John E. Sarno

Sarno's central claim is that most of the chronic back pain he saw came from TMS, a harmless change in muscles, nerves and tendons, rather than from discs, arthritis or a bad posture. He never says the pain is imagined. He says it is real, and that its cause is elsewhere. This is his view, not settled medicine.

He describes the pain as a defence. Strong feelings the mind finds unacceptable, such as rage at people we love or at our own duties, are kept out of awareness, and a vivid physical symptom keeps attention on the body instead. Seeing the trick, he argues, is what takes its power away.

Sarno noticed that many of his patients were hard on themselves, responsible to a fault and keen to be seen as good. He coined the word goodism for that last trait. In his model these traits build pressure and resentment that has nowhere to go.

He taught his patients in lectures and through reading rather than with machines or exercises. He reported that the people who accepted the diagnosis tended to improve, and that those who could not accept it usually did not. That is his clinical experience, not a controlled trial.

Sarno called this thinking psychologically. Instead of blaming a chair or a bend, the reader looks at the pressures of the past day or two: a deadline, a family duty, a resentment left unsaid. The journal on this page is built on that habit.

Sarno thought warnings to avoid bending, lifting or sitting taught people to expect pain from those things, and so they got it. Once a medical exam had ruled out disease, he urged patients to drop the precautions and return to normal life. Talk to your own clinician before changing how you move.

Sarno argued that disc changes and other findings often have nothing to do with the pain. Studies since then have found disc bulges on the scans of many adults who have no back pain at all. Your clinician is the person to say whether a finding on your scan matters.

Sarno described other conditions he believed did the same job as TMS, such as tension headaches and some stomach complaints, and called them equivalents. In his view, treating one symptom physically while ignoring the emotions can leave room for another to appear.

Sarno's proposed mechanism, reduced blood flow to the tissues, has not been confirmed, and mainstream medicine does not use TMS as a diagnosis. But today's pain science, including pain reprocessing therapy, also treats much chronic pain as something the brain can learn and unlearn. Readers often keep that part and leave the rest.