Dr. Sarno’s theory of tension myositis syndrome (TMS) has impacted many people throughout chronic pain communities all over the world. He built his TMS theory from previous psychology work explored by Freud. Let’s explore Dr. Sarno’s view on Freud and his TMS theory evolution.

Freud & Dr. Sarno: Repression

Subconscious thoughts can act similarly to inmates locked away. Our brains place our subconscious thoughts out of sight (into the prison), but not completely out of mind (they still exist). In Dr. Sarno’s The Divided Mind, he details how those with TMS experience repression that serves a protective purpose. He argues that repressed emotions may be too dangerous or painful to deal with normally. Instead, those dangerous emotions are locked away into the subconscious.

While Freud believed that dangerous unconscious thoughts could be dealt with via analysis, Dr. Sarno believed otherwise. He noted in The Divided Mind that often, repressed feelings could indeed not be brought back into the conscious mind by analysis. He found that rage, narcissism, sadness, inferiority and dependency were emotions which stay rooted in the subconscious.

Freud & Dr. Sarno: Timelessness of the Unconscious

Freud often spoke of the id — the “dark, chaotic character, illogical, irrational, narcissistic, dependent, childish, primitive” part of a person’s mind. The id is responsible for our natural, basic instincts, urges and wants. Freud noted that no part of the id corresponded to time. Due to the id being formed early on combined with that lack of time recognition, there are no changes in mental processes within the id due to the passage of time. Impulses, impressions and other mental detritus left in the id are virtually immortal. Even after decades, people will behave as though certain events just happened, due in part to the timelessness of the unconscious.

Dr. Sarno was particularly intrigued by the timelessness of the unconscious mind. He noted that id-based feelings persist throughout life, with people usually reacting in one of two ways: having a drive to be good/perfect or having the inverse to act aggressively. He thought that never reaching expectations will lead people to hold massive reservoirs of interiority within themselves, which can play a huge role in TMS symptoms.

Freud & Dr. Sarno: Psychosomatic Symptoms

Dr. Sarno integrated Freud’s theories of repression and the timeless unconscious with his own experiences with TMS in the medical industry. He came to believe that repression’s true purpose is to protect people, preventing them from the dangerous feelings embedded within the subconscious. In The Divided Mind, he asserted that psychosomatic symptoms which appear alongside repression are “generated to distract the conscious mind and therefore to assist the process of repression.” He notes that psychosomatic symptoms are really all about self-preservation.

Freud & Dr. Sarno: State of Anxiety

Another important piece which Dr. Sarno integrated into his theory is that of anxiety’s role in psychosomatic symptoms. He notes in The Divided Mind that having anxiety is a “reaction to what is being repressed, created by the ego as a distraction.” Anxiety is assisting the repression process. The important distinction that Dr. Sarno makes is that all symptoms — whether pain, anxiety or depression — are not due to illness or disease. Instead, they are a normal reaction to frightening phenomena going on in the conscious mind.

In order to move beyond pain and get back to loving life, those suffering from TMS need to understand the concepts outlined above, and then implement the tools which Dr. Sarno provides in alignment with his theory. I have also covered TMS tools extensively here, if you’re looking for more information.

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