coincidentally, I had a painful kink in my neck at the time, and I couldn’t turn my head to the side.  I hadn’t told anyone about it because I figured that I had “slept funny,” and it would just work itself out. It had been annoying me for several days, but I really wasn’t too worried about it. 

After I read a couple chapters in Healing Back Pain, I came to the conclusion that TMS was the stupidest theory that I’d ever heard of.  I had been taught (by well-respected professors, physical therapists, and physicians) that joint pain was caused by structural problems or muscular imbalances.  Emotions had nothing to do with it.  However, I had to admit that I had always been a perfectionist and very self-critical, and that I’d had lots of the other tension-induced conditions that Dr. Sarno described in the book.  But this Freudian idea that the unconscious mind was full of rage just seemed silly.  I knew a little about psychology, and I was under the impression that Freud’s psychoanalytic theories were outdated and misogynistic, so I was not convinced at all by Dr. Sarno’s explanation. 

A couple other things bothered me, too.  Dr. Sarno had included a very long list of conditions that were all supposed to be tension-induced.  And no matter what the condition--back pain, migraines, irritable bowel syndrome--his cure was always the same.  He said that all a person had to do was read the book and acknowledge that the cause was psychological.  It dawned on me that, according to his theory, the annoying kink in my neck should disappear now that I had read his book.  So I tried turning my head to the side, and much to my surprise, the pain essentially melted away.  This certainly got my attention, but I figured that it just had to be a coincidence.  If this was all it took to get rid of neck pain, I thought, the whole world would know about it, and there’d be no need for orthopedic surgeons, chiropractors, or physical therapists. 

It seemed so crazy that I didn’t even mention my amazing neck recovery to Frieda.  When I saw her again, she told me her recovery story--her back had started hurting after she fell off a horse, and it kept getting worse until she eventually developed a drop foot.  She couldn’t sit for long periods of time, and she couldn’t even drive.  But when she saw Dr. Sarno, he explained that there was nothing physically wrong with her, and he convinced her to drive herself home.  She did, with tears streaming down her face, and she never had any more problems with her back.  She even mentioned that her husband’s hip pain went away after he saw Dr. Sarno, but I still wasn’t convinced.  It just seemed too simple.  I showed the book to a few of the people I worked with at Pritikin, and they all dismissed it without even reading it. 

So I just started observing myself and my personal training clients.  I didn’t like admitting it, but I definitely fit the TMS pattern. When I felt stressed out, my neck would start to hurt, or I’d catch a cold, or my face would break out, or I’d get eczema on my hands, or some other ailment would show up.  Sometimes when I reread Healing Back Pain, the neck pain would disappear like it did the first time, but sometimes it wouldn’t.  I started to see that Dr. Sarno was on to something, but I still wasn’t clear on why it only seemed to work part of the time. 

I saw my personal training clients in their homes, so I got to know them quite well.  I got to know their families, their work schedule, when they went on vacation, when relatives came to visit, when the kitchen was being remodeled, when the car broke down, and when the kids got sick.  I also knew their exercise routines, so I knew if they’d been doing any risky types of movement.  After a while, it became pretty clear that Dr. Sarno was right--joint pain often showed up when big or stressful events were happening, but not so much with heavy exercise or overuse.  For example, my client Ursula’s left shoulder had started to hurt, and she couldn’t raise her arm above shoulder height. Her doctor told her to rest it, so we completely stopped doing upper body exercises.  A couple days later, her right shoulder started to hurt, even though she had been totally resting her upper body.  The pain didn’t go away after a couple weeks, so as a last resort, I gave her a copy of Healing Back Pain.  The next time I saw her, she said, “I read that book and I believe every word of it.  Look!  My shoulders don’t hurt.  Give me back my dumbbells.”  Ursula told me that she already knew that when her husband (the CEO of a company) was having a hard time at work, she would worry about him, and her back would hurt.  Dr. Sarno’s book made perfect sense to her. 

Other clients weren’t so interested in reading the book.  I quickly found that a personal trainer’s advice doesn’t mean nearly as much as a doctor’s.  (Duh.)  If a doctor or a physical therapist had previously told them that the pain was caused by something like tendinitis, bursitis, or muscle weakness, they didn’t believe me when I told them that it might be caused by emotional stress.  I needed a physician to refer them to, so I called Dr. Sarno’s office in New York to see if there was anyone in Los Angeles who knew about TMS.  That’s how I met Dr. David Schechter.  But my clients were still reluctant to see him because they didn’t like the idea that the pain was “psychological.”  It made them sound crazy.  And frankly, I didn’t understand the psychology behind TMS well enough to explain it to them.  All I could tell them was that if they would just take the time to read the book, they’d probably get better.  

A couple years later, Dr. Sarno wrote The Mindbody Prescription.  In this book, Dr. Sarno mentioned that some common psychological disorders such as depression, panic attacks, and obsessive-compulsive disorder (OCD) were all TMS equivalents.  They all worked as a distraction, and could all be cured with psychological awareness.  I had become pretty convinced that all those physical symptoms were stress-related, but I also knew that I’d been depressed for about eight years, and I really didn’t see how the depression could possibly be a TMS equivalent.  According to Dr. Sarno, the depression was distracting me from something that was just too painful for me to acknowledge.  But this didn’t make much sense to me because I thought I knew what I was upset about, and I was just depressed on top of it.  However, I had pretty much reached the end of my rope and I figured I might as well give therapy one more shot.  I knew Dr. Sarno was on to something with the physical symptoms, and I’d heard Howard Stern talk about how he got rid of OCD by using Dr. Sarno’s theory, so I figured I’d at least discuss my depression with a therapist.  (Dr. Sarno doesn’t mention him by name, but Howard’s the OCD case study in The Mindbody Prescription.  He’s described his experience on his radio show and in his book, Miss America.) 

I’d never really been a “happy” person, so I figured that I’d been born with some sort of chemical imbalance in my brain, and that’s why I was depressed.  Now that I think about it, I really don’t know where I got that idea, but I was pretty convinced that there wasn’t anything I could do about it, except take anti-depressant medication.  And that was out, because I was afraid that I wouldn’t feel like myself if I were all drugged up. 

A friend of mine recommended a cognitive therapist to me.  Looking back, it might have been more useful to see a psychoanalytically trained therapist, like Dr. Sarno recommends in his books.  But at the time, I wasn’t convinced that the Freudian/psychoanalytic route was the way to go.  I thought that an analyst would have me lie on a couch and free associate for years before we made any progress, so I was more interested in working with a cognitive therapist. 

In therapy, I bellyached about all the things that I hated about my life, particularly my family situation.  I won’t list off all the individual issues, but suffice it to say that several of my relationships with family members were strained at that time.  It seemed to me that they were doing some really stupid things, and frankly I was ashamed that my family was such a mess.  Now that a lot of time has passed, it’s pretty clear that they were really doing the best they could, and I was too.  At the time, however, I thought that it all made me look bad, and I was afraid that other people would judge me harshly because I came from such a messed up family.  The big problem, though--the one that was responsible for the depression--was that I was ashamed of the fact that I was ashamed of my family. 

As Dr. Sarno has pointed out, it’s not the obvious, conscious fear or anger that triggers the TMS symptoms.  It’s the stuff that we try to avoid that causes all the misery.  And the tricky part is that it’s usually stuff we’ve believed for so long that we don’t even question it anymore. 

In my case, from the time I was a little girl, I had always been taught that good people love their families unconditionally.  It doesn’t matter what awful things family members do, a good person always sticks by them.  It had always been the rule in our house, so I never even questioned it.  The problem was that as I got older, I started to get real irritated with some of the choices certain family members made.  I really wished that my family was different--I wished they were more “normal.”  But I had this deeply held belief that if I were really a good girl, I would be able to accept them just the way they were.  So I could never truly admit to myself or anyone else that I was ashamed of some of them.  And on top of all this, I’m adopted, so I also felt like I should be grateful that I had a family at all.  I didn’t realize any of this at the time, however. 

When I started therapy, my therapist suggested that I buy a book called The Feeling Good Handbook.  I went to the bookstore, looked at the goofy cover of this book, and was almost too embarrassed to buy it.  It seemed like one of those silly self-help books that tell you to just start thinking positive thoughts and next thing you know, you're the happiest person in town.  I didn’t want to go up to the register with just this book, so I looked around for something else to buy with it. 

Fortunately, I happened to find a book called Everyday Zen by Joko Beck and it seemed to make a lot more sense than The Feeling Good Handbook.  It repeated some of the things my therapist had said, but it also seemed to go hand in hand with Dr. Sarno's theory.  It explained that thoughts are just thoughts, and you really don’t need to believe them.  There's no sense in trying to reprogram yourself into thinking happy thoughts all the time, and there's no sense in trying to block out negative thoughts, either.  Instead, the best way to deal with fear or anger is to physically experience it--feel the knot in your stomach, the tightness in your shoulders, the tension in your chest--without getting caught up in all the worry and drama of it.  And if you take some time every day to label your thoughts and pay attention to the way you react to situations, you'll start to uncover a lot of the icky fears that you try so hard to avoid.  And once you become aware of them and let yourself physically experience them, they don't seem so scary. 

I bought the Zen book and started “sitting” daily.  (I really had no idea what I was doing, but I tried my best.)  Even with the therapy, nothing really improved for several months.  Finally, after I visited my family for a week at Christmas, the depression lifted in one fell swoop. 

During the visit, I decided to try the thought-labeling and “experiencing” techniques I’d learned from the Zen book.  So whenever I was interacting with a family member, I’d try to notice whatever thoughts came up and whatever physical sensations came up.  For the entire week, I was a bundle of nerves, and there was a constant stream of thoughts running through my head:  “Having a thought that So-and-So is really annoying.  Having a thought that I can’t stand So-and-So.  Having a thought that if So-and-So doesn’t shut up I’m going to break So-and-So’s stupid face.”  I hated admitting that I felt that way about my own family, and I hated the tightness and tension I felt in my body.  But when I was in the car on the way to the airport, the depression finally lifted.  Like poof.  I wasn’t happy-happy, but I felt normal for the first time in years. 

Months later, I realized what had happened.  I had finally acknowledged all the ick feelings I had about my family, but most importantly, I finally knew that it was totally okay to let myself experience those feelings.  I understood that I could stand right next to my family, admit to myself that I wished they were different, and it didn’t make me a bad person.  It didn’t mean I didn’t love them, either--it just meant that I was afraid of what people would think of me because my family is less than perfect.  (It probably doesn’t seem like a big deal to anyone else, but I was really afraid that the world would come to an end if I let myself experience all this.) 

I really want to emphasize that last paragraph…Lots of people read Dr. Sarno’s books and recognize that their pain is probably just TMS.  Sometimes they can even pinpoint what it is that they’re upset about, but the pain still doesn’t go away.  Not only do people need to identify the feelings they’re trying to avoid, but they need to know that it is totally fine to feel that way.  And when a person knows that it’s actually safe to really physically experience the fear or pain or sadness, the symptoms go away because they’re no longer needed.  It’s not too hard to understand all this in theory, but it can be very hard (at least it was for me) to really know it on a gut level. 

So to recap... Here's how my experience with depression fits in with the TMS mechanism. 

Step 1:  Unconscious Emotions	I was embarrassed of my family, but was ashamed to admit it because it violated my need to be 'a good person who loves her family.'
Step 2:  Physiological Changes	Chemical changes in the brain (changes in serotonin levels, etc.)
Step 3:  Physical Symptoms	In this case, the symptoms were psychological--feelings of depression.
Step 4:  Full-blown Syndrome	I was constantly preoccupied with being depressed.  Not knowing any better, I continued to do what I had always done, which is worry about everything, which just made the depression worse.  I also tended to think in terms of black and white (since my family wasn't perfect, it was awful).

I'm impressed if you're still reading this.  

Anyway, that was the end of the depression.  I don't mean that I've never been unhappy since then.  But there's a huge difference between being bummed out about something and being depressed.  The worst thing about being depressed was that it felt like there was no end in sight.  I didn't know why it was happening, and I really just wanted it to make it go away, but I didn't know how.  Once I understood how this psychosomatic business worked, it didn't seem so scary.  

But I have to admit, it's taken me a long time to understand it.  Zen practice has helped immensely.  I started studying Zen with Joko a few years ago, and I can't recommend it highly enough.  I think that good psychotherapy is more useful for TMS in the short term, but a daily sitting practice is ultimately more valuable.  (I have to point out again, however, that Zen practice is not about becoming pain-free, or about eliminating stress, or about "fixing" one's life.  It's a big undertaking--work with a teacher.)  

I still get TMS flare-ups.  Apparently my favorite distraction "flavor" is knee pain.  Whenever I get worried, I get this goofy pain on the outside of both knees.  It's not very bad--it's just annoying when I sit cross-legged.  (Which is quite often, since I teach yoga.) 

I've learned some important things by watching this pain come and go for a couple years:  

a)  Most of the time when the pain shows up, I know full well what it is that I don't want to deal with.  But the pain usually doesn't go away because I still have a deep-down belief that it's easier to deal with the annoying knee pain than it is to really experience the particular fear or sadness or whatever.  On a sort of unconscious level, I'm actually "choosing" to be in pain.  

b)  There's no reason to beat myself up over it.  Sometimes it just feels too overwhelming to really let myself experience the fear, and that's fine.  I just do the best I can.  (I'm good enough, I'm smart enough, and doggone it, people like me.  Heh.  Kidding.  Even I'm getting tired of this story.  I'm starting to get punchy.)

c)  Trying to make the pain go away often makes it worse.  There's nothing dangerous about the knee pain, so it's fine to just let them hurt sometimes.

d)  It's extremely helpful to talk to other people who understand TMS.  

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