A True Healer

John Sarno defied conventional medical wisdom and cured thousands of patients in the process

As the nation's health care system endures yet another political paroxysm, with the well-being of millions of our fellow citizens hanging on questions of power and money, we could easily be led to believe that medical science itself is a settled matter and that the only debate of consequence is the one that will decide how we get access to it. But the career of Dr. John Sarno, who died on June 22 at the age of 93, is an object lesson in how difficult it is to demarcate the line between knowledge and ignorance. His life and accomplishments, and the medical controversy he left as his legacy, offer a unique lens through which to consider a vexing dilemma: to what degree does the vast national treasure we expend on keeping ourselves well actually contribute to our health, and how much of that profligacy merely perpetuates a vast medical industrial complex?

Until his retirement in 2012, John Sarno was an attending physician at New York University's Rusk Institute, as well as a professor at the NYU School of Medicine. His practice began in 1950 and therefore spanned a rather long period in the development of modern medicine and its underlying methodologies. The vast majority of his patients considered him a great healer (myself among them). Most of the medical profession regarded him as an apostate, or merely irrelevant.

Over the course of his years of treating patients with injuries, many of whom suffered from debilitating pain, Dr. Sarno came to reject one of the basic premises of modern science: that afflictions of the body and of the mind are entirely distinct phenomena. Rather, he advanced a theory, and successfully practiced a method of treatment, that relies entirely on the idea that these component parts, body and mind, are inextricably linked. Beginning with Mind Over Back Pain in 1982, and proceeding in several more books over the next quarter-century, Dr. Sarno expounded on his conviction that the most common diagnoses for back, neck and other associated pain syndromes — namely, spinal damage or abnormality — were just plain wrong.

He arrived at this conclusion by studying the medical histories of hundreds, if not thousands, of patients. In nearly every case in which a patient suffered from chronic back, neck or sciatic pain, he or she also suffered from at least one, and usually several, other widely recognized forms of psychosomatic illness: migraine headaches, asthma, gastrointestinal disorders like stomach ulcers and irritable bowel syndrome, or skin eruptions like eczema and psoriasis. He noticed several things that all of these medical issues had in common with the pain symptoms he was attempting to treat: they were mediated by the autonomic nervous system; they were chronic; and doctors really didn't know what caused them or what to do about them. By default, they were dismissed as "merely" psychological in origin. Consequently, doctors considered them of lesser concern — that is, they affected the patient's quality of life but were rarely life threatening — and so they confined themselves to treating the symptoms.

Dr. Sarno wondered whether the chronic back and neck pain that afflicted so many of his patients was also a psychogenic disorder. What if, instead of finding the root cause in a physical injury or deformity, the pain is actually just another way that the body responds to stress? Moreover, he considered whether pain patients were actually made worse when their symptoms were treated as a physical malady rather than a psychological one. Perhaps they were the victims of medical success: the rise of the surgeon as the sine qua non of medical intervention, the growing availability of pain medication, and the emergence of sophisticated technology like magnetic resonance imaging (MRI), which rendered soft tissues (like spinal discs) clearly for the first time.

All of these advancements conspired to convince doctors and patients alike that back pain is a purely physical condition and should be treated by physical means. To make matters worse, an entire industry of back pain arose, and fortunes have been made selling mattresses, shoes and exercise programs to back sufferers. We became convinced that the back was a fragile object that required delicate care, despite millions of years of evolutionary evidence to the contrary. (Dr. Sarno was fond of the example of a prehistoric pregnant woman unable to escape from predators because her back hurt — how could the species have survived?) This looked to Dr. Sarno like a perfect storm of bad information, and a solution looking for a problem. How could such a large and confident army of orthopedic surgeons, chiropractors, physical therapists and fitness experts all be wrong? He often said that the MRI was the worse thing that ever happened to people with back pain, because it led to a diagnosis that was not only wrong but which reinforced the cycle of fear and caution that only served to aggravate the patient's symptoms.

You could do a lot worse

And so for the next 40 years, Dr. Sarno embarked on a new course of treatment, which consisted primarily of educating his patients about how the brain worked, and teaching them to stop treating their symptoms as physical but psychological in origin. They needed to understand that the pain was neither caused by a physical trauma nor "all in their head", but part of a complicated interrelationship between the central nervous system, the circulatory system, and the muscular and skeletal structure. Through this method of breaking down the web of conditioned responses that feeds the pain — not by eliminating stress (an impossible task) but by understanding it — tens of thousands were relieved of their suffering. Many successfully overcame their pain just by reading Dr. Sarno's books.

Dr. Sarno's detractors criticized him for not conducting traditional clinical trials to support his theories, but he defended himself by saying that he was a physician, not a researcher. Moreover, he asked where the clinical studies were that proved the connection between herniated discs and pain, or between spinal stenosis and pain, or between compressed nerves and pain. There were none. The only evidence offered by traditional orthopedics was the treatment of patients, which was precisely the same evidence that Dr. Sarno provided. And he was only too pleased to stack up his results against those of his critics. The vast majority of his patients became well, and stayed well permanently; large numbers of those who had spinal surgery, physical therapy and other treatments relapsed. As far as he was concerned, the experience of his numerous patients and the research conducted by others provided ample proof of the efficacy of his methods.

There are many examples in the medical literature of diagnoses that appear for a period of time only to disappear eventually as new information overtakes the original suppositions on which they were based. The educator and author Ken Robinson, for instance, denounces the so-called epidemic of attention deficit disorder (ADHD) among children as a concocted problem that feeds the pharmaceutical industry, and allays the concerns of parents, but has little basis in reality. In the past, children weren't diagnosed with ADHD because, he says, "People didn't know you could have that." Robinson's casual put-down neatly encapsulates a key element in Dr. Sarno's theory: suffering people and their doctors will often adapt their symptoms to the diagnoses available.

The average citizen, untrained in the health professions, is inclined to accept that there is sound medical science behind every proffered treatment. But while drugs are subjected to years of rigorous and costly trials before they come to market, there is no equivalent system for testing surgical or other invasive procedures. Medical practice is largely its own testing ground. Many treatments clearly are effective and stand the test of time, but as Dr. Sarno demonstrated, they can also become self-perpetuating economic systems on which many livelihoods depend, even when their efficacy is in doubt. As Upton Sinclair famously said, "It is difficult to get a man to understand something, when his salary depends on his not understanding it."

The inability of traditional Western medicine to cure whatever ails us is not in itself an argument for experimental surgeries, herbal remedies or any other forms of alternative treatment. The fallacy of one proposition offers no proof of the validity of any other. If you need your appendix removed, drop your nutritional supplements and get yourself to a surgeon. But not all medicine yields so readily to diagnosis and treatment, and Western medicine breaks down badly at the intersection of the physical and the psychological. Given how much is at stake in getting health care policy right, we would do well to heed the lesson of Dr. Sarno's life work, and take the time to consider whether the extraordinary cost of medical care actually bears a relation to the state of the nation's health.