Key Learning Points from the book
‘THE DIVIDED MIND’
by Dr.Sarno
What is TMS?
We so often attribute the symptom of physical pain to a physical movement or injury not knowing the reality that the person’s brain decides that time is ripe now and chooses a certain movement to initiate the pain because the person will assume that it stems from an injury, not a brain-generated physical condition that caused the pain.
The type of symptom and its location in the body is not important so long as it fulfills its purpose of diverting attention from what is transpiring in the unconscious.
This is what is called as TMS or Tension Myositis Syndrome also called DPS or Distraction Pain Syndrome.
Most of the structural abnormalities held responsible for pain are not actually responsible. Hence there is little need for surgical or even minimalist physiological intervention.
It is not known what determines the unconscious mind’s choice of which symptom to employ, but it makes no difference since the purpose of all symptoms is same – to distract the conscious mind. The choice of symptom also depends upon what is in vogue at the time.
It is one thing to accept the concept that the mind has great power over the body, but quite another to internalize that knowledge and to understand it on a deeply personal basis.
Unconscious mind causes your immune system to be over-active or under-active causing allergies or infections respectively. The purpose is not to protect you from or expose you to foreign substances but the purpose is to keep your conscious attention focussed on the body.
The rage mentioned here is generated over a period of repression of emotions across many years. The decision-maker in the brain has decided that the overt expression of unbridled rage would ruin the person’s life and expose him to danger or coming to consciousness of repressed emotions other than rage could prove to be emotionally excruciating. In order to prevent that from happening, it automatically infuses physical symptoms in the body which will serve as a fruitful distraction.
It does this without consulting the conscious rational mind which could have chosen to rather express the rage or confront the emotional pain which it feels would be possibly easier than taking the physical pain.
This is how the decision-maker in the brain must be thinking since it asks not the permission of the conscious mind. It totally bypasses the intellect and is a case of clear sub-cortical reaction.
Mind has the power to achieve its end of distraction by altering physiology by the manipulation of the autonomic, immune and neuro-endocrine systems.
The psyche knows very well that it is better to suffer physical pain than to ruin one’s life by manifestations of unbridled rage or intense emotional pain. The psyche views the physical symptoms as the lesser of the two evils. Often in life, unjustified rage is being unfair to the opposite person; so its better to suffer the physical symptoms than put the other person into trouble for no fault of his or her part.
As a society, we are very somatically focussed; pre-occupied with every ache or pain.
Henry Maudsley has said that – ‘The sorrow which has no vent in tears can make the other organs weep.’
Advantages with TMS
Patients of trauma who repress the emotion often do better than those who did not repress or in those whom repression broke down. Repression may lead to consequences like hypertension but it is yet far better than lifelong emotional torment. Without repression, a trauma survivor would be at a risk of long-standing psychological problems.
Generally for trauma-affected people, the pain subsides after the conscious handling of a severely painful emotion, leaving a residue of painful but tolerable feelings that come up from time to time.
Many people also use repression as a coping mechanism to handle day-to-day stress.
If someone has successfully repressed overwhelmingly painful emotions, and has moved on successfully, exploring them in psychotherapy would be the last and the wrong thing one would do. Therapy might not be able to crack through the repression and if it did, it might have the potential to do harm.
We just don’t know whether bringing the unconscious emotions onto the surface through hypnotherapy is also almost safe, particularly in people who are not suffering psychologically.
Historical studies
Some great physicians or scientists like Freud, Charcot, Breur, Alfred Adler, Franz Alexander and Allan Walters are amongst the early ones recognizing the role of psychosomatic disorders in many of the physical diseases.
Psychosomatic disorders fall under the broader category of psycho-genic disorders.
The word ‘psychosomatic’ means ‘mindbody’. It goes to mean that the emotions in our unconscious and conscious minds have the power to alter the very physiology of the body to a certain degree.
The word ‘psychosomatic’ is commonly misinterpreted as ‘imagined or hallucinating symptoms’ or hypochondria.
Freud thought that the physical symptoms were organic (caused by some physical process) but used by the brain for a psychological purpose. He didn’t rightly deduce that the brain and emotions in the unconscious could create physical symptoms by themselves.
The medical community including the psychiatrists at best believe that emotions can aggravate an organic/pathological/physiological illness but it cannot cause it though.
Freud felt that the purpose of repression of powerful emotions was to thwart any attempt at analysis since the same contain socially unacceptable ideas which are also often carrying sexual content. However, he didn’t realize that the purpose of repression and for that matter, pain is protective in the sense that if we were to confront these emotions, the same could be very embarassing or dangerous and emotionally unbearable to the mind.
Freud also felt that all such repressed emotions can be brought to consciousness which is actually not the case. Many of them are permanent residents of the unconscious.
Freud felt that physical pain etc was for punishing oneself, however the case is that pain and other TMS equivalents are meant for self-preservation and not self-flagellation.
Freud correctly postulated that it is the fight between the ego, the superego and the id viz. the adult, the parent and the child which creates the emotions which are repressed or suppressed in our unconscious. Repression is automatic suppression. Suppression is conscious repression.
Whom does TMS or its equivalents happen to?
Certain personality characteristics are typical of people having TMS or its equivalents :
Loss of love or failuire creates a big dent in the self-esteem of a person. This fuels his desire to be perfect and to be good and loved by all. This spawns TMS vulnerability.
Feelings of inferiority stimulates the drive towards superiority, perfection and high accomplishment. Success is often built on insecurity and poor self-regard. Such people are also very sensitive to criticism.
A few other dominant characteristics are that such people are hardworking, conscientious, responsible, driven, success-oriented, needing to be in complete control of our environments, perpetual seekers of new challenges, their own severest critics, compulsive by nature, needing to have the behaviour of others conform to our own narrowly defined standards.
Psychosomatic symptoms are not a part of illness or disease – they should be seen as a part of human condition to which everyone is susceptible.
Foll. contribute to the rage reservoir :
a) Feelings like fear, shame, guilt, vulnerability, loss of control.
b) A big part of the negative could have been generated during the times of our infancy. A parent’s poor emotional state affects the bonding the child develops with him or her leading to unmet dependency needs. Also, a disciplinarian and intimidating parent or a constantly disapproving parent leaves scars of permanent sadness, hurt and anger which are the constituents the psychomsomatic disorders are made out of.
c) Self-pressures like the need to be loved, good and perfect all of which are born from poor self-regard. Deep feelings of narcissism, strong dependency needs and deep feelings of inferiority forms a triad which is another basis for mindbody symptoms.
d) A variety of life pressures related to work, relationships, health, aging etc.
In a way, anger is also one rung higher and it serves the purpose of not allowing our consciousness to come in contact with our emotional pain and sadness.
One of the typical cases of TMS is that of a person who is financially as well as emotionally dependent on a single person say a father. This leads to issues like identity confusion, fear of ‘growing up’ and confront, stand one’s own ground etc. All this breeds self-esteem issues and tremendous resentment and rage.
Denial of the syndrome is a part of the syndrome. Those who refuse to believe that this is how it stems are precisely the one’s who need it most. This is because it is part of the brain’s unconscious strategy to maintain the status quo.
Some of the other traits with TMS-prone patients are :
They are too hard on themselves. They take responsibility too seriously and forget that as adults, it is also okay to have fun.
They have extraordinary expectations of themselves and of those around them and so are often disappointed or angered by what they perceive to be their own shortcomings or those of others.
They always try to do their best not realizing what a hard job it can be. Doing our best all the time can be an exceedingly difficult work and can lead to frustration and buried anger.
They have low self-esteem and need to be fed by compliments from others. Getting better with TMS is learning how to extract yourself from needing recognition from others and learning how to fill that need yourself.
Countries where whiplash is not known at all have no problem called whiplash as such.
Whiplash is not a structural but an emotionally-induced disorder. The awareness of the disorder serves as a trigger to developing the disorder.
The workaholic ethic is also a TMS equivalent.
Culturally, we are a society that promotes and rewards those individuals who blunt their emotions. Being ‘cool, calm and collected’ is a positive value in our culture. Parents often tell a child who is feeling pain, whether physical or emotional, that ‘everything is ok’ or ‘you’ll be all right’ rather than hug them and allow them to express their distress and thereby validate what they are feeling. Our society is emotionally well-defended.
More about EMOTIONS
The outer rage could be a reflection of the inner rage and at the same time it could also be the case of ‘displaced anger’ as the psychologists call it. Displaced anger is often seen as a safe substitute for the forbidden internal rage. Hence people exhibiting displaced anger would have a big reservoir of internal rage.
Since suppression of anger could lead to negative consequences like a panic attack or similar, the same can be avoided by being conscious that such anger will not go away by suppressing but will only add to the rage reservoir inside. Such an awareness by itself could help forestall immediate or delayed negative consequences.
The internal rage rarely comes out in all its colours unless the provocation is too much. Psyche generally manages the game through the physical symptoms alone.
One point we often forget is that there is no cor-relation between intelligence and emotional balance. An example in place would be the terrorists who must be very intelligent to carry out what they do but are very much emotionally driven in a negative manner.
Many patients rarely experience any symptoms other than what they are conditioned to expect. This is a case of Pavlovian conditioning. This is also one of the reasons that the common disorders are only the ones which are currently in vogue. Patients suffer from Pavlovian conditioning which gives rise to the fear against mustering up enough courage so as to disdain the pain and try seemingly harmless postural movements.
Hypertension – A TMS Equivalent
Even with regard to hypertension, the new paradigm has outmoded the old paradigm.
It is not the emotional distress that we feel but those emotions which we have repressed and are unaware of, they lead to hypertension.
The process by which we unknowingly keep distressful and threatening emotions from awareness causes persisting stimulation of the sympathetic nervous system (SNS) thus elevating blood pressure. Instead of focussing on the distressful emotions that people feel, it focuses on the tendency to repress rather than feel painful emotions.
People who tend to experience severe emotional distress in severely stressful life circumstances are much less likely to develop hypertension than people who repress the emotion and are not distressed. Repression of emotion can be a true blessing to many but it leads to hypertension.
Since calm people seldom express, does that mean that being a calm person outs you at a risk of developing hypertension ? No. Some people are calm and handle day-to-day stress calmly.
The emotions we repress have more to do with hypertension and other chronic medical conditions than the emotions we feel ; then we open the door to new approaches for treatment. As per the new understanding, the person who feels the least emotion is the most hypertension-prone rather than the other way around.
Treating TMS
The treatment of TMS is to first :
a) understand the science behind it
b) accept it whole-heartedly
c) Denigrate the physical symptoms
d) Focus on the psychological causes rather than physical symptoms.
e) Overcome the fear of physical activities and participate in the same courageously.
f) Do a daily study program elaborately listing the historical and present-day life factors contributing to the condition. When you sit down and do this thing on a daily basis, the ideas go from your conscious mind to your unconscious mind which is where they should go to stop the process.
The big secret here is that the knowledge itself is curative and catharsis of repressed emotions is not required to foil the brain’s plan of producing physical symptoms.
People exhibiting psychosomatic symptoms must make an effort to imagine threatening internal feelings and equally important, reflect on the magnitude of their feelings and their potential of doing great harm. One must learn to think of these feelings in volcanic terms and understand that their intensity has potential to wreak havoc in our lives and surface stuff which would be too painful to bear.
Rage generally never breaks into consciousness. So the solution is not bottom-up but top-down in the sense that, if the conscious mind can understand the unconscious mind’s strategy, the cover is blown off the covert operation and the pain need not continue.
In words of Adler, ‘ Therapy is about the insightful re-organization of the patient’s thinking which must then lead to insightful re-organization of what is going on in the unconscious to the extent that the psyche is no longer threatened by the rage as it was prior to the teaching or therapy. The magnitude of threat which had characterized the old organization is diminished by the education process during therapy and teaching. Though the feelings in unconsious are beyond our control, The goal of treatment is to enable the patient to respond more adaptively to these feelings in ways which are more optimal than pain.
During therapy, the pain can go down first and then shoot up and there could be other trends. However, the idea is to help the patient embrace the difficult emotion and thereby facilitate healing. One cannot experience by definition what one is not aware of. So the thing to bring about is that the observing part of an individual should become comfortable with the discomfort of what the participating part is experiencing emotionally. Only then can the embraced emotion be experienced not just on an intellectual level but in a more holistic, integrated way. When this is achieved, TMS symptoms are no longer necessary.
The goal of embracing the once-repressed emotion is not simply for the sake of experiencing it but to learn that over time the ‘adult observer’ can tolerate and ultimately integrate the emotion in a new, healthier way.
The ability to embrace sadness, hurt or sorrow for oneself signifies a letting go of the self-critical aspect of one’s personality and the development of self-compassion which is a crucial ingredient for the successful reduction of psychosomatic symptoms.
As the patient becomes more comfortable with the discomfort of embracing these emotions, they integrate mindbody by allowing themselves to let go of that tight, rigid grip the unconscious mindbody has on them through the use of physical symptoms.
The psyche’s strategy can be defeated if we keep ignoring the physical symptoms and keep focussing on the psychological aspects.
Unconscious resists change much more strongly than the conscious. Poetically, someone put it as ‘ Pity me that the heart is slow to learn that the swift mind beholds at every turn’.
So, in some patients, it may take some time to experience relief.
These are the times when we actually are doing the work of healing, by feeling the pain until it eventually begins to ease and becomes more tolerable. We are psychologically healthiest when we can use conscious and unconscious defenses to tamp down emotions that are too much for us, enabling us to encounter these emotions at a pace we can handle, deal with them and ultimately heal.
When correctly following the TMS knowledge therapy, it is critical to understand that the brian doesn’t give up its strategy soon enough. Appearance of new symptoms in new locations is common. What is important is to recognize it as such. Thinking about TMS even when we are well serves as preventive medicine. Those who are able to do this find that they can nip in the bud many aches and pains.
The difference between how we think we should feel about a situation or event in our lives (our conscious emotion) and what we really feel (often the unconscious emotion) becomes psychogenic. Theoretically in a society that encourages and supports expressing emotions, there would be less of a need for psycho-somatic process to supersede.
In short, live your emotions and accept them. Accepting our painful unconscious emotions as part of who we are, is not only a step toward successful treatment but is also a step toward being a more whole human being.
