…there is no separation between the mind and body in the sense that physical stimuli (e.g. an injury) immediately produce changes in our minds (emotions, reactions, etc.) and emotional stimuli (e.g. a scare, a verbal criticism, etc.) immediately produce physical reactions. The relationship between the mind and the body are immediate for survival. It would take too long for thought processes to engage prior to reacting if we happen upon an angry bear. Our survival instincts of an immediate reaction (running, freezing, etc.) are much quicker. William James, the father of psychology, noted that it is not true that first, you see a bear, then your feel fear, and then you run. He reasoned (and we now know he was correct) that you actually see a bear, then you run, and then you feel fear.
Our minds and bodies are constructed (through the process of evolution) to maximize survival. When an animal is frightened, it immediately goes into one of the survival reactions: fight, flight, freeze, or submit (play dead). When we get overwhelmed in our life, our body will react in a way that is designed to help us out of the situation. For example, I saw a woman who had a very difficult childhood with neglect and abuse. Her reaction to this was to look for love and attention whenever and wherever she could find it. She grew up and always attempted to appease others and tended to neglect her own needs. Like many people with MBS, she had a very strong dose of the “shoulds” (as Dr. Sarno often refers to Freud’s superego or conscience). As her life became more complicated and busy, she tried to do more and more for everyone else. Finally, her body reacted by giving her severe migraine headaches and fatigue. These reactions were her body’s way of trying to protect her, i.e. forcing her to rest, to lie down, to stop doing so much for everyone else and to do something for herself. Unfortunately, she there was a great cost to this response, i.e. severe pain and fatigue. I believe it is useful to view the body in this way, as trying to help us, to protect us, rather than as betraying us, which is a common thought that many people with MBS have…
If you pay close attention to your body, you will find that you often have physical reactions (often very mild ones) to common emotions that occur. However, you will usually not be aware of the emotion, because most emotions are subconscious. In fact, about 95% of all of our thoughts and feelings are located in the unconscious mind. (more on this in the next blog) The other day, I saw a friend who had an earaches. He asked if I would look in his ear to see if there was an infection there. The pain had started when he was singing in his choir in the dress rehearsal for a concert. The man next to him was singing close to his ear when the pain started. His eardrum looked perfectly normal and as soon as he learned that there was no infection, the pain went away. This is a very simple and common story. He was nervous about performing in the concert and the singing in his ear gave his mind the opportunity (the idea?) of creating ear pain as a way of alerting him to the nervousness. Accidents and injuries often present the opportunity for the mind to create chronic pain, if there are particular stressful events occurring at the time of the accident. Whiplash is a good example of this; the strain on the neck from an accident would typically heal within a week or two, unless there is something causing the nerve connections to become chronic.
The brain is set up to help us survive. It has mechanisms for immediate reactions to avoid danger. And these mechanisms are intimately tied into the body. In the modern world, we rarely meet bears, but we are commonly confronted with acute emotions and stresses in our daily lives. These stresses frequently result in bodily responses, such as increased heart rate, changes in blood flow to our hands, tension in our stomachs, bladder reactions and muscle or nerve pain. When these stresses are linked to childhood emotions, the reactions are likely to be even greater. I teach all of my patients to pay attention to their bodies, because their bodies are a warning system and they will always alert us to ways that we are reacting to stress and emotions in our lives. The more this is understood, the better off we will be as a society, because people (and doctors) will appropriately recognize common physical symptoms as MBS, rather than as signs of a serious disease.
Much more on this in the future. If you pay close attention to the mind and the body and look for the connections between the two, you will typically learn a great deal about what affects you, what drives you, what scares you, and what makes you tick. This self-knowledge is a great reward for taking unconscious thoughts, feelings and reactions and looking at them with the conscious mind.
Dr. Schubiner writes: “Several decades ago, if a woman came to the emergency department with a fracture and a “story” about falling out of bed, most doctors sent her to the orthopedic surgeon to fix the fracture and then home. Now, we ask more carefully about the fracture to make sure that it was not caused by domestic violence. We look for the underlying cause, even if the cause is related to social, rather than medical, factors. It is time for us to look more carefully and clearly at physical symptoms for which there is no clear disease in the body. We will find the underlying cause: Mind Body Syndrome.”
An auto accident is a powerful situation to have happen. It can definitely “shake you up.” Whiplash occurs after auto accidents, but it turns out that whiplash does not occur after auto accidents in all countries (more on this in a later blog). A study done to look at this was conducted by putting people in a simulation room and having them experience an auto accident. Despite the fact that their neck did NOT move at all, 10% of the people developed Neck Pain that lasted at least 4 weeks!! In some way, they expected to have neck pain and they did. These people were also those who had the most stress and emotional distress in their lives at the time of the experiment.
I have a friend who went to one of my lectures and read Dr. Sarno’s excellent book, The Mindbody Prescription. He had been having chest pains, despite a normal exercise stress test, so his heart was physically fine. After reading the book, he started to pay attention to the times when his chest pain occurred and he found (lo and behold) that there were stressful events or stressful thoughts preceding the pains each time. When he made the connection and dealt with his stress and his thoughts, the chest pain disappeared. Later, he also noticed that his nasal congestion disappeared too. He had nasal congestion in the garden, cutting the lawn, etc. and now he could breathe fine and participate in these activities without problems. He was amazed. A few weeks later, he told me about a time when he was in his home talking to a friend. His friend confided to him that he was having a hard time, was depressed, was on medication and was suicidal at times. My friend suddenly started sneezing, coughing and his eyes were watering. He had to excuse himself and went to the bathroom. While there, he had this thought: “Boy, that got me out of there!” He realized that his body had reacted in a way it “knew,” by the “allergic reaction.” Just as suddenly, the reaction stopped. He realized that his body was trying to protect him from the uncomfortable situation by creating the sneezing/coughing reaction…
What do you think is the result of the ads on TV for medications for anxiety, erectile dysfunction, fibromyalgia, insomnia, restless leg syndrome and others? Here is a powerful message suggesting that people get these symptoms. Some of the people watching are in stressful situations in their lives and this can easily trigger the development of MBS symptoms. So, the ads actually serve to increase the number of people who may develop MBS. That is not good for our health. Fortunately, the more we know, the better we are able to cope with MBS by recognizing that the mind can cause physical symptoms. So, when I get a physical symptom, one of the first things I do is ask myself two questions: “What is going on right now?” “Why might I have developed this symptom?” The answers are often quite obvious.
…genes are NOT destiny in relation to migraine, fibromyalgia, and other syndromes that make up this disorder. While scientists can identify certain genes that are found in association with these syndromes, they will not necessarily be expressed, i.e. they can be “turned on” by what happens in our lives, e.g. stress, emotions, life circumstances, but they can also be “turned off” by changes in our lives, e.g. control, understanding, acceptance, happiness, love.
Certain MBS disorders are commonly seen to “run in families” such as Neck Pain, headaches, stomach pains. However, we must realize that MBS is contagious (see Blog #6) and that it is very easy for certain MBS symptoms to be produced by the mind when stressful events occur in our lives. Which MBS symptoms are “chosen” by the mind depends on a lot of things, but one of those things is what might be reasonably expected. And it makes sense that our minds might expect to have a symptom that “runs in the family”, i.e. that others have.
Job satisfaction is the most important factor that appears to determine if someone will develop chronic back pain or return to work after back surgery…
When stressful events occur, it is known that the muscles of the body can tense up. In fact, the body is capable of tensing very specific muscles during a stressful event. It is not necessary to be aware of any emotions at all. The body may react to stressful events while we may not be aware that we are troubled by something. This occurs because the centers in the brain that cause reactions in the body are in the sub-conscious part of the brain, particularly the hypothalamus, which controls the fight, flight or freeze reactions.
There are two typical ways that back pain can start. One is with an accident, an injury, or with back movement. In this case, there is usually some degree to tissue damage due to the injury. The pain associated with the injury will usually decrease over time and go away once the injury has healed. If there is no serious medical damage, such as a fracture or an injury that damages the spinal column or nerves (doctors can diagnose these conditions with X-rays, MRI’s and by a neurologic exam, of course recognizing what we discussed above that an MRI abnormality is often not diagnostic of a medical condition if the neurologic exam is normal), then the pain should improve within a few days or weeks. However, the pain signals that start in the back and go to the brain can get “learned” as mentioned above and a vicious cycle can get started. Who is more likely to have this vicious cycle begin? The development of chronic pain is most likely in those who are the most stressed or distressed at the time of the accident. The brain has an area called the anterior cingulated cortex (ACC). This part of the brain amplifies pain signals and is activated by stress and emotions. Therefore, once the vicious cycle gets learned by the nerves, and this signal gets amplified in the brain and then muscle spasm and tension increases which increases pain.
Back pain can also start without any injury or accident. In this case, the muscle tension is started by the nerves coming from the brain in response to emotions (whether these emotions are recognized or not) and pain ensues. Once the pain occurs, the vicious cycle can become learned just as in the example above.
Over time, if the back pain doesn’t go away, the individual is likely to become less active and begin to worry and develop fear. These things exacerbate the pain by causing more muscle tension. The longer the pain lasts, the more likely that the individual will develop frustration, exhaustion and depression.
Things to do:
Notice what has been hidden;
Understand what has been a mystery.
Speak what has been unspoken;
Confront what has been avoided.
Accept what needs to be accepted;
Forgive what needs to be forgiven.
Change what needs to be changed.
Here are some of the levels (as I currently see them):
1. Learning that TMS exists, that emotions can cause pain
2. Understanding one’s own emotions, prior stressors, core issues that have lead to the physical and emotional symptoms
3. Starting to uncover these core issues and emotions in writing
4. Speaking the truth to oneself, through writing, meditating, reprogramming the mind
5. Recognizing hidden barriers in our own mind that may prevent us from getting better (see week 3 of the program); honestly asking ourselves the question: Why might my mind prefer to hang on to these symptoms?
6. Speaking the truth to others, telling others what you need, expressing anger or apology or forgiveness
7. Accepting what needs to be accepted; forgiving what needs to be forgiven
8. Doing things that we need to do, physical things (activities), but also things we want to do, and most importantly, figuring out what things need changing in our lives and actively working on those
9. Letting go of past issues, recognizing that what has happened “should” have happened and that fighting reality is a horrible way to live (see the work of Bryon Katie in week 4 of the program)
10. Creating our new self, deciding who we want to be and making that a reality, deciding how we will respond to issues and making that happen
There are many steps and each person may need more of one or more of another. It’s your job to figure out what you need to do. Fortunately, you have a great teacher in this process: yourself, i.e. your mind and your body. It will very clearly tell you when you are doing what you need to do and it will tell you when you still have more work to do. Our bodies talk to us in their language. It’s up to us to decode it. Unfortunately, it’s language is the only one it knows and it if often the language of pain. But pain is nature’s way of alerting us to the fact that there is something wrong. It may be that we just stubbed our toe or placed a finger on a hot frying pan, or it may be that we are stuck in a difficult situation at work or in a relationship. There is a recent research study done by Naomi Eisenberger at UCLA in which they showed that the pathways in the brain that are activated by emotional distress (in this case, a game where the person is excluded; i.e. social exclusion) are the same pathways that are activated by physical pain (i.e. the anterior cingulated cortex). This shows clearly that there is really no difference between emotional pain and physical pain. They are one and the same and the mindbody (as Dr. Sarno calls it) will decide which one (or both) we feel.
Our job is to listen. Our job is to pay attention to our bodies. They are trying to help us by being our teacher. Learn to see what events, emotions, and thoughts occur with increased and decreased pain. Be kind to yourself and to your mind and to your body. Start doing the work of healing yourself. There can be several steps as outlined above. And there is much work to be done for most of us, but this is the essence of being human. Our highest level of accomplishment is in seeing ourselves clearly, in taking control and making changes that need to be made with honesty and with kindness.
* The Guest House
By Rumi
This being human is a guest house
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness
comes as an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture.
Still treat each guest honorably.
He may be clearing you out for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent as a guide from beyond.
The anterior cingulated cortex (ACC) area of the lower part of the brain causes pain to be increased and the things that cause the ACC to be activated are thoughts and feelings of being afraid, guilty, worried, trapped, overwhelmed or angry. Of course, these thoughts and emotions happen to everyone. In addition, certain types of individuals tend to put extra pressure on themselves, have a tendency to be perfectionists and are often sensitive to criticism. It isn’t difficult to see that musicians tend to fit this personality profile.
The area of the brain that reduces pain is the dorsolateral prefrontal cortex (DLPFC) and this part of the brain is activated by clear thinking, understanding, being in control, processing thoughts to avoid worrying or guilt, and dealing with emotions by rationalizing, reappraising and letting go.
The reason symptoms can come and go, alter and change, or transform into new symptoms is that they are all caused by the same underlying physiological issues. These pathways are described in earlier blogs and consist of activation of the amgydala (emotional memory center), the anterior portion of the cingulate cortex (amplifies pain due to fear, worry and frustration), and the autonomic nervous system (activates the fight, flight or freeze reaction). These cause a variety of changes in the brain and body such as increase in muscle tension or muscle spasm, alteration or spasm of muscles in the bowel or urinary tract, activating or inhibiting nerve signals that control our activity and feelings. Once these nerve pathways get activated, they tend to quickly become sensitized and then “wired” to produce learned connections that develop a life of their own and can persist for months, years or even decades unless they are stopped by MBS/TMS therapy. Note that these are physiological changes, i.e. temporary alterations that do not produce tissue destruction or damage, as opposed to pathological changes, such as cancer or heart disease…
The brain will continue to produce “other” symptoms or substitute symptoms for a variety of reasons. One, it’s not ready to give up yet (and you may need to continue to be firm with it). Two, you haven’t yet integrated the changes that you need to make in your life or in your psyche (obviously you have to figure out what those changes are, and that’s where therapy may help as well). Three, you haven’t yet accepted yourself fully and completely, i.e. you are still fighting yourself, doubting yourself, being afraid of symptoms or of certain issues/events in your life. Four, you haven’t yet learned what you need to learn from your symptoms. This may sound odd, but several people in the program have directly asked their symptoms (in meditation or in writing) this question, i.e. “what do I need to learn from you?” Increasingly I have seen that the body is basically trying to protect us by producing MBS/TMS symptoms. Once we recognize this, we can work with our mind and bodies to calm the fears, deal with the issues in our lives which are stressful and produce the danger signals that cause activation of the fight or flight reaction.
Dr. Schubiner blogs: “A common response to triggers is to avoid them. People learn to avoid the movements or foods or people or events. However, that is exactly the wrong thing to do. When you avoid the triggers, you actually give them more power over you. What you really need to do is to overcome them. You need to retrain your brain to avoid developing the MBS symptoms when you encounter the triggers. The way to do that is to be brave and to look forward to encountering the triggers bit by bit and to learn techniques for stopping the nerve pathways that get triggered. The techniques to use are self-talk, breathing and other meditation techniques, therapeutic writing, psychotherapy and a variety of other psychological techniques, such as EMDR.”
Dr. Schubiner writes: “The three major factors in the development of MBS are: 1) External stress, 2) Internal pressures that we put on ourselves and 3) Suppression of emotion or feeling trapped in the difficult situation.”
the prevalence of back pain was much lower in East Germany prior to reunification, however, after the two countries unified the amount of people with back pain in East Germany gradually increased to the level of that seen in West Germany, where it has remained. The authors suggest that the cause of the rise in back pain in East Germans that back pain is socially contagious. This is their explanation: “We hypothesize that back pain is a communicable disease and suggest a harmful influence of back-related beliefs and attitudes transmitted from West to East Germany via mass media and personal contacts.”
