MBS Blog #21–TMS Stories: Understanding the depth and breadth of The Mindbody Syndrome

Understanding the depth and breadth of The Mindbody Syndrome (TMS)

It is clear to most people that emotions can cause physical reactions in the body. When someone gets embarrassed, their face will turn red. When standing up to speak before a large audience, many people would have physical reactions such as sweaty palms, churning stomach, a more rapid heart rate or a dry mouth. These are physiologic reactions obviously caused by activation of the autonomic nervous system that are reversible and do not indicate that there is a pathological or tissue breakdown condition in the body.

Most people also recognize that they can get a headache or a stomach ache after a stressful day. Therefore pain can also be caused by stress and emotions. These immediate reactions are relatively easy to discern as being connected to stress and emotions. Among people who are afflicted with TMS however, the time lapse between when the stress that is responsible for the symptoms may be years or decades. And the symptoms of TMS can be amazingly varied and severe. Common symptoms of TMS include back and neck pain, headaches, abdominal or pelvic pain, TMJ pain, or widespread pain now known as fibromyalgia. TMS symptoms can also be related to ANS activity such as is the case with IBS and IC. Neurologic symptoms of burning, tingling, itching, and other paresthesias may occur. Generalized symptoms such as fatigue are common. Psychological symptoms such as anxiety, OCD, PTSD, and depression are very common manifestations of TMS. And insomnia is very common as well. How can we understand the great depth and breath of these varied symptoms and how can we figure out what precise events and emotions are the causative factors in the life of an individual with TMS?

After conducting hundreds of detailed interviews with TMS sufferers, it is my firm belief that we can determine what has lead to TMS in the vast majority of patients. However, in order to truly understand these individuals with TMS, it is critical to learn to dig deeply in the history and the minds of our patients.

If we are patient and take the time to listen, patients will lead us to an understanding of the source of their pain and other TMS symptoms. We need to learn how to take these sensitive histories and learn what clues to attend to in order to help patients gain the insight into the key issues they will need to cope with in their lives. Certain patients have such overwhelming histories of childhood abuse or neglect, which when coupled with additional trauma in adulthood, gives an obvious explanation of the emotional sources of TMS. However, in other patients, it is necessary to listen for more subtle clues to explain how and why TMS developed.

I have compiled a number of examples to illustrate the thesis that childhood events create specific emotional memories that when triggered later in life cause the onset of TMS symptoms. Typically, there are two other psychological factors in the development of TMS: One is a strong sense of obligation, high expectations, perfectionism, desire to be good, guilt, low self-esteem, and self-blame. The other is a suppression of lack of awareness of the emotions that are reactions to life stressors or the internal pressures that patients put upon themselves.

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#20 “A rose by any other name…”: The importance of the name of an illness

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.   Continue reading

#19–Emotions: What you don’t notice, can hurt you

Emotions, particularly those that are subconscious, were not seriously studied by the scientific community until relatively recently.  For much of the 20th century, psychologists were more interested in studying our conscious awareness and didn’t think that it really mattered what might be going on beneath the surface of consciousness. 

Paul Ekman has gained a great deal of notoriety recently (the new TV show “Lie to Me” is based on his work) and his pioneering work demonstrated that people from all of the different cultures of the world experience and show the same emotions via their facial expressions.  His work is detailed in his book, Emotions Revealed, and is fascinating reading.  Dr. Ekman and others have also conducted research that shows that emotions cause very specific reactions in the body that are distinct.  In other words, emotions are universal and they are indelibly attached to specific physical reactions.  This work has helped to explain why someone may develop back pain when angry and another person may develop headaches.

Another giant in the study of emotions has been Joseph LeDoux, a neuroscientist at New York University.  Dr. LeDoux has done studies to help us understand how emotions are generated and processed in the brain.  His excellent book, The Emotional Brain, details what we know about how the brain handles emotions and we have learned a lot!

We now know that emotions are part of our survival mechanism and are part of the brains of all creatures.  We are hard wired to constantly scan the world around us for danger.  We do this as part of being alive by subconscious brain mechanisms.  When we encounter something that might be dangerous, such as a snake, a menacing look, or a car heading towards us, we instantly react (even before we are truly aware of the danger) in order to avert the danger and save our life.  These reactions are controlled by the amygdala and the autonomic nervous system.  We pick up cues to potential dangers and these nerve signals are instantly transferred to these centers; the amygdala is the center that processes emotions such as fear and anger and the autonomic nervous system (ANS) controls our heart, lungs, bowels, bladder, blood vessels and muscles.  The ANS acts to generate the fight or flight reaction (actually the fight, flight or freeze reaction), which causes our bodies to react to danger.  These systems operate in all creatures on a subconscious basis, meaning we are not consciously aware of these systems.     Continue reading