The Mindbody Prescription: Healing the Body, Healing the Pain, by John E Sarno, M.D. Warner Books, New York, NY, 1999.
Our brains have decided that feeling tense, which is the appropriate response to being tense, is too unpleasant to bear and is not as socially acceptable as having something “physically” wrong. And so the brain makes a few adjustments in circuitry and instead of looking and acting like a nervous wreck, presto – a bellyache or a backache. The reason why the ulcer had to go was that everybody began to realize that it was a phony, that it really meant tension, and that’s not socially acceptable.
Pg 8 No matter how we react to life’s pressures consciously, another world of reactions exists in the unconscious. Because we are not aware of those unconscious feelings and cannot, therefore, control them, and because they are so threatening and frightening, the brain will automatically induce physical symptoms to prevent the dangerous feelings from becoming overt, and thus becoming conscious.
Pg 9 (Super-Ego) The parent is that part of the mind that tells us what is right and wrong, how we must behave and act morally and ethically. This parent resides in both the conscious and unconscious minds and plays a crucial role in psychogenic physical disorders. It is synonymous with conscience; the parent makes us perfectionists and what I term “goodists.” A goodist has a compulsion to please, to be a good person, to be nice. A goodist avoids confrontation, is the peacemaker, always on the alert to help someone, even if it means self-sacrifice. The goodist has a great need to be liked, coupled with the fear of being disliked.
Pg 10 (Ego) 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.
(Id) 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 I 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.
Pg 11 …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.
…analogy of a bank account…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.
Pg 16 Only feelings that the mind perceives as dangerous, and therefore represses, induce physical reactions.
Pg 17 …people treated for TMS consistently get better; the same cannot be said for those treated for chronic pain in the medical community at large.
The threat of rage to explode into consciousness must be of sufficient magnitude to warrant the production of TMS or one of its equivalents.
Pg18 Symptoms are not physical substitutes for bad feelings, like anxiety. Nor are they self-punishment for bad thoughts or guilt. They are players in a strategy designed to keep our attention focused on the body so as to prevent dangerous feelings from escaping into consciousness or to avoid confrontation with feelings that are unbearable.
Pg 19 One of Freud’s biographers, Peter Gay, likened the unconscious to a maximum-security prison where all the desperate criminals, the undesirables and unacceptable, are incarcerated under heavy lock and key. In other words, they are repressed.
…the repressed feelings, like desperadoes, will try to escape. Despite the force of repression, powerful emotions like rage will strive to rise to consciousness. I call it the “drive to consciousness.” Yale philosopher-psychoanalyst Jonathan Lear refers to it as a “yearning for expression” and a desire for a “conscious unification of thought and feeling.”
Pg 20 When patients become aware of the presence of rage or unbearable feelings, these feelings can cease their struggle to become conscious. Removing that threat eliminates the need for physical distraction, and the pain stops.
Pg 21 …children of parents with significant psychological problems like alcoholism, drug addiction, depression, anxiety or psychosis often suffer lasting trauma. If a mother is psychologically inadequate the delicate processes of mother-child bonding and establishing emotional independence, both of which occur in the first months of life, may be disturbed. If a mother was very dependent on her own mother, she may have a need to tie the child to herself because it makes her feel more secure. She may use the love of the child to substitute for the absence of love from her husband or her parents.
Pg 22 Deeply repressed feelings of inadequacy foster the development of personality traits that are almost universal in people with TMS. They tend to be perfectionistic, compulsive, highly conscientious and ambitious; they are driven, self-critical and generally successful. Parallel with these traits, and sometimes more prominent, is the compulsion to please, to be a good person, to be helpful and nonconfrontational. In short, people with TMS have a strong need to seek approval, whether it is love, admiration or respect.
That we all harbor inner feelings of inadequacy cannot be proven, but modern psychoanalytic theorists, like Kohut, have suggested that faulty development of the inner self early in life leaves us with unconscious childish feelings in an adult world.
The drive to be perfect must surely derive from a deep need to demonstrate to ourselves and to the world that we are truly worth something.
Pg 23 An inner sense of inadequacy fuels perfectionism. A person’s station in life or achievements are often deceiving. Feelings of inadequacy are deeply unconscious and, paradoxically, often drive us to be very successful.
Why does the drive to be perfect lead to rage? The pressure superimposed by the mind-parent on the residual child is enraging. …perfectionists unconsciously set up standards for themselves they cannot possibly meet; their inevitable failure to live up to them results in unconscious shame and rage.
…compulsion – the need to be good – is primary. These people are driven to be helpful, often to the extent of sacrificing their own needs. They have a desire to ingratiate, to want everyone to like them….seems to stem from deep feelings of inadequacy.
Pg 24 Though we may consciously want to be and do good, the narcissistic self does not have such an imperative. Indeed, it reacts with anger at the imposition….Completely preoccupied with being a mother, she is unaware that she is unconsciously angry at the baby.
TMS theory would identify hostility and aggression as overt manifestations of something, far more dangerous – repressed rage and suppressed anger. Physical symptoms, anxiety, depression or hostility are, in effect, equivalents of each other. They all reflect powerful processes going on in the unconscious.
Pg 25 One of the residuals of childhood is the desire to be taken care of. Because we do not view this desire as appropriate adult behavior, it is deeply repressed; we are unconsciously dependent. This may lead to unconscious anger because the dependency needs are never satisfied and, paradoxically, we may be unconsciously angry at the person or persons upon whom we are dependent.
Unconscious dependency may lead to other angering complications, such as the poor choice of a mate (someone who will “mother” us) or choosing a profession or work that will be secure or without responsibility, though neither challenging nor fulfilling. Other reactions to the deep-seated feelings of dependency are fierce independence and even aggression.
Feelings of inadequacy and dependency lead to perfectionistic, people-pleasing, guilty-producing propensities. The self, like a child, reacts to the pressure.
Pg 26 We postulate that these events produce “disease” through the mechanism of internal rage. The events are listed in order of decreasing stress:
- Death of a spouse
- Marital separation
- Jail term
- Death of close family member
- Personal injury or illness
- Fired at work
- Marital reconciliation
- Change in health of family member
- Sex difficulties
- Gain of a new family member
- Business readjustment
- Change in financial state
- Death of a close friend
- Change to different line of work
- Change in number of arguments with spouse
Pg 45 The Neurophysiology of Psychogenic Regional (Conversion, Hysterical) Disorders
The crucial point is that the symptoms are not the result of damage or disease of specific body parts. They are perceived as weakness, pain, numbness or blindness only because the appropriate brain cells have been “fired off.” That is known as a conversion reaction. One set of brain cells is stimulated to activity by other brain cells; in this case, the stimulating cells are those having to do with powerful unconscious emotions.
Pg 46 Psychogenic regional symptoms produce no physiological changes in the body. The entire process takes place in the cerebrum of the brain.
The Neurophysiology of Mindbody (Psychosomatic) Disorders
It is as though the brain had decided that conversion symptoms were no longer convincing as disease, so it began to produce processes in which there were obvious physiologic alterations. This was done by involving the autonomic and immune systems. This was done by involving the autonomic and immune systems in the production of symptoms. The part of the brain known as the hypothalamus is an essential way station in the process. The result is TMS and all the equivalents I have listed. Those symptoms resulting from immune system dysfunction reflect either too much or too little reaction to foreign invaders, like pollens or bacteria. Too much results in allergic reactions, too little in a susceptibility to illnesses such as frequent colds or urinary tract or yeast infections.
Pg 51 It is important for people to know that emotionally induced physical processes are normal. The reason is clear. We all suffer the stresses and strains of everyday life, particularly if we try to be conscientious and good. “Normal” people are constantly under pressure and always generating unconscious anger-rage.
Pg 52 The study of neuropeptides and their receptors suggests a network in which information of all kinds, including emotional information, is circulated throughout the body, allowing organs and systems to affect each other. The distinction between brain and body is disappearing, since functions that were thought to originate exclusively in the brain are now found elsewhere, and vice versa. Insulin, thought to be produced only in the pancreas, is now known to be made and stored in the brain, and there is a heavy concentration of insulin receptors in the limbic system.
Benjamin Franklin once said, “Nor is it of much Importance to us to know the Manner I which Nature executes her Laws; ‘tis enough to know the Laws themselves.”
Pg 91 We have incredible healing mechanisms that have evolved over millions of years. No matter how severe, injuries heal. Continuing pain is always the signal that TMS has begun.
Pg 114 …the emotional stress in these physical disorders is not necessarily a result of external causes. It is an internal process resulting in strong feelings that the unconscious mind considers to be dangerous and threatening and which, therefore, must be repressed.
Pg 117 The second group of emotionally induced immune system reactions reflects an inadequate or idiosyncratic response to infectious agents. Frequent colds or urinary tract infections, recurrent herpes simplex, yeast infections, prostatitis, acne – all are examples of an inadequate immune response to an invader.
Pg 118 My clinical experience indicates that emotions can enhance, modify or reduce the efficiency of immune system function.
Pg 134 The theory I propose is that beneath some cancer patients’ nice exterior is a monumental rage that is both the result of the compulsion to be a good person (goodism) and the source of that need. As stated in Part I of this book, the compulsion to please is enraging to the narcissistic inner self and at the same time the parent in the mind is saying, “You are such a nasty, angry person inside. You had better be nice.” We must accustom ourselves to the idea that the brain-mind is a conglomeration of thoughts and feelings that are often at odds with each other. It is not the neat, well-organized, logical organ we would like it to be.
Pg 135 Essential to TMS theory is that many aspects of life are sources of pressure, as described in Part I of this book, and that these pressures induce internal rage. The psychodynamic interaction of perfectionism, goodism and rage is an example. Stressful life events are enraging in the unconscious; the poor parenting and abuses of infancy and childhood sometimes result in permanent rage.
Whether the accumulated rage results in TMS and its equivalents, autoimmune disease, cardiovascular disorders or cancer may be a function of the magnitude of the rage and the depth or power of its repression, according to TMS theory.
Pg 185 Heinz Kohut…Self Psychology….there is a developmental process in infancy in which the child derives responses from its mother (who is known as the selfobject in Self Psychology parlance) that are essential for its normal emotional growth and development. Under optimal circumstances the self in the child has experiences of being admired, affirmed, praised and valued, called mirroring of the grandiose self. Calming, soothing experiences that come from its feeling of having merged with the powerful parental figure coupled with reassuring strengthening feelings of alikeness with the mother, called twinship, further contribute to the development of a healthy self.
Kohut held that psychopathology was based on defects in the structure of the self, on distortions of the self, or on weakness of the self,” and that these were the result of a mismatch between mother and child. The mother’s contribution to the mismatch is obvious if she has psychological problems but may also come from cultural or societal imperatives. Presumably, the infant’s contribution is based on genetic factors.
The child whose psychological needs are not adequately met becomes the adult with problems, among them what are known as narcissistic personality disorders, characterized by narcissistic rage.
Pg 186 Kohut theorized that there is a separate developmental line for narcissism that, adequately nurtured through infancy and the ensuing stages of life, leads to an adult self that is normally narcissistic, mature, cohesive and healthy. The pathological state exists when the deficient self is easily injured and, therefore, in a state of perpetual rage.