A Sarno-Hanson Synthesis

Con­tent note: Spec­u­la­tive, re­lies on as­sump­tions that may not be true, but gen­er­ally points at some­thing that I be­lieve to be a use­ful map, with po­ten­tially im­por­tant im­pli­ca­tions if true, and am in­ter­ested in feed­back.

John Sarno is the pro­fes­sor and physi­cian who dis­cov­ered Ten­sion Myosi­tis Syn­drome (TMS), which has pre­vi­ously been dis­cussed in de­tail by Scott Alexan­der. Briefly, a TMS the­ory sug­gests that chronic pain, and a hand­ful of other chronic ail­ments, may be psy­cho­so­matic, and that the spe­cific mechanism of ac­tion is the brain’s ex­pres­sion of un­ac­cept­able emo­tions through phys­iolog­i­cal chan­nels. For ex­am­ple, an em­bar­rass­ing and in­wardly un­ac­cept­able nar­cis­sis­tic rage at the con­di­tions of one’s life may be ex­pressed as back pain or headache.

Sarno’s the­ory is more de­tailed and spe­cific than this, but for that treat­ment I recom­mend read­ing the book. It is rel­a­tively unim­por­tant to this dis­cus­sion whether the pre­cise de­tails of this the­ory are cor­rect, es­pe­cially be­cause it is ob­vi­ous that some weak form of the the­ory is true. The con­scious mind is the tip of a vast ice­berg of cog­ni­tion, and the parts of the ice­berg un­der the sur­face are by ne­ces­sity those parts that cre­ate pain, emo­tion, com­pul­sions, and all the other men­tal phe­nom­ena that the con­scious mind can’t take credit for—which is most of them.

I can’t help but in­ter­pret Sarno’s hy­poth­e­sis much more broadly than he him­self does. In 2017, Court­ney Dauwalter won the Moab 240, a 240 mile race, in 2 days and ~10 hours. She beat the sec­ond-place finisher by ten hours. If you read or listen to any in­ter­view with her, she dis­cusses how her se­cret is just not stop­ping. She’s fit, but she’s prob­a­bly not 17% more fit than the sec­ond-best ul­tra­ma­rathoner. She’s just un­usu­ally good at ig­nor­ing the pow­er­ful parts of the brain that are in place to stop the body from hurt­ing it­self. It turns out the phys­i­cal limi­ta­tions of the body are well be­yond what the brain im­plies they are. The learn­ing from this is that the brain is so good at con­vinc­ing us that we have these limi­ta­tions, that al­most ev­ery­body even­tu­ally suc­cumbs to their brain’s in­sis­tence that they’re go­ing to die or break down if they keep run­ning, even though it’s not true.

Robin Han­son needs no in­tro­duc­tion, but just in case, he’s the eco­nomics pro­fes­sor and poly­math who re­cently pub­lished The Elephant in the Brain. The premise of this book is that hu­man be­hav­ior can be de­scribed as mostly be­ing in pur­suit of so­cial sta­tus, and that to some de­gree, the func­tion of con­scious­ness and the self-nar­ra­tive is to con­fab­u­late cred­ible ex­pla­na­tions about how this is not what we’re do­ing, so we can more re­li­ably de­ceive oth­ers about our true, un­con­scious mo­tives.

If you take a broad in­ter­pre­ta­tion of both of these thinkers, the up­shot is that state­ments like “the sub­con­scious is very pow­er­ful” are ac­tu­ally laugh­ably un­der­stat­ing the situ­a­tion. The sub­con­scious—the parts of cog­ni­tion that are not con­scious—is do­ing pretty much ev­ery­thing. The con­scious mind is a par­tic­u­lar func­tion­al­ity that serves as part of the sys­tem but has no real au­thor­ity over it. The ubiquitous dis­cus­sions of akra­sia and mo­ti­va­tion prob­lems on this site ex­em­plify the fact that any model of psy­chol­ogy that in­volves the “self” ex­ert­ing “willpower” is a Sisyphean ex­er­cise typ­i­cally doomed to failure. It’s just not a re­al­is­tic model of how we work.

A syn­the­sis of these two thinkers that might yield testable pre­dic­tions goes as fol­lows: Han­son says most of what we do is sig­nal­ing. Sarno says most if not all chronic pain is psy­cho­so­matic. Well, what is the point of pain if not to sig­nal acute dis­tress? Espe­cially chronic pain—there is no in­di­vi­d­u­ally adap­tive pur­pose for chronic pain. A soli­tary leop­ard with de­bil­i­tat­ing chronic pain would just be a dead leop­ard. Hu­mans are differ­ent. Much of our so­cial fabric con­sists of un­con­scious but high-band­width sig­nal­ing be­hav­ior. Body lan­guage is the most ob­vi­ous ex­am­ple; hu­mans can gen­er­ally both perform and re­act to body lan­guage very con­sis­tently with­out even be­ing aware of it.

So let’s take the hy­poth­e­sis that chronic pain is a so­cial sig­nal. Sarno’s the­ory speci­fies that chronic pain is, again, an ex­pres­sion of un­con­scious rage. If we pro­vi­sion­ally treat the Freudian dis­tinc­tion of Id/​Su­perego as a sug­ges­tive map, if not pre­cisely true, then the Id feels strong childlike rages at hav­ing its im­pulses stymied, and the Su­perego sup­presses those rages and pre­vents them from reach­ing con­scious­ness. To stir in a bit of Han­son here, per­haps the Su­perego’s role is to help cu­rate the out­ward nar­ra­tive that we are purely proso­cial and self­less, while the Id’s role is to mo­ti­vate nec­es­sary self­ish be­hav­ior through gen­er­at­ing self-serv­ing im­pulses. It seems plau­si­ble to me that the rel­a­tive “strength” of the Su­perego in mod­ern so­ciety is much greater than it was in an­ces­tral times, and this may ex­plain why chronic pain is an in­creas­ingly preva­lent is­sue in mod­ern times, but this is just a spec­u­la­tion.

If we take the im­pli­ca­tions of all this at face value, then we can con­tem­plate po­ten­tial sig­nal­ing pur­poses for chronic pain. In other words, what is the un­con­scious say­ing? Pos­si­bil­ities that come to mind:

  • “I am le­gi­t­i­mately over­bur­dened and di­rely re­quire more help than I’m get­ting.”

  • “My con­tri­bu­tions are not be­ing ap­pro­pri­ately ap­pre­ci­ated or com­pen­sated, so I will stop spend­ing en­ergy on them by in­ca­pac­i­tat­ing the body.”

  • “There are as­pects of my en­vi­ron­ment that I find profoundly dis­tress­ing, but I am un­able to ex­press this to my co­hort overtly be­cause of so­cial re­stric­tions, so in­stead I’ll give my­self a mi­graine and let the tribe figure out why that might have hap­pened.”

I’ve only re­cently started think­ing in these terms, but it has been benefi­cial to try in­ter­pret­ing ev­ery phys­i­cal sen­sa­tion as some kind of Sarno-Han­son mes­sage from the un­con­scious. Do you some­times feel a phys­i­cal ex­haus­tion and lethargy that mys­te­ri­ously van­ishes when the op­por­tu­nity to do some­thing more fun arises? Do you ever ex­pe­rience a sud­den rise in ten­sion and heart rate for a rea­son you can’t quite pin down? Do you have im­mense trou­ble get­ting out of bed in the morn­ing, but if you have some­thing to look for­ward to that morn­ing, you spring out of bed eas­ily? Con­sider that this is ex­actly the kind of thing that a canny trick­ster un­con­scious would do to see its de­sires fulfilled.

What’s amaz­ing to me—and what I had to read Sarno’s book to ac­tu­ally get—is that you don’t even nec­es­sar­ily have to figure out what the un­con­scious is try­ing to tell you to get such phys­i­cal symp­toms to dis­si­pate. You just have to look in­ward and in­ves­ti­gate your emo­tions, with an at­ti­tude of “Ok, I’m listen­ing, and I see what you’re do­ing, but I don’t un­der­stand why.” For some rea­son, this seems to be enough that what­ever un­con­scious mod­ule is caus­ing the prob­lem can feel heard.