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Indy
Canada
45 Posts |
 Posted - 03/29/2006 : 06:17:54
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Are there any health practitioners on this forum who are using Dr. Sarno's work in their practice? If so, what techniques to do use to help clients/patients who are in the middle of what Dr. Sarno calls "an emotional explosion" or as Carolyn Myss calls "spiritual madness" or what I call "in the mud and the mire"?
Besides Dr. Sarno's video and books, what other techniques do you employ that you feel comfortable sharing that help your clients/patients "get it" - that their physical disorder is related to their emotional repression and denial? This is the biggest challenge I face in working with my clients doing holistic bodywork therapies.
Thanks for any help that you can give me.
Blessings
Indy
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drziggles
USA
292 Posts |
Posted - 03/29/2006 : 08:34:01
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My friend, this is the $64,000 question. As a neurologist relatively new in clinical practice, I have been using Sarno's concepts in some patients, with limited success. It is very difficult to present this idea to people who come into the office having been told by prior doctors or friends that they have herniated disks, pinched nerves, tendinitis, etc.
The first thing I have realized is that it is not a good idea to sell this as gospel to someone at a first visit. The best way I've found to gain trust is by doing some sort of diagnostic test--anything, as long as it is unlikely to find incidental abnormalities. My test of choice is EMG, because it is high-tech, and usually normal in TMS folks (though not always). I'll often bring up the TMS idea (see the script below), but then tell them we're doing a test first.
If I highly suspect TMS, I may bring up the concept in a brief discussion, usually with a "I know you may have been told x, y, or z, but I would like us to consider another possibility that you may not have heard about. There is a rehab physician at NYU named Dr. John Sarno, who has a theory of a condition he calls TMS. Believe it or not, rather than being caused by structural problems like herniated disks, etc., symptoms like the ones you have may be caused by changes in blood flow to certain muscles or nerves. (wait for the nod of understanding, or an interested "hmmm"). These changes in blood flow can be caused by the brain, believe it or not, in response to stress. (look for a cocked head and stink-eye of disbelief or, hopefully, another interested "hmmm")."
I'll talk a bit more about the concept of repressed emotions, then possibly talk about my own experience with back pain and how I found out about Sarno in the first place. I stress that "this was the worst pain I have ever experienced" and "the pain is most definnitely not imaginary..." I may mention that I spent a couple of days with him in his office while I was a neurology resident. How much I get into depends on the level of skepticism of the patient, which I always acknowledge, with a comment like "I know this sounds crazy," or "I was a little dubious at first" or something.
Then I will say, "But before we make that diagnosis, we are going to do a test first, to rule out other possible causes, like nerve damage, etc." I give them a copy of the medscape interview with Sarno, where he sort of lays out the concepts (see links), and give the name of the appropriate book, "if you are interested, you can read more about this in the meantime".
http://www.medscape.com/viewarticle/478840_print
http://www.medscape.com/viewarticle/478852_print
They will come back to the office for the EMG in about 3 weeks, during which time they have hopefully thought about TMS. I do the test, which is usually normal, and tell them that. I try to wait to let them bring up the TMS idea, which they often do. If not, I'll say, "so what did you think about what we discussed?" We then go from there. I'll give them the handout that Sarno gives to his patients, which is a sort of "homework". I'll give them some more tips on how to use the book, or I may recommend they see one of the neuropsychologists in the office who uses these concepts.
I've found this approach is much more effective then jumping out of the gate with TMS and pushing it down their throat. By doing a test, they feel that you are taking their complaints seriously, and not jumping to the conclusion that "it is all in their head". It also makes it more likely that they will come for a follow-up visit, even if they are skeptical. Otherwise, the chances are high that many or even most of your patients will never come back. Sad but true.
Frankly, I also do some profiling. Call me sexist, but I am more likely to use the TMS approach with women than men. If someone has had a bunch of surgeries for pain, I may not use this, though I may feel them out first before making that decision. I am least likely to use this with young men who work as laborers--I think the biases they come in with are just too great to get past.
That is my approach. I would really appreciate any input or ways to make this better, because it's certainly a work in progress! This is the hardest and most stressful part of my job, in many ways, which is kind of unfortunate given that I see people with dementia and terminal cancer. It shouldn't be this hard to do, but it is. Any tips are welcome. |
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Indy
Canada
45 Posts |
Posted - 03/29/2006 : 12:16:04
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Dr. Ziggles
Thank you so much for sharing your approach. I learned many things from what you said. I'm the type that doesn't "mince" words and I usually shoot straight from the hip. But I realize that my approach is not getting very far as far as TMS is concerned because of the sensitivity that my clients have towards the subject of painful emotions.
I like your approach, and it's possible for me because my clients are usually repeats. People do need to think that I'm not accusing them of "it's all in your head" and I'm sure that's how they perceive my remarks sometimes even though that's not exactly my meaning.
One thing that I thought of while reading your message is using my bodywork therapies (massage, reiki, reflexology, acupressure, colonics) as a way of communicating to them that the pain is emotionally based. As I'm doing my hands-on work and because I can feel the repressed energy anyway, I could say to them "I sense that this area of your body is holding old unhealthy energy" if they understand the concept of energy fields, or "I sense that the blood flow is restricted in this area of the body and is causing the muscles/nerves to react" or something like that if my client thinks more physically than energetically. And take it from there. People seem to need proof, real physical proof, that there is something definitely wrong, and my therapies can give me the tool for that so that my assessments are not coming from my head, but from the therapy.
The other thing that I thought of is putting myself in each client's unique perspective psychologically. I remember when I first started to learn of my childhood traumas and how I resisted anyone's suggestion that I needed to heal emotionally. My resistance was my protection from further pain and raising the unconscious memories, so I would immediately reject the suggestion. Putting myself in a client's shoes and taking into consideration his/her mental, emotional, physical, and spiritual strengths and challenges, I can ask myself "What do I need to hear from this therapist/doctor that would make me accept this concept and move forward with it?"
I find that when I do raise the subject of repressed emotions, most times a client will say something like "That doesn't surprise me considering my history" or "I do get angry sometimes over nothing and don't know why" or "I know that there's something nipping at my heels but it's too scary to think about." The challenge for me is not in the acknowledgment of emotional pain, but in getting them to work with it. My work is considered "fringe" or "alternative" so people don't know what to expect when they come and see me and, by the time they do, they are usually open to anything. Doing the work is a different story. Your patients, Dr. Z, would get another perspective if they were seeing an intuitive massage therapist or bodyworker who was on the same "wave length" that you are in terms of TMS.
I've been passing out to my "TMS suspecting" clients a questionnaire similar to Dr. Schechter's (http://www.mindbodymedicine.com) and have had some "bites" with that. Thank you for the Medscape link and suggesting Dr. Sarno's articles. I hope my ramblings have in some way helped you as much as your message did for me.
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Nor
152 Posts |
Posted - 03/29/2006 : 19:24:06
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Dr.ziggles,
Yay! I am so glad to hear of a neurologist adopting this approach. I went the neurologist route a few years ago when I was convinced I had MS. He did the proper testing and viewed my MRI and concluded my symptoms were simply "anxiety-driven". Although I was greatly relieved, I was left puzzled for months until I discovered Sarno. I would have really appreciated learning about him from my neurologist. I'm sure you're helping many people. Keep it up!
Another note you and others may find interesting...I am an occupational therapist and I work in a rehab setting. About 6 mos ago, I had a patient with mild dementia and severe, long term lower back pain due to spinal stenosis. She really seemed to fit the TMS picture perfectly in the way she talked and behaved. I just saw her again last week as she was readmitted due to a fall and her dementia has progressed significantly. Guess what? No more back pain. It is as if her dementia erased the subconscious need to hide those awful feelings. I was fascinated by this.
-Nor
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wrldtrv
666 Posts |
Posted - 03/29/2006 : 23:40:57
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Nor--Yes, Dr Driggles approach would have been welcome when I too recently went the neuro rounds a few months ago. Like you, I also was convinced I had MS. I also thought the same thing when I had similar symptoms four years ago. I used the same neurolgist both times, did every test imaginable incl the MRI. The verdict: nothing. Well, while initially reassuring I was left confused because I continued to have (and still do) various symptoms. If not MS, what? ALS? MD? Parkinsons? I covered all this territory with neurologist. He didn't see a match for any of these. I was very open to a psychological explanation and I even asked him about it. He would politely listen, but seemed noncommital. He's got an excellent reputation and is a very nice guy, but (maybe it's the liability fear) I WISHED he would just say, "Look, we've done all the tests--twice--and there's nothing. Maybe it's time to look for a psychological explanation." Instead, he said something about checking back with him if I had any problems in the future (this was after I was better). Well, it's months later and I'm still confused.
Nor, would you mind recounting your "MS" story? I'm curious if your history matched mine. |
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HilaryN
United Kingdom
879 Posts |
Posted - 03/30/2006 : 14:55:56
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Drziggles, thanks for sharing that. I know it must be frustrating when people don’t take it on board, but given all the conditioning we go through pointing us to the physical, it’s not surprising that a lot of people reject the psychological approach. In your situation it must be harder to persuade people because you’re seeing people who are probably expecting a physical solution and have probably come to you specifically for that.
I know sometimes when I talk about Dr Sarno’s approach I get a funny look as soon as I mention the word “psychological” or “emotions” (I also use the phrase “I know it sounds crazy”) and I immediately blame myself and think “drat, I did that badly – how could I have done that better?” But there is no one way of approaching it so everyone will accept it straight away, because everyone is coming from a different place and has different preconceptions.
Hilary N |
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Nor
152 Posts |
Posted - 03/30/2006 : 20:06:44
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Hi Wrldtrv,
I hate to harp on physical symptoms in this forum but I want to share them since you asked. Also, if others are reading, I wanted to show how extreme an varied TMS can be.
I first had vague GI symptoms which were similar to GERD and gastritis. Felt like food wasn't going down - then I'd panic - then I couldn't swallow easily. Then some cardiac symptoms, chest pain and such. When my primary tested for all this and it came up negative, I began having dizziness. Then the dizziness turned into full-fledged neuro stuff. Tingling, numbness, decreased coordination, shakiness, weakness. That's when I truly freaked out and in a matter of 3-4 days it got markedly worse. I was absolutely convinced something major was wrong. It all makes such sense now because it began at a time when we were just starting to exhale from a real medical trauma my husband went through. That is TMS all the way. As soon as the doc said I was okay, it got much better but still came and went on a much milder basis. Then it morphed into more of a fibro/chronic fatigue-ish thing...joint pain, muscle aches, fatigue, malaise.. It was such a dramatic display of symptoms - not enough to just explain away as "anxiety" alone. I picked up Sarno's book one day by chance and almost wept. The more I read, the more I was convinced. I am not symptom free but I am MUCH better and I believe in Sarno's ideas more strongly everyday. I am so grateful that I discovered him when I did and that I didn't suffer as long as some others on this forum. Dr. Ziggles - you are saving people time they could waste suffering.
I just re-read this and I know it sounds sort of cult-ish. I should also add that I am a skeptical New Yorker and I work in health care. I am not easily lured into things. But Sarno simply makes sense.
I think this is the longest post I've ever written. Hopefully, the info helped. - Nor
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wrldtrv
666 Posts |
Posted - 03/30/2006 : 23:39:51
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Nor,
Thanks very much explaining what happened to you. Isn't it amazing the variety of scary symptoms the brain can create?
The symptoms you described--numbness, weakness, shakiness, weakness--are very familiar to me. When I had the first episode of this stuff four years ago, had all the tests, recovered, I thought it was a bizarre one-time phenomenen. That's why when it happened again this past October (moderately different symptoms this time) I felt shell-shocked. I just couldn't believe it was happening again! Interestingly, both times the problem started overnight. One day I was fine and the next, bizarre symptoms. Both times I was under even more stress than usual. This seems to be the key to me: stress. I think I am especially prone to have psychological strain manifest in the body. |
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Clinical Applications of TMS
