13 Apr Crooked
Cathryn J Ramin’s heavily researched look at the back pain industry, “Crooked: Outwitting the Back Pain Industry and Getting On the Road to Recovery“, is painfully satisfying to read – especially for people who have struggled with back pain and the surgeons, pushers, and needle jockeys that profit from it. Ramin’s book is framed by her personal journey to heal from back pain. Along the way, she sees mainly experts who confront the physical aspects of the issue. For those who understand the relationship between the mind and the body, this makes the book feel a bit like a horror story in which the reader knows that the killer is in the closet. Ultimately though, Ramin recognizes the power of the mind body connection and finds a balance between dealing with the physical aspects of her situation and the emotional ones.
While there are a lot of similarities between Ramin’s process – both personal and professional – and the process that we went through making our film All The Rage, books are very different than films. As an audience, we process written information differently than we do visual information. When constructing a film, we have to be aware of how people process information in real time. To that end, as filmmakers we didn’t go too deeply into the weeds of pain research in the film. Fortunately, as a writer Cathryn did that work to great effect, and put together a back pain expose that provides the written ammunition to back up everything our film subtly argues. In this regard it’s a perfect companion piece to “All The Rage”. It is our hope that viewers who need the facts will turn to the book, and readers who want a more immersive, emotional, and visual complement to the book will turn to the film.
As we worked on All The Rage, we held countless small group screenings to get feedback. Early in the process, we heard from both fans of Dr Sarno and skeptics that they wanted more information about how and why his ideas were important. At that point, we had not developed the emotional foundation of the film, and we reacted to these suggestions by putting in more talking heads and more data. What we found, though, was that this information only made the skeptics more skeptical and it failed to engage the people who already believed in the idea that the mind and body are intricately linked. It was a boring, bloated mess. We stripped out as much of the information as we could and re-focused on telling the story from a more personal perspective. It then began succeeding as a film.
As stated above, Ramin took a personal approach to her story and worked on her book for almost as long as we worked on our film. For anyone who has experienced pain, “Crooked” will be a frustrating read- but only because it confirms so much of we know. On page after page, the book lays bare the failings of the back pain industry, and the blindness with which it has approached the relationship between the emotions and health. “Crooked” is broken into two parts: problems and solutions. While the book offers some strong solutions – including a chapter on Dr. Sarno – there are twice as many chapters focused on the problems.
From the beginning of her pain journey, Ramin’s doctors focused on the physical aspects of what was going on and offered physical therapy, pain killers, and surgery. It’s clear from the book that there was very little discussion about what was going on in her life that might be contributing to the issues. None of the less-invasive treatments helped, and ultimately Ramin went forward with a “minimally-invasive” laser spine surgery. This is probably the most interesting chapter of the book because it is the most personal one, but it’s also the most frustrating to read. The results were not good. In her research, Ramin found that this is generally the case. Maddeningly, the “success” of spine surgery is measured in how well the action was performed – i.e. did the vertebrae fuse properly or was the tissue removed – not how well is the patient faring 6 months or a year down the line.
While my path to healing was somewhat similar, I had the benefit of knowing about Dr. Sarno when my terrible pain first hit back in 2003. As is detailed in the film, my father first read Dr. Sarno’s book in the early ’80’s and was saved from terrible whiplash pain. When my brother had hand problems in the early 90’s, he went to see Dr. Sarno and had a somewhat miraculous recovery. At that point I read Dr. Sarno’s book and banished my own recurrent bouts of back pain for a decade. Then my pain came back in 2003, and my wife urged me to go to the doctor. Our primary care doctor he pooh-poohed Dr. Sarno’s theories and sent me to physical therapy. At the time, I was in my mid-30’s with a two-year-old and in a very difficult situation career-wise (i.e. making good work but making no money) and I knew that my pain was related to the emotions surrounding these realities. However, as much as I tried to focus on the emotional, the physical aspects of the pain kept getting worse. I remember being especially frustrated at the doctor’s office because not only did he dismiss my contention that the pain had an emotional cause, he was also incredibly dismissive of my work. At the time I also attributed the pain to the intense amount of time and physical effort that I was putting in on a project documenting a communities fight against eminent domain that was being used to take their homes for a basketball arena. Having worked on the project for 6 months at that point, I knew a great deal about the corruption and malfeasance that was going on. The doctor lived just outside the project site and insisted that it was good because it would bring more business to the area and presumably boost his property values. I don’t know why I didn’t just storm out of his office right then. Instead, I went to the physical therapy which didn’t help at all. In fact, it got worse and worse until I was left screaming on the floor unable to move. Finally, I made it to Dr. Sarno’s office and began a long, slow road to recovery. So, we began to make a film about Dr. Sarno and his work.
At the time, the back pain industry was in a bull run. In 2001, chronic pain cost the US economy 210 billion dollars a year. By 2012, that number had grown to 636 billion. That increase is nothing short of shocking, and the reasons for it are detailed in “Crooked”. Ramin’s journey to recovery is long, arduous, and filled with mountains of research proving that almost all of the physical treatments for back pain have inconclusive or negative outcomes. This is what ultimately makes the book so difficult to read. For those of us who know the story, it’s like a horror film in which there are no surprises but plenty of carnage. This is not meant as a criticism of the book, but instead of our culture and the medical industry. The book is important, necessary, and a powerful tool that can be used to drive a conversation about where we went wrong and what we can do to make things right.