Three sources of pain
A consultation with Sarno begins conventionally: He reviews a patient's history and performs a complete orthopedic and neurological exam. Each patient is then asked to complete a full-body pain diagram, indicating any tender areas. Since chronic back-pain patients often also have pain elsewhere, the diagram is persuasive in getting them to focus on their emotional lives. "This really makes an impression," says Rochelle. "There's no anatomic way a herniated disk in the back can explain all of this pain. Only the central nervous system--namely, the brain--could do that" After the initial exam, Sarno moves into psychological territory, as he begins eliciting information about a patient's repressed anger. He sees three possible sources:
1. Childhood trauma. The causes range from a parent's divorce or sexual abuse to more subtle issues such as emotional neglect or excessive parental demands.
2. Everyday stress, such as family conflicts, financial strains, and work deadlines. "If all you did was think about the stuff that pisses you off, you'd be yelling and pulling your hair out, and no one would want to be around you," says Marc Sopher, M.D., a staff physician at the University of Vermont in Burlington who uses Sarno's techniques. "That's why you bury the anger." "Happy" events like having a baby also can contribute to hidden rage. "These things affect you much more than you think," says Sarno. "You're Jekyll and Hyde--a loving parent on the conscious level and, at the unconscious level, furious at your infant for keeping you awake at night."
3. Personality traits. If your goal is to be perfect or to please people all the time, you'll always be frustrated. Self-imposed pressures can generate anxiety and anger. Ivo the emotional roots of back pain Perelman, a jazz musician and painter in Brooklyn, N.Y., found his way to Sarno after seven years of tendinitis. The cause, he now realizes, was his basic personality—type-A, workaholic, artistic. "It was overwhelming me," he says, "and it played a major part in my tendinitis."
Sarno's patients list their multiple sources of anger, then spend 15 minutes meditating or writing about one item each day. They also attend weekly lectures, during which Sarno explains his theories more fully. If the pain isn't going away, he has patients attend support groups; if all else fails, he recommends that they work with a psychologist to help resolve the underlying issues. "Those who take responsibility get better," says Rochelle. "Those who want the doctor to 'fix' them will not."