Archive for June, 2008
June 21, 2008
Letter to Dr. Schubiner from Paul Mazzafero, Davie, Florida
I first suffered excruciating back pain in 1984 as a 20-year-old young man. I had searing back and calf pain. I eventually had surgery in 1988 to remove a synovial cyst off my sciatic nerve. However, post surgery the pain was still there. I was scared I would be like this for life and was in pain management. I eventually picked up a book by Dr. Sarno and read it. I went to the Dr. and he assured me my back was fine. I was so emotionally damaged at this point I did not know what to do since I had already been to 21 doctors and had every test, steroid, epidural, etc. I eventually said, “I am fine and this is psychological”. I proceeded to workout like a madman and eventually the pain left me for 16 years. In fact I went on to compete as a boxer and was very active.
Fast forward to 2004, when I was throwing 100 pound logs and felt the dreaded pop and searing calf pain. “Uh oh,” I said and went to my GP and he ordered an MRI which was negative. However, I still had the calf pain. P.T. did not work…..Epidurals did not work……Massage did not work….Chiropractic did not work….Books, exercises, you name it and nothing worked. I was on prednisone and gained weight. I stopped working and contemplated ending it all. I am a vociferous reader and came across your program and within doing the 1st night of journaling I felt relief, not 100% but I felt like a layer was being peeled off an onion. I realized I was in a miserable job when this happened and that I am a perfectionist and I could understand how these factors played an important role in my back pain. Anyways, long story short: within 3 weeks of doing the online program, I was feeling 90% better but still skeptical a little. However, after 6 weeks, I have been pain free 100%. Dr. Schubiner’s course was an introspective look at what makes me tick. I do not think the pain will come back. In fact the 1st week when I started to feel better, an old neck injury and pain mysteriously returned…..I laughed out loud. When I am stressed, I pull out my notebook and read my journal and sometimes re-watch the videos.
#6—Mind Body Syndrome is contagious
When I first started learning about Mind Body Syndrome a few years ago, I was struck by an account by someone who had what is known as repetitive stress injury. He wrote an eloquent account of his story, which was published on Kim Ruby’s excellent web site (www.tarpityoga.com) on MBS or TMS, as Dr. Sarno coined the term, Tension Myositis syndrome. In his account, he spoke of having had RSI many years before, but it got triggered after going to hear a lecture about it.
Medical students are well aware of how the suggestion of the symptoms of an illness can produce those symptoms. It even has a name, “medical studenitis,” since it is quite common to develop some symptoms of the disease you are studying.
Dr. Jean-Martin Charcot in France in the 1800’s had a clinic for what was known as “hysterics” in the day, although these disorders (now we realize are forms of MBS) were considered to be genetic at the time. In his clinic, people with headaches, abdominal pain, anxiety, etc. would arrive and Dr. Charcot had “discovered” that there was a progression to this disorder in distinct stages: motor tics (brief, rapid tic-like movements), clowning (striking bizarre poses and holding them), hysterical seizures (shaking as if in a seizure). Amazingly, when people entered his clinic, they would almost inevitably pass through these stages, confirming Dr. Charcot’s beliefs. There was a young woman with headaches who came to the clinic. Her roommate was in the tic stage, and the next day the young woman had developed the same tics. The power of suggestion is can be extremely strong, especially when given by a powerful person.
#5—Modern Medicine’s Blind Spot
The rapidity of advances in medicine has been staggering over the past 50 years. It has been amazing to see the proliferation of research that has helped us understand how individual cells work, how DNA is translated into proteins that recognize other cells, that repair damaged cells, that create new cells to fight infections, and that communicate with all the cells in the body. We have learned a tremendous amount about how smoking, high cholesterol, and diabetes cause heart disease and about how cancer cells replicate and spread. These advances have created new technologies and medications to fight heart disease, stroke, and cancer by looking at the minute details of cells and proteins. This view of how medicine will advance is now universal; we will find the answers to how the body works and can be healed by looking at the individual areas where the disease is presumed to be. This has worked well so far.
But the problem lies in applying this theory to disorders like Mind Body Syndrome (MBS). In MBS, there is no tissue breakdown in the body, so by looking closer and closer at the “problem area”, we are actually missing the problem. In this case, the problem is in the relationship between the mind and the body. Phantom limb syndrome is a situation where real and severe pain can be caused by the connections between the mind and body, yet there is no “disease” in the area where the pain is felt (i.e. the missing arm or leg). In people with back pain, if there is a fracture, an infection or a tumor, we are best served by applying the techniques of modern medicine; i.e. find the source of the pain in the painful area and treat it with medications or surgery or physical therapy. However, for those with chronic back pain and no fracture, infection or tumor, trying to treat the source of the pain in the painful area can lead to more harm. Why have back surgery for a problem in the nerve connections between the brain and body? Actually, this has been tried in phantom limb syndrome. They tried amputating the limb at a higher spot to try to decrease the pain, but this didn’t work.
MBS Blog #4 – Psychological aspects of MBS
I have discussed the relationship between the mind and the body in prior blogs. Briefly, it is important to realize that they are essentially one, i.e. 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.
#3—What is Mind Body Syndrome Part II
As I mentioned in the last post, 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.