Long before scientists had access to the imaging technology that allowed them to visualize neuronal activity, physiatrist John Sarno grasped the relationship between chronic pain and emotional distress. Every time I told anyone I was writing about back pain, I learned to expect questions about whether I knew Sarno’s work. Almost everyone had run into someone who had been cured by Sarno, often after years of discomfort. I was happy to be able to inform his many admirers that, yes, I had actually spoken with the rock star of the back world. By the time we talked on the phone, Sarno was well up in years—and perhaps less guarded about expressing his feelings than he would have been in his younger days. After medical school at Columbia University College of Physicians and Surgeons, John Sarno worked for a decade as a family practitioner in a small town in upstate New York, making house calls and delivering babies on kitchen tables. He returned to Manhattan for further training
in the medical specialty of physiatry, at NYU Langone Medical Center’s Rusk Institute of Rehabilitation Medicine. At first, Sarno treated hospitalized patients who had suffered strokes and spinal cord injuries or lost limbs to amputation. They worked hard in physical therapy, and according to him most succeeded in regaining significant function. But when Sarno was reassigned in 1965 to the outpatient department at the Rusk Institute of Rehabilitation Medicine, where he became director of the back pain clinic, his patients did not respond well to standard physical therapy protocols. Instead, like migrating birds, they flitted from practitioner to practitioner, fruitlessly trying to find someone who could fix them. One of John Sarno’s senior colleagues at NYU, physiatrist Hans Kraus, had treated John F. Kennedy’s intractable back pain with an intensive exercise protocol. The president had already undergone decades of treatment, including several spine surgeries. The young and reputedly vigorous president was actually so weak, Kraus found, that he couldn’t do a single sit-up. When he was directed to touch his toes, his fingers did not even reach to his knees. In October 1961, JFK started the Kraus program, a rigorous routine including aerobic, strength, and flexibility exercises performed twice a day, three days a week. Within a year, the president was able to lift his small children, pull on his own socks, and swing a golf club. Kraus diagnosed what he called a “muscle tension syndrome,” common among people who were exposed to significant stress, with no ready escape by means of physical action. “Your muscles, your mind, your heart and all your organs prepare to act, but you do nothing,” Kraus wrote in his book, Backache, Stress and Tension. “You may wish to fight, you may wish to flee, but modern civilization prevents you from carrying out your natural impulses. . . . You race your engines without going anywhere.” Chronic muscle tension, Kraus hypothesized, created a cycle that continually generated more pain. He recognized that, without sufficient exercise, oxygen-deprived muscles undergo a process called anaerobic glycolysis, through which lactic acid and other wastes accumulate in the body. Although many other specialists had failed with JFK, Kraus succeeded. John Sarno saw the wisdom in exercise, but he recognized that workouts three times a week were not in the cards for most of his patients. Nor was Sarno convinced that exercise would resolve their back problems, which he viewed as manifestations of emotional turmoil. Although Sarno was neither psychoanalytically trained, nor well acquainted with the works of Sigmund Freud, he attributed the pent-up rage to an unruly subconscious process rather than a physiological one. If he could convince a patient that his subconscious was kicking up a fuss in order to distract him from personal issues, and that this fuss was manifested in reduced blood flow to the postural muscles, the patient would relinquish the notion that something was structurally wrong and shortly return to a functional life. He called the condition “tension myositis syndrome,” or “TMS.”
Sarno found that the patients who had the most success with his approach were hardworking perfectionists, driven by self-imposed pressure that left them feeling stretched to the breaking point. Often, they’d had a chaotic childhood, when they’d struggled to gain control over unpredictable and toxic environments. Although the specifics would not come to light for a couple of decades, in time, research would show that people (especially women) who experience significant physical and psychological adversity in childhood are at greater risk for chronic pain than those whose early days were less challenging. Sarno published his first book in 1982, but it was not until Healing Back Pain: The Mind-Body Connection came out in 1991, eventually selling over a million copies, that he became a household name. In 1998, when Sarno published The Mindbody Prescription: Healing the Body, Healing the Pain, 20/20 coanchor John Stossel was in the midst of his own struggle. After Stossel sat down with Sarno for a chat, he realized that his back felt better for the first time in months. As he planned a TV special on Sarno, Stossel requested permission to call twenty of his patients, randomly chosen from the doctor’s medical charts. The patients that Stossel’s team interviewed all reported being “better,” or even “much better.” Roughly fifteen million people watched that segment, and Sarno became “America’s back doctor.” But there was a problem. Sarno was unmistakably bad for business. He did not endear himself to the medical community when he announced that physicians were “chiefly responsible for the pain epidemic that now exists in this country.” Once patients became Sarnoites, they lost their appetite for serial interventions. They canceled long-scheduled surgical procedures, usually at the eleventh hour, citing a new perception that their problems were emotional, rather than orthopedic. They stopped getting MRIs and spinal injections, and didn’t show up for physical therapy appointments.
At the peak of his popularity, John Sarno charged up to $1,500 for in-person consultations. But each week he set aside several days when he spoke, gratis, to prospective or current patients, regardless of whether they were celebrities, housewives, or truck drivers. He exorcised author and business pundit Tony Schwartz’s spinal demons in forty-eight hours. In our phone interview, Schwartz outlined why he thought Sarno’s approach was so successful: “He takes the fear out of the equation—the fear of ‘Uh-oh, something must really be wrong with me,’” he explained. “And the impact on symptoms is dramatic.” Most of Sarno’s patients never actually saw him. Renn Kaminski, a retired New Jersey police officer, struggled with back pain and sciatica for thirty years—from the time he was nineteen until he reached the age of forty-nine. “Three or four times a year,” he said, “I’d be out of commission for a week. It might be because I’d been involved in a foot chase, or because I’d twisted the wrong way when I was putting on my pants.”
In the middle of a six-month episode of recurrent sciatica, Kaminski limped down the hallway of a local elementary school, where he was teaching kids about drug safety. The school’s principal, familiar with the symptoms, handed him his own dog-eared copy of Healing Back Pain. “I took it home,” Kaminski said, “but I was in too much pain to read it, so I tossed it on the coffee table, where it gathered dust for a couple of months.” When he finally mustered the energy, Kaminski read the book straight through—several times. “Suddenly, I realized that my problem was that my mind was messing with me,” he said. Two weeks later, he was better. “I haven’t had serious pain since,” he said, “which is not to say that I haven’t felt that threatening twinge, where you go, ‘Now, I’ve done it.’ But when that happens, I just shake my hips like a hula dancer—like Stan Musial on the Cardinals used to—and then I stand up straight and walk away. I don’t obsess. I didn’t change my circumstances. I just changed the way my body reacted to the circumstances.”