The Mind-Body Connection to Chronic Pain and other Physical Symptoms
Updated: Sep 7
“Unconscious emotions are a potent factor in virtually all physical, non traumatic ills,” states Dr. Sarno in his book, “The Divided Mind.”
In 1991, Dr. Sarno published “Healing Back Pain”, a New York Times bestseller that was eventually translated into 20 languages. A quick browse through some of the thousands of amazon.com reviews and 4.5 rating shows that, although his theory at the time was controversial within the medical community, it proved immensely popular and ultimately therapeutic to many who suffered from chronic pain. There has since been much research that supports the mind-body pain relationship, but little implementation of that research into medical care.
I recently read Dr. Sarno’s last book (he passed in 2017), “The Divided Mind” and will try to summarize his powerful book below…
Dr. Sarno believed repressed emotions that lurk in the dark recesses of our unconscious mind could directly induce chronic pain symptoms, gastrointestinal conditions, skin disorders, depression, common headaches, dizziness, and tinnitus.
Further, he believed these unconscious emotions might play a fluctuating role along with genetics and environmental factors in other disorders such as autoimmune disorders and hypertension.
Dr. Sarno reinterpreted Freud’s body of work that identified the mind as composed of three separate identities/traits. The id (child-primitive), the ego and the superego.
The id (I’ll use the more descriptive term “child-primitive”) is the product of the ancient (paleomammalian) mind. Its characteristics are that of our primitive, non-social ancient ancestors. The child-primitive is self-centered, bestial, childish, narcissistic, irresponsible and wants to be dependent on others’ care. It inhabits only the unconscious mind; we have no conscious knowledge of the child-primitive’s state within us, yet it is considered the fundamental person inside each of us.
The ego and superego came later in the evolutionary timeline and are the product of the evolving mind as it adapted to the formation of social structures and to further the creation of society. They harbor our newer (neomammalian) brain and facilitate reason, higher intelligence, communication, and morality. Both have access to the unconscious and conscious mind.
The ego is considered the chief executive, the decision maker of the mind; its primary role is protector of the child-primitive. It interprets the outer world for the child-primitive and is rational and logical, but is also aware of the child-primitives demands and reactions.
The superego can be viewed as a moral compass of the mind. Further than just survival, it wants you to be successful and pushes for perfectionism and goodism. The ideals of the superego are in direct conflict with the needs of the child-primitive!
So why do we potentially suffer from chronic pain and other symptoms because of these three traits of the mind?
In short, the unconscious child-primitive harbors feelings of sadness, emotional pain, and rage. It wants to push these emotions into the conscious realm to be expressed, as would have been the norm in primitive times. The ego is aware of this urge for expression and wants to prevent the explosion of the sadness, pain, and rage into consciousness as it believes the pain and sadness would be too dangerous for the person to experience, or the rage to be too socially unacceptable to express. It chooses instead to repress these unconscious emotions by distracting the conscious mind with pain. It decides that physical pain is the less threatening option.
How do repressed emotions specifically cause pain?
The brain has two potential mechanisms, via “stimulation of specific brain nuclei, or by reducing the blood flow to particular muscles, nerves or tendons.” With considerations of findings in SensoriMotor Repatterning (SMR), I will later propose a third mechanism.
What causes unconscious emotional pain and rage?
”When conscious anger is suppressed it will become part of the reservoir of rage in the unconscious.” Further, the child-primitive has no concept of time. Pain is felt as strongly 30 years later in the unconscious as it was when the initial trauma first occurred. The reservoir of rage has been gradually added to through the passing of time and all that life throws at us. Below are some potential contributors to this reservoir of rage:
1. Physical, sexual, or emotional abuse causes large amounts of pain and sadness. Especially if anger was never permitted to be expressed.
2. Not receiving emotional support, enough warmth and love will result in anger, sorrow and pain.
3. Excessive discipline or unreasonable expectations by parents or caregivers.
4. “If you expect a great deal of yourself, if you drive yourself to be perfect, to achieve, to succeed, if you are your own severest critic, if you are very conscientious, these are likely to make you angry inside. Sensitivity to criticism and deep-down feelings of inferiority are common and also contribute to inner anger.”
5. “If you have a strong need to please people, to want them to like you, or if you tend to be very helpful to everyone and anyone, if you are the caretaker type and are always worrying about your family, friends, and relatives, these drives will also make you furious inside, because that’s the way the mind works. The child in our unconscious doesn’t care about anyone but itself and gets angry at the pressure to be perfect and good.”
6. We are all getting older and closer to death. Consciously, we rationalize the demise of our health and the nearing of our death; unconsciously, we are enraged by it.
7. The inner mind resents any kind of life pressure, thus pressures from your job; your spouse; your child, your parents etc can all further enrage the child-primitive and add to the reservoir of pain.
8. “Close personal relationships, no matter how good they are, are often the source of unconscious anger, because it’s very hard to be consciously angry at a parent, a spouse, or a child.” However, self-denial enrages the inner child-primitive.
It is important to note, “Everybody is under pressure from themselves or from life circumstances - and everybody has some degree of rage in the unconscious.”
People who are conscientious, hardworking, very responsible, great caregivers, often perfectionists, are disproportionately prone to mind-body symptoms. In a survey of 104 of Dr. Sarno patients he found that the “perfect-good” drive was either the predominant factor or a very significant factor in 94% of the cases, with life pressures being the second most common factor.
So how does one stop these symptoms from occurring?
Dr. Sarno believes that knowledge is power, and once you realize that the ego is creating pain as a protective mechanism from painful/dangerous unconscious emotions, then the distraction mechanism is no longer of value. The pain can no longer serve the purpose that it was initially created to perform. This is why so many people get better just from reading his book. He found that only 20% of his clients needed referrals to psychotherapists to further dissect the mechanisms of the mind.
However, there is a catch, and he called it the “symptom imperative.” If you realize that lower back pain is truly just a distraction from repressed emotions, the back pain will resolve, but the ego searches for a new way to distract you, and it will choose something that you will naturally assume is not a distraction. For instance, an acute muscle strain in the shoulder should repair to normal function in about six weeks, but the ego may piggyback onto the original injury by decreasing blood flow to the area. The muscle is repaired, but the pain continues as a distraction, you accept the theory that the initial muscle injury is creating the ongoing chronic pain. The ego has successfully tricked the conscious mind and distracted it from the repressed emotions; this is the symptom imperative, a new symptom in a different place, it's root cause is still inner emotional angst.
How Does Dr. Sarno's theory fit into SMR?
I like the theory, and I'm always open to new theories about mind-body connections, as I've noticed a link between the two in clinical practice for years. SensoriMotor Repatterning (SMR) finds faulty compensation patterns caused by previous injuries and changes them to more functional patterns. These patterns are objective findings. There is no question if the patterns exist or not, as changes in muscle function are immediately and notably improved once a pattern has been identified and corrected.
I have always assumed these compensation patterns are generated as a way to work around tissue damage until the tissue heals, at which time the patterns should revert to the more functional, original patterns; but sometimes they don’t. I assume this to be an oversight of the nervous system, but maybe if Dr. Sarno was still around, he might conclude that the ego has deliberately decided not to correct these movement patterns, and the subsequent chronic pain serves as an excellent distraction from the turmoil of the unconscious mind.
Can SensoriMotor Repatterning (SMR) help?
Yes. I spent much time developing techniques to allow the stress stored in the body to be released. Traditional Chinese Medicine (TCM) does not see the mind and body as two separate entities, but instead as a complex whole system. TCM considers stress as being stored in the systems and organs of the body and seeks to balance or remove this stress using the meridian system. It is this system and the related acupoints that have been very effectively integrated into SMR therapy along with neural feedback to direct the specifics of the treatment.
I also consider working with a psychotherapist or psychologist to be an important aspect of dealing with trauma if a client has not already done so.
Dr. Sarno coined the term Tension Mysositis Syndrone (TMS) to refer to real physical symptoms caused by psychological stress. I'm not a fan of the term, mind-body syndrome is so much more self-explanatory.
If this theory resonates with you, I highly recommend watching the documentary “All the rage” about Dr Sarno theory and work, it's an uplifting watch and I get lots of good feedback about the documentary:
Free online video about mind-body syndrome
Free online video "The role the brain plays in pain
The Divided Mind” Dr Sarn
Healing Back Pain, Dr Sarn
The Body Keeps the Score, Dr Bessel Van Der Kol
When the Body Says No: The cost of hidden Stress, Dr Gabor Maté