My back went out yesterday morning. It happens to me about once a year and I’m down for the count for a couple of days. I rarely have back pain or any muscular pain, but I notice that when I do work I don’t enjoy, my shoulders start to ache, and then as soon as I am done, the pain goes away.
Even though I rarely have back pain, when it does strike, it knocks me out and I will to a bit of dread that it might come around again at most inauspicious moments.
So after learning Alexander Technique and other back pain solutions, I’m now looking into the work of John Sarno. He argues that muscular pain usually results from unconscious rage. So I am meditating on and journaling on what I might be enraged about without even realizing it. According to Sarno, crippling pain is usually a defense mechanism so that the unconscious does not become conscious.
I had some intense conversations Wednesday night. Maybe that triggered some realizations about my life that I did not want to face Thursday morning.
As with Freud’s patients, I found that my patients’ physical symptoms were the direct result of strong feelings repressed in the unconscious. In addition, I have drawn on the concepts of three other psychoanalysts: Franz Alexander, founder of the Chicago Institute for Psychoanalysis, did pioneer work in mindbody medicine in this century; Heinz Kohut conceptualized what is known as Self Psychology and pointed out the importance of narcissistic rage; Stanley Coen suggested the crucial idea that the mindbody disorder I was studying (TMS) was a defense, an avoidance strategy designed to turn attention away from frightening repressed feelings.
This book addresses physical disorders that are caused by repressed, unconscious feelings. Because these disorders are very specific, they can be accurately diagnosed and successfully treated.
The Tension Myositis Syndrome is currently the most common emotionally induced disorder in the United States, and probably in the Western world. Since the publication of Healing Back Pain, other painful conditions of significant public health importance have emerged. They, too, are manifestations of TMS….
The adult also functions in both the conscious and unconscious. It is the mediator, the executive, the captain of the ship. Its role is to keep you functioning optimally and protect you from external as well as internal dangers. The unconscious adult may react automatically to certain situations; hence, its decisions are not always logical or rational, according to conscious judgment. This tendency for irrationality in unconscious mental function is crucial to understanding mindbody disorders. The realm of the emotions is composed of two minds; too often we experience the dominance of the unconscious over the conscious. TMS and its equivalents are examples of that dominance.
Last, there is the child, the part of the mind we do not acknowledge but that plays a critical role in our daily lives. It is all unconscious, of course, or we would be constantly embarrassed. Like a real child, it is pleasure-oriented, entirely self-involved, dependent, irresponsible, charming, often illogical and irrational, but unlike a real child, perpetually angry. It is also powerful, although it sees itself as weak and inferior—“after all, I’m only a child.” It is in constant conflict with the parent—a struggle of major importance to the mindbody process.
The concepts advanced by Heinz Kohut, a prominent twentieth-century psychoanalyst, are essential to understanding the sequence of events that lead to physical symptoms. Rather than speak of the child, Kohut postulated the existence of a self in each of us that develops poorly or well in the early months of life. He believed that self-involvement, technically known as narcissism, is normal and healthy if it develops properly, since narcissism characterizes a more or less cohesive self. He theorized a developmental line for narcissism, from the primitive to the fully mature. According to Kohut, narcissism is never given up, is potentially healthy and in a good environment develops into mature forms of self-esteem.
However, it was Kohut’s reference to what he called narcissistic rage that particularly interested me. He postulated that people with personality disorders emerged from childhood with an accumulated, permanent rage that he called narcissistic rage. He suggested that emotional trauma experienced during the developmental years of infancy and childhood was responsible for this rage. I wondered whether there might be some of this rage in all of us, but more particularly, whether it was pressure on this inherently narcissistic self residing in each of us that produced the anger-rage that seems to be responsible for mindbody disorders. This idea is developed more fully in the section that follows.
With this background we can now examine precisely what goes on in the unconscious that leads to physical symptoms.
Pressure and Rage in the Unconscious
I believe that rage in the unconscious has three potential sources:
1. That which may have been generated in infancy and childhood and never dissipated
2. That which results from self-imposed pressure, as in driven, perfectionist or goodist people
3. That which is a reaction to the real pressures of everyday life
I find the analogy of a bank account helpful in describing this to patients. Deposits of anger are made not only during childhood but throughout a person’s life. Because there are no withdrawals from this account, the anger accumulates. Thus anger becomes rage; when it reaches a critical level and threatens to erupt into consciousness, the brain creates pain or some other physical symptom as a distraction, to prevent a violent emotional explosion….
Virtually all of you, however, experienced pain when I pressed on certain muscles in the lateral buttock, the small of the back and the top of the shoulders. Additionally, about 80 percent of you felt pain when I pressed on the long tendons on the side of both thighs.
Because of the physical findings and the history, I concluded that you had TMS and proceeded to tell you what that meant. I said that the structural abnormalities previously identified were not the cause of your pain and that I would present evidence then and in the course of my lectures to buttress that conclusion. The pain, stiffness, burning, pressure, numbness, tingling and weakness were caused by mild oxygen deprivation in the muscles, nerves or tendons involved in each case. In itself this was harmless. Although it could produce more severe pain than anything else I knew of in clinical medicine, you would not be left with residual damage when your symptoms disappeared.
I then proceeded to explain why the brain had seen fit to reduce the blood flow to these areas, causing the distressing symptoms; how the rage and other powerful feelings in the unconscious were threatening to break out into consciousness, and the pain had to be created as a distraction to prevent that from happening. In most cases you were aware of the important psychological factors, like the stresses in your life, perfectionism and goodism or childhood trauma, that were responsible for your pain. You were reassured that resolution (cure) would come with understanding of the process. I said that all of this would be amplified and clarified in the course of two basic lectures, since there was not enough time to present the entire story during an office consultation. We will have spent forty-five minutes together.
This digest of the initial consultation suggests what the therapeutic program will be. We must somehow thwart the brain’s strategy. To accomplish that I encourage patients to:
• Repudiate the structural diagnosis, the “physical” reason for the pain (TMS is a different kind of physical process)
• Acknowledge the psychological basis for the pain
• Accept the psychological explanation and all of its ramifications as normal for healthy people in our society.
…TMS theory finds, by contrast, that whether the symptoms are psychosomatic or psychogenic regional (hysterical), they are designed to serve as a protective reaction to narcissistic rage or other unbearable feelings, and are not a mechanism to punish or fulfill an unconscious wish.