TMS Process, Stage 1

Dr. John Sarno's books obviously go into more detail than I do, and I suggest that you read them. But in the meantime, here's a condensed explanation of how TMS works and how to cure it, based on Dr. Sarno's books and my own experience.

In a nutshell, Tension Myositis Syndrome symptoms (such as back pain) are initiated by our fear of "not being good enough." Everyone experiences this fear to some extent. It's part of human nature. It's very important to understand that no one is crazy just because they're experiencing TMS symptoms.

From the time we're born, we are subject to conditioning. As babies, we're young and helpless, and we know that we need to rely on our parents for survival. So to protect ourselves, we try to adjust our behavior to please the adults that are taking care of us. It doesn't take us long to figure out that some behavior is rewarded by our parents with love and praise, and other behavior is frowned upon or punished. From this conditioning, we start developing beliefs about the world. We come to believe that "good" children behave a certain way, and "bad" children behave in another way.

Over the years, in accordance with our beliefs about good and bad people, we create a long list of requirements for ourselves. If we have a belief that a good kid only gets straight A's in school, then we have to get straight A's. If we believe that fat people aren't as good as thin people, then we have to be thin. We typically put a lot of pressure on ourselves--we need to be successful at work, to have an attractive body, to drive an impressive car, to be an ideal spouse, and to raise a smart, well-behaved child. Underneath those behaviors, there's a low-grade fear of not being good enough. We're afraid that if we're not meeting all our requirements, then we won't be accepted or loved. We're afraid other people will reject us, because they'll discover how gross and flawed we really are. And even though we may intellectually understand that this is silly, we all still believe it deep down in our guts because that's what we've been believing all our lives.

When we're in our comfort zone--when it feels like we're measuring up--things seem OK. But inevitably, situations arise that make us feel like we're not quite living up to expectations. Say, for example, that I'm a new mother. I love the baby with all my heart, but since the baby's been born, I haven't had a decent night's sleep. My husband and I don't get to spend any time alone together. My mother-in-law keeps dropping by the house. I don't have time to hang out with friends. I miss my work, and I miss interacting with adults. Deep down, I resent the baby for making my life so different and so difficult. It's really not bad to have those thoughts because they're just thoughts. But let's say I have a belief that a good mother would never resent her baby. I might not even be consciously aware of this belief--this may be something that I picked up at a very young age and I have just always believed it to be true. But now I think that if I admit to myself or anyone else that I resent my baby, I'm basically admitting that I'm a horrible, selfish mother. And the thought of being considered a bad mother is completely unacceptable. I don't want anything to do with that thought, and I'll do anything to avoid it.

Distractions come in a variety of flavors, and here are just a few examples:

TMS is actually our brain and body's way of helping us out. It's a way of taking attention away from the ick feelings and directing it toward a physical pain. Through the autonomic nervous system, the brain initiates physiological changes, and painful symptoms develop soon after. And usually the symptoms are so painful and distressing that it's impossible to focus on anything else, including the feelings of inadequacy. Of course no one wants to be in physical pain. But on a deep-down unconscious level, we usually believe that it's easier (and certainly more socially acceptable) to deal with physical pain than it is to experience the horrible feelings of unworthiness. This is a very important point to understand about TMS--the pain serves a purpose. It works as a distraction.

A common response to this explanation is "But this doesn't apply to me because I'm not upset about anything." Or "Maybe some people have emotionally-induced pain, but my pain is caused by a real medical condition. The doctor said so."

I'll address that last comment first. It's certainly possible that the pain is being caused by a serious medical condition, like a tumor or an infection, so it's very important for anyone with serious pain to be examined by a physician. However, many structural abnormalities (such as herniated discs or muscular imbalances) are mistakenly blamed for pain that is actually emotionally-induced. I'll talk about that more in Stage 2.

And back to the "I'm not upset about anything" response. Human beings are very good at finding ways to avoid discomfort. So good, in fact, we often don't even realize that's what we're doing. At the risk of sounding like a know-it-all, most people have no idea how angry and/or scared they really are. After watching the TMS pattern in myself and my clients for many years, I've learned something. If a person's immediate reaction is "I'm not upset about anything," it means one of two things: a) they know what's bothering them, and they just don't want to talk about it with me or b) it's something too uncomfortable to even admit to themselves.

Dr. Sarno makes an important point in his books--the feelings that trigger TMS symptoms are not conscious, perceived feelings of anger or fear. The troublemakers are the ick feelings that are simmering below the surface, which is why they're so hard to pinpoint. Say, for example, that my boss criticizes me at work. I'm fully aware that I'm angry about being criticized. But there may be other feelings underneath that anger. Perhaps I'm afraid that my boss is actually right, and that I'm really not doing a good enough job. Or perhaps I'm afraid that my opinions aren't being taken seriously. Or maybe I'm ashamed that I can't handle a little criticism without getting upset. These subtle feelings of "not being good enough" are the ones that need our attention.

Even happy events can trigger TMS symptoms because they can also create feelings of pressure and fear. For example, a wedding is a wonderful event, but it comes with all kinds of expectations--the dress has to be perfect, the ceremony needs to be perfect, the guests all need to have a great time. And once again, it's the fear of not meeting expectations that initiates the TMS process.

Understanding how we try to avoid feeling unworthy is crucial to curing TMS symptoms because this avoidance is what starts the whole syndrome. To eliminate TMS symptoms, the sufferer needs to become aware of the very feelings he's trying to avoid. And he needs to know--deep down in his gut, not just intellectually--that it's completely OK to experience those feelings. I'll talk about this more in the How to Cure TMS section, but for now I want to emphasize the fact that the sufferer doesn't need to eliminate stress from his life, nor does he need to learn how to "manage" stress through relaxation or breathing techniques. He simply needs to identify and experience the feelings he's trying to avoid.

And once again--you're not crazy or mentally unstable if you are suffering from TMS. All human beings are products of conditioning, we all want to avoid discomfort, and we all develop some type of TMS symptoms at some point in our lives. And there's certainly no need to feel ashamed or to blame yourself for developing symptoms. I'm rather surprised at the number of people I've met who believe that Dr. Sarno is "blaming the patient." He's not doing that at all, and neither am I. Anyway, I'll talk about that a bit more in Stage 4.

On to Stage 2.

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