The Deluded Mind: A review of “The Divided Mind”

I just finished listening to an audio version of the book “The Divided Mind: The Epidemic of Mindbody Disorders” (abridged) by John E. Sarno. In the book, Dr. Sarno decrees that many — even most — physical ailments are induced by the mind to distract attention away from painful or objectionable thoughts or emotions.

That’s right, the pain you feel from your tennis elbow is not caused by physical overuse or a muscle imbalance, it’s inflammation induced by your brain to distract you from the rage you feel against your father. This is known as psychosomatic pain, or what Sarno dubs “mindbody” pain. The physical symptoms might go away when treated using conventional medicine, but your deep emotional rage will manifest in a different episode of pain somewhere else in your body. Hence, we see the dynamics of our unconscious protecting us from our inner emotional turmoil. Sarno calls this the “symptom imperative” (bravo for the catchy title). The cure? Well, you’ll have to read one of Dr. Sarno’s books or contact him directly.

Dr. Sarno reminds us repeatedly that:

The conclusions found here are not based on armchair deductions. They are the results of many years of experience with thousands of patients and are reinforced by the findings of highly-trained psychotherapists. Our successful treatment of a remarkably high percentage of patients dynamically supports our findings. [0:9:19]

While that sounds promising, a formal study of the efficacy of his method has not been published. That’s right, despite the fact that Dr. Sarno believes in his heart of hearts that the symptom imperative of psychosomatic pain is real, and that his therapy is highly successful at treating it, he has yet to substantiate his claims beyond the realm of “trust me on this one”. From his CV, it seems he’s had only one peer-reviewed publication in the last 20 years. He must be too busy helping people to waste time on proving that his method works.

Why hasn’t he done a scientific study to support his claims? In chapter two he writes:

If unconscious emotions can be identified and measured objectively, we would have so-called hard data to support our clinical observations. The world of the unconscious mind, like the history of life, cannot be studied exclusively by hard science. How can one objectively identify and quantify the personality traits and emotions that reside, so to speak, in the unconscious? [1:08:18]

In case you hadn’t noticed, that’s a cop-out. The very fact that Dr. Sarno claims to know from experience that his method works means that evidence CAN (in principle) be generated to support his theory. After all, what is his experience based on? Observation. The good thing about science is that it tries to make those observations systematic and objective. Dr. Sarno shrugs off objectivity and seems happy to pick and choose the observations as he sees fit. That’s not science.

Case study: Liam was experiencing back pain, sought physiotherapy and was pain-free for 4 years. But an emotional episode with a girlfriend brought back the pain. This time, he looked for another solution and found Dr. Sarno. Just like thousands of other pain sufferers, Liam’s pain went away after the mindbody therapy. At the time of writing the book, Liam had been pain-free for 3 years, proof that the underlying psychology was the true cause of his back pain.

At least, that’s the way Dr. Sarno describes it. I can’t help wondering why a 3-year stint without pain is considered success when previous occurrences were separated by 4 years. Just what is Dr. Sarno’s criteria for success? Vague, at best, which raises my skeptical antenna.

Dr. Sarno explicitly reveals his fundamental misinterpretation of how the scientific method works when he states that “Success in treatment validates the accuracy of diagnosis”. Sorry, but one cannot conclude a cause-effect relation without a controlled study. Here’s why. Remember how our friend Liam got better after the therapy? Well, maybe Liam bought a more ergonomic office chair around the time of the therapy. The problem is that we don’t know. And unless you’re Liam, there is no way you can know. This is just as case study and, sadly, case studies are all that Dr. Sarno offers us.

It gets even more sketchy. Dr. Sarno makes it clear that he personally selects who is allowed to receive the therapy.

Because acceptance of the diagnosis is essential for a positive outcome, and because so few people are open to such a diagnosis, I have a telephone conversation with all who call for an appointment. After years of experience, it’s not difficult to determine whether someone is a good candidate for the program, and for those who are not, it’s a kindness to them, and to me, to discourage them from making an appointment. [4:11:54]

Such non-random and vague selection criteria deflate his comprehensive claims about the prevalence of psychosomatic illness. It says nothing about you and me, unless we’re willing to call him and beg to take part in his program.

Sigmund Freud, by Max Halberstadt, 1921

This frolic among Freudian theory alludes to some questions that Sarno never seriously asks himself: Why would the mind use physical pain to distract us from our inner rage, especially when the physical pain does nothing to actually address the emotion? Why doesn’t the mind use physical ecstasy to distract you from the pain that is distracting you from your rage? He pads these gaping wounds with more Freudian gauze, exposing more questions than they answer.

Dr. Sarno must be well versed on the interaction between the conscious and unconscious mind, given all his talk of the id, ego, and super-ego. So I find myself wondering, has he never heard the terms “motivated inference” and “confirmation bias”? These are well-known psychological mechanisms by which a person can delude themselves into believing what they want to believe, whether it’s true or not. We form hunches based on our experience, but they remain hunches unless a proper scientific study lends more profound, unbiased evidence. The depth of his conviction does nothing to support his claims. After all, belief is an emotion.

The Liam case serves as an example of probable confirmation bias: Because the criteria for success are vague, Liam’s case is remembered as a success in Dr. Sarno’s mind.

Before I close off, I should mention that Dr. Sarno might be onto something. Pain, after all, is notoriously subjective. It’s the brain’s way of telling you to pay attention to something. In that sense, the symptom imperative seems plausible. Indeed, I fully expect that some pain is psychosomatic. The question is, which kinds of pain?

The true test of a theory is its ability to predict. Why bother forming theories except to predict outcomes? We have the theory of gravity because it allows us to predict that things will fall down. We have the wave theory of light because it helps us predict how two beams of light will interact. The big question for Dr. Sarno: What does his theory predict? He needs to state it in the form of a scientific hypothesis so that it can be tested. If not, then his so-called knowledge is useless to anyone other than himself.

The mind is a powerful device, and we are susceptible to being mislead by its inner workings. Dr. Sarno is an excellent example. He seems to have convinced himself. But given the lack of objective evidence, I’ll remain skeptical.

10 Responses to “The Deluded Mind: A review of “The Divided Mind””

  1. Joseph Cheffo says:

    You act like this guy just came onto the scene. Dr. Sarno is a genius that has cured thousands, include myself, a very skeptical attoney, as well as celebrities such as Howard Stern and John Stossel and Anne Bankcroft, etc, – he is the head of NYU’s pain institute, he is endorsed by famed doctor Andrew Weil, etc.

    He does predict the only thing that matters. Prediction: if you read his books (primarily his introduction book Healing Back Pain) with an open mind you will most likely be cured. He has gathered patient records and repors an cure rate of over 84%, much higher than other treatments such as surgery.

    And no, you can’t really do a standard double blind study with this type of thing. If one tried it wouldn’t work because even if he did cure every person that he saw he could never prove it was because of his treatment, in the same way you as one tests a pill. But he has already proved that he cures people at a higher rate than any other treatment. Prediction: Cure. Nuff said.

  2. Steve says:

    I’m with Joseph on this one.

    I read one of Dr. Sarno’s books repeatedly in 1994 and after about a year worked my way up to where I am now–after suffering from three-plus years of excruciating back pain and sciatica. So where am I now? Well, I’m probably more physically active than 98% of all guys my age, and live with virtually no back pain. But you’re right about one thing. I did have to “waste” several hours reading the thing. And it cost me. Oh yes, it cost me dearly. It cost me… dollars.

    I hope that your skepticism is working well for you, Jeff. Bye now.

  3. Jeff Orchard says:

    Every day, I wave my hands over my desk in a ritual. I do it because it cures people of the common cold. It works so well… I’ve cured millions and millions of people over the years.

    Prediction: If I wave my hands over my desk today, even more people will be cured of their colds.

    Is that science?

  4. Jeff Orchard says:

    @ Steve: Thanks for your comment. I’m glad your back is feeling better.

    @ Joseph: Thanks also for your comment. You propose a hypothesis.

    >> Prediction: if you read his books (primarily his introduction book Healing Back Pain) with an open mind you will most likely be cured.

    Can you be more precise? What does it mean, specifically, to have an open mind? How can we measure that? Also, you need to be specific about what it means to be cured, a way to evaluate a person’s back condition objectively? If you can sort those out, then there is a way to test it.

    Take two random groups of people who have an “open mind” measure above a certain threshold, then randomly assign them to two groups; one group receives Sarno’s therapy, and the other does not. Evaluate their back pain the experiment is over (the duration must be pre-determined). Compare the before and after pain scores. Your hypothesis is that the therapy group will show significantly less pain than the control group.

    Has Sarno done this BASIC kind of study? Not that I’ve seen.

  5. Tim Mac says:

    Jeff – not sure if you suffer any chronic pain, or have dealt with the deleterious affects of your subconscious rage (we can all attest to your conscious rage)but you are obviously a complete dick head. I don’t need a double blind study to prove that, you declare it for all the world to see. Now climb back into the hole from whence you came, and leave us alone. You can keep your pain, and doubt, no one wants you to give it up. Obviously it means a great deal to you. Oh, and one other thing, listening to an abridged audio book does not count as “reading”. This might as well have been a review of a Britney Spears CD…

  6. Jeff Orchard says:

    @ Tim Mac:
    Thanks for your constructive criticism, Tim. I noted, however, that you didn’t contest anything in my blog post. If you have a specific issue with what I wrote, I’d love to hear about it.

  7. Jennifer says:

    I do believe there is a mind-body connection between pain and emotion. But after looking into Sarno’s theories, I find them to be voodoo. I have diagnosed nerve damage to a muscle in my buttock and frayed tendons surrounding my leg. This causes real pain! However, I learned to accept that (a) nothing could be done to “cure” my problem and (b) I would be dealing with my medical issue for the rest of my life. As a result, I was less angry and stressed because I wasn’t looking for an answer that wasn’t there. I started to think of my pain as a friendly reminder that I had to take care of myself by getting acupuncture, massage and take my medication. When you’re more relaxed about things, you breathe more easily and you relax your muscles. That results in less pain. But that alone wouldn’t keep me out of pain. I would still need my medication and massage, etc…

    It’s just not realistic to say that pain exists only because I’m angry about my sad childhood. Sarno is wrong when he says he can’t do a controlled study. I am not a scientist, but even I could think up a controlled study for his method. The simple fact that he’s lying on this point makes him a fraud in my mind.

    Now I’m angry! :-)

  8. Paul Paddon says:

    Hi Jeff,

    I’m curious about your deep set skepticism – I suppose rigorous training in comp sci sure helps! (Curiosity is the antidote to skepticism, by the way).

    You say that:
    “The true test of a theory is its ability to predict. Why bother forming theories except to predict outcomes? We have the theory of gravity because it allows us to predict that things will fall down.”

    This is all well and good for the external, objectively observable world. However, it does not apply to the interior, subjectively felt world. Pain, especially the degree and quality of it is not objective in any sense. At best it can be reported subjectively.

    Any experiment that produced a statistically relevant result of the type you are looking for would just be talking in generalities anyway. Saying that some treatment has the scientific stamp of approval does not guarantee a result either. Ever taken a Tylenol for a headache and not had it go away?

    My sense is that you are trying to weed out the “snake oil salesmen” with your skepticism. And yet, the tone of your writing to me is extreme and rigid to such an extent that perhaps you are throwing the baby out with the bath water.

    To wit, is

    “the pain you feel from your tennis elbow is not caused by physical overuse or a muscle imbalance, it’s inflammation induced by your brain to distract you from the rage you feel against your father.”

    a direct quote or your paraphrase?

  9. Jeff Orchard says:

    Hi Paul. Great to hear from you (Paul and I know each other from grad-school days). Let me address each of your comments…

    I don’t see curiosity as the opposite of skepticism. Skepticism is simply the philosophy of basing beliefs on evidence. It’s more about human psychology than pure science.

    I would argue that pain DOES have a physical instantiation; we just don’t understand it yet. Calling something subjective doesn’t mean it’s supernatural. The perception of colour is subjective, but we also understand much of how it’s encoded in the visual system.

    I’m surprised that so many of the comments I receive are about the TONE of my posts, not so much about the stated facts.

    Indeed, I’m interested in exposing people who are selling things based on unproven claims. My post is a little tongue-in-cheek, but not inaccurate. No matter how you say something, it’ll rub someone the wrong way.

    Finally, that quote you asked about is not a direct quote from the book, but – if I recall correctly – he does discuss a case involving tennis elbow, as well as a case involving the rage one woman felt against her father. The example I gave falls well within Sarno’s claims.

  10. Magenta says:

    I realize that this is an older thread but I would like to add my 2 cents.
    I’ve suffered from lower back pain for more than 4 years. When I first read about Sarno, I’ve accepted his theories before I even bought a book. Desperate people do desperate things;)
    I wanted to believe and it did seem to describe me.

    Fast forward 8 long months with no improvement, I still believed (religiously) in Sarno and that I needed to discover that source of rage ( I had many of them, too much to count). I’ve tried other things but still totally believed Sarno’s theory. Now I think it held me back.

    I would like some expert to tell me how can subconscious mind make decisions?? let alone a decision so complex- to DECIDE that your emotions are too unacceptable for you, so that it gives you pain as a distraction. I can’t believe I even considered this as a possibility.

    What held me back was the thought that my subconscious mind is so ominous and powerful and would do something like this to me. Just how helpless do you feel, and yes, guilty because you can’t beat your own mind.

    What about pain destroying your life almost completely?? ( it distroys relationships, careers, pretty much everything). Isn’t it more dangerous for your existence, than blowing up on your boss or divorcing a spouse? What does subconscious mind have to say about that?
    And what when we discover these sources? Why doesn’t the pain go away?

    But wait, there’s more. Later Sarno claims that autonomic nervous system constricts your blood vessels and that causes the pain. So which one is it?? Your autonomic nervous system, or your sinister subconscious mind?
    Everybody knows that it’s bad to keep your feelings bottled in. Everybody!!!

    How about pain caused by muscles that tighten around your spine from fight or flight response and become chronically constricted? ( there are more than 1000 muscles in back).
    I switched to Art Brownstein’s book and did his stretches and improved for about 50-60 %. And yes, your back CAN be injured, your muscles can be tight ( ask athletes) and if you carelessly strain them further, as Sarno advises, you will give your self a world of pain.
    And of course, try to accumulate as many positive emotions as you can:) Worry and stress are cause of tension and pain. Sarno calls it TMS – M standing for muscles, but why doesn’t he address muscles if it’s a muscle tension and advises against stretches?

    I’ll give him credit for discovering the type of people who get chronic pain-people pleasers, “goodists” who tend to accumulate a lot of rage. But rage is just part of it. Anger is a secondary emotion, behind it, is always fear. Deal with that and all your negative emotions, and you will get better. Dealing with anger indefinitely, will keep you in angry state and prevent you from healing.
    Good luck to you all and thank you for this article. I agree!!


  • Jeff Orchard

    Jeff Orchard is an associate professor of computer science at the University of Waterloo in Ontario, Canada. He has degrees in mathematical nerdism from Waterloo and UBC, and got his PhD in computing science from Simon Fraser University in 2003. Jeff is 99% atheist, 1% agnostic, and is passionate about teaching critical thinking. One of his research goals is to understand how the brain works (and then use that knowledge to take over the world). He has published academic papers in image processing, and is also an evolution buff.