Back Pain and Anorexia
Sarno posits the existence of "TMS equivalents," other psychosomatic conditions besides back pain, which proceed according to the same model. These include such common ailments such as tension headache, migraine, constipation, diarrhea, and certain allergies. In addition, Dr. Sarno identifies a category of more serious illnesses in which TMS may play a role, including high blood pressure, arteriosclerosis, and even cancer.
On page 184 of the appendix to The Mindbody Prescription, Sarno suggests that eating disorders are psychosomatic in nature and follow the TMS model: "I have had many patients who have moved from more severe psychosomatic manifestations to milder ones: bulimia or anorexia nervosa to back pain, for example. My interpretation is that they have improved psychologically and no longer require the powerful distraction."
Similarly, on page 130, he notes: "The more deeply repressed the rage, the greater the potential for serious illness. That idea is, of course, highly theoretical."
It is not surprising that emotions play a powerful role in the development of anorexia nervosa. Previous articles on this topic page have stressed the psychological factors involved in eating disorders (see "The Psychological Basis of Anorexia Nervosa,Part I and Part II"). What makes Dr. Sarno's theory unique is that it attempts to explain a whole host of illnesses, from mild to severe, with a single, unifying "mindbody" model.
As stated previously, the theory is highly controversial. Most members of the medical community reject it, preferring a "structural diagnosis" for back pain (e.g., disc herniation or degeneration). It should also be noted that Dr. Sarno has no psychoanalytic training, although he professionally associates with psychotherapists whom he recommends for patients with more intractable emotional difficulties. And although he believes that most back pain is due to TMS, Dr. Sarno stresses the importance of having a thorough medical examination to rule out serious disease.
Among Dr. Sarno's supporters are Benjamin J. Sadock, M.D., professor and vice chairman of the Department of Psychiatry at NYU Medical Center, and Dr. Andrew Weil, a graduate of Harvard Medical School well-known for his writings on complementary medicine and mindbody phenomena. On page 4 of the May 2000 edition of his newsletter, Self Healing, Dr Weil writes: "According to John Sarno, MD, a physician who has greatly influenced my thinking on the subject, back pain can be a defensive mechanism. The unconscious mind may distract you from uncomfortable emotions by keeping back muscles in spasm." On
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