Sarno has written a series of books in which he sets out his theory. Sarno believes that most back pain stems from emotional factors. Not only back pain in fact, but also most common presentations of pain in general, as well as a range of other symptoms and disorders. According to his theory, the brain produces symptoms "to keep one's attention focused on one's body" in order to protect the person from psychological distress. He attributes the potential for such distress mainly to a "reservoir of rage" left over from childhood: "There's a leftover child in all of us that doesn't want to be put under pressure, and indeed it can get very, very angry." This anger can spill out years later in adulthood because "the unconscious has no sense of time". The risk is all the greater if one has suffered a traumatic childhood. Self-demanding personalities (e.g. perfectionist) are particularly susceptible due to the self-imposed pressures they place on one. A third factor is ordinary everyday stress. Sarno has a somewhat outdated name for his "diagnosis" - Tension Myositis Syndrome - and a hypothesis about the mechanism of pain production: tissue oxygen deprivation from altered blood flow to an area.
The postulated pathophysiological mechanism is of some osteopathic interest, because it is exactly this which the latter also postulated as the main pathophysiological initiator of disease processes. Nevertheless, Sarno is at pains to emphasise that the actual physical mechanism involved is not the fundamental part of his theory: the important thing is that, however the pain symptom is physically produced, the primary cause is not physical, but emotional.
I have said I have considerable sympathy for Sarno's view. This is because my clinical observations, my studies, and my reasoning all point to a significant psychological component to a lot of the pain patients present with at my practice. Moreover, Sarno is dead right when he says that while patients' pain is usually attributed to any pathological phenomena found on x-rays and scans, in actual fact such findings are often just coincidental rather than being of any great clinical significance. He is also right when he states that conventional medical treatments perform poorly with most kinds of musculoskeletal pain.
Yet, while thinking outside the orthodox box, Sarno is ensnared by the same important fallacy that also ensnares much of orthodox medicine, and which ensnared early osteopathic thought, too. This is the fallacy that identifies a single kind of cause and draws straight lines between that cause and all ailments:
- Orthodox medicine looks for "the cause" of all symptoms in identifiable physical pathology.
- Early osteopathy looks for "the cause" of all symptoms in mechanical disorder of the body.
- Sarno looks for "the cause" of all symptoms in his reservoir of rage.
In those circumstances, to take any one of those factors and then to say, "That is the cause of your pain", and further, "That thing must be the cause of all pain" seems to me to be a rather unrealistic and unsophisticated style of thought. The more one attempts to describe complexity in straight lines the more one's understanding becomes boxed in.
- An Expert Interview With Dr. John Sarno, Part I: Back Pain Is a State of Mind. www.medscape.com 7 June 2004
- An Expert Interview With Dr. John Sarno, Part II: Pain Management Prophet or Pariah? www.medscape.com 14 June 2004