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Recently Scott Alexander and a few others have been talking more about the idea of a social contagion, one which spreads real physical problems.
As I’ve argued in previous posts, this social contagion likely causes a number of what we see as purely physical injuries. Many feel that their body is injured. They deal with diagnoses from the medical community such as:
Chronic pain
Fibromyalgia
TMJ
Joint Hypermobility
Some doctors, like John Sarno, have even argued that far more injuries are based on psychological harm, rather than physical, such as:
Hives
Eczema
IBS
Gluten sensitivity/Celiacs
Herniated Discs
The list goes on. These are extraordinary claims, which Sarno backs up with impressive statistics in his book.. Unfortunately I can’t find his paper online, would be curious to take a look if anyone has a link. What Sarno calls the issue, and what other doctors or medical writers such as have supported him in, is a disorder called Tension Myositis Syndrome (TMS.)
The basic mechanism he posits is that our mind uses defense mechanisms to prevent us from thinking certain thoughts. We distract ourselves with drugs, alcohol, fast food, and many other addictions. He thinks that in the modern world, due to our views on physical injury, some people deal with their mind creating physical pain to distract them from emotional issues. This distraction comes out in certain nerves being deoxygenated, which he claims to have proven.
Much of this stress comes from trauma due to unresolved emotional issues, which is pretty standard accepted literature in psychology nowadays. Sarno specifically calls out “anxiety, anger, and feelings of inferiority” as the big culprits, citing that modern life causes many of us to have a lot of anger boiling under the surface. Constraints from work, relationships, illness, loss of loved ones, and in extreme cases childhood neglect or abuse.
To use a more rationalist lens, you could say the most stressor would be status anxiety. Many on the motte have argued that status anxiety is an incredibly common and hidden force that generates massive emotional problems, since the Western world is so hypercompetitive, and it’s difficult to measure up in any walk of life, let alone most. When you don’t feel you're at the top in your work life, social life, or family structure, people get frustrated.
What makes this problem worse is that due to the way modern society operates, we can’t express anger frequently depending on our situation. For those in the PMC, or the business world more generally, it’s considered almost unthinkable to yell at a boss or a client. The whole microaggression concept exacerbates the issue.
Some believe this is a recent phenomena due to stresses of modern life, but I’d argue that the connection between mind and body is far more complicated and older. Writers throughout history would cite feelings of pride which make your chest well, or having your hands tremble with rage. Our minds and bodies are inextricably linked, so it stands to reason that if we have rampant neuroses in our society, some of it would express itself physically.
I’m sure many of those reading this who are more physically active may have an instinctual response of “duh, of course the mind and body are one, it’s the most obvious thing ever.” I’d argue that the inferential distance around this issue opens a vast gulf which is difficult to imagine. If you have not experienced chronic pain, I don’t think it’s something one can confidently model with any real accuracy.
To some degree, patterns of behavior also must matter. A common response to an injury is to exercise, and for most generalized chronic pain issues, this seems to work. The issue arises when someone creates a trapped prior. Basically the idea that they have some condition is so deeply ingrained that the typical fixes don’t work. Many sufferers of chronic pain even admit they think it’s psychosomatic, but still struggle to deal with it. Ultimately Sarno’s method seems to work for them over time. Point is, our modern medical fixation on mechanical causology for injury seems, if not totally wrong, at least to be missing a big piece of the puzzle.
This idea may already swim in the water all around us. After all, we have plenty of colloquialisms such as “trust your gut” or “follow your heart” that suggest a connection. However, the common idea that injuries are almost entirely physical persists.
If true, this hypothesis could be one the discovery of which would shake our society to its roots. Long-lasting physical injuries being caused by emotional pain would alter our entire approach to medicine, let alone overall health or the pursuit of virtue.
It’s important to note that depending on your values, you may prefer the current state of events. If subjecting the emotionally damaged in Western society (most of us) to self-caused physical pain is worth preventing large amounts of anger and other negative emotions from boiling over, that is not necessarily an irrational choice. I’d certainly prefer dealing with one of these issues than living through a revolution or large war.
That being said, it’s a choice we must make without blinders. To ignore the issue entirely is to prevent us from solving it.
I'm not finding any recent papers by John Sarno as an author, just ones referencing his book (or, in a couple cases, including it as part of the experimental criteria by making people read it). There's a few (cfe here or here), but they're not very encouraging. The mechanism being nonsensical Freudian bullshit isn't unusual, and a lot of medical science falls in that category and can still be right on accident, but the scientific procedure is disappointingly bad even by the standards of the time.
The weak version -- that stress can augment inflammation and a variety of other pain-related things, including sometimes turning marginally-healthy people into marginally- (or chronically-) sick ones, is pretty plausible, including to anyone who's had a chronic illness. Indeed, there's a pretty wide variety of illnesses where stress -- sometimes meaning tiredness or lack of rest or energy expenditure but mostly meaning how worried they are -- including some (IBS, eczema, fibromygalia) where that's part of the bog-standard description. Sarno's techniques are probably helpful for this sort of stuff, in the sense that they keep you from basically marinating in it and provide some distractions (though I think there are some unstated risks and downsides).
I'm somewhat more skeptical of the stronger one, that these more severe problems are due to stressors. People do not, in bulk, go to doctors complaining about IBS or Crohn's Disease or even eczema. Famously, Crohn's is one of those things people tend to end up going to doctors with a pile of 'normal' non-chronic non-pain symptoms for years, and only getting filed properly in if they get an early endo/colonoscopy, or a lucky bit of advice (cw: severe psychic damage, tumblr). But these conditions don't tend to focus on highly neurotic people, or those with unusually stressful childhoods, or with histories of abuse. Conversely, you can stress someone out to upset their gut pretty easily, but it's actually pretty hard to do so in just the right way that their large or small intestines produce large abscesses trying to escape their abdomen.
And we have past evidence of other stress-tied digestive track illnesses where microbial infections end up being pretty strongly correlated. And found out in the 1980s!
There's some merged case -- a lot of people have h pylori infections and don't report stomach ulcers, and not everyone exposed to the microbe develop an infection, and it's probably not all strains of microbe and genetic predisposition, so you can come up with a mechanism where stress reduces immune activity or increases inflammation or whatever. Or perhaps herniated discs are things that show up in x-rays with readily-created biological models, but they're also more likely to be chronically painful for and maybe even caused by a culture that allows people to try lifting heavy things in stupid ways while also being more sedentary in general.
But this turns into a mind-body-model-of-the-gaps, in a way that kinda undermines the relevance of the model at all.
I don't know (and don't think!) that this covers everything. I'm still not sure wear fibromygalia falls, for one better-known example. But the limited insight on trying to separate these categories leaves me skeptical in general -- Sarno's bread-and-butter was lower back pain, and that's absolutely ludicrous as a category.
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