A Sarno-Hanson Synthesis



Content note: Speculative, relies on assumptions that may not be true, but generally points at something that I believe to be a useful map, with potentially important implications if true, and am interested in feedback.

John Sarno is the professor and physician who discovered Tension Myositis Syndrome (TMS), which has previously been discussed in detail by Scott Alexander. Briefly, a TMS theory suggests that chronic pain, and a handful of other chronic ailments, may be psychosomatic, and that the specific mechanism of action is the brain's expression of unacceptable emotions through physiological channels. For example, an embarrassing and inwardly unacceptable narcissistic rage at the conditions of one's life may be expressed as back pain or headache.

Sarno's theory is more detailed and specific than this, but for that treatment I recommend reading the book. It is relatively unimportant to this discussion whether the precise details of this theory are correct, especially because it is obvious that some weak form of the theory is true. The conscious mind is the tip of a vast iceberg of cognition, and the parts of the iceberg under the surface are by necessity those parts that create pain, emotion, compulsions, and all the other mental phenomena that the conscious mind can't take credit for - which is most of them.

I can't help but interpret Sarno's hypothesis much more broadly than he himself does. In 2017, Courtney Dauwalter won the Moab 240, a 240 mile race, in 2 days and ~10 hours. She beat the second-place finisher by ten hours. If you read or listen to any interview with her, she discusses how her secret is just not stopping. She's fit, but she's probably not 17% more fit than the second-best ultramarathoner. She's just unusually good at ignoring the powerful parts of the brain that are in place to stop the body from hurting itself. It turns out the physical limitations of the body are well beyond what the brain implies they are. The learning from this is that the brain is so good at convincing us that we have these limitations, that almost everybody eventually succumbs to their brain's insistence that they're going to die or break down if they keep running, even though it's not true.

Robin Hanson needs no introduction, but just in case, he's the economics professor and polymath who recently published The Elephant in the Brain. The premise of this book is that human behavior can be described as mostly being in pursuit of social status, and that to some degree, the function of consciousness and the self-narrative is to confabulate credible explanations about how this is not what we're doing, so we can more reliably deceive others about our true, unconscious motives.

If you take a broad interpretation of both of these thinkers, the upshot is that statements like "the subconscious is very powerful" are actually laughably understating the situation. The subconscious - the parts of cognition that are not conscious - is doing pretty much everything. The conscious mind is a particular functionality that serves as part of the system but has no real authority over it. The ubiquitous discussions of akrasia and motivation problems on this site exemplify the fact that any model of psychology that involves the "self" exerting "willpower" is a Sisyphean exercise typically doomed to failure. It's just not a realistic model of how we work.

A synthesis of these two thinkers that might yield testable predictions goes as follows: Hanson says most of what we do is signaling. Sarno says most if not all chronic pain is psychosomatic. Well, what is the point of pain if not to signal acute distress? Especially chronic pain - there is no individually adaptive purpose for chronic pain. A solitary leopard with debilitating chronic pain would just be a dead leopard. Humans are different. Much of our social fabric consists of unconscious but high-bandwidth signaling behavior. Body language is the most obvious example; humans can generally both perform and react to body language very consistently without even being aware of it.

So let's take the hypothesis that chronic pain is a social signal. Sarno's theory specifies that chronic pain is, again, an expression of unconscious rage. If we provisionally treat the Freudian distinction of Id/Superego as a suggestive map, if not precisely true, then the Id feels strong childlike rages at having its impulses stymied, and the Superego suppresses those rages and prevents them from reaching consciousness. To stir in a bit of Hanson here, perhaps the Superego's role is to help curate the outward narrative that we are purely prosocial and selfless, while the Id's role is to motivate necessary selfish behavior through generating self-serving impulses. It seems plausible to me that the relative "strength" of the Superego in modern society is much greater than it was in ancestral times, and this may explain why chronic pain is an increasingly prevalent issue in modern times, but this is just a speculation.

If we take the implications of all this at face value, then we can contemplate potential signaling purposes for chronic pain. In other words, what is the unconscious saying? Possibilities that come to mind:

* "I am legitimately overburdened and direly require more help than I'm getting."

* "My contributions are not being appropriately appreciated or compensated, so I will stop spending energy on them by incapacitating the body."

* "There are aspects of my environment that I find profoundly distressing, but I am unable to express this to my cohort overtly because of social restrictions, so instead I'll give myself a migraine and let the tribe figure out why that might have happened."

I've only recently started thinking in these terms, but it has been beneficial to try interpreting every physical sensation as some kind of Sarno-Hanson message from the unconscious. Do you sometimes feel a physical exhaustion and lethargy that mysteriously vanishes when the opportunity to do something more fun arises? Do you ever experience a sudden rise in tension and heart rate for a reason you can't quite pin down? Do you have immense trouble getting out of bed in the morning, but if you have something to look forward to that morning, you spring out of bed easily? Consider that this is exactly the kind of thing that a canny trickster unconscious would do to see its desires fulfilled.

What's amazing to me - and what I had to read Sarno's book to actually get - is that you don't even necessarily have to figure out what the unconscious is trying to tell you to get such physical symptoms to dissipate. You just have to look inward and investigate your emotions, with an attitude of "Ok, I'm listening, and I see what you're doing, but I don't understand why." For some reason, this seems to be enough that whatever unconscious module is causing the problem can feel heard.