The Anthropology of Chronic Pain in Modernity 

By Kim Merlo

We must learn to recognize nature’s truths even though we don’t understand them, for some of those truths may still be beyond the ability of the human mind to comprehend. What we need is a compound prescription of humility, imagination, devotion to the truth and, above all, confidence in the eternal wisdom of nature (Dr. John E. Sarno, attending physician in Rehabilitation Medicine at the Rusk Institute, Manhattan)

“We can’t find anything wrong” is a familiar asseveration that many who suffer with chronic pain have heard from a medical professional at least once on their arduous and often insular journey to finding even a modicum of somatic relief. An unimaginable number of people around the world suffer with chronic pain (and what’s known as the symptom substitute in mind-body healing circles; the phenomenon that occurs when the initial pain in one area ends or subsides, and a new area of pain presents itself) that it has become a public health issue that should be classified an epidemic. 

To understand why over 50 million adults in the U.S. suffer with chronic pain it is necessary to examine what changed in the practice of medicine in the mid-20th century, when there was a subtle but lasting shift in how patients were treated. Physicians before 1950 knew that emotions influence illness, thus the whole person was treated. Doctors would glean from the patient’s history various aspects of stress such as relational and financial issues that were manifesting in their lives. If no structural abnormalities were indicated, this personal knowledge was employed to help the patient understand the source of the pain. Contemporary medicine is quite different. As evidenced by the plethora of pharmaceutical advertisements in all forms of media, we’re being programmed to “take the pill,” essentially to treat the symptom. With the rise in specialty medicine, a primary care physician will often send a patient to a specialist, who will no doubt offer a treatment plan, oftentimes involving surgery which keeps the patient focused on the area of discomfort. Sufferers often feel gaslit by the mainstream medical community. They are made to feel crazy. Treating chronic pain has become a lucrative business, yet the problem is still pervasive. 

I walked into Dr. John Sarno‘s office in the spring of 2007. I was struck by his gentle yet confident, fatherly demeanor. I was immediately drawn to him like a trusted old friend. I sensed a wisdom that led me to believe he could offer me relief. A priest who was a dear friend of mine called and told me that I needed to not only read a book that a parishioner brought to his attention, but because the doctor was based in New York City I should try to make an appointment to see him.

The book is called “The Divided Mind” one of several books written by Dr. John Sarno on the subject of “TMS” (coined by Dr. Sarno- tension myoneural syndrome) which is also known as mind-body pain, or the more misunderstood, “psychosomatic” pain. The book listed several ailments that were causing me tremendous suffering, all of which were privy to this priest. My most recent symptom, tinnitus, sent me into a tailspin. It was the straw that broke the camel’s back, so to speak. The onset happened at a very stressful and tumultuous time in my life, and it was just another manifestation to add onto a full plate of pain symptoms.

With the new pressures of first time motherhood, a recent stay in the hospital for pneumonia, and toxic family dynamics abounding, Dr. Sarno was introduced to me at just the right time. Through his writings, lectures, and delving deeper with a therapist trained in the unconscious mind I finally understood why I had chronic pain, and what caused the tinnitus at the time. It took several months, but the tinnitus subsided and my fascination with chronic pain, the unconscious mind, and emotions began. 

My family and I were excited about moving to Ave Maria, Florida from Long Island in January 2018. It was an undertaking that had been in the making for about five years, my husband taking a lateral transfer with his company to a state where many people go to vacation, a beautiful sunny state that could offer us a better quality of life, in a town that sounded promising to Catholics who love the Faith. While I was mostly enthusiastic and positive about the move, I felt sadness thinking about leaving my family, friends, and parish, but comforted myself with thoughts of visits back home on holidays. I pushed many emotions to the back of my mind as we packed up and started our drive south, rain pelting our car from New York to southern Georgia, where the sun emerged as we crossed the border into Florida. For me, it was a sign that a bright new beginning was in the horizon (it was, but not how I imagined) and my family was where we were supposed to be. In retrospect the change was more of a culture shock than I felt, at least emotionally. 

But the physical symptoms presented themselves, one after the other like clockwork. I will mention one symptom, the first which came as a complete surprise- plantar fasciitis. It was only after multiple symptoms emerged that I looked back and understood what was happening. Many doctors and therapists who practice mind-body medicine find that there is a correlation between the area of pain, and the emotions, or situation presenting itself. I see now that the adjustment to “new ground” was more difficult for me than I originally believed. What I’ve learned over the years is that repressing painful emotions is the way I developed psychologically. It’s part of my nature. As is the case with TMS, knowledge is power. These painful symptoms have been learning experiences for me. 

It is important to know what sort of person has a disease than to know what sort of disease a person has (Hippocrates).

Dr. Sarno mentioned that in his 60+ years of practicing medicine, he never once met a person who suffered with chronic pain who wasn’t what he called “a perfect and a good.“ (Dr Sarno’s description of a perfectionist person). He described his patients as hard-working, responsible, someone with a disposition who put a lot of pressure on themselves.

Not only are certain personality types more susceptible to chronic pain, there are other factors that play a part in the likelihood of developing pain. Core beliefs. Trauma in childhood as corroborated by patients with high ACE scores is another (an ACE score is a tally of adverse childhood experiences such as divorce, abuse, neglect, and parental addiction and/or parental mental illness.) Everyday pressures also play a factor in developing chronic pain. We live in a society that places many demands on the individual, with in many cases familial support being in short supply. As the cost of living rises more hours at work are accumulated just to make ends meet.

Everyday stressors accrued over time and not dealt with can have a devastating impact on one’s mental, and subsequently physical, health. And it can be challenging to carve out time for ourselves in this fast-paced culture. I’m old enough to remember a time when most nonessential shops were closed on Sundays. The landscape is quite different now. A higher demand is placed on ‘fear of missing out’ than having a day of rest. Pain is a message, our body’s way of getting our attention. We need to slow down and listen. 

So what did Dr. Sarno and his present day contemporaries have to say about managing chronic pain in an increasingly chaotic world? Let us first explore the mechanism the brain uses to induce pain. 

When Dr. Sarno graduated medical school in 1950 and embarked on his career in rehabilitative medicine he saw many patients with back pain and employed the prevalent treatment at that time which was surgery. He became discouraged by the dismal success rate and started to consider that most back pain might be psychosomatic, meaning the physical pain is induced by the brain for psychological or emotional reasons.

As I mentioned earlier, Dr. Sarno called this process TMS- tension myoneural syndrome- a painful disorder that is completely benign. It is a strategy used by the brain, often employing the autonomic nervous system to distract with pain created by the unconscious mind to keep “unacceptable” or “dangerous” feelings repressed. In these patients there is an unconscious psychological need to develop TMS, because it is more acceptable to the brain to experience physical pain rather than having anger, and even more often- rage- reach consciousness. This serves a psychological purpose. 

Modern Western (northern European) culture frowns on overt displays of emotion (think retorts such as “Keep a stiff upper lip!”) but suffering with physical pain does not carry with it the implicit stigma associated with emotions, such as weakness and character defects. It is often difficult for sufferers to believe that their pain is psychosomatic not only because of the connotations attached to that word but because the pain is excruciating as well as debilitating. In addition, many people think that the world of conscious is the only world. It is not known why the unconscious feelings endeavor to become conscious. But it is perspicuous why the brain would resist. These emotions are deemed too painful or unacceptable to be experienced consciously particularly by those who Dr. Sarno deemed “the goodists” who incidentally are often times “the religious.” 

While there have been more recent developments in the field of Neuroplasticity and chronic pain, which go hand-in-hand with Dr. Sarno’s methods, and which I hope to expound upon in the future, Dr. Sarno describes the process by which the brain induces physical pain as simply reduced blood flow which causes oxygen deprivation to the target area. This creates intense pain in the body, but it is a benign process that causes no lasting harm. That is why the pain isn’t always consistent, and can change in intensity from day to day. Simply put, it is a distraction, a strategy of avoidance to keep repressed emotions safely tucked away in the unconscious mind. And the strategy works. The body keeps score. If it doesn’t express itself emotionally it will present itself as physical symptoms. 

…..unconscious emotions are a potent factor in virtually all physical ills (Dr. John Sarno).

So what is the game plan to relieve the pain? The answer is simple, yet for some it can be incredibly difficult to accept. One must believe the process. Education is key. An educational approach to healing has worked for many people who have simply read Dr. Sarno‘s books, believe the science wholeheartedly, and cured themselves. About 25% of his patients needed additional treatment with one of his therapists who are specialists in the unconscious mind, to help draw out the issues and emotions working in tandem to create pain. As an aside, doctors who specialize in TMS always perform a physical examination to rule out structural issues, cancer, or infection. There are certain conditions related to back pain that are “normal abnormalities’ ‘ such as bone spurs, herniated discs, scoliosis, and even spondylolisthesis. Oftentimes when patients see their x-rays with these normal abnormalities it is a challenge to believe that the pain is psychosomatic. But it has been done as evidenced by the thousands of patients who have been healed by Dr. Sarno. 

Chronic pain can be not only contagious but trendy as well. Hysterical paralysis was in vogue centuries prior, but it is a rarity to witness this today. It presented itself as stomach ulcers in the 1970s, carpal tunnel syndrome in the 80’s, fibromyalgia and pelvic pain in the 90’s and complex regional pain syndrome (CRPS) in more recent years. A fascinating study in 1996 questions the validity of whiplash syndrome as a high prevalence chronic physical injury and asserts that whiplash is a social disorder and culturally dependent. An inside joke is that if one wishes to never suffer whiplash they must move to Lithuania, a country with no medical insurance where collision victims are not “medicalized” and there is no expectation of chronic symptoms. The injury itself is viewed as harmless. Here in the Western world we are exposed to widespread public information regarding whiplash syndrome, and it’s a set up for failure where the victim is medicalized and focused on the symptoms which only cause them to exacerbate. Additionally, collision victims in the western world through insurance and at the prodding of injury attorneys have motive for financial gain and oftentimes even compensation from their workplace. Here, it’s built into the system. 

As you can deduce, the subject of chronic pain is broad and expanding exponentially as we learn more about brain science and Neuroplasticity. Dr. John Sarno was a pioneer in mind-body medicine who understood the human condition He has left a legacy of hope for his followers, the various doctors and other therapists who worked alongside him, learned from him, believed in him and continue to help others heal themselves through education, support, and for me personally, the knowledge that God did not create us as fragile beings who are meant to senselessly, chronically suffer but as extraordinary beings with a mind, body, and soul that once aligned, function to create true and perfect health. 

And be renewed in the spirit of your mind…(Ephesians 4:23).