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Suzanne
USA
66 Posts |
 Posted - 06/26/2004 : 15:36:14
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Registration is FREE for Medscape, but you must register to access the articles and this area. (Medscape is from WebMD)
http://www.medscape.com/px/viewindex/more?Bucket=columns&SectionId=1517
Expert Interview Index Page from Medscape Orthopaedics & Sports Medicine
An Expert Interview With Dr. John Sarno, Part II: Pain Management Prophet or Pariah? 6/15/2004
"In my experience...they wouldn't get better if the structural abnormality was responsible for their symptoms. They would get better by being educated, which is what I do."
An Expert Interview With Dr. John Sarno, Part I: Back Pain Is a State of Mind 6/8/2004
"I found that large numbers of people in whom pain was being attributed to some structural abnormality actually had a totally different disorder...it had to do with the stresses in patients' lives."
Both I saved as PDF's, letter-sized, and they came out to be 4 pages long. |
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JosephB
25 Posts |
Posted - 06/27/2004 : 04:15:05
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| Suzanne - Thanks for the June recent Medscape articles of Dr. John Sarno's interviews (Parts I & II), which summarize all of what I have ever learned about TMS theory. All TMS'ers should read and copy these articles, and keep them handy for periodic review for reinforcement. Thanks again. JosephB |
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Allan
USA
226 Posts |
Posted - 06/27/2004 : 07:34:17
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Great job Suzanne!
I was a little reluctant to register but I figured that there was no harm in it. If I get any spam I can always delete it.
I now have the copies of each interview of four pages each. There is a print button on each one which makes it easier.
These interviews are a great summary of Dr. Sarno’s teachings. They should be copied by all with TMS and put in the back of his book.
Thank you Suzanne.
Allan.
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austingary
USA
95 Posts |
Posted - 06/27/2004 : 08:52:46
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I just read the two parts of the Sarno interview. I agree that they provide an unusually good overview of Sarno's entire thesis. Someone with body pain could just read those two interviews and, if they found themselves reacting positively, go on then to read Sarno's books. But the type of person who is unwilling to credit unconscious mental processes with anything will not even read the interviews, much less the books.
Some specific comments: Here, as in his books, Dr. Sarno doesn't really provide much evidence for his oxygen deprivation theory. I am surprised that he clings to it as much as he does, since, as he admits, exactly how the process works is of minimal importance. I find that this particular idea conflicts so much with common sense -- voluntarily reducing oxygen flow to an extremity does not cause pain -- that it detracts from the rest of the ideas. I believe that there are other doctors who agree with Dr. Sarno in most respects but think that the mental "tension" simply puts the muscle tissue into physical "tension", which eventually turns into trigger-point knots.
Interesting that Dr. Sarno now believes the nerves to be more important than the muscles. Perhaps this is why he sticks with the oxygen deprivation theory, because nerves would presumably not tighten up in the way muscles do.
He says, that his patients "...couldn't possibly have gotten better if the pain were due to the structural abnormality." This conflicts strongly with his own attribution of surgical benefits to placebo effect. Placebo effect is incredibly strong. It's the basis not only of many medical "cures" but of witch-doctoring and faith healing, not to mention the good effects from all the bogus health remedies on the market.
Dr. Sarno knows this and talks about it, yet he refuses to admit that good results from getting his diagnosis, attending his lectures -- or even just reading his books -- could be partially or wholly from placebo effect. The interviewer should have explored this.
I think he will never be taken seriously by his peers until he addresses this problem more convincingly than he does in his books. Just saying that placebo effect is always temporary while results from doing anti-TMS work are not temporary, hence can't be placebo effect, just won't cut it. Unproven premise and too many exceptions.
To his great credit, Dr. Sarno says in the interview that he has "...always wanted to be approved of by (his) peers and haven't gotten it." How many people will ever admit to this, least of all in public?
Finally, I thought that his comment that "...the unconscious has no sense of time" was very interesting. Perhaps that is common knowledge among those more familar with Freudian psychological theories but I had never heard that.
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Dave
USA
1864 Posts |
Posted - 06/27/2004 : 09:01:39
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quote:
Originally posted by austingary
I find that this particular idea conflicts so much with common sense -- voluntarily reducing oxygen flow to an extremity does not cause pain -- that it detracts from the rest of the ideas.
How can you voluntarily reduce oxyten flow to an extremity?
quote:
I believe that there are other doctors who agree with Dr. Sarno in most respects but think that the mental "tension" simply puts the muscle tissue into physical "tension", which eventually turns into trigger-point knots.
This does not explain the nerve and tendon involvement.
quote:
He says, that his patients "...couldn't possibly have gotten better if the pain were due to the structural abnormality." This conflicts strongly with his own attribution of surgical benefits to placebo effect. Placebo effect is incredibly strong... Dr. Sarno knows this and talks about it, yet he refuses to admit that good results from getting his diagnosis, attending his lectures -- or even just reading his books -- could be partially or wholly from placebo effect.
He does explore this in his books. Because many of his patients recover completely and permanently, it is not a placebo. Unless you believe there is a possibility of a permanent placebo effect?
quote:
I think he will never be taken seriously by his peers until he addresses this problem more convincingly than he does in his books.
I agree, Sarno might have gotten more respect and credibility if he had taken a slightly different path in his life, focusing on clinical studies and scientific approaches to proving his theory. I believe that he considers helping people a higher priority. Maybe he'll strike a chord with a zealous young researcher who makes it his life goal to prove Dr. Sarno's theory, and then just maybe, the world will start to recover from this syndrome.
I'm not holding my breath, though. |
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Susie
USA
319 Posts |
Posted - 06/27/2004 : 10:19:01
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| Suzanne- That was so kind of you to post this. It is a good brief summary of his work and would be handy to offer to someone as a preface before reading the book. I sincerely hope more people will start paying attention to Sarno and get the tools we have gotten from him to help themselves. Since I have gotten better, I have a great frustration with those who refuse to listen and totally dismiss his discovery and suffer needlessly. |
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MidwestJim
USA
16 Posts |
Posted - 06/27/2004 : 11:52:20
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quote:
Originally posted by austingary
Here, as in his books, Dr. Sarno doesn't really provide much evidence for his oxygen deprivation theory. I am surprised that he clings to it as much as he does...
I agree. To me, it seems fairly obvious that the unconscious mind has a wide array of tools at its disposal to achieve its desired effect. Mild oxygen deprivation certainly would do it, but inflammation or simply muscle tension could also cause pain. Further, it can't be oxygen deprivation that causes other TMS equivalents such as IBS, skin disorders, etc. |
Edited by - MidwestJim on 06/27/2004 14:10:06 |
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austingary
USA
95 Posts |
Posted - 06/27/2004 : 18:22:28
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Dave: How can you voluntarily reduce oxyten flow to an extremity?
Easy. Wrap a belt or strap around your wrist so that it cuts off the blood flow to your hand. Or do the same thing with your foot. Or just wait until your leg or arm or foot gets into a weird postion and "goes to sleep".
You'll find that cutting the blood flow does not cause pain. It causes numbness. It is only when the blood flow resumes that there is pain.
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austingary
USA
95 Posts |
Posted - 06/27/2004 : 18:44:11
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Dave: This does not explain the nerve and tendon involvement.
Probably not. But I am not trying to explain that. Actually, we don't even know that there is nerve and tendon involvement. Dr. Sarno thinks there is, but maybe the pain is all muscular. Or maybe it is something else. I certainly don't know. But I think his blood flow explanation requires some proof and, so far, there is very little if any.
Because many of his patients recover completely and permanently, it is not a placebo. Unless you believe there is a possibility of a permanent placebo effect?
But many surgical patients recover completely and permanently, yet Dr. Sarno says the results of surgery are usually placebo. Even if only 10% of the surgical patients completely recover, that is better than Dr. Sarno's results if you start before he weeds out the prospects. And we don't know how many of Dr. Sarno's patients recover completely and permanently. All we have is testimonial evidence, the worst kind.
Dr. Sarno defines placebo as something temporary, then claims his results are not temporary, so they can't be a placebo. But that's just his definition. I don't think anyone else defines it that way. The salient point about a placebo is that you get better because you think you will get better, not how long it lasts. I think Dr. Sarno's definition is a straw man that he then knocks down.
I don't think placebo effect should be so cleanly differentiated from other psychogenic "cures". If you get well because of how you think, rather than from something changing physically, then it makes no difference whether you call it whatever Dr. Sarno calls it, you call it "placebo" or you call it an answer to prayer -- it's all the same thing, it seems to me.
Also, I think it is probably common for someone to achieve an initial "cure" via placebo effect (psychogenic means) but then, time and perhaps changes in the person's life take effect and the original problem fades away. Maybe, in many cases, a "temporary" placebo is all someone needs to get to a "permanent" cure.
People often behave in a way to keep their psychogenic cures working. You get "cured", you go around telling everyone about it. You spread the word (you start a website, maybe). In that way, people are their own doctors, creating their own continuing "placebos".
Clinical studies: In theory, you could do a study of Dr. Sarno's methods. I don't have any expertise in this area, but I would think you would take a group of pain sufferers and divide them up into two or three randomly-selected groups.
One group would go to Dr. Sarno for a diagnosis, go to his seminars, etc. Another would go to another "doctor", who was much like Sarno, but he would describe the problem in some other way, then recommend seminars. Just like Sarno. Those people would go to their seminars but would talk about their grandchildren, the weather, politics or something else. A third group would be the control and not see any doctor, no seminars, just bumble along as usual.
After a period of time, then regularly through a few years, people from each group would be interviewed and examined. There would be lots of problems with that study but it would be better than what we have now, which is mostly just testimonial evidence, which, to a scientist, is next to worthless.
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Dave
USA
1864 Posts |
Posted - 06/28/2004 : 08:01:36
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quote:
Originally posted by austingary
Actually, we don't even know that there is nerve and tendon involvement. Dr. Sarno thinks there is, but maybe the pain is all muscular.
Personally I believe very strongly that there is nerve involvement, based on my own symptoms.
quote:
I don't think placebo effect should be so cleanly differentiated from other psychogenic "cures". If you get well because of how you think, rather than from something changing physically, then it makes no difference whether you call it whatever Dr. Sarno calls it, you call it "placebo" or you call it an answer to prayer -- it's all the same thing, it seems to me.
I think the distinction is that with a placebo the root cause of the symptom is not being addressed. The mind is "fooled" into recovery. With TMS the root cause of the problem is being addressed.
I think the most important concept Sarno has given us is that the mind can induce real physical changes in the body. Even if you disregard all of his other theories, this point is critical. Just because we have real, physical, and sometimes debilitating symptoms does not mean that there is something physical that needs to be "fixed." The majority of the medical community cannot even accept this part of the theory, let alone the psychological explanation, which I agree has some holes and could benefit from more formal studies. |
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Dave
USA
1864 Posts |
Posted - 06/28/2004 : 08:06:18
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quote:
Originally posted by austingary
Easy. Wrap a belt or strap around your wrist so that it cuts off the blood flow to your hand. Or do the same thing with your foot. Or just wait until your leg or arm or foot gets into a weird postion and "goes to sleep".
You'll find that cutting the blood flow does not cause pain. It causes numbness. It is only when the blood flow resumes that there is pain.
True, but this is not a faithful reproduction of "mild oxygen deprivation." No doubt that blood flow to the area is reduced, but other things happen in the body as well as a result of doing this. Perhaps the brain shuts down nerves in the area as a protective mechanism.
I agree the basis for the mild oxygen deprivation theory is thin, but the converse is true as well. We cannot be sure that mild oxygen deprivation to soft tissue does not cause pain. |
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goodguy
26 Posts |
Posted - 06/28/2004 : 08:44:37
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An interesting point: Dr. Sarno says that he doesn't recommend relaxation techniques because TMS is not a physical disorder. I have always thought of relaxation as more mental than physical. I wonder what this means for the non-Western part of the world. Does one have to accept the Western ideas of Freud in order to be cured of TMS? In the East, a mindbody approach to medicine has been the dominant form of treatment for all disorders until the relatively recent past. Haven't doctors in the East had success for generations in understanding the psychological origins of most disease, and in successfully treating them with programs that reduce stress on the midnbody (yoga, meditation, nutrition, toxin cleansing, etc?).
I would imagine that most Ayurvedic doctors would not feel that the concept of TMS is anything new. Or, maybe TMS, as described by Dr. Sarno, is a uniquely Western problem due to higher levels of self-imposed stress that can be traced to cultural origins.
Personally, it seems to make sense to me that mediation would be a natural adjunct to the TMS program of education and thinking psychologically. In fact, Dr. selfridge has made it a part of her program.
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Dave
USA
1864 Posts |
Posted - 06/28/2004 : 09:32:55
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quote:
Originally posted by goodguy
An interesting point: Dr. Sarno says that he doesn't recommend relaxation techniques because TMS is not a physical disorder.
I believe Dr. Sarno is referring directly to physical exercises such as stretching. |
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JohnD
USA
371 Posts |
Posted - 06/28/2004 : 10:39:08
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| I think Lance Armstrong put it best when he says in one of his books that he doesn't know exactly why and doesn't need to know why he recovered from cancer that most doctors thought would kill him. Dr. Sarno's theory is far from perfect, after all he is just a human being. We could sit here all day, every day trying to pick it apart, but I'm satisfied because I am healthier than I was before reading Sarno. I think the lesson to be learned from Sarno is that many of our problems are only illusions created by limitations (or misinterpretations) in our own thinking, and once we overcome these limitations, what was formerly thought of as a problem no longer exists. |
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kenny V
USA
268 Posts |
Posted - 06/28/2004 : 12:38:08
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Good stuff John D 
Always Hope For Recovery
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tennis tom
USA
4749 Posts |
Posted - 06/28/2004 : 14:00:13
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quote:
Originally posted by JohnD
I think Lance Armstrong put it best when he says in one of his books that he doesn't know exactly why and doesn't need to know why he recovered from cancer that most doctors thought would kill him. Dr. Sarno's theory is far from perfect, after all he is just a human being. We could sit here all day, every day trying to pick it apart, but I'm satisfied because I am healthier than I was before reading Sarno. I think the lesson to be learned from Sarno is that many of our problems are only illusions created by limitations (or misinterpretations) in our own thinking, and once we overcome these limitations, what was formerly thought of as a problem no longer exists.
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tennis tom
USA
4749 Posts |
Posted - 06/28/2004 : 14:02:55
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JohnD,
Thanks for that thoughtful interpretaion of Dr. Sarno's message. It's very useful.
tt |
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austingary
USA
95 Posts |
Posted - 06/28/2004 : 20:13:42
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Dave: No doubt that blood flow to the area is reduced, but other things happen in the body as well as a result of doing this. Perhaps the brain shuts down nerves in the area as a protective mechanism.
I think you're reaching here. Usually, you don't want to invent new, more complicated, unproven explanations to justify a theory. Occam's Razor: Use the simplest explanation that fits the observed facts.
We cannot be sure that mild oxygen deprivation to soft tissue does not cause pain.
This is a logical fallacy called "Appeal to Ignorance". Something is true because it cannot be proven false. Or it is false because it cannot be proven true.
We cannot "be sure" that the pain is not caused by demons. But no more likely for that.
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Dave
USA
1864 Posts |
Posted - 06/29/2004 : 08:56:59
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Cutting blood flow to your hand by strapping a belt on your arm does not prove anything one way or another. Does it cut off blood flow to the hand? Sure. Is this a valid reproduction of the "mild oxygen deprivation" that Sarno talks about? No.
I don't pretend to offer any facts about this; perhaps my words can be more carefully chosen if they come across that way. We don't know, and won't know in our lifetime, the exact mechanism of TMS. Sarno's theory is just as valid as your claim that mental "tension" simply puts the muscle tissue into physical "tension", which eventually turns into trigger-point knots, or your statements that people have a tendency to hold their muscles in rictus. There is no scientific proof of any of this.
Now if only this debate could be carried out in the medical community, maybe there would be some progress towards proving (or disproving) Sarno's theory. In the mean time, I'll accept his clinical observations and my own experience at face value. |
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2scoops
USA
386 Posts |
Posted - 06/29/2004 : 09:14:10
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"Now if only this debate could be carried out in the medical community, maybe there would be some progress towards proving (or disproving) Sarno's theory. In the mean time, I'll accept his clinical observations and my own experience at face value."
Thank you Dave, I feel the same way. |
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tennis tom
USA
4749 Posts |
Posted - 06/29/2004 : 10:01:13
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| Regarding proof of TMS, if memory serves me, Sarno cites a study that biopsed muscle tissue in a "TMS" state and found less oxygen then normal at a cellular level. |
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An Expert Interview With Dr. John Sarno 6/2004
