Not Necessary to Negate

07 Oct Not Necessary to Negate

“I have to say it’s ludicrous to suggest Dr Sarno is responsible for pain being viewed as biopsychosocial these days. This truly misrepresents the facts and the decades of scientific research culminating in this conclusion. Where was Dr Sarno when Melzack and Wall developed the gate control theory in 1965? That is factually when the idea of bio psychosocial came about.”- a Facebook comment by a professor of physical medicine and rehabilitation on a post regarding an article about Dr. Sarno.

Cathryn J Ramin, author of “Crooked: The Back Book” recently posted a Vox article that Julia Belluz published last week. While it is of course nice to see Dr Sarno written about, I found the article to be problematic because it led with skepticism and the title misrepresented his work. She also buried the lede. The last paragraph quotes him from the very end of our film:

At the end of the recent Sarno documentary, his fans from the “Thank You, Dr. Sarno” project present him with a book of people’s healing stories. Sarno says, “All of this because of one simple idea: the fact that the mind and the body are intimately connected. That’s it. That’s the whole story.”

Michael Galinsky, the maker of the documentary, told me this line from the documentary resonated. “While that might seem to be an obvious truth, the biotechnical approach to medicine essentially negates it in regards to practice,” Galinsky said. That’s now slowly shifting, but it took an unprecedented opioid epidemic — instead of a charismatic doctor — to spur change.

To me that line sums up the whole story. Currently our culture is so deeply rooted in a bio-technical understanding of the world that it is almost impossible for people to see the brain and the body as an interconnected system rather than separate entities. The Facebook post I quoted at the start of the piece dismisses the article for giving Dr Sarno too much credit; however, the article was weighted down with a similar bias, dismissing him for being charismatic rather than fully recognizing that he was right. While Melzack and Wall came up with a theory to describe how the brain and the body might interact, Sarno put a parallel idea into practice – one that was more cognizant of the complexity of emotions – and he had great success treating patients. However, anyone enmeshed in the world of science dismisses him as something of a charlatan because he didn’t play in their sandbox.

As we are all pretty much aware of now, we live in little isolated islands of truth (often on Facebook), and we stick to our belief in those truths even when we are presented with facts that paint a more complex picture. When the Vox article came out, I pointed out to the writer that the title “America’s most famous back pain doctor said pain is in your head. Thousands think he’s right”- was incorrect and misrepresented what Dr. Sarno believed.

Here is what I said, “I have one small suggestion, which is that you reconsider the title. I don’t believe that Dr. Sarno ever said, or even insinuated, that the pain was all in anyone’s head. Instead, he said that the process was initiated in the brain. The problem is that so many people take that to mean that the pain is not to be believed or or that it is not real.”

She replied, “We don’t agree with your interpretation of the headline, however, and the story is quite clear about his ideas, so we think it’s fine to leave.” The title is not just click-bait, it’s wrong. It would be one thing if Dr Sarno had adamantly argued that “pain is all in your head”. Instead, he adamantly argued that this is an oversimplification of what he described.

This is one of the reasons that Dr Sarno had difficulty interacting with other doctors. People have a tendency to hear what they already believe, and since none of the people he was interacting with could look outside of the bio-physical or bio-technical approach that was needed to embrace the simple complexity of what he was saying, Dr Sarno was dismissed out of hand. There are some people who gravitate towards a “science”-based view of the world, and there are others who chafe at the limiting constraints of this perspective. Many people who embrace a strictly “science” viewpoint reject out of hand anything that hasn’t been proven with a randomized control trial, calling it “woo” and deriding it. However, time and time again we have had to accept that this kind of hubris comes with risks of limiting our imagination and our understanding of the world in manners that we don’t fully comprehend.

The commenter quoted above exists within a science/medicine world -the same world that rejected Melzack and Wall for years. However, Melzack and Wall are now credited with establishing the Gate Control Theory of how pain is processed in the brain. As Melzak and Wall did research and worked within their field to push further scientific discussion, their ideas are more accepted than Dr Sarno’s. The commenter is correct that Melzak and Wall published their paper that dealt with how pain is perceived in the brain. Many who work in the field of pain do a cursory examination of what has been written about Sarno and dismiss him because he didn’t publish a great deal of science papers. However, they also miss a great deal. This piece sums up some of the connections between Sarno and Gate Control. On wikipedia their legacy is described as follows,

In 1968, three years after the introduction of the gate control theory, Ronald Melzack concluded that pain is a multidimensional complex with numerous sensory, affective, cognitive, and evaluative components. Melzack’s description has been adapted by the International Association for the Study of Pain in a contemporary definition of pain.[1] Despite flaws in its presentation of neural architecture, the theory of gate control is currently the only theory that most accurately accounts for the physical and psychological aspects of pain.[2]

The gate control theory attempted to end a century-old debate about whether pain is represented by specific neural elements (specificity theory) or by patterned activity (pattern theory) within a convergent somatosensory subsystem.[11] Although it is now considered to be oversimplified with flaws in the presentation of neural architecture, the gate control theory spurred many studies in pain research and significantly advanced our understanding of pain.[1]

I think it would be more than reasonable to give Melzack and Wall a great deal of credit for pushing the world of science to accept and embrace their theory. However, to do so while dismissing Dr. Sarno’s contribution doesn’t seem to be necessary. Gate Control certainly give doctors and scientists a framework within which they can discuss pain among themselves. However, I also think it’s fair to say that Dr Sarno was able to communicate these ideas with great effectiveness to patients through his clinical work, lectures, and books. I also believe that Dr Sarno, while perhaps not taking the same kind of research-oriented approach that Melzack and Wall did, had a more expansive intuitive and metaphorical understanding of the power of emotions.

While Melzack and Wall cracked open the door to a bio-psycho-social understanding of pain, Dr Sarno practiced and confirmed this approach over nearly 5 decades of patient-centered practice, working closely with therapists who dealt with many of his patients. While I think it is very reasonable for this commenter to suggest that Melzack and Wall should be credited for building a scientific case for how pain is perceived, it is not ludicrous that Dr Sarno should be given credit for successfully implementing somewhat parallel ideas into practice in a way that not only healed people, but also helped to ease their way into popular understanding.