Godmindfamily, Chapter 2: Doctor Sarno, TMS (The Mindbody Syndrome), Placebos, Nocebos, Conditioning and Godmindbody

Chapter 2: Doctor Sarno, TMS (The Mindbody Syndrome), Placebos, Nocebos, Conditioning and Godmindbody It is necessary to once again introduce Doctor Sarno and TMS, since the concepts discovered by Sarno are foundational for what comes later in the book, and the information is valuable in its own right and worth repeating.

TMS, or Tension Myositis Syndrome, was discovered by Doctor John Sarno of New York’s Rusk Institute of Rehabilitation Medicine in the 1970’s. It was later updated to stand for The Mindbody Syndrome. Over the decades, TMS became a catch-all acronym for a wide variety of psychosomatic conditions and symptoms, including but not limited to: anxiety, depression, addiction, chronic pain (including most herniated discs, most osteoarthritis, most stenosis, spondylolisthesis, spondylolysis, spina bifida occulta, bone spurs, coccydynia, and scoliosis, bursitis, tendonitis, pinched nerves, sciatica, and ‘strained’ muscles, partial tears or ruptures of tendons and ligaments and repetitive stress injuries), endometriosis, dizziness, whiplash, frozen shoulder, Chronic Fatigue Syndrome (CFS/ME), hay fever, Carpal Tunnel Syndrome, Raynaud’s, perceived food intolerances, psoriasis, Long Covid, indigestion, heartburn, eczema, TMJ (temporomandibular joint), insomnia, Irritable Bowel Syndrome, brain fog, Fibromyalgia, migraines and similar conditions. People have healed from all of the above using mindbody methods and information.

Steve Ozanich and I have made the term TMS still more inclusive. For me, every chronic, endogenous disease is mindbody. That includes autoimmune diseases. In one sense, all ailments and injuries are mindbody, because the universe is generated by the mind of God. People have healed from Ankylosing Spondylitis (my client Ozzy and possibly myself included), Multiple Sclerosis,[i] Lyme Disease[ii] and cancer using mindbody methods, brain retraining or something very similar. The proof is in the pudding that I and others who were severely lactose intolerant are now able to eat. The mindbody approach does not work in every case, but if even one person is able to heal an illness, then it obviously can be done. Many people, however, are better off with conventional medicine, because for Sarno’s approach to work, a high level of motivation, decent reading or listening comprehension, the ability to change one’s mind, and a strong level of belief are required. It is also recommended that you see your doctor if you have symptoms, because rarely there is something serious going on that may need attention.

TMS pain can be burning, tingling, dull or heavy. Symmetrical pain, pain that comes and goes, pain improving with movement or exercise and shifting symptoms are all common manifestations of TMS, which indicate a non-structural origin of the pain.

Sarno understood that TMS pain was a conditioned response. Conditioning was discovered by the Russian psychologist Ivan Pavlov, who conducted an experiment in which a bell was rung at the same time his dogs were presented with food. After a while, the dogs associated the bell with the food, and salivated when the bell was rung, even in the absence of any food being given to them. Conditioning describes the process whereby a stimulus (e.g. the bell) evokes a response – sometimes a biological one – in this case, salivation. When it came to Sarno’s back pain patients, he found that they had associated a stimulus – bending – with the response of back pain. The conditioned association was the cause of the pain, not any physical problem.

Similarly, Doctor Schubiner explained that medical testing reveals that most so-called food allergies are not actual allergies, they are merely perceived food intolerances: conditioned responses in the form of symptoms associated with certain foods.[iii]A placebo is a sham treatment with no active ingredients, typically an injection or pill containing lactose, starch, sugar or saline, that can nonetheless create a positive effect on health through the patient’s expectations – the placebo effect. The word placebo is derived from the latin placere, meaning ‘to please’. Evidence shows that the placebo effect can work even when patients do not have any conscious faith in the placebo, but nonetheless subconsciously associate certain stimuli – a doctor, a white coat, an injection – with a biological response via conditioning. [iv] Obviously, conscious belief in the placebo makes it even more effective.

Sarno wrote about the immense power of belief in sickness and health. He described how one man called ‘Mr. Wright’ had even healed his terminal cancer when he was given an experimental drug called Krebiozen, that he firmly believed would heal him. When the man heard press reports that the drug was ineffective, his cancer came back. His doctor told him they had a new, stronger drug. The man took this ‘drug’ and he went into remission again. Unbeknownst to the man, the drug was a placebo injection. Then Mr Wright was exposed to further news reports that Krebiozen was useless, his cancer came back and he died.[v]

The placebo’s use in clinical practice is commonplace; it is estimated that large percentages of prescriptions function as placebos, whether the prescribing doctor is aware of this or not. A meta-analysis of nearly 3,000 doctors participating in 16 studies from different countries found that 29–97% of GP’s have used placebos at least once, and 46–95% of GP’s have used them at least once in the last year.[vi] Factors such as prior conditioning, the patient’s personality profile, the appearance of the placebo, and empathy from the administering doctor, have all been found to influence the power of the placebo effect.[vii] There is a strong body of evidence that verbal suggestions can produce placebo and nocebo effects.[viii]

In 1955, Henry K Beecher wrote a pioneering paper on the placebo effect called ‘The Powerful Placebo’. In World War Two, Beecher injected wounded soldiers with saline solution instead of morphine and found that placebos relieved pain in a significant number of patients. In 15 studies of patients with different ailments including nausea, pain and coughs, Beecher found 35% of 1082 patients were ‘satisfactorily relieved’ by placebo alone.[ix] Though Beecher’s early work did not have a control group, and has been criticized by modern researchers for alleged methodological flaws, it led to the adoption of double blind randomized controlled trials, in which a placebo group is studied alongside a control group given the experimental drug, and neither participants nor researchers know who has received the drug or therapy under consideration (hence it is ‘double blind’). This major methodological shift is itself testament to the power of the placebo effect. Besides, there is abundant evidence for the placebo effect, with placebo response rates – improvements in symptoms associated with taking placebos – ranging from 15% to 70% across clinical studies.The placebo effect in pain is especially high, with findings between 39 and 56%.[x] About half of the response to antidepressant drugs is thought to be attributable to the placebo effect. In a 1960’s study, French psychiatrists secretly substituted the anti-psychotic drugs of schizophrenics with placebos. They found that a majority of the schizophrenic patients (22) improved, with only one worsening.[xi] The placebo effect has improved symptoms in patients with Parkinson’s’ disease and ADHD (Attention Deficit Hyperactivity Disorder).[xii] The placebo response was also observed in Crohn’s disease, ulcerative colitis and GERD (GastroEsophageal Reflux Disease), hypertension, heart failure, erectile dysfunction, asthma, insomnia and migraine.[xiii]

Bear in mind that these studies are experiments in which patients know they have a good chance of receiving a sugar pill, and don’t know for sure that the experimental drug will even work. Imagine the power of the placebo effect, when patients fully believe the therapy will work!

The flipside of the placebo effect is the nocebo effect, a little understood but extremely potent mechanism whereby negative expectations about health lead to negative health outcomes. Conventional and alternative medicine do not even begin to understand the sheer power of the nocebo effect, and both have been guilty of handing out noceboes like they are skittles.The nocebo effect is an empirically proven phenomenon; numerous studies have shown that the nocebo effect can have significant and real impacts on the body and health outcomes.[xiv] Negative information delivered verbally can make otherwise painless stimulations highly painful, and worsen the pain experienced as a result of standard medical procedures.[xv] Obviously, the nocebo effect inspires negative expectations, which in turn create health anxiety in the subject. For example, one study split women in labour into two groups: the nocebo group, who were told that local anaesthetic would feel like a big bee sting; and another group, who were told they would be comfortable during the procedure. The nocebo group experienced heightened pain during labour compared to the group that was reassured.[xvi] A study of hospitalized full-term infants of diabetic mothers who underwent repeated heel lancing (venipuncture) without anaesthesia to test for blood glucose levels experienced more pain than infants who were not used to heel lancing. The infants of diabetic mothers also felt pain when their skin was cleaned (a part of the heel lancing procedure), in an instance of a conditioned nocebo response.[xvii]In another experiment, a group of subjects were told of the adverse sexual side effects of a hyperplasia drug, and a second group were not informed of those side effects. The group that were told of negative side effects experienced significantly higher sexual dysfunction than the group who were not informed.[xviii]

The nocebo effect even crops up in studies testing for the placebo effect. A mega study found that half of 250,000 placebo treated patients experienced negative side effects.[xix] The placebos could not have caused these effects on a purely physical level because they were inert. And bear in mind, those people thought they might be taking a drug intended to eliminate symptoms, not cause them, with only a chance of potential side effects. Now imagine how strong the nocebo effect can be when a doctor or two tells a patient that they are definitely going to die…

Sarno wrote that placebo cures or improvements were commonplace, but merely led to a shifting of symptoms from one place or bodily system to another, incomplete healing or short-term relief that didn’t last, because the root causes – misunderstanding, unconscious emotions and fear – went unaddressed. The patient was still looking for a solution outside of themselves, and God, and thus the lesson of illness had not been properly learned, and some dysfunction remained. Even the mindbody field uses methods like journaling, psychotherapy and meditation that depend on placebo responses. We know this is true because when sufferers don’t believe journaling, therapy or meditation will heal their symptoms, they usually don’t (meditation and somatic tracking also work by reducing anxiety around symptoms). The rationale behind journaling and therapy for TMS is that the disorder is caused by repressed emotions, so expressing them will be cathartic and healing. In fact, placebo modalities are used because of fear, and merely serve to reinforce that fear – not ideal, when fear of symptoms actually creates those symptoms far more than unconscious emotions do. Ice packs, stretching ‘exercises’, elimination diets and ‘special’ chairs have all been identified as placebos. They can be misleading, because sufferers often feel better when they engage in the ritual. But that didn’t mean the ‘treatment’ was actually healing anything on a deep level. In a nutshell, they believed it would work, so it did, but typically not very well. All because of the mindbody connection.

The unconscious is inherently unknown, a nebulous netherworld that is difficult for many to figure out, so making a therapy hinge upon it is not a good idea and can be extremely time consuming; it was not uncommon for psychoanalytic patients to be in therapy for years.

Freud placed great emphasis on dream analysis. He believed that dreams were about wish fulfilment, and typically represented the fulfilment of a repressed wish.[xx] He cited the dreams some men have about having sex with their mothers as evidence for his Oedipus complex. But nightmares do not necessarily reflect any actual desire for what transpires in them; they are frequently demonic attempts to disturb the mind. Jocasta referenced these kinds of dreams in Sophocles’ play, and said that they are best ignored. She was right. The truth is that, as Penelope said in Homer’s Odyssey, there are two kinds of dreams: those which come from the gate of ivory, and those that come from the gate of horn. The gate of horn dreams are true and prophetic. Jung’s complex symbology is the best guide to decoding these dreams – Jung was right that the unconscious contains contents that are both higher and lower than the ego. The gate of ivory dreams, on the other hand, are misleading. Only rarely does something meaningful appear in dreams that is worth scrutinising. Most dreams are demonic nonsense from the gate of horn, intended to disturb, worry, confuse and mislead. Yes, these dreams can reflect what is going on in the unconscious, but a lot of the unconscious consists of demonic emotions that ought to be repressed. It’s a rubbish tip, people!

Sarno counselled his patients to get rid of all unnecessary interventions (such as ice packs and special chairs) and return to normal activities. He blamed fear and the associated arbitrary physical restrictions for contributing to the pain problem, which he believed was actually caused by fear and repressed emotions, especially buried anger. It was no coincidence most of the patients he saw were driven perfectionists and very nice people. These were the kind of people who tended to worry about their health and bottle up a lot of anger, after all.

According to Sarno, the pain and the fear and all the self-imposed restrictions were merely ‘defence mechanisms’, ways of distracting attention from the unconscious rage that was the true source of the issue. The solution, therefore, was to absorb Sarno’s information, understand the benign psychosomatic or mindbody nature of the symptoms, and ignore the pain ‘distraction’. Although many people had scary things show up on MRI scans or X-rays, the vast majority of these ‘structural’ issues were meaningless. For example, empirical studies have demonstrated that many people without pain had herniated discs[xxi] and osteoarthritis.[xxii] So what was causing the pain, on a biological level? Sarno confessed he didn’t know the precise physiological mechanism for sure, but knew that harmless, reversible mindbody processes were the culprit, because so many of his patients recovered when they understood and believed him and got back to normal functioning.

Doctor Sarno wrote that many of his TMS patients’ pain onset coincided with a period of relative inactivity, such as a holiday, unemployment or retirement. Sarno’s explanation for this phenomenon, which he called ‘holiday syndrome’, was that symptoms filled the mental vacuum in an attempt to prevent unconscious emotions from surfacing. Basically, these people don’t have enough other matters to occupy them mentally, so they can wind up fretting about symptoms, which makes those symptoms worse. For this reason, I call it ‘boredom syndrome.’

Sarno originally suspected that the physiological mechanism for TMS pain was oxygen deprivation via the circulatory system, muscles and nerves.[xxiii] Lately, researchers such as Dr. Howard Schubiner have identified neural misfire as a more likely mechanism.[xxiv] Like Doctor Sarno, I know that the mind can use any organ or bodily system to generate symptoms.[xxv] That being said, it is impossible to feel pain without a nervous system, and of course the nervous system is connected to, and controlled from, the brain. For example, some paraplegics cannot feel injuries to their legs because the nervous system is not functioning there.

Most of those who accepted the TMS diagnosis – a mere 10–20% of all Sarno’s referrals – went on to heal. A minority required psychotherapy to work through the underlying trauma, but a majority of the ‘TMS accepters’ seemingly required only comprehension of the information delivered via two, two-hour seminars, the courage to resume normal activities and possibly a little journaling or emotional expression on the side.

Probably the best scientific evidence for the efficacy of TMS therapy is the Boulder back pain study carried out by Alan Gordon and colleagues. The study found that 66% of subjects suffering from chronic pain were cured or almost cured after four weeks of treatment with mindbody methods.[xxvi] Dr. Schubiner and colleagues have found that significant percentages of people with Fibromyalgia[xxvii] and IBS[xxviii] heal or improve through emotional awareness and expression, a mindbody technique. Noteworthy improvements have been reported in empirical studies testing meditation and journaling on autoimmune patients.[xxix] The best scientific evidence that chronic disease is mentally generated though, is the adverse childhood events study, which found that conditions like autoimmune diseases, heart disease, cancer, depression and addiction were strongly correlated with adverse childhood events such as abuse, parental substance abuse, and growing up in a broken home.[xxx]

Sarno’s work is one of the main inspirations for the Godmindbody approach outlined in my book, Godmindbody: The Bible, Miracles, Prophecy, and TMS Healing Explained. I will briefly summarise that approach here.It is an anatomical fact that the prefrontal cortex (associated with executive faculties such as decision making) and the limbic system (thought to house ‘primal’ emotions) interact heavily with the nervous system. The Autonomic Nervous System (ANS) is responsible for unconscious or involuntary biological processes. It regulates respiration, circulation, the digestive system, the immune system[xxxi], the genitourinary system, the skin, and much more. This means the brain controls the body. And the mind controls the brain, and therefore the body. This should be obvious; limbs and digits respond to mental commands, after all.

The order of causation for mindbody symptoms is thus:1. Mind

2. Brain/nervous system3. Rest of the body

Therefore, a shift in mental state can have profound implications when it comes to health.

But which mental states cause sickness?

The mental states that cause sickness are: 1) fear of symptoms and 2) limiting beliefs about health, inspired by medical misinformation. The fight or flight response – the biological substrate of fear – is associated with TMS. There are numerous studies demonstrating that organ functions controlled by the ANS are affected by placebos and nocebos. This includes evidence that the immune system can be improved by the placebo effect in humans and animals.[xxxii] But ultimately, when people cease to fear a mindbody ailment and believe deeply and fully that it will go away, it does. (You can fear things other than mindbody symptoms and still resolve the illness).When sufferers worry about a particular symptom, it is generated and/or exacerbated. When they get pessimistic about their health and prospects for recovery, or indulge in negative beliefs about their symptoms, TMS persists or worsens. It follows that, when they are exposed to the right information, and possess sufficient desire to recover, TMS sufferers can heal completely by deciding to believe in a full recovery (without relying on fear-driven placebos) and act accordingly by resuming normal activities. That is precisely what happened with the many TMS success stories, whether they fully understood it or not. Strong belief is enough for many people to heal their symptoms, but prayer can boost the efficacy of belief enormously by tapping into the awesome power of the Holy Ghost (see Chapter 6).

Read the next chapter here: https://www.robertensor.com/post/godmindfamily-chapter-3

[i] Lowella, whose story is featured in The Mind Solution: Healing TMS Pain with Doctor Sarno.

[ii] The mindbody coach Rebecca Tolin was diagnosed with Lyme disease, among others, and recovered. Her story is shared in my book, The Mind Solution: Healing TMS Pain with Doctor Sarno.

[iii] Schubiner, Doctor Howard. 2017. Unlearn Your Pain: A 28 day process to reprogram your brain. MindBody Publishing. Pleasant Ridge, MI; 3^rd edition.

[iv] Maj Britt Niemi. Feb 2009. Scientific American. Placebo Effect, a Cure in the Mind. https://www.scientificamerican.com/article/placebo-effect-a-cure-in-the-mind/#:~:text=A%20man%20whom%20his%20doctors,Psychological%20Variables%20in%20Human%20Cancer.%E2%80%9D

[v] Sarno, J. 2003. The Divided Mind: The Epidemic of Mindbody Disorders.

[vi] Atmann, O. 2018. How often do general practitioners use placebos and non-specific interventions? Systematic review and meta-analysis. PLOS One.

[vii] Pardo-Cabello et al. 2022 (Aug). Naunyn Schmiedebergs Arch Pharmacol. shttps://pmc.ncbi.nlm.nih.gov/articles/PMC9361274/#:~:text=Today%20this%20trial%20would%20have,2018).

[viii] Meissner et al. 2011. Philos Trans R Soc Lond B Biol Sci. Introduction to Placebo Effects in Medicine: mechanisms and clinical implications.

[ix] Kienle GS, Kiene H 1997. The powerful placebo effect: fact or fiction? Journal of clinical epidemiology.

[x] Pardo-Cabello et al. 2022 (Aug). Naunyn Schmiedebergs Arch Pharmacol. shttps://pmc.ncbi.nlm.nih.gov/articles/PMC9361274/#:~:text=Today%20this%20trial%20would%20have,2018).

[xi] Lachaux and Lemoine 1989, cited in: Pardo-Cabello et al. 2022 (Aug). Naunyn Schmiedebergs Arch Pharmacol.

[xii] Pardo-Cabello et al. 2022 (Aug). Naunyn Schmiedebergs Arch Pharmacol. shttps://pmc.ncbi.nlm.nih.gov/articles/PMC9361274/#:~:text=Today%20this%20trial%20would%20have,2018).

[xiii] Ibid.

[xiv] Colloca, L. Miller, F. 2012. Psychosom Med. The nocebo effect and its relevance for clinical practice. https://pmc.ncbi.nlm.nih.gov/articles/PMC3167012/#:~:text=Laboratory%20research%20on%20the%20nocebo,informed%20consent%20process%20(3).

[xv] Ibid.

[xvi] Ibid.

[xvii] Ibid.

[xviii] Ibid.

[xix] https://www.ox.ac.uk/news/2020-02-17-nocebo-effect-how-informed-consent-can-cause-unnecessary-harm-trials#:~:text=Research%20published%20today%20in%20the,can%20cause%20its%20own%20harm.

[xx] Freud, S. 1899. The Interpretation of Dreams.

[xxi] Jensen, M et al. 1994. MRI of the lumbar spine in people without back pain. N England J Med. 331;69-73.

[xxii] Min Son et al. 2020. Absence of pain in subjects with advanced radiographic knee osteoarthritis. BMC Musculoskeletal disorders. Volume 21. Article no. 640.

[xxiii] Healing Back Pain (Reissue edition): The Mindbody Connection. 2018. Grand Central Publishing.

[xxiv] Schubiner, Doctor Howard. 2017. Unlearn Your Pain: A 28 day process to reprogram your brain. MindBody Publishing. Pleasant Ridge, MI; 3^rd edition.

[xxv] Healing Back Pain (Reissue edition): The Mindbody Connection. 2018. Grand Central Publishing.

[xxvi] Gordon, A, Ashar, Y et al. 2022. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for patients with Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. Jan 1; 79.

[xxvii] Hsu, M, Schubiner, H, Lumley, S, Stracks, J, Clauw, D, Williams, D 2010. Sustained Pain Reduction Through Affective Self-Awareness in Fibromyalgia: A Randomized controlled trial. J Gen Intern Med. 25 (10).

[xxviii] Thakur et al. 2017. Emotional Awareness and Expression Training Relieves Irritable Bowel Syndrome. Nuerogastroenterology and Motility. Vol 29; Issue 12.

[xxix] Penberthy, J.K.; Chhabra, D.; Avitabile, N.; Penberthy, J.M.; Le, N.; Xu, Y.R.; Mainor, S.; Schiavone, N.; Katzenstein, P.; Lewis, J.E. Mindfulness based therapies for autoimmune diseases and related symptoms. OBM Integr. Complement. Med. 2018, 3, 1–11. Bombana et al. 2019. Psychoanalytic Psychotherapy improves quality of life, anxiety, depression, coping in patients with SLE: a controlled randomized clinical trial. Advanced rheumatology. Smyth, JM et al. 1999. Effects of writing about stressful experiences on symptom reduction in patients with rheumatoid arthritis or asthma: a randomised trial. JAMA.

[xxx] Felitti VJ, Anda R, Nordenberg D, et al. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245–58.

[xxxi] The hypothalamus, another brain structure, also has a known impact on immune function.

[xxxii] Meissner et al. 2011. Philos Trans R Soc Lond B Biol Sci. Introduction to Placebo Effects in Medicine: mechanisms and clinical implications.