kuniga.me > Books > The Mindbody Prescription

The Mindbody Prescription

The main theory of this book, by John E. Sarno, is that a lot of chronic health issues, in particular pain, is caused by repressed anger in the unconscious. He calls this Tension Myositis Syndrome or TMS. He claims the mechanism is that the brain doesn’t want this anger to manifest into the conscious and hence it distracts it with physical symptoms. One way to fix it is often times to acknowledge such source.

That’s pretty much the summary of the book. He spends 172 pages covering all the different conditions that can be caused by this and repeating the same argument over and over.

I don’t know why I had this book on my list, and I tried to approach this book with an open mind and read it all. At some point I was mostly taking notes on all the weak or fallacious arguments he uses in the book rather than learning anything interesting.

Fallacies

Cause and Consequence

In a few scenarios he seems to flip cause and consequence. For example, he claims that people with TMS are obsessed with their pain symptoms. I mean, if you’re in constant pain, wouldn’t you? He later says people with a condition known as Chronic Fatigue Syndrome or CFS have sleep disturbance and suicidal thoughts. I mean if you’re in constant pain and unable to live your life, is it that surprising?

Baseless Claims

In many parts of the book, the author reaches conclusions with anecdotal evidence:

(…) all share the conviction that the mind has the capacity to combat disease and improve health. There’s no question that his is correct.

and

The fact that many people have cured themselves by a study of my books is itself evidence of the accuracy of the TMS diagnosis

Scientific Credibility

He often discredits science-based medical disciplines to make his claims more credible:

Medical principles are thus established by majority fiat rather than scientific evidence.

In another case he discusses a patient who started taking depression medicine got better but the started to have muscle pain. Claiming that the medicine didn’t cure the root cause. He doesn’t even acknowledge the possibility of side-effects of the medicine, or just pure coincidence.

He also spends most of the book using scientic jargon, e.g. using the scientific name of different body parts and explaining their functioning, so that his theory seems more credible.

Occam’s Razor

The mechanism he attributes to the unconscious for dealing with repressed anger is very sophisticated:

The clever brain notices a herniated disk and chooses to locate the symptoms in the proper area purposely.

Similarly, at some point he mentions pain is a Pavlovian response. When you do certain activities the unconcious associates. For example:

You wake up feeling pretty good, but the pain gets worse as the day goes on; (…)

With this argument we can claim that tiredness and sleepness are also Pavlovian responses? One of the examples provide seems harder to refute:

Every night you wake up at exactly three o’clock with severe pain;

Seems like this could be explained by the circadian rhythm and sleeping schedule.

Regression to the Mean

He claims that hypoglycemia is emotionally induced.

I experience it from time to time but it never persists because I am awar of its cause.

So during peaks of the symptoms of hypoglymecia, he “thinks about it”, and magically gets better, instead of the intensity of symptoms just going back to the mean.

This could be an explanation on why his treatment seems to work. People only seek help when their symptoms became unbearable and after consulting with him, just by virtue of the regression to the mean it seems to have an effect.

He does claim his treatment have permanent effect, but what could be happening is that when people get bad again, they “self-help” by using his methods and seem to get better, and do not visit him again.

False Dichotomy

When claiming that tinnitus is also caused by TMS:

If no other cause is found, one may safely assume that is is a TMS equivalent.

Relatedly he says:

Mainstream medicine has not yet realized that the movement to alternative medicine in the United States reflects the failure of conventional medicine to do effectively with a variety of ills.

Just because you can’t fix a problem with method A, it’s something wrong with it and you must use method B. The problem might simply be unfixable. Later in the book he does acknowledge that:

This does not mean that a psychosomatic diagnosis is made by exclusion (…)

but he contradicts this right after:

However, since so few physicians make a psychosomatic diagnosis, an individual may be forced to come to that conclusion on his or her own.

Selection Bias

At some point he mentions that after he started screening patients he decided to treat, his success rate went up! While he claims he only asks patients whether they believe pain can be caused by emotions, but this might be correlated with other factors, for example maybe they had tried psychological treatments before and it didn’t work, which could imply their case is so severe it doesn’t fluctuate for Regression to the Mean to kick in, and he’s excluding those from the sample.

Relately, he never bothered testing his methods using a control group. He mentioned a few patients that had such debilitating pain they could not function, and his methods cured them. He could easily split these into two groups and administer a placebo / uneffective method in one of them and see if there were any differences.

Confounding Factors

He tells of his own experience with hives in his face when he was serving on some military duty in a remote outpost. When he returned to his normal life the hives went away. Instead of acknowledging all the different factors that could play a role in this allergic reaction he claims that the culprit was the emotions associated with the job.

Another way he applies this selection is when citing a study that showed improvements in heart disease after a period of special diet, exercise, meditation, social engagement, etc, and his conclusion is that

psychological factors was the primary reason for the reduction in coronary atherosclerosis.

Western / Modern society. One argument used often is that we have an epidemic of chronic pain and claims that this is a artifact of modern society. He never seems to mention or acknowledge the fact that modern society has a lot of different work patterns such as sitting all day and repetitive movements such as typing in a computer.

Perfecctionists. He claims that people who are perfectionists and people-pleaser are more subject to this because they repress their true feelings. How about the possibility that perfectionists tend to work harder and exert themselves more?

Interesting Points

There are two points he made in the book that I think make some sense. One is the unnecessary intervention in modern medicine. I think there are several studies that show doctors often recommend risky treatments and surgery but there’s no they’re statistically helpful.

The other is that with more sophisticated machines such as MRI with which we get more information, the chance of finding attributing causes to irrelavant details increases.

Conclusion

This is one of the worst books I’ve ever finished reading. To be fair, I don’t discard the possibility that chronic pain has a psychological factor and can even be related to the unconscious. It’s just that his arguments and evidence are very weak.