I believe it was late 1992 or early 1993. I had just passed the Reform Beit Din for my initial conversion to Judaism. I had just started placing and responding to singles ads. I had met a woman over the phone that week and I was fantasizing about her. I think we’d had one good conversation. I had been largely bedridden (about 18 hours a day) for the previous four years with Chronic Fatigue Syndrome (CFS). I was living with my parents in Newcastle, CA. They were away for a few days. I rolled out of bed one night to go pee when my lower left back suddenly seized up and I was absolutely helpless. I couldn’t get up. Nothing like it had happened before. We lived on seven acres. Nobody was close. I started crying aloud for help but nobody could hear me. I panicked. I thought about the woman I’d just met and I dreamed she’d come to rescue me, but no rescue came.
After about 30 minutes, I managed to roll on to my side and push myself up. The pain was severe for a couple of days and then it gradually lessened. I couldn’t believe how vulnerable I was. Not just CFS, but my lower back could go into spasm and I would be essentially paralyzed.
After that, about every year or so, my lower left back would go out similarly and I would be hobbled for a couple of days and then gradually return to normal.
Now I’m reading about John Sarno MD’s methods and I am trying to explore the hidden emotional forces in my back pain. I’m wondering if I had a desire to become became helpless so this new woman would rescue me.
I remember in the weeks prior to my February 1988 collapse into CFS (when I was taking 21 units at college and working about 30 hours a week in addition to strenuous workouts every other day), I kept getting this unwanted and embarrassing thought — “I’m going to break through to success or I’m going to break down. Either way, I’ll get the love that I need.”
It is important to realize that Mind Body Syndrome is not a new diagnosis. When Dr. Sarno described Tension Myositis Syndrome (TMS) in the 1970’s, he created a new name for a syndrome that has actually been known for hundreds of years. I agree with Dr. Sarno that we do need a name for this syndrome (and I will explain why in future blogs). However, when you look at the history of medicine you will find many examples of MBS. I highly recommend the book by the University of Toronto historian, Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Medicine. Dr. Shorter uses the term psychosomatic, which is commonly used in medicine, but a term that I do not prefer to use because it has a connotation of being unkind to the patients, implying that they are somehow less than normal, or somewhat “crazy.” As I often say, I know that people with MBS are not crazy because I have MBS and I know I’m not crazy.
In any case, the reason people get MBS, or physical (or psychological symptoms) due to emotions which are often unconscious, is that they are human. They have a human brain that processes emotions in certain ways and they have human existences that often cause great stress in our lives. That is why there has always been MBS and there will always be MBS. However, the type of symptoms that the brain creates in our bodies does change over time.
For example, we know (courtesy of Dr. Shorter) that a common manifestation of great stress and emotions in the 1600’s and 1700’s was the development of paralysis. A story that captures this is about a young man who was beaten, abused, and berated his whole life by his father. When he was approximately 25 years old, while being berated once again, he had a great surge of energy and suddenly went to hit his father with his fist. At that very moment, his arm became paralyzed and he couldn’t move it at all. We know that he didn’t suddenly have a stroke because he regained use of the arm fully within a short time. And therefore we know that the cause of the paralysis was a combination of emotions, which were all unconscious (i.e. he was unaware that he was feeling them), and the main emotions were anger, fear and guilt. In those centuries, doctors did not consider this type of reaction to be caused by psychological factors, but rather some kind of physical condition. In the 1900’s, doctors learned how to tap on the tendons of an arm or leg and determine immediately if there was a stroke or some other severe neurologic condition. We now call these reflexes, the deep tendon reflexes, and use them all the time. When they are normal, in someone with sudden paralysis, we know that there is no neurologic condition and that the cause of the paralysis is due to MBS.
Since doctors have been able to use deep tendon reflexes, the number of people with paralysis due to stress and emotions has dropped drastically so that it’s relatively rare. Why? The cause of MBS is in the mind, in our unconscious mind that is trying to help us cope with great stress. The unconscious mind will find some physical symptoms to use when necessary and it will choose a physical symptom that makes some kind of sense. And typically, it will choose a physical symptom that will not be seen as “psychological.” Since paralysis is now seen as psychological, it is rarely used by the unconscious mind. We are more likely now to get Back Pain, headaches, fatigue, and stomach pains, which are more likely to be seen as physical conditions and therefore more acceptable to our self and to the doctors.
This is one reason why there are so many people today with these chronic symptoms and often they do not respond to biomedical treatments. Since so few doctors are aware of MBS, they often are not treating the underlying cause of the symptoms and therefore the treatment is trying to cope with the symptoms of the problem and is less likely to be successful…
MBS is not new. As long as there have been humans, there have been physical symptoms caused by stress and emotions. It is important to realize that physical symptoms, even very severe physical symptoms can be caused by stress and emotions. In fact, the emotions that tend to have the largest effect on us are precisely those that we are unaware of. There are two ways to think about how these symptoms can be produced.
The first way is to understand how the neurologic system works. Pain is a learned response, i.e. the body actually learns how to produce certain symptoms by experiencing them. For example, I had a patient who fell and hurt her back as a teenager. A decade later, she was in a very difficult situation in a job where she felt trapped and unable to get out of her problems there. At that moment, suddenly her back seized up and she had tremendous pain. The nerves that send signals from the back to the brain had been fired when she fell as a teenager and those nerve connections had been “learned” at that time. When a significant emotional situation arose where she had no way out, her body responded in a way that it already knew, by producing the Back Pain it had learned 10 years earlier.
A good way to understand how MBS works is by thinking about phantom limb syndrome. In this syndrome, which is very common among amputees, pain or other sensations can be felt in the part of the body (arm or leg usually) that is missing. There is obviously no disease in that area, yet we can feel pain (often severe) that appears to be coming from the missing body part. What has happened is that the nerves that send signals to the brain have been sensitized and are continuing to fire and those signals are interpreted as pain by the brain. A vicious cycle is formed of sensitized nerves that send signals to the brain, then those signals get amplified in the brain (by a structure called the anterior cingulated cortex; more about that area of the brain in upcoming posts), and then signals are sent out to the body by the autonomic nervous system (the fight, flight or freeze system). This pain is real, very real. However, there is no tissue breakdown, no tissue disease in the body. This is exactly what happens in Mind Body Syndrome. We may feel pain in an area of the body, for example, the head or back or stomach, yet there is no tissue breakdown, no tissue disease there. Of course, pain can be caused by tissue breakdown or disease, such as occurs in cancer, infections, or fractures. When the doctors are unable to find disease after a careful and thorough search, the diagnosis of MBS is usually correct. It is important to realize that MBS is a physiologic process, i.e. a process that occurs due to normal reactions of the body. When we get scared, our heart speeds up; when we get nervous, our stomach tightens up or we get clammy hands. These are physiologic processes, normal reactions that are 100% reversible. That is why MBS is curable. It can be reversed by interrupting the vicious cycle.