Vale Dr John Sarno

My latest article on MercatorNet is a brief tribute to Dr John Sarno, whose work on the psychogenic causes of chronic pain helped me in my own efforts to overcome a painful auto-immune disease.

https://www.mercatornet.com/features/view/vale-dr-john-sarno-americas-best-doctor

 

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Miracle cures and short-sightedness

I’m in my second day without wearing glasses, because I want to cure my myopia.

If that sounds bizarre, let me explain.

The miracle ‘cure’

I’ve always been both hopeful and skeptical about the prospect of ‘miraculous’ cures for physical illnesses and ailments.

I use the term ‘miraculous’ loosely to refer to cures that do not match our normal expectations for how health and illness work.

So, for example, I can quite honestly say in one sense that I ‘cured’ my autoimmune disease. My honesty makes me put ‘cured’ in quotation marks because I don’t have sufficient evidence to prove that what happened to me amounts to a ‘miraculous’ recovery from that disease.

In practical terms, I no longer have symptoms of that illness, and I have a subjectively meaningful narrative for how those symptoms came to an end as a result of my own actions.

My rheumatologists were quite happy to give me a provisional diagnosis of ankylosing spondylitis based on my symptoms and a genetic marker. The only caveat is that if my symptoms stopped, then obviously they would withdraw the diagnosis.

A skeptical contention would be that if I hadn’t done anything to change my outlook on the illness and seek some kind of psychological cure to the physical problem, the symptoms would have disappeared anyway.

It’s impossible to prove in my case, and it’s hard to imagine an appropriately rigorous medical trial to test the theory (hard but not impossible).

So for me it remains a choice. I had to choose to face my illness as a reflection of a deeper psychological or spiritual issue. In so doing, I observed a pattern to the symptoms that matched changes to my mental and emotional state. When I became aware of these changes and adapted them, the symptoms ceased.

A short-sighted approach

So what about eyesight?

I’ve been short-sighted for a long time. I had my eyes tested in about year 5 at school, but I may have suffered from short-sightedness before that.

Wearing glasses has always bothered me. I don’t like being so dependent on a fragile external tool to interact with my environment. So when my glasses frame broke two days ago I decided to take the opportunity to investigate the problems with my vision.

Meditation on illness

Both auto-immune disease and short-sightedness  relate to extraordinarily complex biological systems.

An auto-immune disease is a good candidate for examination because it consists in essence of the body attacking itself without an obvious external cause.

But it turns out that myopia is also somewhat mysterious, with both hereditary and environmental factors at play.

Myopia is a form of refractive error due to the shape of the eye. I have trouble seeing long distances clearly because my eye is longer than it ought to be.

I don’t know about you, but my response to being told “your body’s immune system is attacking your joints” and “your eyeball is too long to focus the light properly”, is a profound and indomitable sense of challenge.

The spiritual approach

For want of a better word, let’s call this a ‘spiritual’ approach to illness. The idea is that our experience of life is not simply the random outcome of external processes. Rather, our experience of reality is mysterious and meaningful.

What this means is that something like suffering an auto-immune disease or having bad vision is not an accident or a random outcome. It has deeper significance. It relates to your life and your own person as if you were a character in a story.

Whether we continue to suffer from the illness, or find reprieve, I think it makes sense to try to see the personal meaning in it.

For me this process of looking for meaning begins with observing how I feel about the illness, the symptoms, and their impact on my life.

It turns out that despite not giving much thought to my short-sightedness for many years, I do carry strong feelings about it.

Going for two days without my glasses has made me realise how much fear and powerlessness I feel when I can’t clearly see what is going on around me.

Driving without my glasses is safe enough – I can see every object in my vicinity – but more than a hundred or so metres away and objects become blurred. People are easy to see but impossible to recognise. They become fuzzy humanoid shapes, obvious but unreadable.

The inability to see what’s coming right to the farthest horizon or the very end of the road is fear-inducing. I can see things but I don’t know what they are.

Then there’s the powerlessness. I can’t look down the aisle of a supermarket and read the signs for the food categories anymore. I have to walk towards things to make out exactly what they are. And as for people – they might as well be dressed in shrouds and wearing masks until they come within about five metres of me.

It’s a profoundly alienating experience.

So there you go. This short-sightedness does have a great deal of meaning for me, a meaning I’ve ignored and neglected by wearing glasses all the time.

I don’t want to wear glasses anymore, and that means I have to start confronting and facing these fears and insecurities.

So what am I saying?

Does that mean if I confront my fears and anxieties my eyes will magically change and I’ll be able to see without glasses?

Well, what I discovered when I tried to heal my auto-immune disease was that I had to accept the truth about the disease first. The truth was that my disease was just a reflection of my own psychological and spiritual state.

I know how challenging that sounds, because I resisted accepting it for a long time. I didn’t like the idea that progress would depend on choosing to believe something. If the evidence could convince me, I was ready to believe it. But to just believe, without evidence? That sounded pathetic and weak.

Yet there was evidence. Not evidence that could convince me this was the truth, but evidence that I could make no progress, do nothing more, until I had accepted this basic premise.

To put it bluntly, if my disease really was just some random or genetically determined biological quirk, then I was ******.

If my symptoms weren’t a reflection of my deeper psychological and spiritual state, then there was nothing I could do about it. But if they were a reflection, then nothing was set in stone.

In the end that was the choice: the choice to try to give up or try to find answers.

And if there’s one thing I know from my studies and reading in philosophy and mysticism, it’s that our claims to absolute knowledge of external reality are as much a choice as any.

We choose to believe the world is real, not because we have seen convincing evidence that it is real, but because we have seen evidence that to choose otherwise gives us nothing in return.

If I choose to believe the world is a figment of my imagination, there is nothing anyone can say or do to prove me wrong. But there is plenty that can be said and done to prove that a real world is a much better thing to believe in than a deluded imaginary one.

Melancholic with Type A Personality

I’d heard of Type A and Type B personalities before, but I didn’t seem to fit into either category. Type A are supposedly harder-working, competitive, ambitious, organised, intense, hostile, and stressful. Type B are laid-back, relaxed, disorganised, friendly, and so on.

The problem with a lot of these descriptions is that they seem to be dealing with Type A personalities of a Choleric temperament. But in the pursuit of a cure for my auto-immune condition, I’ve come across more general descriptions of Type A which suggest that a person could be Type A regardless of their temperament.

I don’t think I’d ever be mistaken for being an over-achiever, but that’s because most people think of specific, socially esteemed and easily recognisable achievements like winning sporting competitions, getting promotions at work, hosting big parties, winning awards, and so on.

What about someone who feels bad if they aren’t working toward some kind of goal, however humble or eccentric? Or what about someone who pushes themselves towards goals that they find more difficult than others because of their temperament? Or what about the temperament type that ruminates and analyses everything in exhaustive detail, and treats those silent efforts as a kind of progress to be made?

As I understand it, a Type A personality is about being driven, and it doesn’t matter where you happen to be driving to. I have a med-student friend who is also melancholic and Type A, and  all the study she has to do in addition to family, work, music, and other commitments makes me feel sick just thinking about it. I’m not achieving anything so exalted as a medical degree (or so I tell myself in false humility) yet I greet each moment of potential rest with the question “what could I be getting done instead?”

I’m acutely aware, for example, of not having made any cheese since my blue brie finished over a week ago! Not only that, but my beer reserves are getting perilously low, and I’ll have to make time for another brew soon.

I jumped at the chance to turn this reflection into a blog post, because I haven’t written any for a while and I’m feeling genuinely bad about it, because I’m measuring my self-worth in large part by how productive I am. It doesn’t matter that my idea of productivity isn’t typical: those sardines aren’t going to salt-cure themselves! (Actually, they pretty much do once they get going).

Several months ago, in the midst of severe back pain I tried something a little unusual at the behest of an acquaintance with an interest in hypnotism: I asked my subconscious mind to tell me what the real cause of my pain was.

The answer I received was a mental image of myself lying face down in the driveway of our home, pinned by the front wheel of my car which happened to be driven by another me.  Apparently my subconscious mind loves puns and metaphors as much as I do. The message was clear: I am crushing myself with my own drive.

Still, it’s taken months and additional resources from people with expertise in this field for me to recognise the greater extent of this “drive” that is making me sick, stressed, and sad, when really I have so much to be grateful for in my life.

I’m so accustomed to it, I’ve embraced it so wholeheartedly that this drive feels like “me”. The thought of not accomplishing anything today, or this hour, or this minute makes me feel anxious and nauseated. On some level I’ve decided that I’m running out of time, I need to get things done at any cost. I’ve come to believe in the inherent goodness of purposive activity, and I feel empty and inept without it.

Something is terribly wrong when you feel like you can’t go to the park with your wife and son because it’s too good an opportunity to “get things done”. Something is terribly wrong when the act of getting out of bed to “get things done” is hampered by severe pain despite feeling inwardly fine.  There’s something wrong when the high of analysing, pursuing, and seeking to solve problems and understand mysteries drowns out love, happiness, and the experience of peace.

Part of me enjoys the pressure, the power, the sense of control. But like any addiction, it’s a mask, a distraction and a false sense of self.

A painful attitude

Last week I mentioned Dr Sarno’s work in the context of my auto-immune disease and the intermittent flare-ups of pain and stiffness it brings.

My experience matches others’ accounts of the link between their pain and their broader psychological state: my pain seems to be associated with a self-imposed pressure to perform, to go faster, to get more done, or to be more responsible, more in control.

Sarno’s theory is that such expectations enrage us on a subconscious level, and we create the pain to distract us from what we consider to be inappropriate emotional responses. I’m not sure if this mechanism applies fully to my circumstances, but the expectations definitely play a role.

For example, when I lost my job a year ago I decided to see how far I could push my freelance writing. Things were going well for a few weeks, I felt confident and had dramatically increased my output. Then the pain set in. I ignored it for as long as I could, and in hindsight it’s remarkable that I managed – or wanted to – ignore it at all.

Eventually I realised what the problem was: at some point I had quietly decided that the solution to my employment problems was to write prodigiously and without ceasing. “Decided” is perhaps a bit of an understatement; it’s more like I subconsciously committed myself to that path, with a determined disregard for the consequences. It felt like a gut-level conviction that “This is what I have to do.”

Altogether it took a few weeks from the onset of the flare-up for me to stop ignoring the pain, remember the general psychological theory, work out the specific cause, and reverse it.  In this instance, fully reversing it meant recognising that the amount of work I was doing was not sustainable in the long-term, that the amount of money we needed to survive was much less than I had expected, and that imposing such pressure on myself was simply counter-productive.

I’ve found that this method neutralises the acute lateral pain of a flare-up so long as I genuinely reverse the underlying attitude. However, the long-term medial stiffness and occasional pain has not been responsive to these efforts. I’m working on a resolution for these chronic symptoms, but will have to save it for a later post.

‘Overcoming’ Auto-immune disease

I was diagnosed with an auto-immune disease about five years ago. Since then I’ve intermittently tried to comprehend the cause and etiology of the disease, necessarily going well beyond the limits or context of scientific research.

While there are various studies showing interesting links between aspects of psychology (for example, childhood trauma) and chronic illness in later life, there is a dearth of solid research saying “Zac, this is why you suffer from the immunological analog of punching yourself in the face.”

I’m mostly unapologetic about delving into the kinds of material that some might describe as “new age horseshit” but at the same time I’m increasingly weary and wary of those who accept uncritically the assurances of wealthy, slickly marketed gurus whose message of love, peace, and healing is now available in downloadable format for the one-time offer of $29.95 (monthly subscription).

You only have to look at the most prominent of these new age scions to realise that they show all the signs of being Choleric by temperament, which, in the context of a charismatic marketing campaign based on literally telling sick, sad, and suffering people exactly what they want to hear, does not guarantee that they are frauds, shysters and snake-oil salesmen.  But it does suggest that the supposedly Divine, Transcendent Life-Force or Energy Welling Up From Deep Inside Them™ and inspiring their benevolent mission of love and peace to all humanity looks and sounds a lot like their own ego.

Nonetheless, I can’t afford to wait for scientists to unravel the mysteries of our physical makeup, and the same desire for understanding that led me into philosophy and the study of religion leaves me pretty damn open-minded about the theoretical basis for a pragmatic approach to health and sickness. In other words, if someone wants to argue that the body is a holographic projection of the mind, I’m open to it. But if believing this does nothing, then it remains just an empty possibility, and I have no use for it.

One theoretical context that has provided some value is the work of Dr John Sarno, who came to prominence some decades ago for arguing that many forms of chronic pain are a biological response to an emotional or psychological cause. Coming from something of a Freudian background, he argued that the pain was real, but it was caused by the brain attempting to distract itself from emotional turmoil. Sarno believed that this chronic pain could be overcome simply by accepting its true cause, effectively seeing through the brain’s attempt at self-distraction.

This is only a rough summary of the theory and associated methodology. It is not a broad theory, in the sense that Sarno accepts the legitimacy of genuine physical injuries, diseases, and illnesses; he merely wishes to add this particular syndrome to the panoply of diagnoses and hence treatments. I do not think, for example, that my condition is discussed in Sarno’s books, or if he considers autoimmune conditions to be an expression of the same mechanism.

So if you read something like this sincere account of a person’s struggle to overcome an autoimmune disease by confronting underlying emotional trauma and consequent psychological self-abuse, you can hopefully look past any confusing or confronting references to “new age” themes, and see that he is describing roughly the same underlying mechanism as that proffered, to greater mainstream acclaim, by Sarno.

I’ve mentioned previously in the context of temperaments that the melancholic is prone to physical ailments, and also that the melancholic must, according to Conrad Hock, learn to love suffering. While I’ve interpreted this previously as a brake against the forces of perfectionist idealism, the account above presents it as a means of reaffirming the feeling faculty at the heart of the melancholic temperament.

As the author describes:

My physical healing process began when I realized that tensing against and resisting my severe physical pain was itself a form of stress that added to my illness.

In a similar way, I’ve wondered if even my attempts to root out and uncover the causes of my illness are paradoxically contributing to the stress and intensity that drive it? The further paradox might be that this disease is not something that you overcome, since the illness itself entails confusion over where exactly ‘you’ begin and end in the first place.

If I take my chronic auto-immune disease as a kind of gestalt image of my life in the world, then it is clear that something is not working.  But that I would feel ‘fine’ if not for the pain and other symptoms, tells me that I am missing something more subtle, more profound, or just very deeply ingrained. It may even be, as the author attests, Sarno suggests, and the life of a melancholic implies, that I have learned to function at odds with my own nature.

Auto-Immunity: stop hitting thyself?

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An auto-immune disease is, as far as I can tell, the disease equivalent of accidentally biting off a chunk of your own tongue.

My particular auto-immune disease causes inflammation in various key joints, resulting in mild-to-excruciating levels of pain that erupt seemingly at random throughout the course of the year.

Each doctor I’ve spoken to has been more or less firm about the association between stress or negative affect and flare-ups of the disease; firmly against any such association, I mean. There is no evidence to suggest that the progression of diseases like mine is in any way linked to psychological factors, though there is good evidence that the experience of pain can be moderated by psychological factors.

Needless to say, I’m not content with this and rest somewhat assuredly on the dictum “absence of evidence is not evidence of absence”, taking some confidence in what I know to be the limitations of evidential standards and processes, such that if I find a personal or subjective association, I’m not going to dismiss it on the basis of insufficient peer-reviewed studies.

At the same time, it’s somewhat dismaying to see people dismiss actual studies from a position of willful ignorance and wishful thinking. I’ve seen plenty of people embrace conspiracy theories or other combative attitudes towards established medical and scientific practices and institutions. It’s not a pretty sight. Ideally we should know and understand the things we criticise, and be aware of the limitations of our own knowledge, n’est-ce pa?

As such, I’m not going to tell people that their auto-immune condition is the result of stress and negative affect. What I can tell them is that I’ve noticed in myself that my bouts of inflammation seem to correspond with periods of self-imposed stress or pressure.

It seems I am of a temperament which is inclined to say to itself: “Now you know what you ought to be doing, so do it; do it without ceasing. Do nothing else. Nothing matters but that you do this, and do it diligently forever and ever, Amen.”

For example, I had a flare-up some time after deciding that I ought to pursue my writing more seriously. ‘More seriously’ as in, unceasingly and compulsively without any concept of an end point. On the positive side, that helped me produce an unprecedented number of articles – if I remember correctly: 12 published articles in a one month period.

But as my productivity began to decrease, the conviction that “I must write” slowly devolved from a genuine motivation into a mere sense of grinding necessity. Grinding is perhaps the operative word, as my joints inflamed and it became painful to move.

I’ve noticed since that the pain seems to coincide with these bouts of grueling yet unproductive urgency, the sense that I must get something done without excursion or delay.

Yesterday I noticed a growing sense of urgency relating to ‘getting things done’ with respect to domestic production. I’ve been meaning to make some cheese, but have struggled to find a good local source of necessary ingredients. The delay and the awful heat (42 degrees C yesterday) left me feeling unproductive, and this morning I woke up with the telltale stiffness and pain in my lower back.

As tentative as I am to try to dictate the cause of my illness to others, I’m equally cautious in extolling a particular treatment. I’m not trying to sell anything.

However, I have found it personally beneficial to treat the pain as a symptom of the underlying urgency, and therefore to treat the urgency directly. I do this by making a conscious effort to defuse this compulsive state of mind. I reflect on the fact that it doesn’t actually matter if I make a cheese today/write an article tomorrow, or if I do these things next month, or in all honesty if I never do them ever again.

By ‘reflect’ I mean it’s not enough to simply tell myself that it doesn’t matter. I have to really feel that it doesn’t matter, because feeling it means I can let go of the stress, tension, and urgency. Feeling that it doesn’t matter reveals how truly tense and stressed I have become – winding myself up into a state of impossible and unnecessary tension. I can feel the tension now through my whole body, yet I was oblivious to it until I started to focus on ‘letting go’.

Does ‘letting go’ fix the problem? Objective analysis would be nearly impossible. The factors at play are highly subjective, and would be very difficult to study or isolate under experimental conditions. But like Pascal’s wager, if I’m wrong about the connexion I’ve nonetheless benefited from becoming aware of my stress and tension and reducing them to more salubrious levels.

Feeling more relaxed, happier, and healthier is a pretty benign form of treatment. There’s not really anything to lose.

Does the pain go away? As strange as it might sound: I hadn’t really noticed. In hindsight, it must go away because I notice its subsequent return. But I’m usually so caught up in the great sense of relief and relaxation, the sheer pleasure of ‘letting go’ all the stress, strain, and slowly mounting pressures of life, that the pain, the stiffness and the sense of disease seem to just dissolve away.