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.
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.