Pain Relief Using Psychological Inquiry

Indian Paintbrush, Little Blitzen

Below is a letter I wrote to a person I will name Jill, which I share here with her permission. Jill’s psychological inquiry during a walk in the woods revealed neediness, rage, repression, and pain. These emotions related to her primary relationship. I think these feelings and mind-body responses are almost universal in humans.

Dear Jill,
I want to explain how our session today fits into Dr. Sarno’s theory and suggest some daily practices you can begin right away to address your jaw pain (TMJ).

With our inquiry today, you are able to see and feel some feelings that you are experiencing just below the surface. These are:

-anger about the burden you feel in your life regarding your relationship with your significant other

-a strong need to be seen and loved

-fear that your feelings of anger will make you unworthy of being loved

-pressure on yourself to figure things out so that everything will be OK

-a belief that if you were “better or different” (not confused) you would be able to figure things out and “save the day”

-a belief that if you did things “perfectly” there would be a good resolution to the relationship difficulties

This list provides plenty of evidence that there are painful feelings that “don’t want to be felt.” Of course these feelings do exist inside you, especially in your vulnerable child-self. You are also aware of tremendous pressure (tension) that you put on yourself to figure things out so that your relationship conflicts are resolved. One reason that self-pressure can arise here is the hope that you can fix the problem outwardly and avoid all these feelings. Lots of pressures here, and lots of difficult feelings.

Part of you is experiencing a deep need to be loved and seen. Part of you is resentful that so much effort needs to be put into maintaining this “loving contact.” Why isn’t love easily available!? There is rage about this efforting and not being loved simply for who you are. Although your rage might be a natural response to the unresolvable conflicts and pressures, the rage itself seems to “threaten my connection to love.” Therefore there is a belief that “my rage is dangerous.”

Dr. Sarno’s Theory
This summary of your feelings has all you need to know about why you are in pain, according to Dr. Sarno. You have a child-self which is angry, as well as needy. For your adult self-image, however, this experience of neediness and anger should not exist. The age-old repression strategy of pain—as a distraction, is causing your TMJ.

Recognizing that your mind-body will put you in excruciating pain in order to “not feel” is unbelievable at first. So it is important to grasp how neediness and rage, for example, threaten your sense of self.

How does it feel to own that “I am habitually needy and angry?” Even if you can tolerate this awareness for a few minutes, and disengage from the Superego, rest assured that for your adult-self these feelings ruin the self-image that it believes it needs in order to function in the world.

During our development, when we were in heightened states of neediness and rage, we were sometimes (or often) rejected by our caretakers. This intolerance is passed down over the generations. Strong feelings are energetically difficult for a child, and they become even more threatening because they could not be held by our caretakers. We concluded that feelings like neediness and rage made us unlovable. Over time, we learned to reject the feelings of neediness and rage all by ourselves.

Now, when these feeling states arise down deep, we automatically block them out of our awareness. The repression/suppression is almost complete. Should our programmed repression/suppression activities fail on occasion, and the feelings begin to come to the surface, TMS pain and other symptoms come in to add a layer of distraction. It is “safer” for us to be in pain than to experience these feelings. Part of us believes these feeling have no right to exist.

Dr. Sarno’s approach was a “learning cure.” That is, once we see the strategies the mind-body is using to distract us, this repression strategy loses its effectiveness. The symptoms will subside on their own. We “look behind the curtain” and understand how pain and other symptoms are not the results of anything physical. The symptoms come from our psychology, our inner dynamics.

Today during our walk you practiced telling yourself that the feelings that were arising are OK, that you’d rather feel these feelings than have physical symptoms. You expressed that the painful symptoms don’t help you understand your life (like actually feeling more might), but only waste your time, money and attention. You noticed improvements in symptoms during this self-talk.

Daily Practices
You can begin to treat TMJ symptoms immediately with five practices that we touched on today.

The first practice is responding to physical symptoms by immediately shifting to psychological inquiry, and this means contemplating the feelings of the inner-child in relationship to the feelings you are aware of. For me this can be very repetitive, and I don’t need to find the perfect “answer.” I make an educated guess about how my inner-child is responding to my experiences. If I am pressuring myself to be perfect, there might be rage, for instance. This practice is more about repetition than precision. You are teaching yourself that you understand that symptoms come from not wanting to experience difficult feelings, and that when a symptom is present, the inner-child is probably experiencing some kind of difficult feeling, including not feeling safe that the feelings are happening.

The second practice is telling the mind-body that you as the “commander” do not want the symptoms. You did this today out loud with self-talk.

The third is telling yourself that you are willing to feel your feelings. You are explicitly asking for this. You did this out loud with self-talk.

The fourth practice is thanking your mind-body when it responds the way you want it to (reduction in pain), again with self-talk.

The fifth practice is observing an increase or decrease in symptoms in real time. During our walk you noticed changes in symptoms as you allowed feelings to emerge, and when you used self-talk. When you notice symptoms change, do your best to link changes to feelings, events, ease, or how you are pressuring yourself in the moment. Practicing this, you get more and more evidence that the origin of pain is psychological, not physical.

All of these practices are loosely what Dr. Sarno called “thinking psychologically.” We begin to eliminate all thoughts of physical explanations for symptoms. Luckily it does not have to be done perfectly to have a huge effect. This repetition –doing it daily as a practice is important. It is a long-term education process. Over time, this new way of understanding symptoms and their real causes goes deeper and deeper.

With these psychological practices we eliminate other treatments, because addressing symptoms as if they had physical causes and physical treatments just re-enforces the pain distraction strategy.

To Be Clear
Dr. Sarno suggests that the pressures, conflicts, and difficult feelings did not have to stop or be reduced. Dr. Sarno also assures us that we cannot change our personalities. We just have to make the connection in our minds between the pressures/resulting emotions –and the pain, and the method works. We know that pain is there to distract us from deep feelings, and the pain-distractions stop because they no longer serve a purpose.

This is a mind-blowing relief for me because my perfectionist/striving mind can’t grasp that the pain can stop without “fixing something.” It is also instructive for me to see that “trying to stop my feelings” is deeply enraging, exhausting, and only feeds my TMS symptoms. We try to practice thinking psychologically with compassion and trust in the process. We catch ourselves again and again thinking in our habitual way that the symptoms are caused by physical troubles, and we gently bring ourselves back to thinking psychologically.

By making space for the feelings of our inner-child, the difficulties and inner conflicts will lessen on their own. Compassion arises, and there is less striving and reactivity. In our growing understanding we seek better self-care, and this also reduces the pressure and resulting emotions, and the need to repress. This happens in its own time.