25 Mar The Story Behind The Story
On Tuesday I got a steady stream of emails about a new study that found that mindfulness meditation is a more effective treatment for back pain than either cognitive behavioral therapy or standard care (physical therapy, pain medication, etc). The people writing to me were all aware of the film about Dr. John Sarno that we have been working on for well over a decade. When I clicked on one of the links, to a NY Times article, I noticed right away that the vast majority of the comments contained mentions of Dr. Sarno. Here are the two of the first three comments.
“I’m not surprised by this result. I suffered with debilitating lower-back pain for 20 years starting around age 26, losing 5-8 days of work per year due to it. Twenty years ago I read Dr. John E. Sarno’s Mind Over Back Pain; three weeks later I was pain-free and have not had serious back pain since — occasional stiffness, yes, but the chronic immobilizing pain was gone for good. ……” – Viseguy
“Dr. John Sarno has been writing about this very method for some time. His methods were an absolute Godsend to me after an attack of lower-back pain in 1999. In our insane racket that we like to call ‘health care’ there is no bigger scam than back surgery.”- George S.
Ironically, while Dr. Sarno is a proponent of mindbody based medicine meditation was never a big part of his program. Instead, his focus has been on simply helping patients become aware of the power of the mind body connection. Calming the mind is important and helpful, but without understanding that the genesis of the pain is emotionally based the power of meditation in regards to solving the problem is limited. As Dr. Sarno states at the beginning of the film, “Everyone is under the impression – and they are being encouraged by the medical profession – to think that there is some structural abnormality responsible for pain. When in reality, the tremendous paradox is that the most important reason statistically for pain that people have is what’s going on in their lives, the pressures that they put themselves under. Once you are aware of the nature of this then it ceases to exist which is really a wonderful thing to think about.” Awareness of the true cause is the most important piece of the puzzle.
During the ’60’s and early ’70’s, Dr. Sarno practiced the standard care that he had been taught – physical therapy, bed rest, hot packs, exercises etc. – but found that the treatments were not significantly helping his patients. When he studied their charts, he found that a very high percentage of these patients had a history of other psychosomatic illnesses like migraines, eczema, and colitis. He then looked at the research and found that there were a number of studies done in the ’30’s and ’40’s that pointed toward suppressed rage as a major driver of psychosomatic illness. Once he began to talk to patients and help them to make the connection between their pain and what was going on in their lives, they began to get better. Over time, he developed an extremely effective program and practice that involved examining patients to rule out any structural problem like a broken bone or a tumor. Over time, he found the diagnosis of a disc herniation rarely correlated with the exact site of a patient’s pain and he came to argue that the disc herniation was not the cause. He was ridiculed by his colleagues for this point of view. However, there are now dozens of studies that support his perspective, and the AMA currently recommends that doctors avoid doing MRI’s for non-specific back pain, because of this spurious connection.
Dr. Sarno retired in 2012 but when he was practicing, after ruling out a structural cause of the pain, Dr. Sarno had his patients attend lectures which explained the mind body connection, presented evidence that refuted standard assumptions about pain, and gave patients a framework by which to understand their problems from an emotional perspective. He also conducted optional small group meetings for patients as well as convened a panel of former patients to tell their stories so that others might see a pathway toward healing. While this treatment method might strike some as “new-agey,” Dr. Sarno would bristle at the idea that his treatment was in any way “alternative”. Instead, he argued that other doctors were dealing with an incorrect diagnosis. As he said, “I consider that I practice very conservative, standard medicine. While my theories may involve the unconscious, that doesn’t make them any the less rigorous.” Again, studies on the efficacy of MRI use support his contention that in the majority of back pain cases, the problem is not structural but instead it is emotionally-based.
I first heard about Dr. Sarno in the 1980’s when he began to publish a series of books aimed at patients. Despite the fact that there was no marketing or press for the books, they became best sellers via word of mouth. My father, a psychologist, was given Dr. Sarno’s first book “Mind Over Back Pain” by a colleague. He had a rapid and profound recovery from years of “whiplash” pain (our whole family was in a 10 mile an hour fender bender that resulted in years of pain for my father but no injuries to anyone else). Despite his frugality, he bought a pile of books to have on hand for anyone who had back pain. When I was in my early 20’s, I read the book, recognized how my emotional repression was involved in my pain, and was able to banish recurrent back pain for a decade. When the pressures of parenthood, career, and home ownership piled up on me, my pain came back with a fury and I went to see Dr. Sarno in 2004. At the time, the pain was so excruciating that I needed four Vicodin in order to relax enough to be carried to my car. I know what back pain is. I also knew that my pain had emotional as well as physical attributes. Knowing this didn’t stop the pain spiral from overwhelming me, but it did give me a pathway towards healing. For the past half century, the medical system has ignored the emotional and concentrated solely on the physical. The result is a chronic pain epidemic that dwarfs most other medical costs combined.
Shortly after going to see Dr. Sarno in 2004, my pain began to subside and we began to work with him on a documentary. In the first 3 years, we faced a lot of resistance and hit innumerable road-blocks as we tried to get the project going. Not only did we have no success in finding funding, we also had trouble figuring out how to film patients. Medical documentaries are fraught with ethical dilemmas. In addition, there was such extreme skepticism about Dr. Sarno’s idea that the mind could cause pain that when we were pitching the documentary, or even talking about it to people who did not have a direct experience with his work, we faced profound opposition- and often anger. We didn’t give up, but the project fell into a holding pattern and got pushed to the back burner.
Problems with pain are not only psychological and emotional, but also cultural. When our cultural perspective precludes us from feeling or expressing our true emotions, we lose connection with them. Mindfulness meditation is aimed at re-connecting us with what we feel and this processing of our emotions clearly helps with back pain. However, when we combine this self awareness with the understanding that the true cause of the pain is emotional repression – rather than structural abnormality – the power of the brain to end the pain is enormous. Fifteen years ago, the culture was not ready to embrace these ideas. However it’s clear from the comments section of the New York Times article that the culture has shifted.
While I have often struggled with pain issues, my own experiences (as well as those of my family and friends) has shown me that Dr. Sarno’s ideas work. Still, it bothered me that I had not been able to fully get over my own issues. When his patients didn’t get better, he suggested they see one of the therapists that he worked closely with. I avoided this route for a long time, largely because my father was a psychologist. Eventually, I went to see Dr. Arlene Fienblatt, the first psychotherapist who worked with Dr. Sarno. I only went a few times, but that’s all it took for her to help to put me on a better path of understanding my own pain patterns. While meditation was not a major part of Dr. Sarno’s treatment plan (he focused more on journaling in order to get to the bottom of one’s emotions), I have found that it has been immeasurably helpful to me. However, I think it is important that meditation be combined with Dr. Sarno’s method of embracing the understanding that emotions, rather than a physical abnormality, are most often the true cause of the pain. He found that if patients held on to any belief at all that the cause of the pain was physical, they had more difficulty overcoming it. While some of his patients have had seemingly miraculous cures from reading his books or visiting him in his office, my path was much longer and more winding (everyone is different). However, each day I move further away from my pain.
Part of the reason that it has taken us so long to make our film is that in some sense, it was hard to finish until I had been cured. While I know that pain is a part of life, we are almost done with the film, and I believe that I am almost healed.