19 Feb Jonah Lehrer and Story of Pain

Last week I wrote several pieces in response to the reaction to Jonah Lehrer’s apology speech.  I published one, the second that I wrote, on my blog last week.  This is the first piece that I wrote. I was told by others that it was too related to our own work to post elsewhere.  As such I combined parts of this piece and the other to make a more focused article.  I thought though, that the connection between our work and Mr. Lehrer’s was very relevant to the production of our newest film and have decided to post it here.

I am a fan of Jonah Lehrer’s writing.  While he made some unfortunate decisions, most notably, the forging of 5 Bob Dylan quotes, it is undeniable that he is a great storyteller.  He synthesizes ideas in ways that consistently and cogently challenge accepted paradigms and orthodoxies.  I first came upon Lehrer’s writing about a year ago when I read, “Why Science is Failing Us” in Wired.  The article directly related to our film, “Story of Pain”, that we have been working on for nearly 10 years.  The film deals with the relationship between stress and health, and focuses in on Dr. John E. Sarno.

For several decades Dr. Sarno has argued that herniated discs cannot be responsible for the vast majority of back pain that is attributed to them.  In addition to treating paitents since the early 1950’s Dr. Sarno has written a number of popular books that deal with the relationship between emotions and pain.  While his books are wildly popular, he has largely been ignored by the mainstream medical system as well as by journalists.  Dr. Sarno believes that the pain epidemic in America, which cost over 636 Billion dollars in the United States in 2012 – more than cancer, diabetes, and heart disease combined – is largely driven by stress and repressed emotions.  It is precisely because of the fact that it is being treated almost entirely as a structural or physical problem that the epidemic is growing so rapidly.  Mr. Lehrer’s article connected with our work on several levels.  Firstly, it focused on the way in which humans have a tendency to “tell a story” about the things that we see. Those stories also tend to be shaped by what we are looking for, and we unconsciously ignore details that don’t support that story.  Secondly, the article focused on data about back pain that supports what Dr. Sarno has been saying for 40 years.  I was elated to see that someone in the mainstream press world had looked behind the frame that we dealing with.

When MRIs came into use, people saw disc herniation and assumed that this was the cause of their pain.  No one bothered to test this hypothesis and they simply started doing surgeries.  Meanwhile, Dr. Sarno checked MRIs for possible tumors, but he firmly rejected the diagnoses that patients brought in from other doctors.  Dr. Sarno noted that the connections between the pain that people felt and disc abnormalities they had rarely matched up.  He found that people who resisted the idea that their emotions could be the cause of the pain wouldn’t improve as much.  It became increasingly clear to him that the mind and the body were intimately connected.

Despite multiple studies that show NO causal correlation between the existence of a herniated disc and back pain, and not a single study that shows one, the use of MRIs and surgeries continue to increase.  Every six months or so another article comes out in the mainstream media about a new study that confirms what Dr. Sarno knew to be true.  These articles are basically blips on the radar that do not change the behavior of doctors or patients.

Mr. Lehrer’s article was clear and direct.

“The only solution for this mental flaw is to deliberately ignore a wealth of facts, even when the facts seem relevant.  This is what’s happening with the treatment of back pain: Doctors are now encouraged to not order MRIs when making diagnoses.  The latest clinical guidelines issued by the American College of Physicians and the American Pain Society strongly recommended that doctors ‘not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain.”

Unfortunately, the medical system hasn’t really changed its behavior as evidenced by the increase in spending on back pain care including MRIs, surgery, and steroid shots that are no better than a placebo (and which can be deadly as we saw last fall with the epidural-induced meningitis outbreak).

As outsiders to both science and journalism we have been staggered by the lack of response to clear data that refute many common medical practices.  Every now and then we will come across an article or speaker who takes on the dominant paradigms, but they are often marginalized or discredited.  This is especially true if they speak in a language that challenges the absolute validity of scientific data.  If the article is in a mainstream publication, it usually has a he said/she said slant that dilutes the challenge to dominant thinking.  People challenge power at their peril.  However, in the 10 years that we have been working on the film we have seen an increasing number of people willing to explore the complex relationship between the mind and body.

What makes Jonah Lehrer’s article more powerful than most is that he ties the failure of the medical industry to respond to this data into larger patterns of behavior.  The article was a revelation to me.  It was the first time I had found a voice in the media that seemed to be saying the same thing that we were trying to capture in our film.  Those who are invested emotionally, financially, and intellectually in an idea are not likely to see or believe data that doesn’t support their beliefs, and they are quick to seize upon data that does.  From our own personal experience, as well as the testimony of thousands of devoted believers and fans, it was clear that Dr. Sarno was on to something powerful.  However, despite his credentials and history, not only was he ignored by his colleagues, he was actively disparaged by them.  In the only major media piece about Dr. Sarno, John Stossel interviewed a surgeon for a 20/20 story who compared seeking treatment from Dr. Sarno as effective as “going to a cemetery and swinging a cat around your head”.

Our newest film, while largely about Dr. Sarno, is also a film about mindbody medicine (many people now write it as a single word to emphasize its singularity).  As such it is also about how we perceive and react to the world around us.  Jonah Lehrer has written extensively about this issue and communicates his ideas with much more clarity than anyone else I have read. The incredibly complex interaction between mind and body is often examined as a dualistic system rather than the inherently interconnected system that it is.  The complexity of this interaction makes it difficult to study for pretty much the exact reasons Mr. Lehrer wrote about in his wired article.  In order to run a study that will get funding, one needs to limit factors of the study in order to get repeatable results.  This means that when scientists want to do a study, they try to isolate the variables as much as possible.  However in the real world, a myriad of variables affect outcomes.  As such, data captured in this way is inherently flawed.  Yet it is only this kind of data that has “value”, especially to those who rely on data for their income and careers.  This disconnect between inherent complexity and the need for clarity is precisely the reason that science, and I would argue journalism, has inherent limitations, especially when taken in isolation.  When writers report on a press conference and confine their article to the subject of the event they allow the subject to frame the issue.

In general, as a society, we don’t pursue knowledge as much as we pursue profits.  The hunt for the repeatable, the patentable, the marketable, and the profitable have a direct affect on decision-making.  But, we blind ourselves to the somewhat invisible frames of capitalism that define us.  We do not live in a world of pure motives and thoughts, yet we rely on our organizational structures to create the appearance of truth, justice, and fairness.

In the last year, I have read all three of Jonah Lehrer’s books, and all three do a great job of challenging the subtle frames that shape our perception of the world.  I do not view myself through the frame of a journalist, a scientist, or a “documentary” filmmaker.  I am an artist who works with film, and I believe that the role of the artist is to challenge oneself and the audience to look past frames.  As such, I found Lehrer’s first book, “Proust was a Neuroscientist,” to be his most powerful.  As the book details the ways in which artists have been able to look past the scientific frames of their day to discover truth that science only came to discover years later, it also subtly challenges the science of today.  In this case, the artist (Mr. Lehrer), working as a writer, subtly makes it clear that we want so desperately to believe we have figured out the world’s mysteries that we blind ourselves to the greater truths that surround us.  His work has helped me to see these hidden frames more clearly.

The connection between the text of “Proust was a Neuroscientist” and Dr. Sarno and his work is profound.  When Dr. Sarno was a young man he had to decide between a career in music or medicine.  While he had an affinity for science he was constantly looking for creative solutions to problems.  A quiet innovator, Sarno started the first group practice in NY state because he believed that the exchange of ideas between doctors in different fields was important.  When the standard care for back pain that he had been taught did not yield results he pored over his patient’s charts searching for answers.  Like his literary hero, Sherlock Holmes, he knew that he must be missing an essential clue that would make itself known.  In a moment of insight he saw that 80% of his patients with pain problems had a history of psychosomatic illness like ulcers, colitis, and migraines.  He started to talk to patients about what was going on in their lives and found that when they could see a connection between their pain and their stress they started to improve.

This wasn’t rocket science, but it worked.  In fact it worked precisely because it was simple and understandable and it gave patients the room, and a reason, to acknowledge their less conscious feelings.  Over the years he continued to develop his treatment methodology, but he also kept it simple.  For the most part he had to contend with societally created ideas about health and welfare; as well as a societal tendency to frown upon the expression of emotions.  While he had increasingly positive results with his patients, his books also proved to be wildly successful.  He was adamant about the idea that he was not practicing alternative medicine, yet it is only the vanguard of integrative medicine, people like Dr. Andrew Weil and Gabor Mate who have embraced his approach.

Dr. Sarno’s creative approach and insights make him the kind of character that Jonah Lehrer would write about, and indeed he has. It is writers like Lehrer who act as the bees in our information ecosystem, patiently connecting the dots so that we might get the benefits of science.  His creative insights have helped me to understand Dr. Sarno’s work with more clarity. Based on the response to his speech yesterday, it was clear that the community of journalists that write about science think he should be banished from our society.  I read most of his books after his fall from grace.  I still found the insights to be powerful.