Naming an illness can be one of the most critical aspects of caring for someone, especially if the illness falls into the category of stress-related illnesses. It is a universal truth that anyone with medical symptoms wants and in fact, needs to know what is causing it. So often in modern medicine, our answer is “We don’t know.” We don’t know why some people get cancer and others don’t. Many people with heart attacks have normal cholesterol levels and no obvious risk factors for heart disease.
For stress related illnesses, such as migraine and tension headaches, fibromyalgia, TMJ syndrome, irritable bowel and bladder syndromes, fatigue, and most people with chronic neck and back pain, it is absolutely critical to be able to name the illness correctly. Doctors who are unfamiliar with the powerful role the mind has in being able to produce significant and sometimes severe physical symptoms will always label the illness as a purely physical one. Hence, we see the proliferation of illnesses named as a syndrome or with a description that doesn’t help the person understand the true underlying cause of the illness. Fibromyalgia is a good example of a severe syndrome who’s name literally means “pain in muscles and tendons.” Unfortunately, people with this disorder already know that they have pain. The name helps to legitimize the disorder, but it doesn’t help to solve the problem of helping them get rid of their pain. In fact, the name can become a prison of sorts and can give them the impression that they will always be in pain, because the medication and physical therapies usually do not work.
Therefore, for stress-related illnesses in which there is no tissue destruction in the body (e.g. not cancer, or stroke, or heart disease, or diabetes, or lupus, or rheumatoid arthritis), it can be extremely helpful to learn that one actually has a mind body issue, which Dr. Sarno terms Tension Myositis Syndrome, while I tend to use the term, Mind Body Syndrome. These terms mean the same thing; that the symptoms are caused by reactions in the body to stress and emotions, which can be both conscious and/or subconscious. The reason I don’t use TMS as often is that it implies some inflammation in the muscles (the definition of myositis), and there is no inflammation in the muscles in TMS/MBS. Dr. Sarno has started to use the term, Tension Myoneural Syndrome more recently, which keeps the same letters of TMS, but takes out the inflammation reference.
Other doctors use other terms as well. Dr. Brady was written about Autonomic Overload syndrome and Dr. Schechter has written about Tension Distraction syndrome.
It doesn’t matter too much to me what people call it, but what does matter very much to me is that people understand the nature of it. There are some people who can become trapped in the diagnosis of TMS or MBS. Just as they can begin to see themselves as being sick when given a diagnosis of IBS, or migraine, or fibromyalgia, or degenerating discs, some can develop the same relationship to TMS. That is, they can see themselves as a victim of their life events, their stressors, or their mind. If they have tried to cure themselves using TMS methods and have not succeeded right away, they may become worried that they won’t be able to get better or that they have a disease called “TMS.”
I received a great question the other day. Someone with MBS asked if they could drink caffeine, because caffeine can activate the autonomic nervous system and might this not aggravate MBS.
Here was my answer to this question:
Your question about caffeine is a good one and an important one. The short answer is that caffeine will not hurt you (unless you think it will, which means it could feed into MBS). The more important answer is that many people have a significant misunderstanding about MBS/TMS and the autonomic nervous system (ANS).
There is no doubt that the ANS is involved in causing the symptoms of MBS, but to understand this relationship, you need to think more carefully than just what things activate or deactivate the ANS. People with MBS do not have an overly active ANS in general. Dr. Brady calls it autonomic overload syndrome, which is somewhat misleading to my way of thinking. There are aspects of ANS activity that are overly active, but they are typically very specific aspects and lead to very specific symptoms. Even while having back pain or headache or irritable bowel syndrome, people with MBS have normal heart rates and blood pressures and bladder function; all of these are normal because of normal ANS function.
John Burns studied the muscle activation of people with low back pain as well as their blood pressures and heart rates while they experienced certain emotions in the laboratory (sadness and anger). He found that anger produced increased activation in low back muscles, but no activation in the shoulder muscles (trapezius) and no changes in blood pressure or heart rate.
The point that I am trying to make is that your (our) ANS is fine. It is not diseased. We don’t have to treat it gently or worry if we are stressing it. When you exercise, the ANS is really activated and this is a good thing. Caffeine will not hurt you. What will hurt you is thinking that you are sick or diseased. What will hurt you is worrying about your ANS or your body. What will hurt you is fear of hurting yourself. When you stop worrying, you can start living. That is what will set you free. Then the small parts of the ANS that are acting up will calm down.
One thing that learned by doing mindfulness meditation for many years is this: “There is more right with you than there is wrong with you, by far.” This is particularly true for those of us with Mind Body Syndrome, which includes just about everyone.
To your health,
Howard Schubiner, MD