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The Panic and Pain of Mind-Body Dualism

Updated on August 27, 2013

In the opening scene of the classic semi-autobiographical comic novel Three Men In Boat, the writer Jerome K. Jerome is looking for a hay fever treatment when he casually begins reading about other diseases. By the time he’s finished, he concludes that he has every disease on the list. "I had walked into that reading-room a happy healthy man. I crawled out a decrepit wreck." He goes to his doctor, an "old chum" who gives a him prescription for a good meal, a pint of beer, a ten-mile walk every morning, and going to bed at 11 every night. "And don’t stuff up your head with things you don’t understand."

In the 21st century, the list of symptoms, ailments, and treatments seems to have expanded exponentially, and a few clicks online elicit total body panic, usually in the middle of the night. We are too tense to sleep. Even when we try to avoid cyber induced illnesses, we are confronted with TV ads interrupting our favorite shows with reminders that we pee too frequently, we’re not happy enough, and we should be getting more frequent and longer lasting erections. So we hurry ourselves to the doctor. What does our 21st century American doctor prescribe? Rather than telling us to walk ten miles, he or she doles out pharmaceutical samples, orders tests, and sends us on our way more convinced than ever that our few remaining days on earth will be "quite miserable." Writers seem particularly prone to this sort of panic (not to mention bad alliteration).

Many times, my imagination has been stoked by casual comments from well-meaning doctors. Once, a doctor who sounded as if he’d practiced several English phrases and used them with abandon, had his finger fully up my rectum and casually said, "So, have any other of your family members had prostate cancer?" Another time, a doctor in California, in 1982, cavalierly misdiagnosed me with an incurable disease. "You might," he said, "Never have these symptoms again." Then again, I thought, I just might. So after years of anxiety-induced discomfort, I summoned the courage to get the test that confirmed what I should have known all along. The doctor was dead wrong. Even now, thinking about it can sometimes bring on fear. There have been instances since then. Each time, fear and anxiety exacerbated a minor stress-induced problem. No wonder we avoid doctors.

But it’s not their fault. They are trained to be objective, to diagnose based on a 10-15 minute meeting and then treat the symptoms, usually by giving you some pills. If the pills don’t work, you go back for another 10-15 minutes. You get different pills because sometimes one pill doesn’t work when another will (nobody really knows why). Or you get a stronger dosage with more potential for uncomfortable side effects. When these pills fail, you’re often then propelled into the land of specialists and expensive testing. A year later, after numerous inconclusive tests, you’re feeling worse than you ever have. Each doctor has an opinion or theory based on their specialty. A urologist will think prostate infection, a orthopedist might say muscle tear or strain, and a neurologist blames nerve impingement. They don’t consider the effect of their musings. Sometimes they merely shrug and move onto the next patient.

A placebo might help you as effectively as any prescription, but doctors are reluctant to use them for obvious reasons. What if they give someone a sugar pill and the patient dies? Whoops. They must remain objective. Logically then, they cannot acknowledge the opposite of placebo -- the "nocebo effect," a belief your ailment will appear or get worse rather than disappear or get better. Often, the nocebo effect occurs after a speedy misdiagnosis. Have you ever had a minor pain and, when you were told it was some degenerative disease, felt much worse? A mild symptom like a burning feeling on your skin becomes "incurable neuropathy." Muscle pulls and strains send you into the claustrophobic MRI tube. When the results show a herniated disk, your worst fears have been confirmed -- you won’t be able to walk ever again. Anxiety can cause symptoms, which can cause more anxiety, which can cause more symptoms. If your doctor says you have a problem, you will be much more likely to experience that problem. Soon you are like Jerome K. Jerome and feeling "seedy." You imagine the end of the world.

However, most of it is balderdash. Everyone, as they age, develops such things as herniated disks and spinal stenosis but most don’t have any pain at all. So how did you get your back, thigh, groin, arm (endless list) pain? You did nothing different. Your pain seemed to come from nowhere. There was no injury that you can remember. Or you had an injury and everything healed properly. But you still have lots of pain. At this point, you should consider that you might be suffering from a "mind-body disorder." We all have some repressed anger. It’s a natural phenomena. Getting older can cause anger. After all, who among us likes to admit the five-mile run we used to speed through now takes twice as long and makes our body ache? Maybe you have repressed anger impinging on your already overstressed life. Maybe your pain has become a "habit" initiated by misdiagnosis and perpetuated by fear.

Such emotional factors can cause physical symptoms. This is the key premise behind the work of Dr. John Sarno and others who have followed him. You may be thinking the premise obvious. But current medical doctrine does not accept this notion, while paradoxically accepting that stress and anxiety can exacerbate symptoms. (Even stranger when you consider that doctors have no trouble accepting you’re stress-induced headache. So why not a backache?) If you read Sarno’s books, you may initially think they offer no solution at all. That’s because we’re all looking for a quick fix. We’re stuck in our pill-popping mentality. Thinking "psychological" when you have a "physical" pain is not what we’ve been taught to believe. It is more acceptable to have a horrible cold, a bad back, irritable bowel syndrome, constipation, and urinary frequency than to admit a "psychological problem." Suffering through your pain to "get it done" makes you a hero. What happens when you say you have "emotional problems?" What a wimp! Most of us would rather have the pain. But neither would be nice, wouldn’t it?

Sarno’s books are often repetitious. But as it turns out the repetition is important, like practicing your multiplication. The "solution" lies in accepting that your brain is causing your pain. Current studies of the brain show that you can change your neural pathways, and logically then eliminate or "unlearn" your pain. "When we learn a bad habit, it takes over a brain map, and each time we repeat it, it claims more control of that map and prevents the use of that space for ‘good’ habits. That is why ‘unleaning’ is often a lot harder than learning" (Norman Doidge in "The Brain That Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science"). Doidge also suggests that "brain exercises" can be as effective as drugs. The brain is nueroplastic. It changes. Often, even after an injury has healed, your brain remains changed. New neural pathways have been established. If you panic and obsess over the pain -- will I have pain for the rest of my life? -- the pathways become entrenched, "learned," and remain long after the injury has healed. You must then "unlearn" your pain.

For too long, we have unconsciously accepted Descartes’ mind-body dualism; that is, that the mind is completely different than the body. Sure, it is comforting to know that the mind can exist without the body, and therefore "life" after death is possible. But this same dualism creates a world in which we treat the body as if it were separate from the "mind." However, with new studies in nueroplasticity, the barrier between mind and brain have crumbled. We can now think of mind and brain as one. The mind becomes the brain. The brain is part of the body. Now we can integrate the mind and the body and treat individuals as whole human beings.

Know the Nocebo Effect

The "nocebo" effect is basically the opposite of the placebo effect. Like the placebo effect, the nocebo effect is a "self-fulfilling prophecy," only the nocebo is a belief that some ailment will appear or get worse, rather than disappear or get better. For example, if patients are warned about nausea as a side effect of their medication, they are, according to documented scientific research, three times as likely to experience nausea as those not warned. So, how do you tell if you are experiencing a nocebo effect?

  1. Have you experienced side effects from medicine in the past? If so, you are more likely to expect side effects from your current medication, and that expectation can increase the chances of a nocebo effect.
  2. Are you an anxious person, prone to depression? Anxiety and depression can cause physical symptoms. This can be a self-perpetuating cycle. Anxiety and depression can lead to medication, which can lead to the expectation of side effects, which can produce side effects, causing more anxiety… Insurance companies and doctors are quick to prescribe pills but not the therapy that is usually also required. And patients are quick to swallow pills because its conceivably more private than therapy, less time consuming, and easier to get insurance to pay.
  3. What color is your pill? Even the color of the pill can cause patients to have varying reactions. If your pill is blue or green, you might experience a depressant nocebo effect… sleepiness, fatigue, and so on. If your pill is red or orange, you will experience a stimulant nocebo effect.
  4. Have you had this symptom before? How often? If you’re sick, you are hyper-attentive to physical symptoms. A previous mild symptom like itchy skin, burning feeling, and aches morph in your mind to "incurable neuropathy" caused by your medicine, or worse.
  5. Do you trust your doctor? If you believe your doctor, then you are more likely to experience symptoms, or not, depending on what the doctor says.
  6. Are people around you experiencing similar symptoms? Many studies have shown "group effects," "mob mentality," and "mass hysteria." If you are around people who experience your symptoms, your are more likely to experience them yourself. On the other hand, of course, knowing that you are not alone can help ease your anxiety, and thus reduce symptoms. Know the difference between hysteria and commiseration. Online discussion forums can be helpful, but one-on-one personal interaction seems better, as long as you are both trying to lift each others spirits and are trying to overcome the nocebo effect.

If you suspect you are experiencing a placebo effect, think about something else. Distract yourself. Don’t question anything and forget about researching your condition. Try to enjoy feeling good.

Doctors, traditionally reluctant to accept or try to use the placebo effect, are not keen to recognize the nocebo effect. Imagine being sued for not telling a patient about possible side effects. Then being sued for telling a patient about possible side effects.

Futuristic Health Care – Fantasy?

Imagine hospitals full of life, glittering domes soaking up sunlight in winter and reflecting it in summer, hospitals where suffering is alleviated and patients wake to the smell of spring rain and lilacs. Your personal physician leads your health team, and you meet your team-leader, a specialist, scientist-teacher. You discuss your health while sitting on the wooden deck overlooking green hills.

Your specialist teaches you about your personal Nano-bio-machines swimming in a glistening drop of water, like tadpoles in a crystalline river, the drop dropping onto your dry lips, and rushing into the current of your body. Your Nano-bios are on their way to schedule a meeting with your tumor, traveling your electromagnetic aura, and your physician and specialist can smile and scientifically say the word "aura" without sniggering. Your specialist touches your arms and slowly runs fingers up, making a U-turn at your armpit, to your stomach and your tumor, where your Nano will settle, and translate, so that your specialist and your tumor can have a serious therapeutic discussion. Tell us, he asks, what is your purpose?

What will your tumor say? Will it respond that you always worried too much, and you held all that worry in your stomach, that you swallowed too much pride? And where did that pride come from? Did you want to become rich and famous, an entertainer, miserable, then dead? You tried. You tried hard, like the lone errant penguin heading toward the end of the earth. You kept pushing as if that glimpse of ice sparkling on your summit was worth the agony and worry? And now you cannot smell lilac in spring. Or perhaps you never ventured forth and are looking back on missed opportunities and have languished in a stagnant pool for too long, staring at someone else’s accomplishments, trying to understand a George Eliot quote, "It is never too late to be what you might have been." Or maybe you ate too many plastic foods.

Your specialist discusses these issues with the tumor. You listen to their conversation. It becomes a heated debate, fierce even, and you finally join in. Unable to keep silent any longer, you yell at yourself, and your specialist diverts your anger into a direct discussion with your tumor. After a lengthy lively exchange, you and your tumor agree, you convince your tumor to stop growing, to recede into the vapor, reform itself into a smile, or a touch, or the sweet smell of the lilac.

Your Nanos, having accomplished their task as translator, dissolve into a mild sedative interacting with your dopamine, stimulating your serotonin, and ready with a small shot of norephinephrine for you when you wake later ready to play soccer with your eight-year old daughter.

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    • Jeff May profile image

      Jeffrey Penn May 5 years ago from St. Louis

      Hi kathryn,

      It is puzzling, isn't it, as I know that problems can arise without any pain as well. Sarno does offer good advice however as I run and hike and am now in my late fifties. If I worried too much over every ache and pain I wouldn't get any exercise at all. Thanks for your usual insightful comments. Jeff.

    • kathryn1000 profile image

      kathryn1000 5 years ago from London

      I have seen a book by Dr Sarno and can well believe his theory.

      But i am puzzled.If you see a therapist for treatment for repressed anger it takes along time to uncover why you fear your anger and become able to express it.Dr Sarno seems to say to someone,You're angry.Then they get better soon.

      I was told I would have sciatica forever but I cured it by raising up the washing up bowl in the kitchen!

      Also,illness and pain can make you angry or depressed.

      Now I have arthritis pain 24/7 but not in my back.

      However learning muscular relaxation cured my headaches after doctors gave up on me!

      A good piece.Thank you,Jeff.I've been off for a while owing to family problems.

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi jandee, Great stories. Thanks for sharing. Most ailments can be "treated' through rest, meditation, water, exercise and a proper diet.

    • jandee profile image

      jandee 6 years ago from Liverpool.U.K

      Well presented humour,

      made me laugh a lot.Last time I saw a doc. was after a druggie smashed into me and my car sending me in a full circle ,they got out of their car and took off!-never visit the doc,-unless my crazy hound pulls me over and I crack something,never, ever take pain-killers as the worry about side-effects would be worse than the pain.

      As somebody said symptoms usually go and without being smart about it(lot of docs do super work). I know a bloke who had 4 different opps for a bladder problem . None of them worked then he discovered alkaline and is free from any problems by simply taking a fresh grapefruit daily /grapefruit drink.or a kiwi,

      enjoyed reading,


    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi Stephanie, Thanks for stopping by. Yes, I'm unlearning all sorts of pains in all the usual places. I suppose some of it is inevitable but lots unnecessary. The attention can serve as a reinforcer in some people. Good comments and insight. Jeff.

    • Stephanie Henkel profile image

      Stephanie Henkel 6 years ago from USA

      Doctors are different now because of the pressure they're under to see more patients; patients are different because they have access to so much more health information without the proper background to filter it. The combination doesn't always bode well for the patient. I found the theory of "learned pain" pretty interesting, and can identify people who have not only "learned" their aches and pains, but who are, on some level, enjoying them for the attention and sympathy they get. While some people will truly want to "unlearn" their pain, others may find it hard to give up. Your hub was thought provoking and interesting. Now I have to figure out how to "unlearn" that pain in my knees... Voted UP!

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi James. I'm impressed you must have known instinctively that doctors could make things worse. Eventually, yes, most so-called aliments go away. I would have been much better off had I not visited either of the doctors I mentioned in this article. Always enjoy your input and love to read that we agree on something. Jeff. (Maybe health care costs would go down if we treated individuals as whole human beings instead of test subjects for drug companies and if fewer people ran to the doctor for hangnails.)

    • James A Watkins profile image

      James A Watkins 6 years ago from Chicago

      I very much enjoyed this fascinating article. I agree with your concepts. That is why I do not go to doctors. I have had numerous "ailments" through the years but they always go away—sometimes after five years even.

      That opening photograph is quite lovely. I will look for the book by Dr. Sarno.

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Thanks for stopping by Tom.

    • Tom Rubenoff profile image

      Tom Rubenoff 6 years ago from United States

      Fascinating. It serves one to acknowledge the power that the mind and emotions have on the body. Wonderful article. Thank you.

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi randslam. Since a lot of the work I do requires me to spend long hours by myself, I can understand the doctor's comment. Sitting around staring at your navel eventually will require you to visit your physician. If you think about it long enough, something will hurt. The good news is that people don't have to. Changing the way they think will change the way they feel. Thanks for you usual insightful comments.

    • randslam profile image

      Rand Zacharias 6 years ago from Kelowna, British Columbia

      Great hub, Jeff.

      I'm not one to enjoy any kind of medical visit, but that's generally a guy thing. So there's another hub for those wishing to discuss medical management.

      It is fascinating that people, in general, have such faith in their medical practitioners when often their success rate is about as hit and miss as a local forecaster's record.

      Exercise and diet do solve most issues unless one is suffering from a debilitating disease.

      A few years back I had to go in for a deep cut and discussed the clientele of a walk-in clinic with the doctor.

      In his opinion, "80 percent of the people I see are just lonely."

      It seems a shame that in a world with the telecommunication technology we have that the number one place a lonely human will visit is the physician--instead of an eDating site.

      So for all those unhealthy lonely folks? Find someone to talk to...hopefully the people you meet aren't hypochondriacs.

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Thanks Dusty. Your comments are insightful and they prompted a chuckle or two. I guess you have to be a certain age to understand the humor, or maybe just a little crazy. Not sure which it is. But I loved your comments and your addition to the conversation. Thanks again.

    • 50 Caliber profile image

      50 Caliber 6 years ago from Arizona

      Jeff, I found this article quite interesting. I could make a new hub in response of a one man test study. Instead I'll agree that it is "mind over matter" if "you don't mind, it don't matter" LOL The doctor stood back to me asked a few questions as he typed on his touch screen. 10 minutes later he opens the door retrieves computer generated prescriptions and signs 4 of them, hands me samples for a few and says take them as written and I'll see you back in 6 weeks then shakes my hand and moves on.

      We have lost medical care and simple suggestions to a multi-million dollar pill industry that provides fully paid weekend resorts for doctors and staff in exchange for pushing their product.

      I now look at prescriptions and side effects before filling them. I find too often possible side effects may be the one it is supposed to eliminate. What a merry go round. A drug for us old guys who develop problems urinating, I read can cause the sphincter in the bladder to fail resulting in you loosing all problems urinating, you become incontinent. Now there's a place I don't want to go, "in my pants" LOL

      The naturalist healer told me, "try drinking 8 cups of water every day" to hydrate, "wait until you have a strong urge and then do your business". 2 months later common sense I haven't the problem.

      I enjoyed this article and even laughed at some of your points, sadly it is the root of skyrocketing health care prices and health insurance.

      Voted up to a good tongue in cheek, yet informative article all should ponder. Thank you.



    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi innersmiff, Let's not forget of course that hypochondria is a psychological disorder:) While you do have to take this all with a chuckle, let's not be too harsh on hypochondriacs by calling them idiots.

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi J Burgraff. I'm not sure how I'm being a fearmonger. My intent certainly isn't to scare anyone. Hopefully, those in pain will realize they don't need to be. But of course, just talking about having pain can induce anxious people to have it. Regarding brain plasticity... while yes there are periods in brain development that are especially "plastic" and much of that is "before ten" the exciting new research shows that the brain can grow new neural pathways, overcoming developmental problems. "The Brain That Changes Itself" is an especially good read about the frontiers of neuroscience. Also, of course, as your hubs show, diet and exercise play a hugely important role. Have you seen Food, Inc, or read "The Omnivore's Dilemma"? (People who call everyone "sweetie" seem to be generally happy:)

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Hi hybrid, thanks for stopping by.

    • innersmiff profile image

      James Smith 6 years ago from UK

      Good work. Every minor occurance is a sign of health defect and every character trait a psychological disorder these days. The only disorder most of these idiots have is hypochondria.

    • J Burgraff profile image

      J Burgraff 6 years ago

      Sweetie,I think you are being a fearmonger yourself. And by the way, brain plasticity doesn't last much after ten. Not that I don't love what you wrote.

    • hybrid12346 profile image

      hybrid12346 6 years ago

      Very interesting article, keep up the good work. Thank you!

    • Jeff May profile image

      Jeffrey Penn May 6 years ago from St. Louis

      Thanks Enlydia, for being the first visitor and adding good comments. We can change. Thanks again, Jeff.

    • Enlydia Listener profile image

      Enlydia Listener 6 years ago from trailer in the country

      Very useful, I rated this up. Thanks for sharing...I like the part about our brains being neuroplastic...which means they can adapt and change...also like much of our body.