The story from upstate New York doesn’t want to go away. There have been at least three national TV spots in the last few weeks about the 12 high school students who have developed tics. Neurologists consider tics and Tourette’s syndrome to be chronic neurologic disorders that are primarily inherited. The treatment consists of medications to attempt to control the abnormal movements and it is not generally believed that individuals can have any control over their tics.

However, the mini-epidemic in LeRoy High School near Buffalo is believed by excellent neurologists to be caused by a conversion disorder, i.e. a physical symptom that is not a pathological or structural process, but is caused by stress and unresolved emotions. In other words, this is a manifestation of Mind Body Syndrome (MBS) or a Psychophysiologic Disorder (PPD). (I will use these terms interchangeably.)

When one looks at the history of mini-epidemics of PPD, evidence abounds that PPD is a contagious disorder. There have been well-documented epidemics of repetitive stress injury, sick building syndrome, and psychogenic seizure-like activity (also known as pseudo-seizures). There is an interesting research article from Germany that demonstrates that back pain appeared to be contagious after the fall of the Berlin Wall. So, it isn’t really surprising that almost any symptom can be caused by MBS. Once a careful medical history, physical exam, and environmental evaluation rules out evidence for a pathological disorder, the diagnosis of MBS should be confirmed.

In the LeRoy High School situation, experts have done this and have concluded that the girls are suffering from PPD. However, this apparently hasn’t gone over very well with the patients, their parents, or many members of the community. Today’s report showed angry parents filling a meeting of the school board asking them to prove that their buildings are safe. Of course, they have a clean bill of building health from the state of New York and the CDC. Yet, a psychological explanation for physical symptoms doesn’t seem to ring true or satisfy most people.

Over the past few weeks, I have encountered several stories about tics and Tourette’s syndrome that suggest that it may not be as much of a neurological disease as we once thought. Story #1: A friend told me about a young man who suffered with Tourette’s for his whole childhood and adolescence. As an adult, he participated in an intensive psychological retreat during which he expressed and processed many emotional issues from his life. The tics resolved.

Story #2: I met a psychologist who told me that he cured a teenager of Tourette’s “by accident.” The young man was sitting in the psychologist’s office and while waiting, he was throwing some balls into a box over and over. When the psychologist entered, the boy apologized for his behavior and stopped. But the psychologist suggested that it was fine to throw these balls and encouraged him to continue to do so, which he did. During the course of a single one hour session, the boy expressed many issues that were bothering him and threw the balls more forcefully. Following the session, he seemed relieved. The tics disappeared and never returned.

Story #3: I was telling these stories to a friend. He immediately began to tell me his story. As a child, he was diagnosed with Tourette’s syndrome. The tics were incredibly embarrassing and humiliating to him. He hated them and vowed to stop them. He decided to resist them and spent many nights in bed holding his body against the urge to “tic.” After a few weeks of mental effort directed to stopping the tics, they went away and have not recurred.

I am not suggesting that all tics or all Tourette’s syndrome is caused by PPD, but it wouldn’t surprise me if many cases are. It is interesting that over time, people with Tourette’s tend to grimace and even swear uncontrollably. Grimacing and swearing, of course, are signs of anger. Could it be that some people with Tourette’s syndrome have unresolved resentment, anger, or rage? It would certainly be wonderful if there were a relatively simple solution to these horrible disorders. We need to do some studies to determine if tics and Tourette’s may respond to our usual MBS approach and treatment. If you know of people with these disorders who are interested, please have them contact me at hschubiner@gmail.com

It shouldn’t be too surprising that some neurological events are contagious. Patterns of speech are clearly neurological events. People who grow up in the south have different speech patterns and inflections than do those from the north. Phrases such as “like” and “you know” have become ubiquitous in the speech patterns of teenagers (and adults) in recent years. If these neurological events are contagious, why not tics?

To your health,
Howard Schubiner, MD

To your health, Howard Schubiner, MD

The Hero’s Journey as Story: The Irreducible Diagnostic Criterion
by Jared Egol

The patient, in present times, faces chronic, painful and dismissively mistreated and misappropriated syndromes of stalled emotional progress. Despite seeking to function at our service against pain and a variety of illness, medicine is traipsing feet-first into a biologic-centric approach to the treatment of our stories. Stories are completed, edited, examined, shared and propagated. And, most importantly, they are added to. They are not treated. Any treatment becomes a subscript to the through-line of how our life proceeds postscript. Health, like being human, is raconteurism. It wishes to be resolved and triumphant.

While the scientific community begins to trumpet the mind-body connection as a wellspring for treatment possibility, it seems to passively disconfirm the blunt fullness of what mind-body awareness can be, greater than the sum of its words on paper: that the qualitative first step to treatment starts pre-diagnosis and pre-medicine, at the human condition, which in and of itself is idiopathic. If the mind-body paradigm is to someday be championed as a keystone of accepted treatment in the 32nd century, it must concede that the human condition’s only unit of perceivable measure by outside meters can be its stories, just as atmospheric pressure cannot be interpreted in kilojoules. By dimensional analysis, if spoken words are the sub-units of those stories, then the feelings evoked, hugs had, nods afforded and change experienced by the recipients of them are the units of their transfer: lessons.

I believe that the doctors who rise above the ranks will be those identified as narratorial asides in the stories of the hero –the patient– who takes and imparts lessons in equal measure to the physician. Even the word-bare, thought and action-heavy field of intensive care, which my father occupied himself with for almost three decades, will one day evolve to contain the parameters of narrative in its protocol, even if I don’t know how it will look.

Today, books on the subject of mind-body infrangibility in healing try to elucidate our likenesses as cauldrons of two differentially conjoined substrates: a self-contained, phenomenal interaction of tangible organic measurements with intangible outputs we’ve labeled incompletely as thoughts and feelings. As they ebb and flow in the images of our days, months and years, the horizon between the two becomes incomprehensibly blurred, and they are ultimately able to be dismissed as the same. An emotion, such as anger, is sometimes pigeonholed by New-Age health progressivists as a quantity extractable through some physical or psychic manipulation, no different than if it was two milliliters of fluid drained from a pilonidal cyst into a syringe. This floppy conclusion has more of what is intended by making boldface the narrative of the patient unto the doctor, but it still lords over the experience by reducing who we are to what we are, which cannot be done.

Yet such acknowledgments are very positive steps towards the unification of a truly medical protocol that I whisper for so unsubtly. The faster that the diagnosis of dismissal– where medicine here has operated for too long by calling a cyst a cyst, and generally eschewing the patient’s hopes and dreams around and about the cyst in eight minutes or less–is hastened toward its place in medical archaeology, the more hope can be secured to a day when each patient can see a physician who abides by a readiness to confer the storytelling power to the patient, and understand how that concession coupled with his hard-fought knowledge of the body can transform a patient’s medical visit from symptoms into lessons for both.

The phrase “medicine as an art” has become hackneyed, unfocused refuse in the bargain bin of good-sounding written idioms. But art interacts with souls, making it all performance art. Doctors, by injecting story into their practice of humans who seek to be sated by it, can indemnify the cliche by making it true. The supple difference lies with defining who the artist is.

It is harder to see in simple cases, such as the man who comes to the office to have a cut stitched and disinfected. The overt lessons — be mindful of where your hands are, slow down when cutting vegetables, etc– make this example tepid at best. But it is the complex cases involving pernicious chronicity, such as fibromyalgia, where the true narrative elements emerge, and the story becomes not only the process, but sometimes the cure for the symptoms.

All stories have their beginning, their middle and their end. Basely, the beginning wraps the elements of the narrative (the hero, the setting, the stakes) around the story recipient, hopefully giving context and orientation to what is happening. The middle is little more than the opposing elements that rankle the hero’s progress toward whatever end he or she has desired. The end, the third act, puts the hero into the driver’s seat of the story, making him an active participant. Naturally, but usually unconsciously, we seek to feel the change the hero is about to make, the lesson about to be or continue to be learned. By becoming active in the third act, when things are at their gravest, the hero truly is heroic, because he has adapted and solved the nature of his current problem by solving himself in a way amenable to victory. He has made a connection, learned, or recoiled against forces averse to his success.

The patient who went to the doctor to have his lacerated finger assessed and treated has very little (if any) adversity to galvanizing his position as a hero of that story. Yet when medicine presents conditions like fibromyalgia, chronic fatigue syndrome and various others as constellation symptomatologies, diagnoses of exclusion, incurable or psychosomatic, it is only burgeoning forward with its old ways, with the single enlightenment coming from the acknowledgment that it has failed as a machine.

As the psychosomatic, or mind-body diagnosis makes headway, the terrible truth is that it stands not only as baseless but destructive to most people suffering from a fibromyalgia diagnosis. But if contextualized as a story, the power to be healed from the pain and fatigue through the recognition that the worsening pain and worsening fatigue can be considered the third act, when things are irrefutably at their worst. For these patients, the third act has gone on for years and sometimes decades, exhausting them of tangible and intangible outputs alike.

There is a label for this that does not work. Victim. These people are derisively positioned as victims. They are seen as defective, whiny, angry and annoying. Even worse, they’re called liars. But they contain in them the elements of change that every human has, the natural right and obligation to stories. If they have stories, then those stories have heroes. Upon being saturated by pharmaceutical and biologic subterfuge, which stands to divert possibility for self-healing and placing it in the hands of drugs marketed as heroes by the milligram, the ability of these suffering human beings to be heroes unto and for themselves is destroyed. And as the trend descends them farther down a funnel, they begin to see any humanistic, non-drug suggestions for success as vituperative, “all-in-their-head” nocebos designed to guard them against their potential.

What got them to fibromyalgia was bad enough, and are the things that need acknowledgment and confirmation by the physicians of the future. Patients need to listen to their stories, and have explained convincing science by convincing hearts about the very condition of unbelief they’ve had beaten into them. Through the hardest of things to do, examining what in them needs to change and doing it, the third act of them at this time can be closed and celebrated vivaciously, for they then will become the heroes that their body has pleaded for them to become. I am an example of this, and continue to be.

Cancer patients speak about how being diagnosed did great things for their lives. Cancer is an inverse of greatness, but it hastens the clock of self-evaluation by sparking the reality of imminence. Even when dead, by facing the forces of their disease and calling themselves to action by living through, living from it and inspiring others to be conscious of whatever lessons they discovered, cancer patients are labeled heroes with ease and gusto.

Along the spectrum of disease are daunting voids of ignorance for what is both observable and treatable, and not everyone will get the chance to break free from theirs. But the compassion to have a story heard, discussed and reciprocated with positive power from a physician who knows why the journey through it has been eagerly made since he was a child, is a tool of inexhaustible medical power that, when coincided with the proven mind-body afflictions, can even revert the course of disease, as long as the patient is demonstrated a chance to revert back into the hero of their tale.

The only way out of this horrible cycle is to recognize this whole pattern and take control over it. There is no such thing as someone who is unworthy of self-respect and of love. We all have those things as part of our birthright. The most important thing that I teach in my Mind Body Syndrome program is “be kind to yourself.” Cultivating kindness to self, acceptance of self and forgiveness to self are key aspects of healing. Without this, we are often stuck in an endless search for relief from pain and suffering. There are several exercises in the program (see Unlearn Your Pain) that help to create these qualities. When people are kind and accepting to themselves, they feel so much better about everything in their lives. Research confirms this as work by Dr. Kristin Neff at the University of Texas shows that self-compassion improves motivation and happiness, while decreasing anxiety and depression. There are a couple of excellent books that I recommend. The Spirituality of Imperfection by Ernest Kurtz and The Mindful Path to Self-Compassion by Chris Germer offer great insight and exercises to help those who tend to “beat themselves up.” Dr. Neff is publishing a book entitled, Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind.

In The Black Swan, Nina sacrificed herself for her art and plunged into the depths of insanity. I have seen people who were so consumed with guilt, shame or fear that they were held hostage by these powerful emotions, stuck in chronic pain, fatigue, anxiety, and/or depression. Developing a healthy sense of self, giving oneself the benefit of the doubt, taking time for oneself, and accepting our faults are all critical steps in the process of healing. Do yourself a favor by doing yourself a favor!

To your health,
Howard Schubiner, MD

Stuttering (or stammering, I believe these can be used interchangeably) is quite common in children. I don’t recall this, but my mother told me that I started to stutter right after my sister was born. I guess I was used to being the “prince” in my household until she came along to usurp my parents attention. Fortunately, it didn’t last too long. My mother got me to sing songs (the stutter disappeared during singing) much of the time, gave me extra attention, and the nerve pathways reversed over time.

Stuttering typically begins in childhood, but there is another form of stress-induced speech disorder that usually begins later in life that is similar to stuttering, spasmodic dysphonia. This condition occurs primarily in young adults (ages 30-50) and is more likely to affect women, which is similar to the demographics of those who suffer from Mind Body syndromes, such as headaches, fibromyalgia, back and neck pain, and irritable bowel and bladder syndromes. There is no known abnormality of the vocal cords, per se. The difficulty in speaking is variable, can be made worse with stress, and may not occur during singing or speaking in high pitched voices (when slightly different nerve pathways are activated, as apparently my mother figured out when trying to help my stuttering). Some professional singers suffer from this condition and can have difficulty in singing.

When I have conducted detailed interviews with people with spasmodic dysphonia, the typical pattern emotional events that create MBS are present. We find childhood priming events (such as emotional, physical or sexual abuse, or situations similar to those experienced by the later King George) and triggering events later in life (such as losses, situations that trigger the “danger” signals, etc.) that produce the nerve pathways leading to the characteristic speech pattern of spasmodic dysphonia.

When one reads the medical literature about spasmodic dysphonia, the notion that this disorder can be caused by psychological distress is soundly dismissed. But that is also the case for the rest of the MBS disorders. For example, those with chronic fatigue syndrome are insulted when this notion is broached and the recent study showing that psychotherapy can help chronic fatigue syndrome is criticized by the support groups that would rather be afflicted with a virus, that may be incurable than entertain the possibility of being able to reverse the severe fatigue by psychological means.

Reversing stuttering and spasmodic dysphonia is the same as for other manifestations of MBS. The first step requires a clear understanding that the symptoms are real; they are not imagined, nor are they produced willfully, but are created by powerful nervous system pathways that will continue to trigger symptoms until they are stopped. The second step is to realize that one can get better. This is not a genetic condition (there may be genetic predispositions, but these require environmental triggers to be expressed, and can be reversed). This is not a degenerative neurologic condition such as Parkinson’s disease. It is reversible, so there is the strong possibility that one can improve and reverse the condition with MBS treatment. The third step is to investigate the circumstances (starting with childhood events and carefully exploring the situations that triggered the symptoms) that created the speech problems. An open and detailed review of one’s life will generally make the connections quite obvious. A guide to this process is available in my book, Unlearn Your Pain (chapter 5).

Once these steps have occurred, it should be clear that the actual diagnosis is Mind Body syndrome and this usually releases a great deal of positive energy that is necessary to unlock the nervous system pathways that keep one stuck in the abnormal speech patterns (or other symptoms of MBS). The treatment program outlined in Unlearn Your Pain includes a variety of therapeutic writing exercises, meditative exercises, positive affirmations, and other exercises that are designed to help people reverse their symptoms. Conscious processes can override the learned nerve pathways and this is the beauty of treating MBS—the majority of people experience significant or dramatic improvements. As with King George, when one “finds their voice” they can reclaim their life.

To your health,
Howard Schubiner, MD

A number of amazing things have happened so far this year in our corner of medical practice that I tend to refer to as Mind Body Syndrome.

One momentous event in my life was that my book, Unlearn Your Pain, was published.  After two years of work, I was thrilled to see the book in print.  You can read the first chapter on my website or on the amazon.com website, where it is available for purchase.  Since I published it myself, it will not be available in stores unless it gets picked up by a distributor.  To date, the reviews have been pretty positive.  I tried very hard to create a book that would explain the scientific validation of Mind Body Syndrome in terms that anyone could understand, but would also be convincing to the discerning physician or therapist.  This journey through the neurology and the psychology of pain make up the first 4 chapters.  The fifth chapter contains the complete version of the interview process that I have developed over the past several years.  I attempted to duplicate the experience of seeing me for an extended office visit.  I hope it will allow people who suffer from MBS to recognize the connections between their life events and the onset of MBS symptoms.  Chapters 6-10 consist of the whole intervention program that I’ve developed and that I teach in small group settings at Providence Hospital, in the Detroit area.  Finally, there is a concluding chapter and a set of frequently asked questions.

I would deeply appreciate feedback on any aspect of the book.  Please feel free to email me if you have comments, suggestions, or criticisms!!

Another momentous event occurred at the end of March.  We held our second annual conference on Mind Body Medicine on the UCLA campus in sunny Los Angeles.  We had almost 200 people there, which was a huge increase from our first conference in Ann Arbor, where we had about 50 people.  We were thrilled with the response and a distinguished panel of speakers spoke on MBS (we often used TMS).  You can learn more about the conference at the TMS Wiki that we’ve set up.   See tmswiki.wetpaint.com for all of the details on the conference and videos of many of the presentations, including some that I did.  We hope to have more conferences in the future, as well as training opportunities for physicians and therapists.

Finally, today was a new experience for me.  I was on a live national radio show.  Along with Dr. David Clarke (his book is entitled, “They Can’t Find Anything Wrong”), we were interviewed by Rosie and took a few calls from her listeners.  Rosie’s show is on Sirius/XM radio and it is a hopeful sign that the message we represent appears to be more likely to be accepted by the general public.  Our message is simple: Real pain and other symptoms are commonly caused by stress and emotional reactions to stress.  When a medical workup reveals no significant underlying medical disease, it is likely that Mind Body Syndrome is the real culprit.  Treating MBS is usually not that difficult once the true nature of the symptoms are discovered.  This message is not new.  Ovid said it over 2,000 years ago: “When the mind is ill at east, the body is affected.”  However, this message is revolutionary for our era because modern medicine has a large blind spot by ignoring the powerful role the mind has on the body.

To your health,

Howard Schubiner, MD

Fortunately for Mind Body Syndrome, we do know what is causing the symptoms: stress and emotional reactions that were typically primed in childhood and emerge later in life in response to new stressors which are linked to the earlier emotions (“emotional speed dial”), which is coupled with limited awareness or suppression of emotions and body reactions which alert us to a perceived danger.  I am currently finishing a book, entitled Unlearn Your Pain, which attempts to detail these processes from a psychological and neurological perspective.  It is axiomatic that the greater awareness and understanding of the cause of Mind Body Syndrome, the better we will be able to resolve the underlying emotional conflicts and eliminate the resulting physical or psychological symptoms.

For many people, the explanation above is sufficient to get them on the path towards healing.  However, for the more scientifically inclined, the question of “why is this happening?” goes deeper.  What is happening on a physical level in the body to create these symptoms?

There is clear scientific data to show that the pain and other symptoms experienced are real.  Studies by Dan Clauw, M.D. and colleagues at the University of Michigan clearly document that the pain of fibromyalgia (for which there is no evidence of physical tissue damage in the areas where the pain is being felt) activates the same brain structures as pain caused by tissue damage in the body.  However, a process known as central sensitization is present, which suggests that the nervous system and brain have developed pathways that create and activate pain.  These processes are learned and malleable since the pain often moves from place to place in the body and is greatly affected by stress and emotions. Dr. Clauw has also shown that people with chronic back pain also have central sensitization.  (This effect is demonstrated by increased amount of pain reported after pressure is exerted to the thumb.) Derbyshire and colleagues at the University of Pittsburgh have also shown that pain induced by hypnosis activates the same areas in the brain as does pain caused by heat applied to one’s hand. In short, the brain can create real pain.

Despite these data suggesting that the most important place to look for the cause of chronic pain in MBS is the brain, it is clear that effects in the body do occur.  When MBS causes diarrhea, the colon is activated to increased peristalsis (stool propelling motion); while when MBS causes constipation, the colon shows decreased activity.   When we get embarrassed, our face may turn red, obviously a sign of vaso-dilation of blood vessels; while stress can also cause our hands to get cold and clammy, which is caused by vaso-constriction of blood vessels.

There are scientific articles that document changes in tissues due to stress.  Studies of how quickly wounds heal in people with more or less stress show that healing is delayed and there is evidence of vaso-constriction and release of inflammatory cytokines, which cause slower return of these tissues to normal.  However, since this delay in healing is small (on the order of a few days) and the tissues do heal after wounds, I don’t think that these mechanisms of vaso-constriction and changes in the tissues persist long enough to explain pain that lasts for months, years, or decades.

In order to fully explain Mind Body Syndrome, it is necessary to explain symptoms that last for years and symptoms that are remarkably varied and complex.  Would vaso-constriction and tissue changes explain ringing in the ears, fatigue, anxiety, frequent urination, diarrhea, and constipation?  I don’t think so.  The only way to explain the varied manifestations of MBS is to understand that nervous system activation, probably of the autonomic nervous system (ANS), which becomes learned or wired into the brain is the likely culprit.  The ANS can cause increases or decreases in GI motility (for example, irritable bowel syndrome), urinary contractions (irritable bladder or interstitial cystitis), blood vessel constriction or dilation (migraine headaches, fainting, or flushing), rapid or slow heart beat, and activation (anxiety) or deactivation (fatigue and depression) of general nervous system activity.

It seems to me that attempts to explain MBS by focusing on what is going on in the peripheral tissues are misleading.  They tend to make people about a physical problem such as not getting enough oxygen to the body or persistence of soft tissue injuries that are not present.  Therefore, they may not be focusing on the real problem: learned pathways in the brain that need to be reprogrammed.  I believe that this concept better explains MBS in all of its manifestations and affirms that there is no significant physical problem that requires intervention.  When therapeutic energies are focused on changing the brain in order to change the symptoms, successful outcomes are more likely.

To your health,

Howard Schubiner, MD

I submitted a proposal to Kripalu, thinking that it would be a long shot. To my knowledge, no one has ever conducted such a seminar based upon the particular model initially proposed by Dr. Sarno. I didn’t hear from Kripalu for several months. One day, I mentioned the proposal to a close friend. Serendipitously, his sister, Annie Price, had just started working there and he called her to see if my proposal was being reviewed. She pulled it out of the pile and within a few weeks, I got an email asking if I could arrange to spend a week at Kripalu leading this retreat.

After working with people suffering with chronic pain and other syndromes caused by MBS for the past 6 years, it is becoming clear that there are a variety of paths to healing. For some, it only takes learning that emotions can cause pain and simply applying that revolutionary concept to their own life. These are the miraculous stories that most doctors (including me) love to tell. For others, it is necessary to look deeply into their life and work diligently and courageously at clearing the emotions that have been creating underlying mental conflict and tension. Others need to challenge the associations that have developed by pushing through pain that occurs with movement or exercise. In a blog I wrote on September, 2008, I described several steps that are often necessary to fully heal MBS (and heal one’s psyche at the same time).  I have listed them here as well.

1. Learning that MBS exists, that emotions can cause pain.

2. Understanding one’s own emotions, prior stressors, core issues that have lead to the physical and emotional symptoms.

3. Starting to uncover these core issues and emotions in writing and reflecting.

4. Speaking the truth to oneself, through writing, meditating, reprogramming the mind.

5. Reclaiming our bodies by doing the things which have triggered symptoms and using affirmations and self-talk to reprogram the brain so that these triggers (such as movements, exercise, certain foods, times, places, people) stop leading to MBS symptoms.

6. Recognizing hidden barriers in our own mind that may prevent us from getting better (see week 3 of the program); honestly asking ourselves the question: Why might my mind prefer to hang on to these symptoms?

7. Speaking the truth to others, telling others what you need, expressing anger or apology or forgiveness.

8. Accepting what needs to be accepted; forgiving what needs to be forgiven.

9. Doing things that we need to do, physical things (activities), but also things we want to do, and most importantly, figuring out what things need changing in our lives and actively working on those.

10. Letting go of past issues, recognizing that what has happened “should” have happened and that fighting reality is a horrible way to live (see the work of Byron Katie in week 4 of the program).

11. Creating our new self, deciding who we want to be and making that a reality, deciding how we will respond to issues and making that happen.

Because it can be complicated and difficult for many to overcome MBS (see some recent blogs of stories from brave people who have persevered to become symptom-free, for example, Joe’s story from October, 2009), we should be looking for innovative ways to help in the recovery process. The retreat at Kripalu was an attempt to create such a program.

From my perspective, the retreat went very well. I interviewed people separately to help them uncover the emotions that were creating their specific symptoms. Everyone was accepting of the MBS diagnosis and they all began to accomplish the first of the steps towards healing. There was enough time for people to bond together and share their stories. Kripalu is a healing environment, with healthy food, yoga classes, massage therapists, a great facility, and beautiful grounds. We had time for several directed meditations and mindfulness training. And they were away from their usual work and home lives, which allowed them to concentrate on their own healing and reflect on their lives. Everyone seemed thrilled with the retreat experience. I will solicit some of their stories in future blogs and get their input about this form of MBS work. Many of them began to see results in their attitude, mood, energy level, and pain within a few days. Time will tell if this experience worked to jump-start their recovery. They are now beginning the long, difficult work of going through the 4-week online program. I have tremendous faith in them and am grateful to them for attending this first MBS retreat. I’m not sure yet if this format will continue to be offered, but I think it holds great promise. There is clearly a need for new and different ways of doing this work.

I currently teach a 4-week class for healing MBS in the Detroit area. There is also the online program and now there may be a retreat format. I am coming out with a book in a couple of months. This will provide yet another option. I will write about that soon.

Send me your thoughts about the retreat format for healing MBS.  I’d be interested in your feedback.

To your health,

Howard Schubiner, MD

Here’s his story as told in an email to me:

“As far as my pain goes, I cannot report any miraculous change in symptoms; however, I continue to experience a very subtle phenomenon that I have dubbed an “erosion of tension.” Like the tide coming in and out, eroding the beach, it seems like my tight muscles are very, very slowly beginning to loosen. Then they contract again (or feel contracted), but when each time this happens (each time being like one back and forth of the tide), the tension in the muscles seems just the slightest bit less than before – so slight a difference, however, as to seem non-existent for the first few months that this was happening. Now, it has been long enough and steady enough that I believe it is happening, but doubt still lingers because of how subtle it all seems. Nonetheless, I am convinced of the MBS diagnosis. I do think that I am a particularly tough case, though. When I read about people who are totally healed by reading Dr. Sarno’s book one time through, I can get very envious, and also, sometimes, filled with doubt about whether I have MBS at all. But I am beginning to settle into the knowledge that I do.

Since first reading Dr. Sarno’s book (about nine years ago), I have forgiven my parents for an abusive childhood, begun to come to terms with a very rigid and intense Catholic upbringing, been able to sort through childhood traumas, been able to give up excessive drinking, gone through a whole year of psychotherapy, am finally done with the incessant belief that “there is something wrong with me” physically, and am at work on believing that there is nothing wrong with me mentally. I also went back to college and got a degree from an elite college, realized and admitted my deeply ingrained traits of perfectionism and self-hatred, rekindled a relationship with my wife and my daughter, my parents, and many other strangers. I have written literally thousands of pages of reflection, inquiry, and self-discovery, and have begun to remove from my shoulders the weight of the world, (and maybe, perhaps, if only for an instant, begun to rather like myself). I will say that most of the significant changes listed have come in the last year, with the help of your MBS website.

So, in one sense, yeah, I still have pain, and I’d love for it to be gone; but, in a weird sort of way, due to the incontrovertible changes for good that have transpired amidst the process of trying to “get healed”, I can now consider the pain a kind of benevolent guide. And while it was very difficult to trust this guide (it seemed so hostile and set against me) at first, I do trust it now; and if the pain is not totally gone yet, then I must choose to believe that it is because there is still more work that must be done.

The whole process has been like peeling an onion – one layer after another, after another – or, like unwrapping a gift, that gift being the unveiling of my long-covered-up True Self, which I hid so well for fear of it being destroyed by the hostile world surrounding. I think that this happened at such a young age that “undoing” it, at this adult age, seems semi-mystical. In actuality, perhaps it is just very natural. Or, yet again, perhaps the natural and the mystical are one in the same. I still don’t entirely understand any of this. The work of a Catholic monk by the name of Thomas Keating has helped exponentially. He writes much about the true/false self dichotomy; and has developed a form of Christian meditation that comes from ancient monastic practice. It is called Centering Prayer and I would highly recommend it to any other patients that you come across who, like me, struggle with a legacy of Christianity that might be suspicious of all things Eastern. You can learn more about his work here, if you have an interest: www.contemplativeoutreach.org

The greatest relief, thus far, has come in the instances where I’ve been able to throw up my hands and plead my ignorance. I don’t understand any of this! A favorite poet repeats the line: “I know nothing and I’m overjoyed. I know nothing and I’m overjoyed.” And I find myself resting in this, his mantra. This whole experience/journey/process has had a kind of supernatural aspect to it, and I find it very difficult to lay down my former ideas and just trust the leading, but this is what’s necessary. And that’s okay, I tell myself. I don’t have to be comfortable with it all the time. But, I’ve never been able to let my guard down like that before. I’ve always needed to concretely and intellectually “figure it out.” Be sure there were no surprises. And I have literally spent my whole life plagued by this vain attempt to make sense out of which religion was the true, right religion; what God wanted from me; whether or not the world was headed toward some kind of apocalyptic destruction; and on and on ad nauseam… But none of this has served me. It hasn’t allowed me the freedom to serve others either! It has only constructed a life lived in fear, isolation and self-hatred. Letting myself just be some guy who doesn’t have all the answers has been the greatest liberation of my life, and I know that it has been the catalyst to much of my own healing, both physical and otherwise.

Know that I am grateful for the opportunity to share these thoughts with you. And thank you for your continued interest and support. I feel confident that you are helping far more individuals with this work than you will ever get to know this side of the grave.”

Joe, thank you for those kind words.  You, also, are helping many people by your words, your example, and your wisdom. It is amazing how often the truth comes to us when we least expect it or when we aren’t really trying. Often we see the truth when we have surrendered to the realization that we are just who we are, and nothing more.  And that we are all that we need to be.

To your health,

Howard Schubiner, MD

Over the past couple of years, a new line of research has been developed which documents that certain disorders are socially contagious.  Nicholas Christakis and James Fowler have published articles in the New England Journal of Medicine and in the British Medical Journal documenting that smoking, obesity and happiness all share the ability to be affected by those around us.  The more people you know who are smokers, the more likely it is that you will be a smoker.  The same is true for having contacts who are overweight.  And if you have more friends and relatives who are happy, you are more likely to be happy!  It seems obvious that these issues can be affected by being in close contact because these issues are generally thought to be caused by our values, our thoughts and our behaviors.  That is, we can choose whether we smoke, how much we eat and exercise, and how to respond to the stresses in our lives.

Reading these articles made me think once again about the contagiousness of mind body syndrome.  I wrote a blog about this last year (Blog #6, June 20, 2008), but we now have some data and a way to measure this construct that we call social contagion.  Can physical symptoms be contagious?  We know that the flu or the common cold are contagious, i.e. you can catch it by being in close contact with someone who has it due to being exposed to the virus which causes it.  We would never think that you can catch cancer or heart disease because these are diseases caused by something that goes wrong inside your body, not something you catch from someone else.

If you read this blog, you are familiar with Mind Body syndrome, which is when one gets physical symptoms, such as back pain, headaches, fibromyalgia, irritable bowel syndrome or irritable bladder syndrome, due to stress and emotions that are either suppressed or unexpressed.  If these syndromes can be caused by stress and emotions, they may have many similarities with smoking, obesity and happiness, which are also related to stress and emotions.

Dr. Christakis referred me to one of his articles in which he suggests that headaches can be contagious.  He also indicated an article on back pain by Dr. Raspe and colleagues in Germany (Raspe, et. al. International Journal of Epidemiology 2008;37:69-74).

In this study, they gathered surveys on the amount of back pain reported by East Germans and West Germans, both before and after the fall of the Berlin Wall and the reunification of Germany.  Surprisingly, the prevalence of back pain was much lower in East Germany prior to reunification, however, after the two countries unified the amount of people with back pain in East Germany gradually increased to the level of that seen in West Germany, where it has remained.  The authors suggest that the cause of the rise in back pain in East Germans that back pain is socially contagious.  This is their explanation: “We hypothesize that back pain is a communicable disease and suggest a harmful influence of back-related beliefs and attitudes transmitted from West to East Germany via mass media and personal contacts.”

If headaches and back pain are shown to be socially contagious, this would be a huge advance in the understanding of what causes them.  The concept of Mind Body syndrome is not widely understood by physicians or by patients, even though everyone knows that you can get physical symptoms when under stress.  As I often say, your face turns red when you get embarrassed, your stomach tightens up when you have to give a speech, and you get a headache after a stressful day.  Doctors have recognized that stress and emotions can cause paralysis in the absence of a disease process such as a stroke or an infection, which is known as a conversion disorder.  However, most doctors do not realize that stress and emotions can cause chronic pain.

The work of Christakis and Raspe now offers the possibility of showing that certain disorders are related to stress and emotions, at least in part.  If we are able to use research methods similar to those used in these studies, we will hopefully be able to better understand the causes of common pain syndromes that are causing a tremendous amount of suffering in the world.  Let’s hope that this research goes forward.  The sooner these disorders are clearly understood, the sooner we will be able to help decrease suffering as well as medical testing and procedures which are unnecessary.

To your health,

Howard Schubiner, MD

I have learned so many things about the mind and the body over the past 5 years of working with patients with Mind Body syndrome.  One of the most interesting things is that disorders that we considered psychological, such as anxiety, depression, PTSD (post-traumatic stress disorder), and OCD (obsessive-compulsive disorder) actually are similar to (dare I say identical to?) Mind Body syndrome.  In other words, these disorders are caused by patterns of neurological response to stress and emotional reactions to stressful situations.  This leads to two conclusions: 1) that psychological disorders such as these occur as part of MBS and typically are exchanged (substituted) with pain and other typical MBS symptoms and 2) we can treat these disorders effectively using the same methods as we use for MBS. 

Read the story of Jacob, who had OCD, which morphed into chronic pain.  He learned that he had to deal with the OCD and the pain, but that they were connected by being components of Mind Body syndrome.

“About 10 years ago I had back pain for 2-3 years and read Dr Sarno’s book and also had a MRI which showed no problems and my back pain went away.  A couple years ago when having my second child I started getting high anxiety and really bad obsessive-compulsive disorder (OCD) about things like locking doors, chemicals around house and just about anything else.  Then about a year ago, I had surgery, and the pain after surgery started going away but lingered and then after taking numerous tests and seeing specialists and searching the internet about why the pain was not going away it started getting worse and worse.  Soon I was taking Vicodin for pain and searching for any cure I could find.  I even tried a pain clinic and had a nerve block which did not work and even made my back hurt for a few weeks (the doctor warned me that it was a possible side effect).  I was getting pretty desperate and depressed.  The pain was nearly unbearable.  I was taking sleeping pills at night to sleep and pain killers during the day. 

I saw Dr Schubiner during the middle of this and he tried to help me realize that the pain was caused by MBS and there was no physical problem.  However, I don’t think I really believed what he was saying.  I called him many many times desperately in pain.  One thing was weird and amazing:  when I was in really bad pain my OCD would subside, and then when the pain was a little better, the OCD would ramp back up.   I tried reading Dr. Sarno’s books and writing 1-2 hours every day.  Some days it seemed to work, other days it didn’t. 

I knew in the back of my mind that the pain was mostly mental, but it as so severe that it controlled me and my thoughts.  One day I was in my garage and I came to the realization that the pain had to be mental and I suddenly felt really confident.  The next day I woke up feeling a lot better.  But a couple of days later, the pain was back with a vengeance.  However, whenever I was able to be confident that I knew what was causing my pain (MBS), it would subside.  This happened a number of times, but I would always seem to slip back into pain.

Once when researching pain online (I do this much more often than I should), I stumbled across information about movements that can cause a hernia, which can cause pain in the lower abdominal area (my area of pain).  One of the things mentioned was lifting a heavy weight.  Well, that has become a big stumbling block in my recovery, as I would feel a little better and then I would lift something and sure enough I would start feeling more pain.  The pain wouldn’t necessarily occur right away, but it would start in a day or two, as I obsessed about it and got mad at myself for lifting whatever it was. 

I do feel better now.  I have a much better understanding of how my mind creates pain and how my obsessive thoughts are a big part of this problem.  I still have some pain every day.  It’s usually minor compared to what it was, but there is still some pain.  Every couple weeks it will get worse, usually after I obsess about lifting something.  But it gets better after a couple days.  Generally what’s worse than the ongoing pain is the fear in lifting anything over 15-20 pounds.  I know deep down that it is silly but the bombardment of thoughts about it is not worth putting my self through it.  Fortunately for me, my job does not require any lifting and I have become a pro at leaving the room to go to the bathroom when something heavy needs picked up.  I am definitely not cured but am holding on to the progress I have made. 

There are two things that I think are definitely true. The pain definitely takes my mind off of the obsessive thoughts/fears.  The second thing is that no one can help you but yourself.  It has to come from you.  I kept trying to look to somebody for an answer.  I think I started feeling better when I forced myself thru the agony to make it thru a day without taking any pain pills.  I always worried what if I would take the maximum amount of pain pills and still couldn’t make it through the day.  And I also worried that I would never start feeling better.  I do believe that when I was able to stop fearing the pain even a little (I still fear it to some degree as I was hesitant to even write this), that helped me feel better.  Now I just take a pain pill when it is really bad, but I know it will feel better in a couple days.

I am trying to take it day by day and not worry about tomorrow.  If I have some pain, I try not to worry about “what if it doesn’t go away.”  It is tough, but today I’m definitely better than I was a year ago.  The pain is sometimes better and sometimes worse, but it’s not near as bad as it was.  It’s the same with the OCD, sometimes better and sometimes worse, but again, it’s definitely not as bad as it was.  Unfortunately, I’m still terrified of lifting anything that might cause a hernia, but usually those thoughts go away after awhile.  But I can live with that.”

I am very impressed with Jacob’s story as it shows how difficult it can be to conquer MBS, especially when it is complicated by severe anxiety, in this case in the form of obsessive-compulsive disorder.  Jacob taught me that physical symptoms (typically pain) and psychological symptoms (typically anxiety or depression) are frequently exchanged for each other.  I have seen innumerable examples of symptom substitution over the years; pain moves from place to place, ringing in the ears replaces pain, pain replaces anxiety, insomnia replaces pain, diarrhea or constipation replaces OCD, depression replaces pain, fatigue replaces urinary symptoms.  Jacob had to cope with both pain and OCD; and as one improved the other one worsened.  It took great courage for him to face both of these symptoms at the same time in order to begin his recovery.  His story also teaches us that recovery isn’t always quick and immediate; it is often a prolonged and rocky journey.  Jacob isn’t totally free of pain or of OCD, but he understands himself better and has made tremendous strides in alleviating both of his MBS symptoms.  And, while he continues to work towards freedom, he can enjoy his life.

To your health,

Howard Schubiner, MD