Tms Quotes

For example, if surgery is employed to relieve back pain due to TMS, it will prove to be only a placebo “cure,” and similarly, if Prozac is used to treat depression, it will prove to be only a chemical “cure.” In both cases, the patient will soon develop new symptoms. The TMS and the depression are not disorders in themselves; they are symptoms of unconscious conflicts and must be treated with psychotherapy to avoid the inevitable return of new

Another experiment, conducted by Pascual-Leone when he was a researcher at the National Institutes of Health, provides even more remarkable evidence of the way our patterns of thought affect the anatomy of our brains. Pascual-Leone recruited people who had no experience playing a piano, and he taught them how to play a simple melody consisting of a short series of notes. He then split the participants into two groups. He had the members of one group practice the melody on a keyboard for two hours a day over the next five days. he had the members of the other group sit in front of a keyboard for the same amount of time but only imagine playing the song--without ever touching the keys. Using a technique called transcranial magnetic stimulation, or TMS, Pascual-Leone mapped the brain activity of all the participants before, during, and after the test. he found that the people who had only imagined playing the notes exhibited precisely the same changes in their brains as those who had actually pressed the keys. Their brains had changed in response to actions that took place purely in their imaginations--in response, that is, to their thoughts. Descartes may have been wrong about dualism, but he appears to have been correct in believing that our thoughts can exert a physical influence on, or at least cause a physical reaction in, our brains. We become, neurologically, what we think. (p33)

A burst of high-frequency TMS pulses applied over Broca’s area on the left side would shut down the ability to speak, Shirley told me. This wasn’t what they were doing in the autism study—what they proposed was a much subtler tweaking. But I was intrigued by her comment and didn’t let it go. “Did you actually try it yourself?” I asked her. It turned out that she had—in fact, quite a few of the researchers, as part of their training to work in the lab, had experienced the speech-suppression TMS. They offered to show me what it felt like.

I inadvertently had a very high dose of environmental transcranial magnetic stimulation (TMS) when commissioning a very high powered utility electronic power plant and I can assure you that it can do very strange things to your thinking and the effects last a very long time!

Being lonely as a kid might well have been necessary for me,” I told audiences in my talks. “If I’d had the friends I dreamt of, I’d never have spent the time to become the machine aficionado I am today. Now that I’m grown I can put that in perspective. The world is full of friendly people with no technical skills. The few of us who see into machines like others see into humans are singularly uncommon, and we’re valued for that. If we use a technology like TMS to help a lonely teen today, will we be taking that exceptional ability away from him tomorrow? Should we trade friends in seventh grade for designing a working spaceship at age twenty-five?

• The pain is due to TMS, not to a structural abnormality. • The direct reason for the pain is mild oxygen deprivation. • TMS is a harmless condition, caused by my repressed emotions. • The principal emotion is my repressed anger. • TMS exists only to distract my attention from the emotions. • Since my back is basically normal, there is nothing to fear. • Therefore, physical activity is not dangerous. • And I must resume all normal physical activity. • I will not be concerned or intimidated by the pain. • I will shift my attention from the pain to emotional issues. • I intend to be in control—not my subconscious mind. • I must think psychological at all times, not physical.

THE CONSCIOUS AND UNCONSCIOUS MINDS There is a section in Studies on Hysteria entitled “Unconscious Ideas and Ideas Inadmissible to Consciousness—Splitting of the Mind,” written by Breuer. Today, we would substitute the word emotions for ideas, but that disagreement aside, the concept that we humans have two minds is very important to an understanding of TMS. It is clear that we are two different people—one of them conscious and the other unconscious.

to see that the danger and emotional pain remain contained. My experience with TMS has convinced me that the purpose of this repression is to protect the individual, to prevent the painful, dangerous feelings from coming to consciousness and causing even greater distress. The psychosomatic symptoms that accompany this repression, while sometimes extremely distressing, are not some form of punishment but are generated to distract the conscious mind and therefore to assist the process of repression.

There appears to be a close connection between these skin disorders (acne and warts) and the emotions. As with virtually all of these mind-body processes, there is no laboratory proof of the causative role of emotions, but there is certainly a mountain of clinical evidence. Acne is one of the common "other things" that people with TMS have had or continue to have even while they're having back trouble. And then there's the story of the man who developed an itchy rash under his wedding band that disappeared as soon as he separated from his wife. Other gold rings did not produce a similar rash. It has been suggested that other skin disorders like eczema and psoriasis are related to the emotions. I am inclined to agree but have no evidence one way or the other. (page 195)

The concept of “brain plasticity” refers to the ongoing capacity of the brain and the nervous system to change itself. Everything that we do, think, feel, and experience changes our brain. A stroke or a traumatic brain injury can affect brain plasticity, and plasticity may also be associated with such developmental disorders as autism. Increased brain plasticity may also potentially endow a person with unanticipated new abilities, as John appears to have experienced in this book. TMS, or transcranial magnetic stimulation, the intervention that John undergoes, provides a unique opportunity for us to learn about the mechanisms of plasticity, and to identify alterations in the brain’s networks that may be responsible for a patient’s problematic symptoms, and also for recovery.

This curious effect was noticed as far back as 1892, when textbooks on mental illness noted a link between “religious emotionalism” and epilepsy. It was first clinically described in 1975 by neurologist Norman Geschwind of Boston Veterans Administration Hospital. He noticed that epileptics who had electrical misfirings in their left temporal lobes often had religious experiences, and he speculated that the electrical storm in the brain somehow was the cause of these religious obsessions. Dr. V. S. Ramachandran estimates that 30 to 40 percent of all the temporal lobe epileptics whom he has seen suffer from hyperreligiosity. He notes, “Sometimes it’s a personal God, sometimes it’s a more diffuse feeling of being one with the cosmos. Everything seems suffused with meaning. The patient will say, ‘Finally, I see what it is all really about, Doctor. I really understand God. I understand my place in the universe—the cosmic scheme.’ ” He also notes that many of these individuals are extremely adamant and convincing in their beliefs. He says, “I sometimes wonder whether such patients who have temporal lobe epilepsy have access to another dimension of reality, a wormhole of sorts into a parallel universe. But I usually don’t say this to my colleagues, lest they doubt my sanity.” He has experimented on patients with temporal lobe epilepsy, and confirmed that these individuals had a strong emotional reaction to the word “God” but not to neutral words. This means that the link between hyperreligiosity and temporal lobe epilepsy is real, not just anecdotal. Psychologist Michael Persinger asserts that a certain type of transcranial electrical stimulation (called transcranial magnetic simulation, or TMS) can deliberately induce the effect of these epileptic lesions. If this is so, is it possible that magnetic fields can be used to alter one’s religious beliefs? In Dr. Persinger’s studies, the subject places a helmet on his head (dubbed the “God helmet”), which contains a device that can send magnetism into particular parts of the brain. Afterward, when the subject is interviewed, he will often claim that he was in the presence of some great spirit. David Biello, writing in Scientific American, says, “During the three-minute bursts of stimulation, the affected subjects translated this perception of the divine into their own cultural and religious language—terming it God, Buddha, a benevolent presence, or the wonder of the universe.” Since this effect is reproducible on demand, it indicates that perhaps the brain is hardwired in some way to respond to religious feelings.

When applied to the prefrontal lobes, TMS has been shown to enhance the speed and agility of cognitive processing. The TMS bursts are like a localized jolt of caffeine, but nobody knows for sure how the magnets actually do their work.” These experiments hint, but by no means prove, that silencing a part of the left frontotemporal region could initiate some enhanced skills. These skills are a far cry from savant abilities, and we should also be careful to point out that other groups have looked into these experiments, and the results have been inconclusive. More experimental work must be done, so it is still too early to render a final judgment one way or the other. TMS probes are the easiest and most convenient instrument to use for this purpose, since they can selectively silence various parts of the brain at will without relying on brain damage and traumatic accidents. But it should also be noted that TMS probes are still crude, silencing millions of neurons at a time. Magnetic fields, unlike electrical probes, are not precise but spread out over several centimeters. We know that the left anterior temporal and orbitofrontal cortices are damaged in savants and likely responsible, at least in some part, for their unique abilities, but perhaps the specific area that must be dampened is an even smaller subregion. So each jolt of TMS might inadvertently deactivate some of the areas that need to remain intact in order to produce savantlike skills. In the future, with TMS probes we might be able to narrow down the region of the brain involved with eliciting savant skills. Once this region is identified, the next step would be to use highly accurate electrical probes, like those used in deep brain stimulation, to dampen these areas even more precisely. Then, with the push of a button, it might be possible to use these probes to silence this tiny portion of the brain in order to bring out savantlike skills. FORGETTING TO FORGET AND PHOTOGRAPHIC MEMORY Although savant skills may be initiated by some sort of injury to the left brain (leading to right brain compensation), this still does not explain precisely how the right brain can perform these miraculous feats of memory. By what neural mechanism does photographic memory emerge? The answer to this question may determine whether we can become savants. Until recently, it was thought that photographic memory was due to the special ability of certain brains to remember. If so, then it might be difficult for the average person to learn these memory skills, since only exceptional brains are capable of them. But in 2012, a new study showed that precisely the opposite may be true. The key to photographic memory may not be the ability of remarkable brains to learn; on the contrary, it may be their inability to forget. If this is true, then perhaps photographic memory is not such a mysterious thing after all.

The pain is due to TMS, not to a structural abnormality. • The direct reason for the pain is mild oxygen deprivation. • TMS is a harmless condition, caused by my repressed emotions. • The principal emotion is my repressed anger. • TMS exists only to distract my attention from the emotions. • Since my back is basically normal, there is nothing to fear. • Therefore, physical activity is not dangerous. • And I must resume all normal physical activity. • I will not be concerned or intimidated by the pain. • I will shift my attention from the pain to emotional issues. • I intend to be in control—not my subconscious mind. • I must think psychological at all times, not physical.

The pertinent bias here is that these common pain syndromes must be the result of structural abnormalities of the spine or chemically or mechanically induced deficiencies of muscle. Of equal importance is another bias held by conventional medicine that emotions do not induce physiologic change. Experience with TMS contradicts both biases. The disorder is a benign (though painful) physiologic aberration of soft tissue (not the spine), and it is caused

The pertinent bias here is that these common pain syndromes must be the result of structural abnormalities of the spine or chemically or mechanically induced deficiencies of muscle. Of equal importance is another bias held by conventional medicine that emotions do not induce physiologic change. Experience with TMS contradicts both biases. The disorder is a benign (though painful) physiologic aberration of soft tissue (not the spine), and it is caused by an emotional process.

TMS is a strategy of the brain to keep unpleasant thoughts and emotions from rising from the unconscious into the conscious mind. The brain, through established physiologic pathways, creates pain as a distraction. By focusing our attention on physical symptoms, we keep these painful thoughts and emotions repressed. This is a very effective strategy, as there is an absolute epidemic of mindbody disorders in our society.

TMS patients cope only too well in reality; it is their unconscious minds that are cowardly. The best evidence of the validity of this concept is the fact that patients are able to stop the process simply by learning about it.

The study of psychoneuroimmunology is highly scientific and will play an important role in our understanding of many serious disorders, such as cancer and the autoimmune diseases (like rheumatoid arthritis and diabetes), but in my view it is but one segment of a larger study of how emotions may influence any of the organs and systems of the body. TMS

If the low back pain is accompanied by pain in the leg, or sciatica, there is even greater concern and apprehension, for this raises the possibility of the herniated disc and the possibility of surgery. In this media-dominated age, very few people have not heard of herniated discs, and the idea arouses great anxiety, resulting in greater pain. If, in the course of medical investigation, imaging studies show a herniation, the apprehension is multiplied even further. And if there should be feelings of numbness or tingling in the leg or foot and/or weakness, all of which can occur with TMS, because of burgeoning fear, the conditions for a very protracted episode of pain are defined. As will be discussed later, herniated discs are rarely the cause of the pain (see here). There is not a great deal one can do to speed the resolution of such an episode. If the person is fortunate enough to know what is going on, that this is only a muscle spasm and there is nothing structurally wrong, the attack will be short-lived.

Those that involve the back of the head are clearly related to the posterior neck muscles that are part of TMS. Some patients report pain all over the head; others have it in the frontal region. A common complaint is of severe pain “behind the eyes.” When they are unilateral (involving one side only), severe, and are accompanied by nausea, people are inclined to call them migraines. Tension headache can be as disabling as the worst neck, shoulder, or back pain.

the sufferer. What distinguishes them from tension headache is some sort of neurological phenomenon, usually visual, preceding the onset of the headache. I had a jagged, curved line that occupied varying parts of my visual field. It looked like cracked glass, and it “scintillated”—that is, it flashed on and off very rapidly. For some reason they are called “lights.” They usually started with a small dot that obscured a part of the visual field and over a period of minutes developed into the full-blown pattern described above. The phenomenon lasted about fifteen minutes, gradually faded out, and was then followed by the headache, which could go on to become very severe. What is a little scary about migraine is that it has been well established that it is due to constriction of a blood vessel within the substance of the brain. Once I had an episode during which my speech was incoherent for about an hour, something called aphasia, the result of the temporary constriction of a vital artery in the speech area of the brain. But the good news about migraine is that it, too, is an equivalent of TMS and can be stopped in precisely the same manner,

In retrospect, I know very well why I was getting migraines way back then and what I was repressing. Now when I get the warning signal, I can usually figure out what I am angry about and am constantly struck by the fact that no matter how many times I recognize that I have repressed anger, I will do it again and again, for it is apparently part of my nature, the way I developed psychologically, to do this. But see how powerful knowledge can be. By recognizing what I was doing, I was able to stop a very nasty physical reaction. Just as with TMS.

For many years I was under the impression that TMS was a kind of physical expression or discharge of the repressed emotions just described. In fact, this is what I suggested in the first edition of this book. I had been aware since the early 1970s that these common back and neck pain syndromes were due to repressed emotions. Eighty-eight percent of a large group of patients with TMS had a history of other tension-related disorders, like stomach ulcers, colitis, tension headache, and migraine headache. But the idea of TMS as a physical manifestation of nervous tension was somehow unsatisfactory and incomplete. Most important, it did not explain the repeated observation that making a patient aware of the role of the pain as participant in a psychological process would lead to cessation of pain, to a "cure." (page 56)

It was a psychoanalyst colleague, Dr. Stanley Coen, who suggested in the course of our working on a medical paper together that the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious. This, he explained, is what is referred to as a defense. In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere. It is intended to focus one's attention on the body instead of the mind. It is a response to the need to keep those terrible, antisocial, unkind, childish, angry, selfish feelings (the prisoners) from becoming conscious. It follows from this that far from being a physical disorder in the usual sense, TMS is really part of a psychological process.

Anxiety arises in response to the perception of danger and is logical unless the perception is illogical, as is often the case. The anxious person tends to anticipate danger, often where there is little or none. This is the nature of the human animal. However, he or she is often not aware of this anxiety, for it is generated in the unconscious out of feelings that are largely unconscious and are kept in the unconscious through the well-known mechanism of repression. Because of the unpleasant, embarrassing, often painful nature of these feelings and the anxiety they generate, there is a strong need to keep them out of consciousness, which is the purpose of repression. As will be seen later, the purpose of TMS is to assist in the process of repression.

It is likely that for most of us, the compulsive need to do well, succeed, and achieve is a reflection of deep seated feelings of inferiority. Wherever it comes from, the need to accomplish or live up to some ideal role, such as being the best parent, student, or worker, is very common in people who get TMS. p.41

Brain entrainment: Neurofeedback (NFB) Transcranial Magnetic Stimulation (TMS) Brain Computer Interface (BCI) Hyperbaric Oxygen Therapy (HBOT) Floatation Tanks (REST) Reduced Environmental Stimulation Therapy Nootropics: Caffeine Nicotine Lion’s Mane mushroom Adderall Ritalin Modafinil Brahmi Winter Cherry (Ashwagandha) “Qualia Mind” a proprietary blend Ginkgo Biloba Maca root Yerba Mate Green Tea Aniracetam Phosphatidylserine Plant Medicines & Psychedelics: Ketamine LSD Psilocybin Iboga MDMA

It is likely that for most of us, the compulsive need to do well, succeed, and achieve is a reflection of deep seated feelings of inferiority. Wherever it comes from, the need to accomplish or live up to some ideal role, such as being the best parent, student, or worker, is very common in people who get TMS. (page 41)

If I can convince the conscious mind that TMS is not serious and not worthy of its attention, better yet that it is a phony, a charade, and that rather than fear it one should ridicule it, that most of the structural diagnoses are not valid and that the only things worthy of one's attention are the repressed feelings, what has been accomplished? We will have made the TMS useless; it will no longer have the ability to attract the attention of the conscious mind; the defense is a failure (the cover is blown, the camouflage is removed), which means the pain ceases. If that all sounds like something out of science fiction or Grimm's fairy tales, one can only say that it works and has worked in a few thousand people over the last seventeen years. (page 87)

- "How can I tell the difference between TMS and pain from overworking unused muscles?" - That's easy. When you've done some unaccustomed physical activity and wake up the next morning with aches in your arms or legs, it's a good kind of ache and it's usu- ally gone by the following day. The pain of TMS is always nasty, and it doesn't go away very quickly, if at all. (page 111)

We're going to try to stop the body from reacting physically to your emotions." "We want you to learn to send messages to the subconscious mind." "Information is the penicillin that cures this disorder." "The cure is knowledge." "Until now, your subconscious mind has been in charge; I'm going to teach you how to have your conscious mind take over." "Get mad at your brain; talk to it; give it hell." "TMS is a trick your mind is playing on you - don't fall for it." "TMS is a sideshow designed to distract you from what is going on emotionally." "The symptoms are an act to mask what's going on in the psyche." "Most of the structural changes in your spine are natural occurrences." "The brain doesn't want to face up to the repressed anger, so it is running away from it." "By laughing at or ignoring the pain, you are teaching the brain to send new messages to the muscles." (page 106)

A placebo cure is almost always temporary, and we are looking for permanent resolution of the pain. Therefore, we would not be satisfied with a placebo cure. This is all too common. People are administered a large variety of physical treatments, feel better for a few days, and then need another treatment. (And, of course, they never overcome their fear of physical activity.) One of the reasons I know the TMS program does not induce a placebo reaction is the fact that almost all patients have permanent resolution of symptoms. A second reason is that the placebo effect is based on blind faith; patients know little or nothing about the disorder they have and the rationale for treatment. They simply trust the treating practitioner. The educational program employed in the treatment of TMS is the very opposite. I teach patients literally all I know about the disorder; they are encouraged to ask questions, and they are warned that they must find the diagnosis logical and consistent. Their recovery depends on information, on awareness. They are active participants in the recovery process. This is anything but a placebo process. Perhaps the most compelling argument that what we do is not a placebo is the fact that on numerous occasions since the publication of the book Mind Over Back Pain, the predecessor of this one, people have reported complete and permanent resolution of pain simply by reading the book. There is no personality influence here, no bedside manner; just plain, solid information. And we have learned that that's what it takes to banish TMS. (page 109)

I remind them (patients) that the musculoskeletal system is not the only one where the brain can set up a diversion. It can do the same thing in the gastrointestinal tract; the head, with tension or migraine headache; the skin; the genitourinary tract. The brain can cause mischief in any organ or system in the body, so one must be on guard. I advise my patients to consult their regular physicians if a new symptom occurs but to let me know about it since it may be serving the same purpose as TMS. For example, stomach ulcers should be treated with proper medication, but it is almost more important to recognize that they are coming from tension factors. (page 112)

Patients are taught that there is no correct way to bend or lift, one doesn't need to avoid soft chairs or mattresses, corsets and collars are unnecessary, and in general the great number of admonitions and prohibitions that have become part of back pain folklore are simply without foundation, because TMS is a harmless condition, and there is nothing structurally wrong with the back. Running is not bad for the spine; weak abdominal muscles do not cause back pain; strong back muscles do not prevent back pain; it is perfectly all right to arch the back, swim the crawl or breast stroke; man was meant to walk upright (Homo sapiens and his ancestors have been doing so for somewhere between 3 and 4 million years); a short leg does not cause back pain. One could go on and on. (page 110)

In my experience, structural abnormalities of the spine rarely cause back pain. That ought not surprise us, for this epidemic of back pain is very new. Somehow the human race managed to get through the first million years or so of its evolution without a problem, but if the structural diagnoses are correct, something happened to the spine during the last evolutionary eyeblink, and it has begun to fall apart. This idea is untenable. One suspects that these spine abnormalities have always been there but were never blamed for pain, because there was no pain to blame them for. Fifty years ago, back pain was not very common, but, more importantly, nobody took it seriously. The epidemic of back pain is due to the enormous increase in the incidence of TMS during the past thirty years, and, ironically, the failure of medicine recognize and diagnose it has been a major factor in that increase. Instead of TMS, the pain has been attributed primarily to a variety of structural defects of the spine. It's essential to know that almost all of the structural abnormalities of the spine are harmless. (page 117)

Fifty years ago, back pain was not very common, but, more importantly, nobody took it seriously. The epidemic of back pain is due to the enormous increase in the incidence of TMS during the past thirty years, and, ironically, the failure of medicine recognize and diagnose it has been a major factor in that increase. Instead of TMS, the pain has been attributed primarily to a variety of structural defects of the spine. It's essential to know that almost all of the structural abnormalities of the spine are harmless.

Anxiety arises in response to the perception of danger and is logical unless the perception is illogical, as is often the case. The anxious person tends to anticipate danger, often where there is little or none. This is the nature of the human animal. However, he or she is often not aware of this anxiety, for it is generated in the unconscious out of feelings that are largely unconscious and are kept in the unconscious through the well-known mechanism of repression. Because of the unpleasant, embarrassing, often painful nature of these feelings and the anxiety they generate, there is a strong need to keep them out of consciousness, which is the purpose of repression. As will be seen later, the purpose of TMS is to assist in the process of repression. (page 43)

It was a psychoanalyst colleague, Dr. Stanley Coen, who suggested in the course of our working on a medical paper together that the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious. This, he explained, is what is referred to as a defense. In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere. It is intended to focus one's attention on the body instead of the mind. It is a response to the need to keep those terrible, antisocial, unkind, childish, angry, selfish feelings (the prisoners) from becoming conscious. It follows from this that far from being a physical disorder in the usual sense, TMS is really part of a psychological process. (page 56)

The term trigger points, which has been around for many years, refers to the pain elicited when pressure is applied over various muscles in the neck, shoulders, back, and buttocks. There is some controversy over what precisely is painful, but most would agree that it is something in the muscle. Rheumatologists, who have taken the lead in studying fibromyalgia (TMS), appear to avoid using the term, probably because of its association with other diagnoses through the years. I neither use it nor avoid it, for I have concluded that these points of tenderness are merely the central zones of oxygen deprivation. Further, there is evidence that some of these points of tenderness may persist for life in TMS-susceptible people, like me, though there may be no pain. In the first chapter, the point was made that most patients with TMS will have tenderness at six key points: the outer aspect of both buttocks, both sides of the small of the back (lumbar area), and the top of both shoulders. These tender points, trigger points, call them what you will, are the hallmark findings in TMS, and they are the ones that tend to persist after the pain is gone. It is an important part of the physiology of TMS to know that the brain has chosen to implicate these muscles in creating the syndrome we know as TMS. Patients sometimes ask if breathing pure oxygen will relieve the pain. This has been tried and, unfortunately, does not help. If the brain intends to create a state of oxygen deprivation, it will do so regardless of how oxygen rich the blood is. (page 77)

The work of Dr. Hans Selye is credited with first drawing attention to how stress affects the body; his research and writing were prolific and stand as one of the major accomplishments of medicine in the twentieth century. Dr. Selye's definition of biological stress is "the nonspecific response of the body to any demand made upon it." Stress can be either external or internal to the individual. Examples of external stress are your job, financial problems, illness, change of job or home, caring for children or parents. However, the internal stressors appear to be more important in the production of tension. These are one's own personality attributes, like conscientiousness, perfectionism, the need to excel, and so forth. People often say that they have a very stressful job and that's why they're tense. But if they weren't conscientious about doing a good job, if they weren't trying to succeed, achieve, and excel, they wouldn't generate tension. Often such people are highly competitive and determined to get ahead. Typically, they are more critical of themselves than others are of them. (page 36)

If fake- niceness rules, then there must be an equal counterbalance—and that counterbalance is pure rage. The opposing psychic force to feigned niceness is blinding rage which happens to be the root of TMS pain, and most likely all illness. So, life is a constant dance for balance between intellectualization and feeling—repression and expression.

Medical specialists flinging procedures and prescriptions at you—betahistines and SSRIs, SNRIs, benzos and CNS depressants, DNRIs, rTMS, ECT, CBT, DBT—if the list seems inexhaustive, it’s because it is, all sorts of fancy-colour pills that nuke your libido and make your limbs tense up with a writhing athetosis. Besieged by waves of nausea, I have never wanted to kill myself more than when I was on sertraline.

daily reminders. • The pain is due to TMS, not to a structural abnormality. • The direct reason for the pain is mild oxygen deprivation. • TMS is a harmless condition, caused by my repressed emotions. • The principal emotion is my repressed anger. • TMS exists only to distract my attention from the emotions. • Since my back is basically normal, there is nothing to fear. • Therefore, physical activity is not dangerous. • And I must resume all normal physical activity. • I will not be concerned or intimidated by the pain. • I will shift my attention from the pain to emotional issues. • I intend to be in control—not my subconscious mind. • I must think psychological at all times, not physical.

It was a psychoanalyst colleague, Dr. Stanley Coen, who suggested in the course of our working on a medical paper together that the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious. This, he explained, is what is referred to as a defense. In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere.

Think psychological, not physical, An idea that is most quizzical. No one would have guessed Emotions deeply repressed Could produce such tension Not even to mention TMS. There is nothing to fear! Subconscious, do you hear? You concentrate on pain, A back sufferer’s bane, To divert one’s attention From underlying tension. Your secret is out; You have lost your clout. So give it up, resign— TMS is benign! I am in control, not you. I have learned that I’ve got to— Think psychological, not physical.

Many TMS patients are the antithesis of hostile; they often have a strong need to be good, nice, pleasant, accommodating, and helpful. Though they may be ambitious and often very accomplished, they do not necessarily pursue their goals with the intensity that seems to be characteristic of the Type A person.

To understand the phenomenon of avoidance in TMS one must constantly bear in mind how radically the unconscious mind differs from its conscious counterpart. The unconscious is terrified by the rage and reacts to avoid it by keeping it repressed and employing physical symptoms to aid in that repression. One of Freud’s biographers, Peter Gay, likened the unconscious to a maximum-security prison where all the desperate criminals, the undesirables and unacceptables, are incarcerated under heavy lock and key. In other words, they are repressed. If these feelings are already repressed, you may ask, what is the need for a distraction? The prison analogy is particularly apt; the repressed feelings, like desperadoes, will try to escape. Despite the force of repression, powerful emotions like rage will strive to rise to consciousness. I call it the “drive to consciousness.” Yale

I noticed that the more severe TMS sufferers had early disconnects with their mothers— some, so overwhelmed by the next fear of separation that they found themselves curled up in the fetal position, unable to move or speak. They had reverted back to an earlier, preverbal state of brain development. Most everyone I communicated with who was suffering from chronic pain had admitted that they had experienced early abandonment fear, or rejection. So there is some form of residual panic in TMSers from infancy —childhood separation anxiety, causing a chronicity of anxiety— most likely mother’s absence due to her attention being directed toward younger siblings, or an infinite number of other reasons.

As Dr. Sarno has shown, you do not need to change your personality to heal. The understanding of the TMS process and full belief are all that are normally needed to heal, but not always. Sometimes your life needs to be dissected and specific memories discharged to heal.

These statistics suggest very strongly that the cause of most back pain is emotional, for the years between thirty and sixty are the ages that fall into what I would call the years of responsibility. This is the period in one’s life when one is under the most strain to succeed, to provide and excel, and it is logical that this is when one would experience the highest incidence of TMS.

In the group of disorders referred to as tendonitis, the tendon is correctly identified as the offending part, but the reason given for the pain is incorrect. The anatomy is right, but the diagnosis is wrong. It is generally assumed that the painful tendon is inflamed because of overuse. So the treatment is to immobilize and rest the part and/or inject the tendon with a steroid (cortisone). Relief is often only temporary. Many years ago, the suspicion dawned on me that tendonitis (more properly called tendonalgia) might be part of TMS when a patient reported that not only had his back pain resolved with treatment but also his elbow had ceased to hurt. I put this to the test and, indeed, found that I could get resolution of most tendonalgias. I now consider tendon/ ligament to be the third type of tissue involved in TMS. Common sites of tendonalgia are the shoulder, elbow, wrist, hip, knee, ankle, and foot. (page 138)

Inflammation must be discussed, for it is the explanation presented for many cases of upper and lower back pain and is the basis for the prescription of both steroidal (cortisone) and nonsteroidal (such as ibuprofen) anti-inflammatory drugs. Because of the magnitude of the back pain problem, these medications are widely used. Experience with the diagnosis and treatment of TMS makes it clear that the source of the pain is neither spinal structures nor inflammation. An inflammatory process is an automatic reaction to disease or injury; it is basically a protective, healing process. The response to an invading bacteria or virus is an inflammation. (page 140)

The physiology of TMS begins in the brain. Here repressed emotions like anxiety and anger set in motion a process in which the autonomic nervous system causes a reduction in blood flow to certain muscles, nerves, tendons, or ligaments, resulting in pain and other kinds of dysfunction in these tissues. The autonomic nervous system is a subsystem of the brain that has the responsibility for controlling all of the body's involuntary functions. It determines how fast the heart beats, how much acid is secreted into the stomach for digestive purposes, how rapidly one breathes, and a host of other moment-to-moment physiologic processes that keep our bodies functioning optimally under everyday circumstances or in emergencies. The so-called fight or flight reaction that all animals share, particularly important in lower animals, is directed by the autonomic system. In order to meet the emergency, every organ and system in the body is properly prepared. For some systems it means total cessation of activity so that the body's resources can be mobilized to deal with the danger more effectively. Typically, most of the body's nutritive and excretory activities are shut down, the heart beats more rapidly, and blood is shunted away from less important functions so as to be available in larger quantities for systems that are crucial to escape or fight, like the muscles. The critical importance of the autonomic system of nerves is obvious. (page: 71)

The term trigger points, which has been around for many years, refers to the pain elicited when pressure is applied over various muscles in the neck, shoulders, back, and buttocks. There is some controversy over what precisely is painful, but most would agree that it is something in the muscle. Rheumatologists, who have taken the lead in studying fibromyalgia (TMS), appear to avoid using the term, probably because of its association with other diagnoses through the years. I neither use it nor avoid it, for I have concluded that these points of tenderness are merely the central zones of oxygen deprivation. Further, there is evidence that some of these points of tenderness may persist for life in TMS-susceptible people, like me, though there may be no pain. In the first chapter, the point was made that most patients with TMS will have tenderness at six key points: the outer aspect of both buttocks, both sides of the small of the back (lumbar area), and the top of both shoulders. These tender points, trigger points, call them what you will, are the hallmark findings in TMS, and they are the ones that tend to persist after the pain is gone. It is an important part of the physiology of TMS to know that the brain has chosen to implicate these muscles in creating the syndrome we know as TMS. Patients sometimes ask if breathing pure oxygen will relieve the pain. This has been tried and, unfortunately, does not help. If the brain intends to create a state of oxygen deprivation, it will do so regardless of how oxygen rich the blood is.

This is an important strategy, but one must be careful that it does not become a ritual. Patients are given a list of twelve key thoughts, and it is suggested that at least once a day they set aside fifteen minutes or so when they can relax and quietly review them. They are called daily reminders. * The pain is due to TMS, not to a structural abnormality. * The direct reason for the pain is mild oxygen deprivation. * TMS is a harmless condition, caused by my repressed emotions. *The principal emotion is my repressed anger. * TMS exists only to distract my attention from the emotions. * Since my back is basically normal, there is nothing to fear. * Therefore, physical activity is not dangerous. And I must resume all normal physical activity. * I will not be concerned or intimidated by the pain. * I will shift my attention from the pain to emotional issues. * I intend to be in control-not my subconscious mind. * I must think psychological at all times, not physical. (page 97)

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I concluded that all of the postural muscles are targets for tension but that some are more susceptible than others (see Figure 8). Perhaps the explanation for this is that the most important postural muscles are the ones most frequently involved. Note the high proportion of patients with buttock tenderness: 77 percent on the left and 78 percent on the right. The buttock muscles keep the trunk upright on the legs, a very important job. The neck muscles keep the head erect on the trunk, and the muscles at the top of the shoulders stabilize the arms so that they can be used properly; if the shoulder muscles are not functioning properly, arm function will be severely curtailed. The higher numbers involving the right neck and shoulder may have something to do with the fact that most of us are right-handed. The importance of this pain on pressure cannot be overemphasized. Muscle tenderness on pressure is the hallmark of TMS; it is the only objective evidence of the alteration in muscle physiology brought about by TMS. It explains the "trigger points" that doctors have been talking about for years, which can now be recognized as the central zone of a wider area of muscle pain induced by blood deprivation. Only the postural muscles and their associated nerves are targets for TMS; the muscles of the arms and legs are not similarly involved. This is a clinical fact, similar to the fact that the stomach or colon may be a target organ for tension, so it is not necessary to know why. One wonders, however, if the nature of their work is what makes postural muscles selectively susceptible to TMS. Because they are responsible for maintaining head and trunk posture and supporting the arms at the shoulders, they are constantly active during one's waking hours and,

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frees the body to heal itself. In taking away the fear, confusion and feelings of victimization so characteristic of TMS, we give the body a chance to do "its own thing.

I needed complete healing for my own inner peace of mind—which only served to slow my healing. I continued pushing ahead of my own light, returning back into my own shadow. I decided to turn my frustration of the possibility of pain-in-perpetuity into a healing mechanism for the final stage of healing. I would turn this pain against itself. Archaic anger is negative energy without a purpose. I decided to direct this frustration-energy toward movement and activity. From now on, when I woke up in pain, I was going to run twice as long, lift twice as long, and punish my inner brat twice as much. Surely, this would be the panacea? No, not quite. However, I began to notice that each time I had a day of increased pain, the next time that I had a better day, the pain was less. So with each fall, came a higher high—the old dark before dawn platitude. Change was indeed occurring in a nonlinear fashion but I was also moving ever upward, toward the pinnacle of healing. TMS was holding on, but slowly losing its grip on me, or my grip on it.

A day came in healing summer on which I got up to run and the bottom of my right foot hurt so intensely that I couldn’t stand on it. It was on the bottom right pad. Doctors call this neuroma or neuropathy, but it clearly is not. I laughed at this point, almost feeling sorry for the TMS in me. I no longer feared the pain. I can only describe the pain on the bottom of my foot as a golf ball on the right pad of my foot (no, I know what you’re thinking, I checked the shoe, it wasn’t a golf ball). I dressed to run. As I started down my driveway I slammed that foot into the cement as hard as I could slam it. The first few hits were excruciating and sent a tingling through my face, but by the end of my driveway, the foot pain was gone. I focused my attention on a part of my back that felt great and continued running. Some mornings the pain would be in my heels so I began slamming my heels on the ground as hard as I possibly could without breaking my foot. Too many people whose feet hurt begin to placate their pain, they let their foot pain hold their attention by babying their feet, needlessly controlling their lives because doctors erroneously diagnose them as having foot neuropathy (there are over 100 types of so-called neuropathies). I have helped several people get rid of their foot pain and know another individual who has gone from trouble walking, to jogging, through TMS healing. Never yield to pain—if you do, then you give in to your unconscious motivation for it.

Our failing physical health is a reflection of our unresolved deeper emotional status through a disruption in the normal functioning of the autonomic nervous system. "Removal of the infant from the mother immediately after birth…to perform the usual rituals…does result in separation and actually traumatizes the infant in the process. Trauma is basically in its purest form disregulation, (meaning) an interruption in the normal smooth regulatory patterns of autonomic cycling which we call homeostasis: optimal state of regulatory function within the brain and body, and that’s what’s disrupted because the part of the brain that develops and grows with attunement regulates that autonomic cycle and that brain does not develop as well if one doesn’t have the early experience of attunement and bonding." — Robert Scaer, MD, The Body Bears the Burden Attunement is a responsive, harmonious relationship. The lack of immediate connection, or attunement, especially with mother—beginning at birth—ignites a lifetime of longing to be reconnected, causing various sorts of autonomic irregularities, depression, and anxiety. Many TMS sufferers report they never bonded with their mother or father, leading to a lifetime of emptiness filled with continuous self-punishment. The father’s role comes along a little later, but is just as critical in the emotional development process that feeds the child what it needs for harmony and balance. Without these connections comes a deep void that is often filled with drugs, depression, anxiety, violence, perfection, and of course TMS. That person who brings tears to your eyes when you reflect back in your life is the one you never made a connection with—and deeply longed to. Early Separation = Fear = Anger = Energy =Autonomic Disregulation ARISING SIMULTANEOUSLY

I have been struck by the fact that many patients will report the onset of attacks of TMS before, during, or shortly after major holidays. The reason is obvious: Big holidays usually mean a lot of work, particularly for women, who take the responsibility in our culture for organizing and carrying out the festivities. And, of course, society demands that this be done cheerfully, with a smile. Usually the women are completely unaware that they are generating great quantities of resentment, and the onset of pain comes as a complete surprise.

Based on history and physical examination, all of these people have TMS but are programmed to believe they suffer from something else. What gives strong support to the idea that these reactions are conditioned is that they disappear within a few weeks as patients go through my treatment program. If they were structurally based, they would not go away after treatment (consisting primarily of lecture seminars), which is what happens with successfully treated patients. The conditioning is broken by the educational process.

There comes to mind the case of a man who had found himself financially well-off enough to retire from business at an early age and who shortly thereafter developed the pain syndrome for which I saw him. As we talked, it became apparent that since his retirement, he had become preoccupied with a number of family problems, there had been a number of deaths in the family, he was worried about the health of the business he had left (in the hands of relatives), and he had begun to wonder what his life was all about now that he was retired and was thinking about aging and mortality for the first time. His concern about these matters, considered consciously and unconsciously, had produced sufficient anxiety (and anger) to precipitate the TMS. Conventional medicine had attributed his pain to an aging spine, and treatment for that had, naturally, failed. He had TMS; his troubles were not in his spine—they were in his life.

Anger may be one of the most important and least appreciated of the emotions we generate. The celebrated psychoanalyst and ethicist Willard Gaylin published a book in 1984 titled The Rage Within, which explored the subject of anger in modern man. Because anger is so antithetical to our idea of appropriate behavior in a civilized society, we tend to repress it at the very moment it is generated in the unconscious and so remain unaware of its existence. There are many reasons, most of them unconscious, why we repress anger. They were enumerated in the psychology chapter (see here). The tendency to repress undesirable emotions is a supremely important element of one’s emotional life, and, again, we are indebted to Freud for the concept. We repress feelings of anxiety, anger, weakness, dependency, and low self-esteem, for obvious reasons. At the other end of the emotional spectrum, there is what Freud called the superego; this is our Moses. It tells us what we should and should not be doing, and it can be a hard taskmaster. In fact, it adds to the pressures that make us anxious and angry and so actually contributes to the tensions within us. As I have said earlier, people who get TMS tend to be hardworking, hyper-responsible, conscientious, ambitious, and achieving, all of which build up the pressure on the beleaguered self. One further observation. Just as there is a powerful tendency to repress undesirable emotions, there seems to be an equally strong drive to bring them to consciousness. It is this threat to overcome repression that necessitates the creation by the brain of such things as TMS, ulcers, and migraines.

This book is the successor to Mind Over Back Pain, which was published in 1984. It described a medical disorder known as the Tension Myositis Syndrome (TMS), which I have had reason to believe is the major cause of the common syndromes of pain involving the neck, shoulders, back, buttocks, and limbs.

It seemed logical to conclude that their painful muscle condition might also be induced by tension. Hence, the Tension Myositis Syndrome (TMS). (Myo means “muscle”; Tension Myositis Syndrome is defined here as a change of state in the muscle that is painful.)

Studies and clinical experience of many years suggest that these common pain syndromes are the result of a physiologic alteration in certain muscles, nerves, tendons, and ligaments that is called the Tension Myositis Syndrome (TMS). It is a harmless but potentially very painful disorder that is the result of specific, common emotional situations. It is the purpose of this book to describe TMS in detail.

For many years I was under the impression that TMS was a kind of physical expression or discharge of the repressed emotions just described. In fact, this is what I suggested in the first edition of this book. I had been aware since the early 1970s that these common back and neck pain syndromes were due to repressed emotions. Eighty-eight percent of a large group of patients with TMS had a history of other tension-related disorders, like stomach ulcers, colitis, tension headache, and migraine headache. But the idea of TMS as a physical manifestation of nervous tension was somehow unsatisfactory and incomplete. Most important, it did not explain the repeated observation that making a patient aware of the role of the pain as participant in a psychological process would lead to cessation of pain, to a “cure.” It was a psychoanalyst colleague, Dr. Stanley Coen, who suggested in the course of our working on a medical paper together that the role of the pain syndrome was not to express the hidden emotions but to prevent them from becoming conscious. This, he explained, is what is referred to as a defense. In other words, the pain of TMS (or the discomfort of a peptic ulcer, of colitis, of tension headache, or the terror of an asthmatic attack) is created in order to distract the attention of the sufferer from what is going on in the emotional sphere. It is intended to focus one’s attention on the body instead of the mind. It is a response to the need to keep those terrible, antisocial, unkind, childish, angry, selfish feelings (the prisoners) from becoming conscious. It follows from this that far from being a physical disorder in the usual sense, TMS is really part of a psychological process.

We have postulated that in TMS the autonomic system selectively decreases blood flow in certain muscles, nerves, tendons, and ligaments in response to the presence of repressed emotions like anxiety and anger. This state is known as ischemia—that is, the tissue involved is getting less than its normal complement of blood. This means that there will be less oxygen available to those tissues than they are accustomed to, and the result will be symptoms—pain, numbness, tingling, and sometimes weakness. These things happen because of the critical importance of oxygen in all physiologic processes. When it is reduced below its normal levels, one can expect a reaction that will signal that fact.

What this means for the etiology (cause) of TMS, as I have long maintained, is that fibromyalgia, also known as fibrositis and myofibrositis (and to some as myofasciitis and myofascial pain), is synonymous with TMS.

The various health disciplines interested in the back have succeeded in creating an army of the partially disabled in this country with their medieval concepts of structural damage and injury as the basis of back pain. Though it is often difficult, every patient has to work through his or her fear and return to full normal physical activity. One must do this not simply for the sake of becoming a normal human being again (though that is a good enough reason physically and psychologically by itself) but to liberate oneself from the fear of physical activity, which is often more effective than pain in keeping one’s mind focused on the body. That is the purpose of TMS, to keep the mind from attending to emotional things. As Snoopy, that great contemporary philosopher, once said, “There’s nothing like a little physical pain to keep your mind off your emotional problems.” Charles M. Schulz, the creator of Peanuts, is clearly a perceptive man.

I find myself searching endlessly for ways of getting the message across. Certain phrases may reach some people but not others—so I use them all: “We’re going to try to stop the body from reacting physically to your emotions.” “We want you to learn to send messages to the subconscious mind.” “Information is the penicillin that cures this disorder.” “The cure is knowledge.” “Until now, your subconscious mind has been in charge; I’m going to teach you how to have your conscious mind take over.” “Get mad at your brain; talk to it; give it hell.” “TMS is a trick your mind is playing on you—don’t fall for it.” “TMS is a sideshow designed to distract you from what is going on emotionally.” “The symptoms are an act to mask what’s going on in the psyche.” “Most of the structural changes in your spine are natural occurrences.” “The brain doesn’t want to face up to the repressed anger, so it is running away from it.” “By laughing at or ignoring the pain, you are teaching the brain to send new messages to the muscles.” “We’re going to help you take the Sword of Damocles into your hands instead of having it hang over your head.

I am particularly grateful to a patient, Ms. Norma Puziss, who presented me with the following verse at the completion of her treatment program. It is now a regular part of the lecture-discussion. Think psychological, not physical, An idea that is most quizzical. No one would have guessed Emotions deeply repressed Could produce such tension Not even to mention TMS. There is nothing to fear! Subconscious, do you hear? You concentrate on pain, A back sufferer’s bane, To divert one’s attention From underlying tension. Your secret is out; You have lost your clout. So give it up, resign— TMS is benign! I am in control, not you. I have learned that I’ve got to— Think psychological, not physical. I am sure that this wonderful bit of verse has been helpful to many of my patients, since it captures one of the basic ideas so beautifully.

In my experience, structural abnormalities of the spine rarely cause back pain. That ought not surprise us, for this epidemic of back pain is very new. Somehow the human race managed to get through the first million years or so of its evolution without a problem, but if the structural diagnoses are correct, something happened to the spine during the last evolutionary eyeblink, and it has begun to fall apart. This idea is untenable. One suspects that these spine abnormalities have always been there but were never blamed for pain, because there was no pain to blame them for. Fifty years ago, back pain was not very common, but, more importantly, nobody took it seriously. The epidemic of back pain is due to the enormous increase in the incidence of TMS during the past thirty years, and, ironically, the failure of medicine to recognize and diagnose it has been a major factor in that increase. Instead of TMS, the pain has been attributed primarily to a variety of structural defects of the spine.

Review the Daily Reminders This is an important strategy, but one must be careful that it does not become a ritual. Patients are given a list of twelve key thoughts, and it is suggested that at least once a day they set aside fifteen minutes or so when they can relax and quietly review them. They are called daily reminders. • The pain is due to TMS, not to a structural abnormality. • The direct reason for the pain is mild oxygen deprivation. • TMS is a harmless condition, caused by my repressed emotions. • The principal emotion is my repressed anger. • TMS exists only to distract my attention from the emotions. • Since my back is basically normal, there is nothing to fear. • Therefore, physical activity is not dangerous. • And I must resume all normal physical activity. • I will not be concerned or intimidated by the pain. • I will shift my attention from the pain to emotional issues. • I intend to be in control—not my subconscious mind. • I must think psychological at all times, not physical.

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The reason for the redness is the same reason for the various other skin manifestations like psoriasis and eczema: chronically hidden tension—TMS. These symptoms all result from psyche imbalance with accompanying autonomic nervous system imbalance, from chakra imbalance.

Single pulse transcranial magnetic stimulation (sTMS) is FDA-approved for the acute treatment of migraine. Two pulses can be applied at the onset of an attack and this can be repeated. The use of sTMS is safe where there is no cranial metal implant, and offers an option to patients seeking non-pharmaceutical approaches to treatment. Similarly, a noninvasive vagus nerve stimulator (nVNS) is FDA-approved for the treatment of migraine attacks in adults. One to two 120-second doses may be applied for attack