Proliferation
This is Western Coffee—notes on building the creative body. Last time: Certainty. The whole series is here. Please share this email; you can sign up free below.
This is the third installment in a discussion of emotional factors in chronic pain.
When it dawned on me, in October, that the pain that had recently worsened in my knee—though intensely real, even measurable from the outside in the form of swelling—might be a product of my mind, I had a bit of an early-2000s-thriller “This ends now” moment. I felt real anger that I was dealing with this phenomenon yet again, and doing so weeks before the most intimidating athletic effort of my life, the New York City Marathon.
I went to the mirror and said to my mind, “This symptom is going to go away. And so are all the others (including what I’d been referring to as piano-bench pain in my other leg, which has since morphed into being-a-passenger-in-a-car pain and going-to-the-movies pain). And they’re not coming back. I’m not falling for this ever again!”
But my mind is not a pushover. Actually, its response reminds me a little bit of dealing with my cat Joan: If you order her not to scratch the rug in the office, she’ll stop—but the next time you see her, she’ll be in a self-satisfied loaf position on the kitchen table, the only place in the apartment from which she is prohibited. Driven from there, she’ll busy herself harassing her roommate, Tommy.
Thus it was that my right shoulder seized up a few days later, eventually radiating pain into my arm and hand. Thus it was that both of my hip flexors started to become unmanageably painful—but only on one particular running route. A toothache, some old pain in my grip, prostatitis, ectopic heartbeats: These things and a number of others recurred from earlier times, and that prompted me to look backward more broadly. How many medical issues from the last decade had been psychogenic?
(The knee didn’t improve in time for the marathon, but my past experience with all this made me feel good about a gamble that it wasn’t a serious structural issue—something I would still have gotten checked out with a doctor if the problem had kept persisting—and lo and behold that symptom went away within a couple weeks of the race.)
The list of my historical symptoms that I eventually put together had more than 50 things on it, from silent migraine to plantar fasciitis. (In “The Mindbody Prescription,” John Sarno presents a broad catalog of symptoms that can have a psychogenic origin.) For me, making that list was a revelation. I had known for years about tension myoneural syndrome (TMS), Sarno’s name for the brain’s synthesis of pain to distract from repressed emotion, and its analogues in the digestive and cardiovascular and other systems of the body. I was persuaded of its validity because when I’d accepted it as a diagnosis, my own long-term intractable pain, resistant to every other therapy, had finally lifted. I’d drawn from the same method at other times, too, for example in 2021 to interrupt a never-ending cycle of respiratory infections—which worked, after a terrifying one-off episode of bleeding gums. (I’m telling you, the mischievous cat doesn’t give up easily.) And yet even for all that I’d embraced it, the full relevance of this model to my life had escaped me.
My case may be unusual in the sheer variety of neurogenic symptoms I’ve experienced. But what it drives home to me is a reminder that the brain is the most versatile organic entity there is, with major influence over almost everything our bodies do: No wonder it would have a lot of ways of making us miserable, if it has settled on that as a strategy—however perverse and misguided—for keeping us emotionally safe.
I have come to wonder if there was something about my assertion to my brain that I wouldn’t fall prey to TMS or its equivalents anymore that set of a cascade of these symptoms—a kind of greatest-hits death rattle. For a few days I even had an echo of the pain my right leg that had driven me to such despair a decade ago, and whose vanquishing made me a determined Sarno convert to begin with.
In the “well that’s interesting” department: After an echocardiogram last July showed indications of mild pulmonary hypertension, potentially a flashing red light for an endurance athlete, I started to incorporate that issue into my thinking about how TMS expresses itself in my body. This is by no means proof positive of anything, I realize, but when I returned for a follow-up echo this week, things were looking good. “No pulmonary hypertension,” my doctor noted on the results.
Kindly send me your thoughts, questions, and provocations: dmichaelowen@gmail.com. And say hi on Instagram, or let’s Peloton together: @leggy_blond.