Book Review: The Divided Mind

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The audio book reviewed here is Dr John Sarno’s ‘The Divided Mind’ narrated by Paul Hecht and John Boles. I didn’t realise there were two narrators until checking the credentials after listening to the book! In any case, I found it clearly narrated and well paced. The material in the book is quite complex and would repay close study for the reader interested in psychosomatic medicine. Sarno originally trained in general medicine and at his website is described as a Professor of Rehabilitation Medicine. I found it difficult to draw conclusions about the material in the book as I think it requires considerable reading around the subject but found it very interesting. Sarno develops some of the underlying theory of Alfred Adler and Sigmund Freud. He maintains that there are a number of mind-body disorders and refers to Adler’s description of the brain giving rise to physical symptoms. Indeed he quotes from Adler who discusses possible mechanisms by which the brain can produce effects on the body. This appears to be the basis for psychoneuroimmunology and he refers to Professor Candice Pert’s work on the ‘Molecules of Emotion’ (see review here). He distinguishes between Freud and Adler in that he states that Freud did not consider the notion that bodily symptoms could arise from the brain for the purposes of ‘distracting’ the brain (or mind) from distressing emotions. Through his work Sarno suggests that these emotions include rage and gives clear examples where anger is controlled at the conscious level only to emerge in symptoms. I wasn’t clear on the abbreviation TMS in the book and only realised it was Tension Myositis Syndrome on looking elsewhere. Sarno’s arguments are logically developed and seem to me intuitively valid. However a quick search of Medline using the keyword ‘Tension Myositis Syndrome’ resulted in four references with one being a 2007 study by Schechter and colleagues. Such a search may not produce all of the relevant studies although it would be useful to see further formal evidence to support both the diagnosis and the treatment efficacy.

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7 thoughts on “Book Review: The Divided Mind

  1. david schechter, md

    Good review. TMS has helped tens of thousands of patients, maybe more, but agree very little formal research published on this subject. One reason– no pharmaceutical support—due to innovative, cost effective, non pharmacological approach. Funding difficult to obtain, RCT challenging in mindbody intervention such as this (educational/psychological treatment program).

    But would love to publish more data.
    David Schechter, MD
    http://www.smi-mindbodyresearch.org

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  2. Dr Justin Marley Post author

    Hi, thanks for taking the time to comment and I respect the considerable amount of work you have done in this area and the possible benefits of TMS. I’ve checked out the website, you’ve included at the end of your comment and again that’s a great resource. I’ve come across a few really good ideas that never make it into the mainstream. The question I kept asking on reading Sarno’s book was ‘why isn’t TMS in DSM or ICD. There is a psychologist by the name of Blashfield who has come up with a number of criteria for diagnostic criteria – just to paraphrase

    ‘1. There should be at least 50 journal articles on the proposed diagnostic category in the last 10 years….’ 2. Diagnostic criteria should ‘include self-report measures, structured interviews and rating scales’ 3. ‘There should be at least 2 empirical studies by independent research groups demonstrating high interclinician correlations’ 4. ‘The proposed category represents a syndrome of frequently cooccurring symptoms, described in at least 2 independent studies’ 5. ‘There should be at least 2 independent empirical studies showing that the proposed category ” can be differentiated from other categories with which it is likely to be confused’

    I thought that if there were validated criteria for TMS with demonstrated good inter-rater reliability this would facilitate construction or replication of studies internationally and also bring it a step closer to being considered for diagnostic manuals. If that were achieved it would mean that many more groups might become interested in this area. There might be useful contacts from the working groups on related disorders for the new DSM-V. Additionally it might be interesting to see if there were any people doing similar types of work for the Psychodynamic Diagnostic Manual as they might have some insights in this area.

    The diagnostic criteria informs and facilitates the treatment directed research. Even here it might not be necessary to do big, expensive RCT’s. The research could be built into clinical practice. The research application could be made for a prospective cohort study which includes people that were undergoing treatment in any case. Depending on the usual treatment practice this shouldn’t affect the physician’s workflow too much – just an extra few forms to be completed including the consent form. This in turn should minimise additional costs. A stamped addressed envelope sent a year or two down the line after participation should provide a useful indicator of medium term treatment efficacy. Additionally even now, a retrospective (postal) survey of previous patients would provide useful data providing it clears ethics (no reason why not).

    Anyhow, I’ll take a closer look at some of the resources on your site when I get a chance.

    All the best.

    Regards

    Justin

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  3. David Schechter MD

    Justin,
    All your comments are apropos.
    As for DSM, somatization… is the category that this would potentially fall into. My colleagues who work in this area have been speaking with some of the editors of the next DSM about this diagnostic and treatment paradigm.
    Perhaps this ‘epiphenomenon” description is not easily integrated into existing reductionistic categorizations. Perhaps it’s a treatment modality that works… but the diagnostic component is a misnomer. There are a lot of questions to ask and to answer. I’d love the help!
    I do know, however, that remarkable clinical responses happen to a high percentage of people, with chronic, benign, idiopathic, unexplained or miscategorized pain syndromes when they are told the pain is TMS/benign, the solution is thinking psychologically, not structurally, and they ‘get on with their lives’. Sometimes it takes more than this, sometimes this is all it takes. For some in depth psychotherapy is crucial, for others reading a book is enough. The pain resolves, the ‘physiology’ must change, and the problem recedes or disappears. Little or NO medication is used.
    Fascination with this has led me to treat and study this conceptualization for quite a long time now.
    Perhaps others will be inspired to collaborate or take the work further along.
    Best,
    Dave

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  4. Dr Justin Marley Post author

    Hi Dave,

    Thanks again for the comments. Best of luck with this and i’ll be keeping a close eye on this. I’m also interested in reading more of Professor Sarno’s works

    Regards

    Justin

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  5. Pingback: Books Reviewed to Date (Last Updated 7.4.12) « The Amazing World of Psychiatry: A Psychiatry Blog

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