The Divided Mind PDF

John E. Sarno

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 The Divided Mind
Healing Chronic Pain through Psychological Insight
and Understanding
Written by Bookey
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About the book
In "The Divided Mind," Dr. John E. Sarno embarks on a
groundbreaking journey to uncover the intricate connections
between our emotional well-being and physical health,
challenging conventional notions of chronic pain and illness.
Through compelling case studies and a deep dive into the
psyche, Sarno reveals how repressed emotions, particularly
rage and anxiety, can manifest as debilitating physical
symptoms—a phenomenon he terms Tension Myoneural
Syndrome (TMS). Bridging the realms of psychology and
medicine, this transformative book not only empowers readers
with knowledge but also offers a path to healing that
transcends traditional medical paradigms. "The Divided Mind"
beckons you to re-examine the roots of your pain and consider
a revolutionary approach to achieving true health and
wellness.

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About the author
John E. Sarno, M.D., was a groundbreaking physician and
professor of rehabilitation medicine at the New York
University School of Medicine. Renowned for his pioneering
work in the field of mindbody medicine, Dr. Sarno dedicated
his career to understanding the psychological roots of chronic
pain and other health disorders. His innovative theories and
treatments have sparked both acclaim and controversy,
challenging conventional medical paradigms and fostering a
new understanding of the powerful connection between the
mind and body. Over his distinguished career, he published
several influential books, including "Healing Back Pain" and
"The Mindbody Prescription," which have profoundly
impacted both medical professionals and patients worldwide.
With "The Divided Mind," Dr. Sarno delves deeper into the
intricate interplay between mental and physical health, further
solidifying his legacy as a transformative figure in modern
medicine.

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Summary Content List
Chapter 1 : WHAT IS PSYCHOSOMATIC MEDICINE?

Chapter 2 : A BRIEF HISTORY OF PSYCHOSOMATIC

MEDICINE

Chapter 3 : THE PSYCHOLOGY OF PSYCHOSOMATIC

DISORDERS

Chapter 4 : TREATMENT

Chapter 5 : HYPERTENSION AND THE MINDBODY

CONNECTION: A NEW PARADIGM

Chapter 6 : MY EXPERIENCE WITH TENSION

MYOSITIS SYNDROME

Chapter 7 : A RHEUMATOLOGIST’S EXPERIENCE

WITH PSYCHOSOMATIC DISORDERS

Chapter 8 : MY PERSPECTIVE ON PSYCHOSOMATIC

MEDICINE

Chapter 9 : STRUCTURAL PAIN OR PSYCHOSOMATIC

PAIN?

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Chapter 10 : A FAMILY DOCTOR’S EXPERIENCE WITH

MINDBODY MEDICINE

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 Chapter 1 Summary : WHAT IS
PSYCHOSOMATIC MEDICINE?

Section Summary

Introduction to Case study of John R, highlighting the need for self-understanding in healing from mindbody
Psychosomatic disorders.
Medicine

Mind-Body Psychosomatic disorders occur when the brain influences physical symptoms due to psychological
Relationship reasons.

Categories of
Psychogenic Disorders
Common manifestations (e.g., blushing).
Pain exacerbation due to stress (e.g., anxiety post-accident).
Symptom reduction through psychological awareness (e.g., war injuries).
Hysterical disorders with bizarre symptoms.
Psychosomatic disorders with real physical changes (e.g., TMS).

Symptom Imperative When one psychogenic symptom is treated, new unrelated symptoms may arise, highlighting the
need to address psychological roots.

Common Mindbody Other conditions (e.g., gastrointestinal issues, migraines) are linked to the autonomic-peptide
Disorders system and require psychological treatment.

Current Status of Pervasive skepticism about psychosomatic disorders exists among patients and the medical
Mindbody Medicine community, with a preference for quick fixes.

Final Thoughts Critique of contemporary medicine's neglect of psychosomatic disorders; emphasizes the need for a
holistic view and recognition of emotional-physical connections.

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WHAT IS PSYCHOSOMATIC MEDICINE?

The narrative begins with a case study of John R, a

seemingly confident businessman who suffers from
debilitating physical pain, indicative of mindbody disorders.
The author, Dr. John E. Sarno, emphasizes the necessity for
patients to understand their conditions themselves for
healing.
Dr. Sarno describes the intricate relationship between mind
and body, noting that psychosomatic disorders arise when the
brain influences physical symptoms through psychological
reasons. He outlines various categories of psychogenic
disorders, including:
1.
Common manifestations
like blushing or butterflies in the stomach.
2.
Pain exacerbation
due to psychological stressors, such as anxiety post-accident.
3.
Reduction of symptoms
through psychological awareness, illustrated by war injuries.
4.

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Hysterical disorders
, characterized by bizarre symptoms without physical causes.
5.
Psychosomatic disorders
where the brain induces real physical changes, exemplified
by tension myositis syndrome (TMS).
Dr. Sarno asserts that psychosomatic symptoms often spread
in epidemic-like fashion through social influence,
misdiagnosis, and the availability of medical treatment,
suggesting that many symptoms, like back pain or
fibromyalgia, may result from psychological sources rather
than structural abnormalities.

THE SYMPTOM IMPERATIVE

Dr. Sarno introduces the "symptom imperative," explaining

how when one psychogenic symptom is treated, the brain
may generate new, unrelated symptoms to maintain the
psychological distraction. He highlights that the importance
lies in addressing the psychological roots of these disorders,
indicating that conditions like TMS are often misdiagnosed
by medical professionals.

COMMON MINDBODY DISORDERS

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The author identifies other mindbody conditions including
gastrointestinal issues, migraines, and genitourinary
disorders that frequently spring from the autonomic-peptide
system, again stressing the need for correct psychological
treatment alongside medical interventions.

CURRENT STATUS OF MINDBODY MEDICINE

Despite significant evidence and successful treatment

outcomes for mindbody disorders, Dr. Sarno notes a
pervasive skepticism among both patients and the medical
community. He discusses the stigma surrounding
psychological assessments of physical symptoms, resulting
in patients preferring quick fixes like medications or
surgeries rather than exploring underlying emotions.

FINAL THOUGHTS ON PSYCHOSOMATIC

MEDICINE

The chapter concludes by critiquing contemporary medicine's

failure to recognize psychosomatic disorders, emphasizing
the importance of a holistic view that acknowledges the

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connections between emotional states and physical ailments.
Dr. Sarno argues that understanding and addressing
unconscious emotions is vital for effective treatment and true
healing in psychosomatic medicine.

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Example
Key Point:Understanding the mind-body connection
is vital for recognizing psychosomatic disorders and
seeking holistic healing.
Example:Imagine that you often experience severe
migraines, and every doctor you've visited insists on
prescribing medication. One day, as you sit quietly,
reflecting on your life, you realize that these migraines
seem to worsen during particularly stressful periods at
work when you feel overwhelmed and undervalued.
This epiphany highlights the link between your
psychological state and physical symptoms; by
exploring these emotions instead of relying solely on
medications, you might discover that addressing the
sources of your stress could lead to a significant
reduction in your migraines. This insight reflects the key
idea that true healing often stems from understanding
the underlying psychological issues contributing to
physical pain.

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Critical Thinking
Key Point:The connection between psychological
states and physical symptoms is complex and often
overlooked.
Critical Interpretation:While Dr. Sarno’s work
highlights the significant role of psychological factors in
physical ailments, it is crucial to approach his
conclusions critically. The notion that ailments like back
pain or fibromyalgia stem primarily from psychological
origins challenges long-standing medical paradigms.
However, this perspective may not encompass the full
range of biological and environmental factors
contributing to such conditions. Research from various
medical fields, including neurobiology, neuroscience,
and cardiology, suggests multifactorial causes of pain
and illness (e.g., Apkarian et al. 2005; Geha et al. 2008).
Thus, while Sarno’s emphasis on emotional awareness
can be enlightening, it is essential for readers to
consider that his conclusions may not universally apply
or replace traditional diagnostic methods.

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 Chapter 2 Summary : A BRIEF
HISTORY OF PSYCHOSOMATIC
MEDICINE
Section Summary

A Brief History of Psychosomatic medicine is critical for understanding pain disorders, influenced by the unconscious.
Psychosomatic Key figures include Charcot, Breuer, Freud, Adler, Alexander, and Walters.
Medicine

Charcot Charcot advanced the study of hysteria, establishing it as a legitimate diagnosis and influencing
Freud's shift towards the mind and unconscious emotional processes.

Breuer and Freud Breuer and Freud studied psychogenic disorders related to hysteria, revealing symptom substitution,
where unmet emotional conflicts create new symptoms.

The Conscious and Breuer introduced the idea of a split mind, where psychogenic symptoms distract from repressed
Unconscious Minds feelings influenced by the unconscious.

Freud Freud identified the unconscious role in psychosomatic disorders but conflated psychogenic and
organic causes, explaining the conflict between primitive emotions (id) and rational thought (ego,
superego).

Evolution and the Id The id generates basic emotions; its desires can lead to psychosomatic symptoms when in conflict
with the moral guidance of the ego and superego.

Narcissism, Freud suggested childhood-rooted emotions of inferiority lead to emotional pain and unresolved
Narcissistic Rage, internal conflicts.
and Inferiority

Evolution, the Ego, The ego evolves from the id to manage societal pressures, leading to repression that manifests as
and the Superego psychosomatic symptoms.

Anxiety and Anxiety from repressed emotions protects against confronting painful feelings, similar to other
Repression psychosomatic symptom mechanisms.

Aggression and Freud related aggression to self-punishment, viewing symptoms as defensive responses to
Self-Punishment unconscious anger rather than guilt expressions.

Adler Adler emphasized social context's role in psychological health, connecting feelings of inferiority to
emotional pain and psychosomatic symptoms.

Alexander Alexander linked emotional states with physical illnesses, enhancing the understanding of
psychosomatic medicine.

Walters Walters recognized psychogenic pain as valid, emphasizing its psychological origins over pure
physical causes.

Conclusion The history of psychosomatic medicine illustrates the connection between the unconscious mind and
physical symptoms, highlighting the enduring relevance of earlier theories in contemporary
psychology.

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A BRIEF HISTORY OF PSYCHOSOMATIC
MEDICINE

Psychosomatic medicine lacks a defined scope, yet it plays a

critical role in understanding common pain disorders, which
the author believes are primarily psychosomatic in nature.
Prominent figures in this field include Charcot, Breuer,
Freud, Adler, Alexander, and Walters, who shed light on the
effect of the unconscious on physical symptoms.

CHARCOT

Jean-Martin Charcot significantly advanced the study of

neurologic disorders and hysteria, transforming it from
ridicule to an established diagnosis. His meticulous
observations set the stage for Freud's shift from neurology to
the study of the mind, identifying the influence of
unconscious emotional processes on physical symptoms.

BREUER AND FREUD

Josef Breuer and Freud explored the link between

psychogenic disorders and the unconscious through their

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work with hysteria, revealing the ongoing relevance of these
early findings. Freud noted the phenomenon of symptom
substitution, where underlying emotional conflicts lead to the
development of new symptoms unless addressed.

THE CONSCIOUS AND UNCONSCIOUS MINDS

Breuer's explorations led to the idea of a split mind, with

unconscious emotions influencing physical symptoms. The
authors assert that psychogenic symptoms serve as protective
distractions, diverting attention from repressed feelings.

FREUD

Freud is credited with recognizing the role of the

unconscious in psychosomatic disorders, though he conflated
psychogenic and organic causes. He theorized that the mind's
dynamics involve a battle between the id (primitive
emotions) and the ego and superego (reason and morality).

EVOLUTION AND THE ID

The id, residing in the unconscious, generates primitive

emotions and drives. The tension between the id's desires and

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moral imperatives from the ego and superego can lead to
psychosomatic symptoms.

NARCISSISM, NARCISSISTIC RAGE, AND

INFERIORITY

Freud posited that emotions rooted in childhood experiences

contribute to feelings of inferiority that manifest as emotional
pain. These sentiments persist unrecognized, fueling
unresolved conflict within individuals.

EVOLUTION, THE EGO, AND THE SUPEREGO

Freud’s concept of the ego evolved out of the id to manage

societal pressures for survival and morality. This struggle can
lead to repression, manifesting as psychosomatic symptoms.

ANXIETY AND REPRESSION

Anxiety, stemming from repressed emotions, serves to

protect the individual from confronting painful feelings,
similar to how other psychosomatic symptoms operate.

AGGRESSION AND SELF-PUNISHMENT

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Freud examined the connection between aggression and
self-punishment, ultimately viewing symptomatology as a
defensively structured response to unconscious anger rather
than an expression of guilt.

ADLER

Alfred Adler recognized the influence of social context on

psychological health, proposing that universal feelings of
inferiority drive individuals toward striving for superiority,
linking emotions to psychosomatic symptoms.

ALEXANDER

Franz Alexander advanced the understanding of

psychosomatic medicine, emphasizing the intrinsic link
between emotional states and physical illnesses in diverse
medical conditions.

WALTERS

Allan Walters identified psychogenic pain as a valid

phenomenon in his work, underscoring the psychological

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origins of pain rather than strictly physical etiology.

CONCLUSION

The history of psychosomatic medicine reveals a rich

tapestry of insights connecting the unconscious mind's
dynamics with physical symptoms. While early theorists laid
the groundwork, contemporary understanding emphasizes the
universality of these experiences in the human condition.

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Chapter 3 Summary : THE
PSYCHOLOGY OF
PSYCHOSOMATIC DISORDERS

THE PSYCHOLOGY OF PSYCHOSOMATIC

DISORDERS

In this chapter, John E. Sarno explores the psychological

underpinnings of psychosomatic disorders, emphasizing how
childhood experiences shape adult behavior and health.
Using a case study of a young engineer who successfully
alleviated his chronic pain through self-awareness and
understanding, Sarno illustrates his theory that such physical
symptoms often arise as distractions from repressed
emotions, particularly rage.

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PAIN AND REPRESSION

Sarno discusses how pain serves as a defense mechanism

against unconscious emotions. He highlights the concept of
repression, where individuals suppress feelings considered
unacceptable, leading to psychosomatic symptoms as a form
of self-protection. Insights into the unconscious mind reveal
a complex interplay between emotional repression and
physical manifestations of pain.

EMOTIONS GENERATED IN INFANCY,

CHILDHOOD, AND ADOLESCENCE

Childhood experiences, including emotional, physical, or

sexual abuse and subtle emotional neglect, contribute to a
reservoir of unconscious rage and emotional pain that
persists into adulthood. Sarno outlines how these past
traumas can lead to psychosomatic disorders, as individuals
grapple with memories and feelings they cannot easily
express.
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Audio THE PERFECT
SELF-IMPOSED PRESSURES:
AND THE GOOD

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Chapter 4 Summary : TREATMENT

TREATMENT

Dr. Sarno reflects on a skeptical patient's inquiry about the

effectiveness of mindbody medicine, emphasizing that
recovery requires understanding, not simply faith. His
exploration of tension myositis syndrome (TMS) began in
the 1970s as he observed a pattern of psychosomatic
symptoms among his patients, including chronic back pain,
which he historically misdiagnosed. Recognizing the
limitations of conventional treatments, he concluded that
accurate diagnosis is essential for effective treatment.
The core of TMS treatment lies in education about its
underlying anatomy, physiology, and psychology, which
facilitates patients' acceptance of their condition. Sarno notes
that knowledge is transformative, with some patients finding
relief simply from reading his books. Success hinges upon
acceptance of a psychosomatic diagnosis, as denial
perpetuates the syndrome. The ideal patient often exhibits
conscientiousness and perfectionistic tendencies.

THE PROGRAM

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The treatment begins with a comprehensive consultation,
including medical and psychosocial history. Dr. Sarno
identifies key psychological factors, teaching patients about
the benign nature of their symptoms. The core educational
component is a two-hour lecture detailing the psychosomatic
process, emphasizing that psychological states trigger
physical pain.
Patients are instructed to refrain from physical treatments and
encouraged to confront their pain while addressing emotional
conflicts. A daily study program encourages introspection
about past trauma and current stressors contributing to their
emotional state. Patients must learn to disassociate their pain
from structural abnormalities, embracing its emotional roots.

DAILY STUDY PROGRAM

Patients should read Sarno's literature, allocate time daily for

reflective writing, and compile lists of emotional stressors.
The objective is to understand internal conflicts and how they
relate to their physical symptoms, leading to greater
emotional awareness and ultimately reducing pain.

GROUP MEETINGS

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These meetings have evolved from lectures to traditional
group therapy settings, providing an environment for patients
to share experiences, challenge misconceptions, and support
each other. The therapeutic goal is to change perceptions of
pain and prepare patients for deeper emotional exploration.

WHY IS KNOWLEDGE CURATIVE?

Dr. Sarno posits that the acquisition of knowledge negates

the need for repressed emotions to manifest as physical pain.
Affirmation of psychosomatic origins allows patients to
approach their symptoms differently, leading to sustainable
relief. Personal experiences and therapy sessions work to
bridge the gap between unconscious awareness and
conscious acceptance of emotional conflicts.

PSYCHOTHERAPY

For some patients, additional individual or group therapy is

prescribed. This psychotherapy focuses on revealing and
addressing repressed emotions. The primary goal is to foster
greater comfort with negative feelings to facilitate healing.
Various techniques, such as dream analysis, can assist

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patients in re-establishing their emotional connections,
thereby alleviating physical symptoms.

CASE STUDIES

Several patient cases illustrate the efficacy of Sarno’s

approach. Abner, Hiroku, and Liam all demonstrated how
confronting deeply embedded emotional conflicts led to
significant reductions in pain. Relating their physical
symptoms to unconscious emotional issues enabled them to
gain insight and become pain-free over time.

AN OUTCOME STUDY

Data collected from a cohort of patients revealed that a

majority experienced significant pain relief and functional
improvement through Sarno's educational approach.
Follow-ups indicated a notable percentage found themselves
free from physical restrictions, showcasing the effectiveness
of understanding and addressing psychosomatic disorders.
In conclusion, Dr. Sarno emphasizes that successful
treatment requires recognizing the complex interplay
between mind and body, integrating psychological insight
into physical healing through education and therapeutic
support.

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Example
Key Point:Understanding the psychosomatic
connection is essential for effective treatment of
chronic pain.
Example:Imagine you've been struggling with persistent
back pain for years, spending countless hours at doctors’
appointments, seeking physical treatments that offer
little relief. Now consider a moment during one of Dr.
Sarno’s lectures when he explains that this pain may be
linked to unresolved emotional conflicts rather than a
physical ailment. As you listen, a realization dawns on
you: your pain might not be simply a result of physical
stress, but instead a manifestation of suppressed feelings
related to anxiety and perfectionism. Empowered by this
knowledge, you begin to reflect on your past
experiences and emotional triggers, gradually accepting
the idea that confronting these feelings could actually
lead to real relief from your pain. This transformative
understanding becomes a crucial step in your journey
toward healing—a key point that illustrates the profound
connection between the mind and body.

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Critical Thinking
Key Point:The pivotal role of psychological insight in
treating physical symptoms is contested.
Critical Interpretation:Dr. Sarno emphasizes the
necessity of understanding the psychological roots of
physical pain as central to his Tension Myositis
Syndrome (TMS) treatment approach. This perspective
suggests that psychological conflicts can manifest as
physical symptoms, thus requiring a shift in how
patients view their pain. However, this viewpoint is not
universally accepted. Critics argue that not all physical
pain can be attributed solely to psychological factors
and that denying potential organic causes may lead
patients to forgo essential medical treatments. For
further contrary perspectives, one could consult the
works of pain researchers like John J. Bonica or articles
in medical journals that discuss the biopsychosocial
model of pain, which incorporates biological,
psychological, and social elements in understanding
individual pain experiences.

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Chapter 5 Summary :
HYPERTENSION AND THE
MINDBODY CONNECTION: A NEW
PARADIGM

HYPERTENSION AND THE MINDBODY

CONNECTION: A NEW PARADIGM

*Overview of Author and Chapter Context*

Dr. Samuel J. Mann, an expert at the Hypertension Center of
New York Presbyterian Hospital, contributes this chapter to
highlight that a significant number of hypertension cases may
stem from repressed, unconscious emotions, challenging
traditional views that directly correlate emotional distress
with high blood pressure.
*Understanding the Mindbody Link*
Dr. Mann suggests that while psychological factors do
contribute to hypertension, they are intricately linked to
emotional repression rather than the commonly held belief of
direct emotional stress leading to high blood pressure. He
proposes a new paradigm that focuses on unconscious
feelings rather than visible stress reactions.

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*Old vs. New Paradigms*
-
Old Paradigm
: Proposes that significant stress and negative emotions like
anger and anxiety lead to sustained hypertension. Techniques
to manage stress are assumed to alleviate hypertension.
-
New Paradigm
: Advocates that repressed emotions, which remain
unacknowledged, can cause prolonged sympathoadrenal
activation, increasing blood pressure. This reframing allows
for better understanding and treatment of hypertension.
*Critique of the Old Paradigm*
Many studies and clinical experiences invalidate the link
between transient emotional distress and long-term
hypertension. While emotional responses can temporarily
influence blood pressure, they do not lead to persistent
hypertension. Dr. Mann emphasizes that the
misunderstanding stems largely from studies focusing on
short-term effects of minor stressors rather than examining
deeper, repressed emotions that might have lasting impacts.
*Study Conclusions*
Research lacks consistent evidence supporting the idea that
anxiety or stress leads to hypertension. Dr. Mann illustrates

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that people who frequently express anger do not correlate
with elevated hypertension levels, further challenging the old
paradigm. Instead, emotional defensiveness—unawareness of
emotions—has been found to relate more closely to
hypertension.
*Psychological Underpinnings of Hypertension*
Dr. Mann points out that emotions we repress, particularly
those associated with past trauma or intense life experience,
can lead to hypertension. He presents cases that exemplify
the disconnect between emotional distress and hypertension,
highlighting that people coping well with stress can still
develop high blood pressure due to unaware emotional
repression.
*Patient Case Studies*
Illustrating his points, Dr. Mann recalls various patient
experiences emphasizing the role of repression in
hypertension:
1.
Susan's Experience
: Despite severe life stress, her blood pressure remained
stable, underscoring that ongoing psychological distress does
not necessarily equate to persistent hypertension.
2.
Jim's Example

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: Diagnosed with cancer and outwardly calm, his
hypertension stemmed from denied emotions rather than
conscious distress.
*Implications for Treatment*
The new understanding of hypertension presents novel
treatment options:
1.
Drug Therapy
: Recognition of the psychological components may shift
treatment towards drugs that target the sympathoadrenal
system (like beta and alpha blockers), rather than
conventional options like diuretics and ACE inhibitors.
2.
Psychotherapy
: This may not always be appropriate for patients who have
successfully repressed trauma. The new paradigm implies
selective use of psychotherapy where psychological factors
heavily influence hypertension.
*Conclusion & Summary*
Dr. Mann calls for a shift in how clinicians view
hypertension, emphasizing the need for further exploration
into repressed emotional states as the true underlying cause
of many cases. By acknowledging the mindbody connection
through a new lens, medical practitioners can develop more

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effective treatment strategies for patients with hypertension
linked to psychological factors. This reframing of belief has
the potential to reshape future research and therapeutic
approaches to hypertension and related conditions.

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Chapter 6 Summary : MY
EXPERIENCE WITH TENSION
MYOSITIS SYNDROME

MY EXPERIENCE WITH TENSION MYOSITIS

SYNDROME

Introduction to Dr. Sarno's Concepts

Ira Rashbaum, M.D., a Clinical Associate Professor at NYU,

shares his journey into Tension Myositis Syndrome (TMS)
after being introduced to Dr. Sarno's ideas during his
residency. He observed psychological factors influencing
physical pain and decided to deepen his knowledge by
training with Dr. Sarno.

First Patient Experiences

Dr. Rashbaum recounts treating patients with chronic pain,

illustrating how they often attribute their symptoms to
physical activities or structural issues. He shares the story of

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Ms. S, who overcame long-standing back pain linked to
psychological stress, validating the TMS diagnosis through
her recovery. Another patient, Ms. D, suffered from
debilitating back and neck pain but regained her health
through understanding TMS.

Family Dynamics in Treatment

He highlights cases like Ms. EH and her mother, who both

embraced the TMS diagnosis after a family tragedy. Their
mutual support lent credibility to the mind-body connection,
leading to successful recoveries.

Managing Older Patients

Dr. Rashbaum discusses the unique challenges of treating

older patients with TMS, noting the complexity of
distinguishing between TMS symptoms and legitimate
structural conditions. Effective treatment often involves
addressing emotional factors, particularly in the context of
aging.
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Chapter 7 Summary : A
RHEUMATOLOGIST’S EXPERIENCE
WITH PSYCHOSOMATIC
DISORDERS

A RHEUMATOLOGIST’S EXPERIENCE WITH

PSYCHOSOMATIC DISORDERS

Introduction to Dr. Andrea Leonard-Segal

Dr. Andrea Leonard-Segal is a board-certified internist and

rheumatologist with a substantial career in medicine,
specializing in the treatment of chronic pain at the Center for
Integrative Medicine.

Reflecting on Medical Training and Practice

Initially drawn to both internal medicine and psychiatry, she

focused on rheumatology for the long-term patient
relationships it offered. Despite practicing standard care, she
found many accepted treatments and diagnoses to lack

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scientific basis, leading to unsatisfactory patient outcomes.

Understanding Chronic Pain

Dr. Leonard-Segal's experience with chronic pain highlighted

the difficulties in treating conditions like back pain where
standard interventions often failed. Intrigued by
inconsistencies in patient responses to treatment, she sought
better explanations for why some patients experienced
debilitating pain without observable physical abnormalities.

Introduction to Dr. John Sarno's Concepts

Her personal experience with back pain led her to Dr. John
Sarno, whose work on psychosomatic disorders challenged
conventional medical thinking. This journey transformed her
approach to treating chronic pain, emphasizing psychological
rather than strictly structural causes.

Identifying Common Patterns in Patients

Patients with chronic pain often share traits, such as normal

physical examinations despite severe symptoms and a history
of stress. Their pains are frequently exacerbated by

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psychological factors rather than direct physical injuries,
leading to a cycle of fear and avoidance of physical activities.

The Need for Evidence-Based Medicine

Leonard-Segal critiques the conventional medical community

for its lack of evidence supporting many standard treatments
for chronic pain. She points out the failure of commonly
accepted therapies to undergo rigorous testing, emphasizing
the need for improved clinical practices.

Patient Case Studies

She shares successful case studies where patients diagnosed

with emotionally induced pain improved through
understanding their symptoms' psychological origins. Many
patients experienced life changes and regained control over
their physical and emotional well-being after accepting the
connection between their emotions and pain.

The Mind-Body Connection

Dr. Leonard-Segal underscores the importance of

recognizing how emotional pain can manifest as physical

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pain, supported by scientific literature linking stress to health
issues. She argues for a broader acceptance of psychological
factors in diagnosing and treating physical ailments.

Conclusion on the TMS Diagnosis

Dr. Leonard-Segal emphasizes that the diagnosis of TMS

(Tension Myositis Syndrome) symbolizes hope and signifies
a path towards genuine healing, self-awareness, and a
satisfying life. Addressing emotional health is crucial in
achieving complete recovery for patients suffering from
psychosomatic pain conditions.

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Chapter 8 Summary : MY
PERSPECTIVE ON
PSYCHOSOMATIC MEDICINE

MY PERSPECTIVE ON PSYCHOSOMATIC
MEDICINE

James R. Rochelle, M.D., who trained in orthopedic surgery,

discusses his experiences and insights into treating chronic
pain within the framework of psychosomatic medicine.

DISILLUSIONMENT WITH “CHRONIC PAIN”

Initially, Dr. Rochelle referred chronic pain patients to

specialists who often employed various diagnostic tests and
injections premised on structural abnormalities. However, he
found these conventional methods lacking, as they rarely
provided long-term relief and often led to medical pessimism
among patients.

PAIN MANAGEMENT

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Frustrated by conventional approaches, Dr. Rochelle
attempted to manage pain more effectively through
medication, particularly opiates, and lifestyle modification.
Nevertheless, he remained aware of the limitations of this
method and felt uncertainty in adequately treating chronic
pain.

WHAT'S MISSING?

Dr. Rochelle realized that understanding the psychology

behind chronic pain was crucial. Influenced by Dr. Andrew
Weil’s endorsement of tension myositis syndrome (TMS) and
the work of Dr. Sarno, he began to reconsider the
psychosomatic nature of chronic pain conditions.

SOCIAL HISTORY

Dr. Rochelle emphasized the importance of taking a thorough

social history during patient evaluations. He recognized that
asking about childhood experiences, personality traits, and
life stressors allowed for a fuller understanding of the
emotional factors contributing to chronic pain.

PHYSICAL EXAM: TENDERNESS

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He learned from Dr. Sarno that findings of tenderness in
various muscle groups indicate TMS rather than structural
lesions. This led him to reassess the conventional focus on
degenerative conditions and structural images, guiding him
towards recognizing the emotional sources of pain.

ONE DIAGNOSIS

Dr. Rochelle noted that symptoms of TMS could shift

location, demonstrating the "symptom imperative." This
understanding allowed him to unify various pain
presentations under one diagnosis, providing patients a sense
of hope and validation about their experiences.

IMPLEMENTING TMS IN MY PRACTICE

The approach towards managing TMS was tailored to each

individual’s needs. Patients were educated on TMS and
encouraged to embrace their diagnosis. Dr. Rochelle
conducted regular lectures to familiarize patients with the
concepts and importance of addressing the psychological
aspects.

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CASE STUDY: REJECTING THE DIAGNOSIS

A seventy-two-year-old woman with shoulder and arm pain

initially agreed to attend a lecture on TMS but later sought a
second opinion. This case highlighted the challenges faced
from patients who resist unconventional diagnoses, often due
to a desire for quick fixes.

THE LECTURE

Dr. Rochelle’s lectures aimed to provide patients with both

understanding and community, creating an environment
where they could gain insight into their pain. He addressed
common concerns and encouraged discussions to foster a
supportive atmosphere for healing.

CASE STUDY: REFERRAL FOR

PSYCHOTHERAPY

A forty-six-year-old nurse with chronic pain symptoms

recognized her condition as TMS after discussions about her
traumatic childhood experiences. Her experiences
underscored the need for deeper psychological exploration
and the significant impact of unresolved emotions on

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physical pain.

CASE STUDIES

Highlighting various cases including carpal tunnel syndrome

and fibromyalgia, Dr. Rochelle illustrated how these
diagnoses often mask deeper psychological issues rooted in
traumatic experiences and stress. He emphasized the need for
persistent and thoughtful exploration of patients' emotional
lives to avoid superficial treatments that fail to address the
underlying causes of pain.
Through Dr. Rochelle's reflections, it becomes evident that
true healing in chronic pain requires a shift from strictly
physical treatments towards an integration of psychological
understanding, allowing patients to reconnect with their
experiences and regain control over their lives.

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Chapter 9 Summary : STRUCTURAL
PAIN OR PSYCHOSOMATIC PAIN?

STRUCTURAL PAIN OR PSYCHOSOMATIC

PAIN?

Introduction to Dr. Douglas Hoffman

Dr. Douglas Hoffman, a practitioner with a diverse

background in family medicine and sports medicine, focuses
on the psychological and societal aspects of psychosomatic
disorders. He expresses frustration with the lack of
understanding and acceptance of these concepts among many
of his patients.

Clinical Case Examples

Dr. Hoffman shares case studies from his practice to

illustrate the psychosomatic nature of various pain
conditions. He describes a range of patients suffering from
chronic pain, emphasizing that many of these cases, although

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primarily psychosomatic, are often diagnosed and treated
based on the standard medical model without
acknowledgment of their psychological origins.

Personal Journey and Understanding of Pain

Through his own experiences with chronic back pain, Dr.

Hoffman discovered the theories of Dr. Sarno, which linked
psychological factors to physical pain. His personal journey
led him to integrate these insights into his medical practice,
recognizing that many musculoskeletal conditions arise from
psychosomatic origins.

Misconceptions About Pain

The author critiques the widespread belief in the structural

model that attributes all pain to physical abnormalities. He
explains that many musculoskeletal pain syndromes are not
effectively alleviated by traditional treatments because they
do not address the psychological roots of the suffering.

Install
Triggers of Bookey App to
Psychosomatic Unlock
Pain Full Text and
Audio
Dr. Hoffman discusses the significant role that physical

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Chapter 10 Summary : A FAMILY
DOCTOR’S EXPERIENCE WITH
MINDBODY MEDICINE

A FAMILY DOCTOR’S EXPERIENCE WITH

MINDBODY MEDICINE

Introduction to Dr. Marc Sopher

Dr. Marc Sopher, a family physician, has practiced in Exeter,

New Hampshire since 1990. He has utilized mindbody
medicine extensively in his practice, treating a range of
psychosomatic disorders. He initially encountered Dr.
Sarno's work while seeking to resolve his own back pain and
has since trained with him to integrate these principles into
his medical practice.

The Family Practice

As a family physician, Dr. Sopher emphasizes the

importance of recognizing psychosomatic symptoms. He

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notes that traditional medical training often neglects the
psychological origins of physical symptoms, resulting in
misdiagnoses and ineffective treatments. Through his
experience, he identifies the prevalence of mindbody
disorders among patients with chronic pain.

Diagnosis and Treatment Challenges

Dr. Sopher discusses the issue of differential diagnosis,

emphasizing that many common diagnoses like herniated
discs are often wrongly prioritized in pain assessment. He
argues the lack of evidence supporting structural diagnoses
limits physicians’ understanding and acceptance of
psychological factors in health.

Patient Reactions to TMS Concepts

Introducing patients to the concept of TMS (Tension

Myositis Syndrome) can be challenging. Many patients
expect physical treatments and often react with skepticism or
anger when presented with psychological explanations for
their pain. Dr. Sopher shares a success story involving a
skeptical patient who ultimately found relief through
acknowledging the psychological roots of his pain.

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Educating Patients about TMS

Dr. Sopher promotes self-education as a critical component

of healing from TMS. He begins discussions by validating
patients' pain before explaining how emotions can manifest
as physical symptoms. He identifies three sources of
unconscious rage that contribute to mindbody disorders:
daily life stresses, unresolved emotional distress from
childhood, and internal conflicts stemming from perfectionist
traits.

Strategies for TMS Treatment

1.
Make a List
: Patients should identify stressors and unresolved issues that
might be contributing to their pain.
2.
Reflect
: Ongoing self-education is vital for understanding TMS and
maintaining health.
3.
Discard Physical Remedies

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: Patients are encouraged to eliminate unnecessary physical
treatments since they do not address the psychological causes
of pain.
4.
Be Eternally Vigilant
: Continuous awareness and reflection can help patients
maintain their recovery and spot potential relapses.
5.
Resume Activity
: Re-engaging in previously enjoyed activities is essential for
recovery, overcoming fears associated with pain.

Case Histories

Dr. Sopher provides multiple case histories that illustrate

various patients' journeys towards understanding and
addressing TMS. Each case highlights different emotional
backgrounds and personal stressors that contributed to their
pain, ultimately leading to recovery through the acceptance
of psychological components.

Final Thoughts

Dr. Sopher expresses his confidence in the future integration

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of TMS theory into mainstream medicine. He believes that
greater awareness and understanding of the mind's role in
physical health will lead to more successful patient outcomes
and a shift in medical practices toward including
psychological considerations in treatment.

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Best Quotes from The Divided Mind by
John E. Sarno with Page Numbers
View on Bookey Website and Generate Beautiful Quote Images

Chapter 1 | Quotes From Pages 15-36

1.It is the suffering patient who must come to
understand his malady . . . and by understanding
it, banish it.
2.The mind that contains the root cause of their physical
distress
3.The persistence of the pain—the fact that it often lasts for
months or even years—is explained by an ingenious idea
conceived by behavioral psychologists many years ago.
4.It is highly significant that the rapid spread of carpal tunnel
syndrome coincided with the spectacular growth of the
computer industry.
5.The mind simply renders a tendon in the arm slightly
oxygen deprived, which results in pain.
Chapter 2 | Quotes From Pages 37-60
1.Psychosomatic medicine is a ghost, a set of ideas

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 without a body.
2.Charcot had managed to elevate the clinical condition from
a subject of ridicule to an established diagnosis.
3.The psyche will simply create another symptom to take its
place.
4.The mind-split between conscious and unconscious is
neurotic; we are all 'neurotic.' Therefore, neurotic is
normal.
5.Unconscious emotions are a potent factor in virtually all
physical ills.
6.The brain has the capacity to initiate physical symptoms by
stimulating appropriate brain nuclei.
7.Psychosomatic phenomena are not a form of illness; they
must be seen as part of the human condition.
Chapter 3 | Quotes From Pages 61-83
1.Knowledge is power.
2.The symptoms are serving to protect the individual rather
than hurt him or her by allowing unwelcome feelings to
escape into consciousness.

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3.The pain came into being as a psychosomatic
process—what we call TMS—in order to prevent the overt
expression of this rage.
4.It is the part of the brain whose inclinations are in direct
conflict with the more responsible, intelligent, moral
propensities of the ‘new brain.’
5.We are much further along now in understanding why the
high-achieving young engineer developed TMS.
6.Symptoms can be initiated in response to emotional states.
7.The drive to be good could be equally enraging to the
child-primitive.
8.The unconscious rage can contribute to physiologic
alteration—including coronary arteriosclerosis.
9.We possess ideas, but we are possessed by feelings.
10.Psychosomatic disorders are common and universal.

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Chapter 4 | Quotes From Pages 84-113
1.What you need in order to get better, my friend, is
not a leap of faith but a leap of understanding.
2.Successful treatment depends on an accurate diagnosis.
3.Denial of the syndrome is part of the syndrome.
4.Knowledge was the key to treating TMS.
5.The fact that my books can 'cure' is convincing evidence
that our therapeutic program is not a placebo.
6.The educational process can stop the pain.
7.Knowledge, awareness, and insight have been the
cornerstones of analytically oriented psychotherapy since
Freud.
Chapter 5 | Quotes From Pages 114-137
1.There is no single cause for hypertension, but
instead, a mosaic of causes.
2.I will present the very convincing evidence that this old
paradigm is wrong, and will present a new paradigm that
makes more sense of hypertension by linking hypertension
to the emotions we repress.

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3.It is not the emotional distress that we feel, but those
emotions we have repressed and are unaware of, that leads
to hypertension.
4.When I suggest to a worried patient with a high reading
that she, in fact, might not have hypertension, the surprise
and relief often results in lower readings.
5.The emotions we repress are often much more powerful
and painful than the emotions we consciously experience.
Chapter 6 | Quotes From Pages 138-148
1.I could go into considerable detail about the
enormous public health problem posed by chronic
pain in the United States and most of the Western
world... The cost in human suffering is
incalculable.
2.All beginnings are difficult.
3.For the next three months I saw patients with him, attended
all his lectures and group meetings, and listened with
fascination to psychologists’ reports. I began to realize that
a doctor had to be more than an engineer to the body, that

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 feelings and who we are had an enormous amount to do
with human illness.
4.I have been very busy living my new pain-free life; I am so
excited. To bring you up-to-date, I am doing GREAT! My
life changed dramatically after coming to see you... Many
people are amazed when I tell them I am pain free. They
cannot believe it.
5.One of the most frustrating aspects of practicing TMS
medicine is declining to treat a patient who might have
TMS or an equivalent but I’m just not sure.
6.The only time I’d been back to Berlin’s Olympic Stadium...
I began to scream every dirty curse word, every obscenity I
knew.

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Chapter 7 | Quotes From Pages 149-163
1.It was gratifying to see people who have been
dogged by intermittent attacks of pain break the
cycle.
2.Patients for whom we care are our best teachers; we cannot
fool them.
3.I often tell my patients that they need to come to view
themselves as I see them, healthy and strong, rather than as
they have been seeing themselves.
4.This education became a new pathway to benefit patients in
a simple, noninvasive, and confidence-building way.
5.Getting better from TMS is learning how to extract
yourself from needing recognition from others and learning
how to fill that need yourself.
6.The beauty of the TMS diagnosis is that it is a hopeful one
that can result in a true cure.
Chapter 8 | Quotes From Pages 164-179
1.The possibility that chronic back pain is
psychosomatic was intriguing to me.

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2.There is no need to spend time and money on multiple
diagnostic exams and visits to specialists.
3.The TMS diagnosis is liberating and empowering for
patients.
4.With such gloomy prognoses, patients became disheartened
and lost hope that they could live a normal life again.
5.The knowledge that a person has one condition, TMS, and
not several different and unrelated diagnoses is a huge
benefit.
6.People can rediscover faith and hope in the future.
7.The educational program a try... It’s natural to have
reservations about a concept that is so different from
orthodox medical diagnosis and treatment.
Chapter 9 | Quotes From Pages 180-198
1.How can I go back and practice the way I’ve been
practicing knowing what I know now?
2.Acceptance and understanding are the foundation for
successful treatment of a psychosomatic disorder.
3.Pain serves to distract the mind from the emotional to the

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 physical.
4.I’ve cured patients with fibromyalgia.
5.If you don’t treat the cause of a symptom you cannot
expect a cure.
6.The challenge is to determine when a physical trigger
results in a structural disorder or a psychosomatic disorder.
7.It’s easier to suffer with physical pain than it is to
acknowledge the emotional ones.

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Chapter 10 | Quotes From Pages 199-218
1.Let me be clear. I truly believe that the physicians
patients see are in medicine in order to help others.
They do wish to heal, to make people well—it is a
worthwhile and gratifying endeavor. So, based on
their knowledge and experience, they honestly and
sincerely offer treatment that they believe will
help. But their knowledge base is not complete.
2.Simply by changing how you think about the connection
between your brain and body, you will begin to feel better.
I will not be recommending oral medication, special
exercises, surgery, injections, physical therapy,
manipulation, acupuncture, massage therapy, prolotherapy,
or any other of the multitude of alternative therapies.
3.Through the process of education, you will gain a better
understanding of how psychology can affect
physiology—how your brain can be responsible for the
creation of very real physical pain.
4.The reservoir of rage is Dr. Sarno’s term, and I think it

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 provides a compelling image for the origins of pain.
5.Eternal vigilance is the proverbial ‘ounce of prevention.’
This is why it is necessary to spend some time each day
reflecting.
6.I have seen many patients who struggle with it. If they are
unable to conceive of a source of rage or a serious stressor,
they may doubt that they have such a reservoir in their
unconscious. But it’s important to remember, the reservoir
can fill with unpleasant thoughts and emotions of all sizes.
7.Do not be discouraged if pain returns or occurs at another
location. Remember, your brain does not want to give up
its strategy of distracting you with pain—this is how we are
made.

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The Divided Mind Questions
View on Bookey Website

Chapter 1 | WHAT IS PSYCHOSOMATIC

MEDICINE?| Q&A
1.Question
What was the initial impression of John R when he first
visited the clinic?
Answer:John R appeared to be a successful,
confident businessman, but upon attempting to sit
down, his demeanor changed dramatically,
revealing fragility and caution, indicating he was
either in excruciating pain or feared pain.

2.Question
How does Dr. Sarno view the role of the physician in
treating mindbody disorders?
Answer:He believes the physician's role is to guide the
patient towards understanding their condition, asserting that
healing comes from the patient's own insight, rather than
from medication or surgeries.

3.Question

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What is the significance of understanding the mindbody
connection according to Dr. Sarno?
Answer:Understanding this connection is crucial as it reveals
that buried emotions, particularly rage, can manifest
physically, leading to chronic pain and psychogenic
disorders.

4.Question
Why might many patients struggle to accept the notion
that mindbody disorders originate from psychological
factors?
Answer:Patients often associate psychological ailments with
stigma, feeling that it implies weakness or insanity, making
them resistant to recognizing their symptoms as emotional in
origin.

5.Question
What does Dr. Sarno mean by 'the symptom imperative'
in the context of psychosomatic disorders?
Answer:The symptom imperative refers to the brain's ability
to create new symptoms when existing ones are treated,
acting as a distraction from repressed emotions, ensuring the

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cycle of psychosomatic symptoms continues.

6.Question
How did John R's treatment differ from conventional
approaches to his pain?
Answer:Instead of resorting to drugs or surgery, John R
engaged in understanding the psychological roots of his pain,
leading to a profound and lasting resolution of his symptoms.

7.Question
What connection does Dr. Sarno make between societal
trends and the prevalence of psychosomatic disorders?
Answer:He highlights that psychosomatic disorders can
spread like epidemics, often influenced by cultural trends,
misdiagnosis in medicine, and the accessibility of treatments,
which perpetuate symptoms.

8.Question
How does Dr. Sarno relate the concept of primary gain to
chronic pain conditions?
Answer:He argues that chronic pain serves a primary gain by
distracting the conscious mind from unconscious emotional
conflicts, rather than reflecting any secondary gain, such as

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sympathy or support from others.

9.Question
What are the implications of misdiagnosing
psychosomatic disorders according to Dr. Sarno?
Answer:Misdiagnosing these disorders leads to inappropriate
treatments, increased suffering, and escalated healthcare
costs, as patients undergo unnecessary surgeries or drug
therapies that don’t address the underlying psychological
issues.

10.Question
What does Dr. Sarno suggest as a necessary approach for
treating psychosomatic disorders?
Answer:He advocates for a combination of psychological
understanding and therapeutic interventions that address
repressed emotions, rather than purely physical treatments or
medications.
Chapter 2 | A BRIEF HISTORY OF
PSYCHOSOMATIC MEDICINE| Q&A
1.Question
What is the primary focus of psychosomatic medicine

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according to John E. Sarno?
Answer:The primary focus of psychosomatic
medicine is to reveal that many common pain
disorders, which have afflicted millions, are actually
psychosomatic in nature—originating from
unconscious emotional conflicts rather than strictly
physical causes.

2.Question
How did Jean-Martin Charcot influence the field of
psychosomatic medicine?
Answer:Jean-Martin Charcot elevated the clinical
understanding of hysteria from ridicule to an established
diagnosis, which influenced Sigmund Freud's shift in focus
from neuropathology to psychopathology, ultimately helping
shape the understanding of psychosomatic symptoms.

3.Question
What contributions did Freud make regarding the
understanding of psychosomatic symptoms?
Answer:Freud introduced the concept of the unconscious

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mind, recognizing that physical symptoms can be
psychogenic and arise from internal emotional conflicts. He
also described the symptom imperative, where if one
symptom is alleviated, another may emerge if the underlying
emotional issues are not addressed.

4.Question
What does Sarno mean by ‘symptom imperative’?
Answer:The symptom imperative refers to the phenomenon
where the psyche generates new physical or emotional
symptoms to take the place of those that have been relieved,
indicating that the underlying emotional conflict must be
resolved rather than merely treated.

5.Question
Explain the significance of the split between the conscious
and the unconscious mind in psychosomatic medicine.
What does Sarno conclude about its universal nature?
Answer:The split between the conscious and unconscious
mind is significant in understanding psychosomatic
disorders. Sarno argues that this split is not just a feature of

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'neurotic' individuals but is a universal trait of the human
experience; everyone has the potential for psychosomatic
symptoms.

6.Question
How did Alfred Adler’s views differ from Freud’s in
terms of understanding psychosomatic disorders?
Answer:Alfred Adler emphasized the universal feeling of
inferiority as a driving force for human behavior, linking it to
physical symptoms, whereas Freud focused more on the
conflict of instincts and repressed desires. Adler recognized
emotions stemming from social contexts as vital in
understanding psychosomatic conditions.

7.Question
What role does repressed emotion play in the
development of psychosomatic symptoms, according to
Sarno?
Answer:Repressed emotions play a critical role in the
development of psychosomatic symptoms as they are hidden
from consciousness for protective reasons. Symptoms
emerge as distractions to protect the individual from facing

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painful emotions.

8.Question
How does Sarno reinterpret Freud’s views on the
relationship between consciousness and the unconscious?
Answer:Sarno reinterprets Freud’s views by suggesting that
rather than suppressed ideas being merely undesirable or
reprehensible, they serve a protective function. Emotional
pain is concealed by psychosomatic symptoms to prevent
conscious awareness of distressing feelings.

9.Question
What implications does Sarno suggest about treatment
methods for psychosomatic disorders?
Answer:Sarno implies that treatment should focus on
addressing the emotional conflicts and psychological roots of
the symptoms rather than relying solely on physical or
chemical interventions, which often overlook the central
psychogenic origins.

10.Question
What does Sarno argue about the mainstream medical
community's perspective on psychosomatic symptoms?

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Answer:Sarno argues that mainstream medicine largely
denies or ignores the psychogenic origins of many
symptoms, leading to ineffective treatments and contributing
to ongoing epidemics of pain and dysfunction.

11.Question
Why does Sarno believe that understanding the history of
psychosomatic medicine is vital for current practices?
Answer:Understanding the history of psychosomatic
medicine provides crucial insights into the relationship
between mind and body, the origins of symptoms, and
highlights the need to integrate emotional and psychological
factors into modern medical practices for effective treatment.
Chapter 3 | THE PSYCHOLOGY OF
PSYCHOSOMATIC DISORDERS| Q&A
1.Question
What can childhood experiences teach us about adult
pain management and mental health?
Answer:Childhood experiences shape our emotional
responses and coping mechanisms in adulthood. As
demonstrated in the case of the engineer,

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deep-seated emotions from childhood can manifest
as physical pain. Understanding these connections
can empower individuals to better manage pain by
addressing underlying emotional issues.

2.Question
How does the unconscious mind influence physical
symptoms according to the book?
Answer:The unconscious mind can create physical symptoms
as a defense mechanism against repressed emotions like rage
and sadness. For instance, the engineer's leg pain disappeared
when he confronted his feelings about his job, highlighting
the mind's power over bodily sensations.

3.Question
What role does self-imposed pressure play in the
development of psychosomatic disorders?
Answer:Self-imposed pressures, such as the drive to be
perfect, can create a reservoir of unconscious rage. This
internal conflict can then lead to psychosomatic symptoms as
the mind attempts to distract from these painful emotions.

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4.Question
According to Sarno, is pain always a result of physical
causes?
Answer:No, Sarno argues that many physical pains, like
those from TMS (Tension Myositis Syndrome), arise from
mental and emotional issues rather than just physical causes.
These symptoms are often psychosomatic and serve to
protect against confronting uncomfortable feelings.

5.Question
What is the significance of becoming aware of
unconscious feelings, as suggested in the text?
Answer:Becoming aware of unconscious feelings can lead to
freedom from pain. The case of the young engineer illustrates
this, as just recognizing his dissatisfaction with work
alleviated severe pain, showing that awareness can facilitate
healing.

6.Question
How do societal pressures play a part in psychosomatic
disorders?
Answer:Societal pressures, such as expectations in work and

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family roles, can generate stress and internal conflict, leading
individuals to repress feelings that ultimately manifest as
physical symptoms. The unconscious mind reacts to these
pressures by creating distractions in the form of pain.

7.Question
What can modern medicine learn from Sarno's insights
into psychosomatic disorders?
Answer:Modern medicine needs to integrate understanding
of the mind-body connection. By recognizing that emotional
health significantly impacts physical health, practitioners
could improve treatment outcomes for many patients
suffering from chronic pain.

8.Question
What does the case of Mr. O illustrate about the
continuity of symptoms in psychosomatic disorders?
Answer:Mr. O's case demonstrates the symptom-imperative
phenomenon, where alleviation of one symptom results in
the emergence of another, indicating that the underlying
psychological issues remain unaddressed. This emphasizes

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the importance of deeper psychological exploration for
long-term healing.

9.Question
Why might repressed rage and emotional pain lead to
psychosomatic symptoms, according to the article?
Answer:Repressed emotions like rage and pain do not simply
fade away; instead, they can boil over into physical
symptoms as a mechanism for the mind to protect itself. The
pain provides a distraction from facing these uncomfortable
emotions, thus reinforcing the psychosomatic connection.

10.Question
Can deep introspection transform emotional pain into
physical symptoms?
Answer:Yes, through introspection and understanding the
roots of one’s feelings, individuals can often confront and
process their emotional pain, which can alleviate or even
eliminate psychosomatic symptoms. Awareness is a key
element in this transformative process.

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Chapter 4 | TREATMENT| Q&A
1.Question
What is the fundamental shift needed in the mindset of a
patient seeking treatment for psychosomatic disorders?
Answer:Patients need a 'leap of understanding'
rather than just a 'leap of faith' to effectively engage
with the mindbody approach to healing.

2.Question
Why is understanding the nature of Tension Myositis
Syndrome (TMS) crucial for recovery?
Answer:Knowledge is identified as the key to treating TMS,
as it helps patients recognize that their physical pain is often
a psychosomatic reaction to underlying emotional stress.

3.Question
What role does acceptance play in the healing process of
TMS?
Answer:Acceptance of the diagnosis and the understanding
of its psychosomatic nature are essential; without this
acceptance, patients may struggle to overcome their
symptoms.

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4.Question
Can you provide an example of how knowledge leads to a
reduction in pain for someone with TMS?
Answer:In the case of a patient who read 'Healing Back Pain',
they recognized their traits of perfectionism and
responsibility, which they tied to their back pain, leading to a
complete cessation of pain within weeks after embracing the
concepts presented.

5.Question
What misconceptions exist around structural
abnormalities and their relationship to TMS symptoms?
Answer:Many patients are misled into believing that
structural abnormalities, such as herniated disks, are causing
their pain, when in fact these are often not directly linked to
their symptoms.

6.Question
How does the educational component of the TMS
treatment differ from traditional approaches?
Answer:Unlike traditional methods that focus on physical
symptoms and treatments, TMS education addresses the

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psychological roots of pain, fostering awareness that helps
disarm the pain response.

7.Question
Why might some patients not benefit from the TMS
program?
Answer:Patients who are unwilling or unable to accept the
concept that their pain is psychosomatic, or who are not open
to the educational approach, are less likely to succeed in the
program.

8.Question
What is the main outcome reported from the treatment of
patients in Sarno's program?
Answer:A significant proportion of patients enjoyed relief
from their pain and regained normal physical function after
participating in the educational and therapeutic components
of the program.

9.Question
In what way is the psyche involved in the persistence of
TMS symptoms?
Answer:The psyche utilizes pain as a distraction from

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unresolved emotional conflicts, reinforcing the belief that the
pain is due to physical issues rather than emotional origins.

10.Question
How can a deeper understanding of one's emotions
facilitate healing from TMS?
Answer:By recognizing and embracing suppressed emotions
such as anger and sadness, individuals can disrupt the cycle
of psychosomatic symptoms and pave the way for recovery.

11.Question
How does the emotional history of a patient impact their
experience with TMS?
Answer:Patients with unresolved emotions from childhood
often manifest this pain in adulthood, making insight into
their past experiences critical for overcoming TMS.

12.Question
What advice did Sarno give patients regarding physical
activity after pain relief?
Answer:Patients are encouraged to resume normal physical
activity after experiencing relief from pain, as returning to
these activities shows a state of normalization and helps

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counter the fear that perpetuates symptoms.

13.Question
What is the relationship between psychotherapy and the
treatment of TMS according to Sarno?
Answer:Psychotherapy can be beneficial for patients who
need to explore deeper emotional layers that contribute to
their TMS, suggesting that understanding psychological
dynamics is part of the healing process.

14.Question
Why is it important for patients to express any doubts
they have about their diagnosis or treatment?
Answer:Expressing doubts allows for open dialogue that can
elucidate misunderstandings and reinforce the patient's
engagement in their recovery process.

15.Question
What does Sarno mean when he states 'pity me that the
heart is slow to learn'?
Answer:This phrase underscores the human difficulty in
reconciling emotional experiences with rational
understanding, emphasizing the need for patience in personal

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healing.

16.Question
What role do group meetings play in the recovery process
as described by Sarno?
Answer:Group meetings serve as supportive environments
where patients can share experiences, gain insights from
others, and reinforce adherence to the treatment principles,
enhancing therapeutic motivation.

17.Question
How do emotional conflicts manifest in physical
symptoms according to the experiences shared in the
chapter?
Answer:Emotional conflicts often lead individuals to
subconsciously suppress feelings, resulting in physical
manifestations like pain as a distraction from those
unpleasant emotions.

18.Question
Can you name a patient case that illustrates the process of
recognizing and working through repressed emotions?
Answer:Abner’s case demonstrates how understanding his

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childhood experiences of neglect led to the acknowledgment
of his repressed anger, which ultimately alleviated his back
pain.

19.Question
What conclusion can be drawn about the efficacy of Dr.
Sarno's method in treating psychosomatic disorders?
Answer:Dr. Sarno’s method effectively addresses the root
psychological issues behind physical symptoms, allowing
many patients to achieve lasting relief through education and
emotional awareness.
Chapter 5 | HYPERTENSION AND THE
MINDBODY CONNECTION: A NEW
PARADIGM| Q&A
1.Question
What is the main idea behind Dr. Mann's new paradigm
related to hypertension?
Answer:The new paradigm suggests that
hypertension is largely linked to repressed emotions
rather than emotional distress that individuals
consciously feel. It emphasizes that it is the emotions

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that remain hidden and unexpressed that can lead to
persistent activation of the sympathetic nervous
system (SNS), resulting in sustained high blood
pressure.

2.Question
How does Dr. Mann differentiate between the old and new
paradigms regarding the mind-body connection in
hypertension?
Answer:The old paradigm emphasizes that emotional distress
directly leads to hypertension, positing that high stress and
anxiety cause blood pressure to rise. In contrast, the new
paradigm focuses on repressed emotions, asserting that it is
not the distress we consciously experience but rather the
emotions we suppress that drive hypertension.

3.Question
What role does repression play in individuals with
hypertension according to Dr. Mann?
Answer:Repression acts as an unconscious defense
mechanism where individuals keep distressing emotions
from their awareness. This ongoing repression can lead to

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persistent stimulation of the sympathetic nervous system,
which in turn contributes to elevated blood pressure.

4.Question
Why does Dr. Mann believe traditional stress
management techniques may not effectively treat
hypertension?
Answer:Because traditional stress management techniques
focus on reducing conscious emotional distress, they do not
address the underlying repression of emotions that the new
paradigm identifies as a significant factor in hypertension.

5.Question
Can you give an example that illustrates the differences
between the emotional responses in patients with
hypertension from both paradigms?
Answer:Dr. Mann presents the case of Susan, who
experienced significant emotional distress due to her son's
cancer diagnosis, yet showed no increase in blood pressure.
In contrast, Jim, who faced a life-threatening illness, claimed
not to feel upset, though his repressed emotions contributed
to his elevated blood pressure. This juxtaposition underscores

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the importance of recognizing hidden emotional factors over
visible distress.

6.Question
What therapeutic approaches does Dr. Mann suggest for
treating hypertension linked to repressed emotions?
Answer:He recommends engaging with medications that
target the sympathetic nervous system, like alpha and beta
blockers, as they may be more effective for people whose
hypertension is tied to repressed emotions, compared to
traditional diuretics or ACE inhibitors.

7.Question
How does Dr. Mann’s perspective on hypertension change
the traditional view of those who worry about their blood
pressure?
Answer:He emphasizes that individuals who worry about
their hypertension often do not have true hypertension but
may exhibit temporary high readings due to anxiety during
clinical assessments. He suggests that their anxiety does not
cause their hypertension but can lead to misleadingly
elevated blood pressure readings during medical

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examinations.

8.Question
What impact does Dr. Mann hope his insights will have
on future research in psychology and hypertension?
Answer:Dr. Mann hopes to shift the focus of mind-body
research from only what individuals consciously report to
also exploring repressed emotions, as this could lead to better
understanding and treatment of hypertension and other
unexplained medical conditions.

9.Question
What critical observation does Dr. Mann make about the
link between emotional distress and hypertension?
Answer:He notes that despite vast research, emotional
distress, characterized by anxiety or anger, does not correlate
strongly with long-term hypertension development. Instead,
he argues that repressed emotions play a more substantial
role.

10.Question
How does Dr. Mann’s chapter challenge widely accepted
beliefs in medical psychology?

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Answer:The chapter challenges the notion that emotional
stress and visible distress are primary contributors to
hypertension, proposing instead a focus on the often
unrecognized and unaddressed emotional factors residing in
the unconscious.
Chapter 6 | MY EXPERIENCE WITH TENSION
MYOSITIS SYNDROME| Q&A
1.Question
What sparked Dr. Rashbaum's interest in Tension
Myositis Syndrome (TMS)?
Answer:Dr. Rashbaum's interest in TMS was
sparked during his second year of residency when he
overheard a group excitedly discussing Dr. Sarno's
lecture on the psychological origins of pain. His
curiosity led him to explore cases where traditional
structural explanations for pain were inadequate
and to reflect on his own experiences with pain
related to stress.

2.Question
How did Dr. Rashbaum's experiences shape his

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understanding of pain?
Answer:Through his personal experiences with pain during
significant life events and his training under Dr. Sarno, Dr.
Rashbaum came to understand that feelings and
psychological factors play a crucial role in human illness.
This realization shifted his perspective from viewing doctors
solely as engineers of the body to recognizing the importance
of a holistic approach to health.

3.Question
What challenges do patients with TMS face in acceptance
of their diagnosis?
Answer:Many patients find it difficult to accept the diagnosis
of TMS, often leading to frustration during treatment. This
nonacceptance is particularly pronounced among family
members of TMS patients, who may struggle to understand
or believe in the mind-body connection.

4.Question
What was the outcome for Ms. S after being diagnosed
with TMS?

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Answer:Ms. S, diagnosed with TMS, returned to normal
activities within three months. She managed occasional mild
pain associated with family stress but reported leading a
normal life overall, illustrating the efficacy of recognizing
and addressing the psychological underpinnings of her
symptoms.

5.Question
How did Ms. D's story reflect the themes of TMS?
Answer:Ms. D had a long history of pain that spanned from
her childhood into adulthood and was exacerbated by
stressful life events. Through Dr. Rashbaum's lectures and
the TMS framework, she connected her emotional and
psychological struggles with her physical symptoms,
ultimately leading to her transformation into a pain-free life,
demonstrating the potential power of addressing TMS.

6.Question
What does the case of family members with TMS suggest
about emotional connections?
Answer:The synchronized recovery of Ms. EH (daughter)

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and Ms. SH (mother) highlights the impact of emotional
connections and shared experiences in treatment. Their
openness and understanding of TMS allowed them to support
each other through the recovery process, showing how family
dynamics can influence healing.

7.Question
What can be learned from Dr. Rashbaum’s experience
treating the elderly with TMS?
Answer:Dr. Rashbaum's experience indicates that older
patients often display intensified personality traits like
perfectionism, and they may additionally face issues of
self-worth post-retirement. Treatment requires careful
differentiation between legitimate structural issues and those
arising from TMS, stressing the importance of addressing
both mental and physical health.

8.Question
How does the perception of aging influence symptoms in
older TMS patients?
Answer:Perceptions of aging can provoke feelings of rage,

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sadness, and hopelessness, which may manifest as TMS
symptoms. Acknowledging these emotions and their impact
is critical in effectively managing and treating pain in elderly
patients, as illustrated by Mr. K's case.

9.Question
What insights do the cases of Ms. G and Ms. M provide
on fibromyalgia and TMS?
Answer:The experiences of Ms. G and Ms. M reveal that
many diagnoses, such as fibromyalgia, can be misunderstood
and related to TMS. Their rapid improvement demonstrates
how recognizing the mind-body connection can lead to
significant symptom relief, emphasizing the need for
appropriate diagnoses.

10.Question
What emotional patterns contributed to Mr. R's TMS
diagnosis?
Answer:Mr. R's history, marked by trauma and familial
dynamics, particularly an abusive relationship with his father,
contributed to his TMS. His perfectionism and deep-seated

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feelings of inadequacy, compounded by significant life
stressors, ultimately linked his emotional distress to his
physical symptoms.

11.Question
Why is the treatment protocol for TMS described by Dr.
Rashbaum particularly tailored to patients?
Answer:Recognizing differing learning styles and needs, Dr.
Rashbaum adapted his lectures into two parts to enhance
understanding and retention among his patients. This tailored
approach has evidenced better outcomes, particularly for
Medicare patients, showing the benefit of personalized
treatment strategies.

12.Question
How does Dr. Rashbaum view the relationship between
the mind and body in TMS?
Answer:Dr. Rashbaum believes that TMS is fundamentally a
psychological disorder that expresses itself through physical
symptoms. Understanding why the brain engages in this pain
creation process is more crucial than exploring the

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physiological changes, illustrating a comprehensive approach
to treatment.

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Chapter 7 | A RHEUMATOLOGIST’S
EXPERIENCE WITH PSYCHOSOMATIC
DISORDERS| Q&A
1.Question
What commonality do patients with chronic pain share
according to Dr. Leonard-Segal's observations?
Answer:Patients often experience symptoms
triggered by insignificant physical incidents or
stressors, despite lacking any objective evidence of
injury. They have normal physical exams, no signs
of inflammation or disease, and their symptoms
often do not resolve like typical injuries.

2.Question
How did Dr. Leonard-Segal's perspective on chronic pain
change after her experience with TMS?
Answer:Initially, she felt powerless in treating chronic pain
patients. After learning about TMS and applying its
principles, she found she could help patients achieve amazing
recoveries from persistent pain, leading to more hope and
empowerment in her practice.

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3.Question
What factors contribute to the development of TMS in
patients?
Answer:Emotional stressors, unrealistic self-expectations,
feelings of inadequacy, and high personal responsibility often
contribute to the psychological causes of TMS. Many
patients feel out of control in their lives, and their physical
symptoms distract them from deeper emotional issues.

4.Question
How does Dr. Leonard-Segal suggest patients begin their
road to recovery from TMS?
Answer:Patients should recognize that their symptoms have
emotional roots and be open to psychological insights and
understanding their deeper feelings. Learning to reduce
self-imposed pressures and replacing fear with awareness is
crucial.

5.Question
What role does self-acceptance play in healing TMS?
Answer:Self-acceptance allows patients to lower their
expectations of themselves, understand that it's okay to not

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be perfect, and recognize the emotional conflict tied to their
symptoms. This shift promotes healing and alleviates the
physical manifestations of their stress.

6.Question
What does Dr. Leonard-Segal mean when she
distinguishes between 'real' pain and emotional pain?
Answer:She stresses that while TMS symptoms are indeed
physical and painful, they arise from emotional conflicts and
should not be mistaken for pain caused solely by physical
conditions like injury or disease. Understanding this
connection is key to healing.

7.Question
According to Dr. Leonard-Segal, why is it important for
the medical community to rethink treatment approaches
for chronic pain?
Answer:The prevailing treatments often lack scientific
backing; it's vital to investigate psychological factors
influencing pain and explore more holistic approaches that
address the mind-body connection, rather than just focusing
on physical symptoms.

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8.Question
What steps does Dr. Leonard-Segal recommend for the
medical community to validate treatments for conditions
like TMS?
Answer:She advocates for rigorous scientific studies,
including double-blind trials, to examine the efficacy of
treatments for chronic pain conditions and to explore the
psychological dimensions that may play a crucial role in
these syndromes.

9.Question
How can an understanding of TMS lead to a
transformational experience for patients?
Answer:Recognizing and addressing the emotional roots of
their pain can empower patients, leading to significant
improvements in their physical health and overall emotional
well-being. This can foster a greater sense of control over
their lives.

10.Question
What conclusion does Dr. Leonard-Segal draw about
societal expectations and their impact on individual

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health?
Answer:Societal pressures for perfection and achievement
can lead to stress and TMS symptoms. A shift in perspective
toward acceptance of being average and understanding
personal limits can reduce stress and help in healing.
Chapter 8 | MY PERSPECTIVE ON
PSYCHOSOMATIC MEDICINE| Q&A
1.Question
What is the main cause of chronic pain according to Dr.
Rochelle's perspective on psychosomatic medicine?
Answer:Dr. Rochelle believes that the primary cause
of chronic pain is not simply structural
abnormalities as traditionally thought, but rather
emotional and psychological issues, particularly as
explained through the concept of tension myositis
syndrome (TMS). He asserts that unresolved
unconscious emotions and stressors can manifest as
real, physical pain in various parts of the body.

2.Question
Why does Dr. Rochelle reject conventional pain

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management techniques?
Answer:Dr. Rochelle became disillusioned with conventional
pain management techniques because they often offer only
temporary relief without addressing the root psychological
issues. He found that many patients revisited for injections or
therapies that didn’t lead to sustainable improvement and that
the focus on physical causes of pain ignored significant
emotional factors.

3.Question
What role does a patient's social history play in
understanding their pain?
Answer:The social history is crucial in understanding a
patient's pain because it provides insight into their emotional
background, personality traits, and life stressors. Dr.
Rochelle emphasizes that many patients experience chronic
pain as a response to unresolved issues from childhood and
current life pressures, and recognizing these factors is
essential for effective treatment.

4.Question

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How does Dr. Rochelle incorporate TMS theory into his
practice?
Answer:Dr. Rochelle incorporates TMS theory by educating
his patients about its principles, conducting thorough
evaluations of their social histories, and emphasizing that the
pain they experience is often related to their emotional state
rather than just physical conditions. He encourages patients
to attend lectures on TMS to foster understanding and
healing.

5.Question
What is the significance of 'tenderness' in diagnosing
TMS according to Dr. Rochelle?
Answer:Tenderness is a significant finding in the diagnosis
of TMS. Dr. Rochelle notes that widespread tenderness
indicates that chronic pain is rooted in muscular and
emotional issues rather than structural problems, helping to
guide him away from unnecessary surgical interventions and
towards a more holistic healing approach.

6.Question

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How does Dr. Rochelle address the common
misconception that psychosomatic means pain is 'all in
the head'?
Answer:Dr. Rochelle clarifies that while TMS involves
psychological factors, the pain is very real and physical. He
strives to reassure patients that their pain is not imaginary,
but rather a physiological response influenced by emotional
stress, thereby legitimizing their experiences.

7.Question
What changes did Dr. Rochelle implement in his practice
after learning from Dr. Sarno?
Answer:After learning from Dr. Sarno, Dr. Rochelle shifted
his focus to include a thorough exploration of patients'
emotional backgrounds, emphasizing the importance of
social history and tenderness in diagnosis and treatment. He
began to prioritize education about TMS and stress
management techniques in his treatment plans.

8.Question
What are the long-term implications of addressing
chronic pain through a psychological lens according to

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Dr. Rochelle?
Answer:By addressing chronic pain through a psychological
lens, patients are more likely to experience lasting relief as
they understand and resolve the emotional roots of their
discomfort. This holistic approach fosters empowerment and
enables individuals to reclaim full, active lives without the
fear of re-injury or deterioration.

9.Question
How does Dr. Rochelle view the relationship between
personality traits and chronic pain?
Answer:Dr. Rochelle sees a significant connection between
certain personality traits, such as perfectionism and
'goodism,' and the development of chronic pain. He believes
that these traits can contribute to internal conflict and
emotional stress, which in turn manifest as physical
symptoms.

10.Question
What is the impact of addressing the 'psychology of
chronic pain' on a patient's recovery?

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Answer:Addressing the 'psychology of chronic pain' leads to
a deeper understanding of the patient's emotional struggles,
promoting healing that goes beyond alleviating physical
symptoms. This comprehensive approach helps patients
reconnect with their bodies, confront their emotional pain,
and ultimately achieve better health outcomes.
Chapter 9 | STRUCTURAL PAIN OR
PSYCHOSOMATIC PAIN?| Q&A
1.Question
What transformative realization did the family physician
experience during his visit with Dr. Hoffman?
Answer:After discussing his chronic low back pain
and its psychosomatic nature, the physician realized
that he could no longer practice medicine in the
same way, as he understood the deeper
psychological factors affecting his patients' pain.

2.Question
How did Dr. Hoffman’s personal experiences inform his
current medical practice?
Answer:Dr. Hoffman's own struggles with low back pain,

Scan to Download
compounded by the pressures and expectations of medical
school and his pursuit of perfection, led him to discover the
psychosomatic explanations for pain, changing how he treats
patients.

3.Question
What was the significance of the symptom imperative
described by Dr. Sarno?
Answer:The symptom imperative refers to the phenomenon
where, if the original symptom is treated without addressing
the underlying emotional causes, the body will create new
symptoms in other areas to distract from those unresolved
emotions.

4.Question
How does societal perception influence the understanding
and treatment of psychosomatic disorders according to
Dr. Hoffman?
Answer:Societal norms often dismiss the legitimacy of
psychosomatic pain, leading both patients and doctors to
attribute pain solely to structural issues, which perpetuates a
cycle of misunderstanding and inadequate treatment.

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5.Question
What can trigger psychosomatic disorders aside from
physical injuries?
Answer:Psychosocial factors, such as emotional stress,
societal expectations, and major life changes, can also trigger
psychosomatic disorders, showing the intricate connection
between emotional states and physical health.

6.Question
How should physicians approach the treatment of
psychosomatic disorders?
Answer:Physicians should accept that these disorders exist
and focus on understanding patients' emotional pain rather
than solely relying on standard physical examination or
imaging, which may miss the underlying psychosomatic
issues.

7.Question
What role does emotional repression play in the
development of psychosomatic disorders?
Answer:Emotional repression can lead to physical symptoms
as individuals defend against painful feelings, seeking

Scan to Download
distraction through physical pain, thus creating a cycle where
emotional issues manifest as chronic pain.

8.Question
In which ways can patients benefit from recognizing their
pain as psychosomatic?
Answer:Patients gain empowerment by understanding their
pain as psychosomatic, allowing them to confront and
process repressed emotions, which can lead to significant
pain relief and improved emotional well-being.

9.Question
What observational distinctions can help identify a
psychosomatic disorder?
Answer:Clinicians should look for a history of
psychosomatic disorders, the timing of pain in relation to
emotional events, variability in symptoms, and atypical
physical responses that do not conform to standard
anatomical explanations.

10.Question
How does one's personal history influence their
experience of pain?

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Answer:A patient's background, including past traumas,
familial relationships, and life stressors, can shape their pain
experience, often leading to chronic symptoms when
unaddressed, highlighting the psychosomatic connection.

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Chapter 10 | A FAMILY DOCTOR’S
EXPERIENCE WITH MINDBODY MEDICINE|
Q&A
1.Question
What led Dr. Marc Sopher to embrace mindbody
medicine in his practice?
Answer:Dr. Sopher's journey toward embracing
mindbody medicine began after he read Dr. Sarno's
book 'Healing Back Pain', which helped him
eliminate his own long-standing low back pain.
Intrigued by the effectiveness of a simple reading in
alleviating his discomfort, he contacted Dr. Sarno
and trained with him to better understand the
psychological origins of physical symptoms.

2.Question
How does Dr. Sopher define the role of unconscious
phenomena in physical symptoms?
Answer:Dr. Sopher emphasizes that unconscious phenomena
play a crucial role in explaining why many patients
experience chronic symptoms. He observed that traditional

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medical training often neglects the psychological dimensions
of patients' symptoms, leading to treatments that focus on
physical rather than psychological causes.

3.Question
Why do many patients struggle to accept the concept of
TMS?
Answer:Many patients are conditioned to believe in purely
physical explanations for their pain and may feel dismissed
or invalidated when confronted with the idea that their
symptoms may be psychological. This fear of being
perceived as 'imaginary' or 'hypochondriac' leads some to
reject TMS concepts.

4.Question
What is the 'reservoir of rage' and how does it relate to
physical pain?
Answer:The 'reservoir of rage', as described by Dr. Sarno,
symbolizes the accumulation of repressed negative emotions
and stress in the unconscious mind. When this reservoir
overflows, the brain produces physical pain to distract from

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the emotional turmoil, thus serving as a defense mechanism
against unpleasant thoughts and feelings.

5.Question
What is the significance of validation in the
doctor-patient relationship when treating TMS?
Answer:Validation is essential for maintaining trust in the
doctor-patient relationship. It reassures patients that their
pain is real, not imagined, and creates an environment where
they can explore the psychological causes of their symptoms
without feeling dismissed.

6.Question
What practical steps can patients take to address their
symptoms related to TMS?
Answer:Patients are encouraged to: 1. Make a list of stressors
and sources of anger; 2. Regularly reflect on TMS theories
and treatment principles; 3. Discard unnecessary physical
remedies; 4. Be vigilant about their condition; and 5. Resume
activities they enjoy, reinforcing the belief that they are
capable and fine.

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7.Question
Why is it essential for patients to understand that TMS is
not about positive thinking but rather accurate thinking?
Answer:Understanding TMS requires recognizing how
psychological factors impact physical sensations rather than
relying on positive affirmations alone. Accurate thinking
entails breaking away from societal myths that physical
symptoms must have structural causes, allowing patients to
confront and address the true psychological origins of their
pain.

8.Question
How does Dr. Sopher illustrate his treatment approach
through a case history?
Answer:He shares the story of a patient, Glen, who initially
rejected the TMS diagnosis but later found relief by
embracing it after reading related materials. This highlights
how knowledge and understanding can empower patients to
recognize and address the psychological components of their
pain.

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9.Question
What hope does Dr. Sopher express about the future of
TMS in medicine?
Answer:Dr. Sopher is optimistic that TMS will integrate into
mainstream medicine as more patients experience relief from
pain through its principles. He believes that the growing
body of successful cases will compel the medical community
to recognize the brain's role in physical sensations.

10.Question
What does Dr. Sopher want readers to take away from his
experiences with patients suffering from TMS?
Answer:He hopes readers will understand the profound
connection between the mind and body and recognize that
many chronic conditions may stem from psychological
origins. By sharing his experiences, he encourages a shift in
perspective toward more holistic approaches to health and
wellness.

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The Divided Mind Quiz and Test
Check the Correct Answer on Bookey Website

Chapter 1 | WHAT IS PSYCHOSOMATIC

MEDICINE?| Quiz and Test
1.Psychosomatic disorders arise when the brain
influences physical symptoms through
psychological reasons.
2.Dr. Sarno believes that treating physical symptoms is more
important than addressing the psychological roots of
mindbody disorders.
3.According to Dr. Sarno, conditions like Tension Myositis
Syndrome (TMS) are often misdiagnosed by medical
professionals.
Chapter 2 | A BRIEF HISTORY OF
PSYCHOSOMATIC MEDICINE| Quiz and Test
1.Psychosomatic medicine has a clearly defined
scope that is universally accepted.
2.Freud's work highlighted the importance of underlying
emotional conflicts in the development of new physical

Scan to Download
 symptoms.
3.Franz Alexander did not contribute to the understanding of
psychosomatic medicine.
Chapter 3 | THE PSYCHOLOGY OF
PSYCHOSOMATIC DISORDERS| Quiz and Test
1.Childhood experiences, including abuse and
neglect, contribute to an unconscious reservoir of
emotional pain that manifests as psychosomatic
symptoms in adulthood.
2.Sarno believes that external pressures, such as work and
family responsibilities, do not significantly impact
psychosomatic disorders.
3.The 'symptom imperative' refers to the tendency of the
psyche to alleviate one symptom only for another to arise
as a distraction from repressed emotions.

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Chapter 4 | TREATMENT| Quiz and Test
1.Dr. Sarno believes that recovery requires
understanding, rather than simply faith.
2.Patients in Sarno's treatment should rely on physical
therapies rather than confronting their emotional conflicts.
3.Knowledge about the psychosomatic origins of pain can
negate the need for repressed emotions to manifest as
physical pain.
Chapter 5 | HYPERTENSION AND THE
MINDBODY CONNECTION: A NEW
PARADIGM| Quiz and Test
1.Dr. Mann suggests that repressed, unconscious
emotions are a significant factor in hypertension.
2.The old paradigm claims that ongoing psychological
distress inevitably leads to persistent hypertension.
3.Research supports a strong link between anxiety, stress,
and persistent hypertension according to Dr. Mann.
Chapter 6 | MY EXPERIENCE WITH TENSION
MYOSITIS SYNDROME| Quiz and Test
1.Dr. Rashbaum believes that psychological factors

Scan to Download
 can influence physical pain in patients.
2.Tension Myositis Syndrome (TMS) is primarily caused by
structural issues in the body rather than emotional
problems.
3.Older patients do not face any unique challenges when
being treated for TMS.

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Chapter 7 | A RHEUMATOLOGIST’S
EXPERIENCE WITH PSYCHOSOMATIC
DISORDERS| Quiz and Test
1.Dr. Andrea Leonard-Segal believes that standard
medical treatments for chronic pain are always
based on solid scientific evidence.
2.Dr. Leonard-Segal's approach to treating chronic pain
incorporates psychological factors as significant
contributors to the patient's experience of pain.
3.The diagnosis of Tension Myositis Syndrome (TMS)
represents a lack of hope for patients suffering from
psychosomatic pain conditions.
Chapter 8 | MY PERSPECTIVE ON
PSYCHOSOMATIC MEDICINE| Quiz and Test
1.Dr. Rochelle found that conventional methods for
treating chronic pain provided long-term relief.
2.Understanding the psychology behind chronic pain is
crucial for effective treatment according to Dr. Rochelle.
3.Dr. Rochelle emphasized the importance of physical
examinations over understanding patients' social history in

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 chronic pain management.
Chapter 9 | STRUCTURAL PAIN OR
PSYCHOSOMATIC PAIN?| Quiz and Test
1.Dr. Douglas Hoffman emphasizes that many
chronic pain cases are primarily psychosomatic.
2.According to Dr. Hoffman, all pain is due to physical
abnormalities and can be treated with standard medical
practices.
3.Emotion and societal influences do not play a significant
role in the development of psychosomatic disorders
according to Dr. Hoffman.

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Chapter 10 | A FAMILY DOCTOR’S
EXPERIENCE WITH MINDBODY MEDICINE|
Quiz and Test
1.Dr. Marc Sopher has been practicing as a family
physician since 1990 in Exeter, New Hampshire.
2.Dr. Sopher believes that psychological factors play a
significant role in the diagnosis of chronic pain.
3.Dr. Sopher claims that all patients readily accept the
concepts of Tension Myositis Syndrome when they are
introduced to them.

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