But Sarno goes further. He says that in a pronounced majority of back-pain cases—perhaps 75 percent—the cause is solely psychological. In his view, compressed and herniated disks are almost always part of the normal aging process and irrelevant to back pain. "It's like gray hair—so what?" declares James Rochelle, M.D., an orthopedic surgeon in Mena, Ark., who applies Sarno's techniques in his own practice.
According to Sarno, repressed anger stemming from early traumas and daily (and often self-imposed) pressures cause the mind to react by producing a distraction—such as pain—via the autonomic nervous system, the body's regulator of functions like heart rate and blood pressure. The result is diminished blood flow—and hence, reduced oxygen delivery—to parts of the body. Over time, small decreases in oxygen lead to muscle spasm, nerve dysfunction, numbness, and tingling. "The pain is not in your head" he tells patients. "It's in your body. But what's in your head causes it to happen."
Sarno is well aware of what his critics say. They point out that his evidence for oxygen deprivation causing pain rests, somewhat shakily, with two small Scandinavian studies on fibromyalgia from the 1980s. He has no randomized, controlled trials that could prove the effectiveness of his techniques. And it doesn't help that he's never published follow-up data in medical journals showing how his patients have fared long-term.
But patients in pain embrace anything that gets results. "He saved me from repeat surgery for a herniated disk" says Susan Light, M.D., a drug-development consultant in California. "He's done wonders for me."