Bests & Worsts Reviews from Amazon

Let's face it: modern medicine doesn't quite have a handle on the nature of pain and its biochemical, psychological and physiological origins. The treatment of spinal pain, particularly the chronic variety, is one of medicine's most vexing problems. Even for the mildly afflicted, it is one of those alarming conditions that tends to rear its ugly head from time to time. About 80 percent of the population will experience back pain at one time or another and it is a leading cause of disability. What is lesser appreciated is this: Long-term studies designed to compare outcomes for back pain sufferers who undergo conservative, non-surgical treatment vs. invasive spinal surgery reveal that pain and disability levels on the whole are a lot more similar a decade or so later than not. All too often, spinal surgery fails to offer a permanent cure. Doing little or nothing at all may also result in a remission of symptoms. Except that hasn't been my experience. I have suffered constant, injury-related spinal pain for 14 years. I have the diagnostic tests to confirm my back pain's "discogenic" origin. I have owned Dr. Sarno's book "Healing Back Pain" for more than half as long as I've suffered. Recently I began to reread it. It still makes me as incensed as it ever did. Only this time I'm here to explain why. (And please bear with the fact that this is my experience/opinion --- each is entitled to his or her own.) Dr. Sarno's thesis is at turns fascinating and frustrating. It is fascinating in that so many people find relief from simply reading a book that in four words and broad strokes argues "It's in your head". It's useful in that it aims to convince readers who might otherwise live in fear of triggering a flare-up to go on and live life. It's frustrating in that Dr. Sarno, in encouraging a return to normal activity, fails to take credit for what amounts to a very conventional (and credible) approach: Becoming more active is the common denominator to many successful back pain reduction methods! It's ironic in that Dr. Sarno, while mentioning "body" in the title, really doesn't take much stock in the body at all. To the average person, the word "body" conveys a physical, biochemical system, but in Dr. Sarno's world only the mind matters in the quest to alleviate back pain. It is frustrating, finally, in that many of Dr. Sarno's claims pertaining to what medical science does or doesn't validate are outdated; his first book came out in 1984 and his medical training took place 40+ years ago. Consequently, his theories deny more current thought on the role of inflammation in many disease processes: The Anti-Inflammation Zone: Reversing the Silent Epidemic That's Destroying Our Health (Zone (Regan)). In cases of severe nerve compression or unresolved joint damage (arthritis), tissues tend to hurt -- to what extent or for how long is the question. Pain may be a product of a stress-prone "personality structure", as the doctor argues, but to what degree it may also be a matter of environment, genetics, toxins and one's general health he doesn't address. The answer will no doubt vary according to individual, yet Dr. Sarno rejects the everyone-as-an-individual-case out of hand. He argues that psychological stress triggers a physiological reaction in which oxygen deprivation in the tissues forms the basis for what the doctor has coined "Tension Myositis Syndrome" or TMS. While the oxygen deprivation hypothesis is compelling, without further research Dr. Sarno cannot make an argument in support of his TMS thesis any more than he can disprove competing explanations or treatments on the basis of inadequate evidence. There are still too many unknowns in medicine -- and the understanding of pain in particular -- to issue iron-clad pronouncements about what is or is not to blame. Dr. Sarno's book is heavily influenced by Freudian thought, minus the license to practice psychiatric medicine. The work relies largely on anecdotal observations wherein back-pain patients who endure an acute period of crisis or stress manage to "hold it together" only to suffer a dramatic pain episode after the fact. He writes of individuals who try to relax on vacation only to end up experiencing severe pain at the very moment they ought to feel footloose and carefree -- and then attributes his interpretation of cause-and-effect to an "overly-conscientious nature". Perhaps so, but the theory needs fleshing out and to my knowledge Dr. Sarno hasn't published the research and for that reason has yet to persuade the mainstream medical community to embrace TMS as a disorder. Let's take Dr. Sarno's contention that nice people -- the overly-conscientious in his vernacular -- tend to suffer more numerous or persistent forms of pain and discomfort. By inference, those with narcissistic personalities, were they to be studied, should report the most feelings of physical well-being for they are less concerned about making friends and influencing people (or what others may think of them, in any case). Indeed, this would be an interesting psychological study: Do certain personalities experience less pain? Unfortunately, nowhere does Dr. Sarno indicate that such a study has validated his thesis that "personality structure" (quoting his words) is more influential than physiology in the perception of pain. The doctor postulates that repressed anger, specifically, is at the root of all sorts of phenomena from knee, jaw and back pain to allergies, ulcers and migraines. He describes his own experience banishing migraine pain by recognizing it as symptom of repressed anger. Similarly, he has alleviated allergy to cats by acknowledging the sniffles as the mind's particular manifestation of weakness. Someone less charitable might chalk it up to "learned denial"; the problem remains but one is convinced beyond a shadow of a doubt to ignore it at all costs. Not that putting pain out of one's mind is a bad strategy -- providing it's not due to a deadly spinal tumor as another reviewer here reported -- but let's acknowledge it for what it is! Sans the occasional caveat about chest pain (could be the heart) and head pain (could be a brain tumor), Dr. Sarno's message comes down to a single claim: Acknowledge that pain is in the mind for this carries the power to release the mind from its devious plot to invoke physical symptoms to detract from subconscious mental processes (what Freud called "conversion disorder", otherwise known as hysteria). Is it a snake-oil cure? Not exactly. But a case of "too good to be true", it might. If chronic pain were straightforward, wouldn't a lot of us have figured it out already? Dr. Sarno highlights the medical mysteries associated with the origins of pain, pointing out that it is not uncommon for pain to fail to correspond to objective medical indicators like X-rays and CAT scans. Sarno omits the conventional neurological explanation for this phenomena -- that recent injury can trigger diffuse inflammation in adjacent tissues or that a ruptured disc can leak content into the spinal canal that can inflame otherwise healthy nearby nerves. Instead, the failure of an anatomical abnormality to account for or correspond to patients' reports of pain, Sarno concludes, means that pain must be the mind's way of attempting to distract us from something else -- perfectionism, compulsions and anger to name Sarno's "big three" emotional culprits. In Dr. Sarno's world, confusion over correlation and causation abound. If you buy this for a back problem, upon reading this you will also learn you have a psychiatric issue to boot! In the same era this book was originally published, recovered memory syndrome was all the rage with thousands of people laying claim to all sorts of repressed and buried atrocities from incest to Satanic cults. For some, such problems are all too real and psychological help is appropriate. And yet, for countless others, how many "healings" of the body have come about as the product of families and friendships split apart by an individual actively searching for a bigger, badder culprit to explain mundane physical and social problems? One of the testimonials printed in the last chapter comes from no less than a psychotherapist who says she looks forward to "healing" of sciatic pain even as she expresses her deepest appreciation to Dr. Sarno for helping her to uncover the real culprit: child sex abuse! Dr. Sarno might have opted to defer to mental health professionals but he doesn't. His book is very much geared toward the self-help reader, and he spells out his belief that all but the rare case is a DIY job. Therein lies the dangerous aspect of this book, all the more so for readers who are repressing deep, dark secrets! Personally, much of my experience departs from Dr. Sarno's many anecdotes. One of my worst episodes of low back pain -- enough to hospitalize me for three days with absolutely no use of my lower limbs -- occurred while I was in no way, shape or form attempting to repress anger while in the midst of a difficult situation. And yet, here comes Dr. Sarno in his insistence that the physical pain of TMS can be alleviated through emotional honesty: He writes, "I recall a woman with a persistent pain problem who lived with a very difficult brother. Despite pyschotherapy the pain continued. One day she told me that she had done an unusual thing; she had gotten furious at her brother, had shouted and ranted at him and stormed out of the house. And with that -- the pain disappeared." Now here's the kicker, even by Sarno's own admission: "Unfortunately, she could not maintain her strong posture and the pain returned". Seemingly it does not occur to Dr. Sarno that the above-described, or for that matter the soldiers studied in World War II who did not need heavy doses of morphine following serious battlefield injury -- another one of the doctor's cherry-picked examples -- might have another explanation? It's well known that powerful emotions, not unlike intense exercise, can trigger endorphins, oxytocin and adrenaline, among many other chemical states that alter mood and pain perception. It is likely that a biochemical state within the brain carries the power to interrupt or temporarily mask pain. The woman in the example, above, may not have been able to maintain her emotional resolve simply because the brain is unable to maintain a "biochemical high". Biochemical modification is one reason why antidepressants are sometimes used to control Fibromyalgia, among other chronic pain conditions: Meds of this type impact Serotonin and thus play a role in reducing pain in much the same way a powerful mood state or the powerful but temporary "fight or flight" response achieves a similar, performance-enhancing function. (Note that I am not endorsing any particular treatment, only referencing it as a point of contrast.) Early on in the book the doctor intimates that if pain were a result of age, degeneration in the joints and old injuries no one should be more miserable than those of advanced age -- and yet it is working-age people, he argues, who suffer most. Dr. Sarno observes that most chronic pain originates during the "age of responsibility" between 30-60. His logic goes like this: because one isn't really "old" yet -- never mind that for much of human history living beyond age 50 WAS considered old! -- age and injury-related physiology must not be as important as psychology! If the medical studies do, in fact, confirm that people between 30-60 are more likely to report pain than the elderly -- and I don't know that they do -- there's another potential explanation: Pain in the elderly, compared to the working-age adult, may be less appreciated because A) as one progresses further in life one might not expect to keep up the pace of a working-age person, meaning the older one becomes the less likely one is to seek or receive the treatments offered to or sought by younger people; B) the elderly -- and more notably their doctors -- buy into society's expectation that pain is inevitable, as in "You're old. What did you expect?" Indeed, why complain to one's doctor about what may be perceived as *normal for one's age*? Whatever the reason why the elderly allegedly feel better (or complain less) than working-age adults, Dr. Sarno should have no doubt who struggles more with pain as an age group in their day-to-day lives. One need only observe who is more apt to undergo a hip or knee replacement, buy a walker or install bars in the shower -- stiffness, weakness, immobility -- it entails pain! (Which is why, despite enduring 14 years of pain, I, for one, am not about to visit an old folks home to profess a worse predicament!) None of this is to say that Dr. Sarno isn't on to something. He's on to the fact that the mind is a very powerful tool. He understands that fear, anxiety and tension is only going to exacerbate "weak" areas of the body (and he admits he doesn't know why they are weak). Indeed, the depression that can accompany incapacitating pain is very real and the fear of returning to normal activity is frequently a handicap in and of itself. Even so, the doctor's hypothesis invokes the old chicken-or-the-egg, correlation vs. causation conundrum. Is a negative state of mind the primary cause of discomfort or is depression -- aka "anger turned inward" -- the byproduct of declining health, which may exhaust one's physical reserves and increasingly put to test one's coping skills? In the end, Dr. Sarno's entire work pushes the limits of over-generalization and his anecdotes-as-evidence read like a classic case of confirmation bias. One might think the doctor's psychosomatic label would strike more readers than not as patently patronizing. So why is his book so highly regarded? For the same reason, I suspect, nearly *all* books and DVDs purporting to help people with back pain are highly rated: HOPE IS EMPOWERING. False hope, on the other hand, is no placebo. It's a bitter pill to swallow. And yes, that's my beef! Dr. Sarno's solution, in a nutshell, is this: Publish a work arguing that bodily pain is the physical manifestation of a repressed mind, market it to "type A" personalities who must feel they are in the driver's seat at all times -- with the turn of a page one can will pain away! -- sit back and hope that self-hypnosis, as conveyed through the pages of this book, kicks in to deliver the much-desired relief. Now don't get me wrong: If it works, more power to you! My main concern -- for which I post this review as a first-time "buyer beware" -- is that Dr. Sarno's work NOT become the basis for harsh judgments, pat answers and the "guilting" or shunning of people for whom it does not work. Yes, there is a mind-body connection to better appreciate in this and many other aspects of health. The problem with Dr. Sarno's take on TMS (pain) as a Freudian manifestation of conversion disorder is that in fixating on what is less-than-agreed-upon in medicine the book backfires on some of the very readers it is designed to reach. This triggers a left-brained, overly analytical or skeptical response rather than the "open minded" one the doctor's adherents claim is necessary! Worse, "Healing Back Pain: The Mind-Body Connection" is weak on solutions. Dr. Sarno spends the overwhelming majority of the book describing his psychosocial clinical observations while offering relatively few techniques to ward off full-fledged TMS. Instruction on meditation, stress reduction and body-awareness aren't provided because, in contrast to the title -- and this is absolutely key to understanding his approach -- the doctor would have his readers *ignore* the body state entirely. The mere realization that one is angry or overly conscientious IS the cure! With or without this book, studies show most cases of back pain will resolve. My own long-standing experience with chronic pain notwithstanding, back injury is not necessarily a life sentence. Proper body mechanics and a return to an active lifestyle will itself help to improve quality of life. There is no mental magic in that.