The Panic and Pain of Mind-Body Dualism

In the opening scene of the classic semi-autobiographical comic novel Three Men In Boat, the writer Jerome K. Jerome is looking for a hay fever treatment when he casually begins reading about other diseases. By the time he’s finished, he concludes that he has every disease on the list. "I had walked into that reading-room a happy healthy man. I crawled out a decrepit wreck." He goes to his doctor, an "old chum" who gives a him prescription for a good meal, a pint of beer, a ten-mile walk every morning, and going to bed at 11 every night. "And don’t stuff up your head with things you don’t understand."

In the 21st century, the list of symptoms, ailments, and treatments seems to have expanded exponentially, and a few clicks online elicit total body panic, usually in the middle of the night. We are too tense to sleep. Even when we try to avoid cyber induced illnesses, we are confronted with TV ads interrupting our favorite shows with reminders that we pee too frequently, we’re not happy enough, and we should be getting more frequent and longer lasting erections. So we hurry ourselves to the doctor. What does our 21st century American doctor prescribe? Rather than telling us to walk ten miles, he or she doles out pharmaceutical samples, orders tests, and sends us on our way more convinced than ever that our few remaining days on earth will be "quite miserable." Writers seem particularly prone to this sort of panic (not to mention bad alliteration).

Many times, my imagination has been stoked by casual comments from well-meaning doctors. Once, a doctor who sounded as if he’d practiced several English phrases and used them with abandon, had his finger fully up my rectum and casually said, "So, have any other of your family members had prostate cancer?" Another time, a doctor in California, in 1982, cavalierly misdiagnosed me with an incurable disease. "You might," he said, "Never have these symptoms again." Then again, I thought, I just might. So after years of anxiety-induced discomfort, I summoned the courage to get the test that confirmed what I should have known all along. The doctor was dead wrong. Even now, thinking about it can sometimes bring on fear. There have been instances since then. Each time, fear and anxiety exacerbated a minor stress-induced problem. No wonder we avoid doctors.

But it’s not their fault. They are trained to be objective, to diagnose based on a 10-15 minute meeting and then treat the symptoms, usually by giving you some pills. If the pills don’t work, you go back for another 10-15 minutes. You get different pills because sometimes one pill doesn’t work when another will (nobody really knows why). Or you get a stronger dosage with more potential for uncomfortable side effects. When these pills fail, you’re often then propelled into the land of specialists and expensive testing. A year later, after numerous inconclusive tests, you’re feeling worse than you ever have. Each doctor has an opinion or theory based on their specialty. A urologist will think prostate infection, a orthopedist might say muscle tear or strain, and a neurologist blames nerve impingement. They don’t consider the effect of their musings. Sometimes they merely shrug and move onto the next patient.

A placebo might help you as effectively as any prescription, but doctors are reluctant to use them for obvious reasons. What if they give someone a sugar pill and the patient dies? Whoops. They must remain objective. Logically then, they cannot acknowledge the opposite of placebo -- the "nocebo effect," a belief your ailment will appear or get worse rather than disappear or get better. Often, the nocebo effect occurs after a speedy misdiagnosis. Have you ever had a minor pain and, when you were told it was some degenerative disease, felt much worse? A mild symptom like a burning feeling on your skin becomes "incurable neuropathy." Muscle pulls and strains send you into the claustrophobic MRI tube. When the results show a herniated disk, your worst fears have been confirmed -- you won’t be able to walk ever again. Anxiety can cause symptoms, which can cause more anxiety, which can cause more symptoms. If your doctor says you have a problem, you will be much more likely to experience that problem. Soon you are like Jerome K. Jerome and feeling "seedy." You imagine the end of the world.

However, most of it is balderdash. Everyone, as they age, develops such things as herniated disks and spinal stenosis but most don’t have any pain at all. So how did you get your back, thigh, groin, arm (endless list) pain? You did nothing different. Your pain seemed to come from nowhere. There was no injury that you can remember. Or you had an injury and everything healed properly. But you still have lots of pain. At this point, you should consider that you might be suffering from a "mind-body disorder." We all have some repressed anger. It’s a natural phenomena. Getting older can cause anger. After all, who among us likes to admit the five-mile run we used to speed through now takes twice as long and makes our body ache? Maybe you have repressed anger impinging on your already overstressed life. Maybe your pain has become a "habit" initiated by misdiagnosis and perpetuated by fear.

Such emotional factors can cause physical symptoms. This is the key premise behind the work of Dr. John Sarno and others who have followed him. You may be thinking the premise obvious. But current medical doctrine does not accept this notion, while paradoxically accepting that stress and anxiety can exacerbate symptoms. (Even stranger when you consider that doctors have no trouble accepting you’re stress-induced headache. So why not a backache?) If you read Sarno’s books, you may initially think they offer no solution at all. That’s because we’re all looking for a quick fix. We’re stuck in our pill-popping mentality. Thinking "psychological" when you have a "physical" pain is not what we’ve been taught to believe. It is more acceptable to have a horrible cold, a bad back, irritable bowel syndrome, constipation, and urinary frequency than to admit a "psychological problem." Suffering through your pain to "get it done" makes you a hero. What happens when you say you have "emotional problems?" What a wimp! Most of us would rather have the pain. But neither would be nice, wouldn’t it?

Sarno’s books are often repetitious. But as it turns out the repetition is important, like practicing your multiplication. The "solution" lies in accepting that your brain is causing your pain. Current studies of the brain show that you can change your neural pathways, and logically then eliminate or "unlearn" your pain. "When we learn a bad habit, it takes over a brain map, and each time we repeat it, it claims more control of that map and prevents the use of that space for ‘good’ habits. That is why ‘unleaning’ is often a lot harder than learning" (Norman Doidge in "The Brain That Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science"). Doidge also suggests that "brain exercises" can be as effective as drugs. The brain is nueroplastic. It changes. Often, even after an injury has healed, your brain remains changed. New neural pathways have been established. If you panic and obsess over the pain -- will I have pain for the rest of my life? -- the pathways become entrenched, "learned," and remain long after the injury has healed. You must then "unlearn" your pain.

For too long, we have unconsciously accepted Descartes’ mind-body dualism; that is, that the mind is completely different than the body. Sure, it is comforting to know that the mind can exist without the body, and therefore "life" after death is possible. But this same dualism creates a world in which we treat the body as if it were separate from the "mind." However, with new studies in nueroplasticity, the barrier between mind and brain have crumbled. We can now think of mind and brain as one. The mind becomes the brain. The brain is part of the body. Now we can integrate the mind and the body and treat individuals as whole human beings.