Book Review: Unlearn Your Pain (2016)

This is a very long read to ultimately conclude "who knows, there's probably a strong placebo effect."

Anecdotally, I can say there is a strong placebo effect, but it isn't complete. I think what is missing in all of this is perhaps what role stress hormones have in inducing inflammation in old injury sites.

My wife has chronic back pain due to years of working as a nurse in a hospital, moving patients and such. Some things help, some do not. I have what was once diagnosed as fibromyalgia, and I can say that having lived with it long enough, there are several triggers which are totally unrelated to stress (though stress can play a role too, it isn't necessary).

I’ve been becoming more skeptical that chronic pain I have is physically based.

Contrary to the article, my best guess is that my psychological pain is not being -expressed- as physical pain, but rather my physical pain is my mind’s way to -distract- me from the psychological pain that threatens to come to the surface.

To see this, notice it’s pretty clear that we distract ourselves in all sorts of ways from psychological pain, i.e. smartphone, social media, hacker news. Physical pain just happens to be a very engrossing form of distraction that takes all your attention and focus.

One can start becoming increasingly skeptical by monitoring how much time during the day you -actually- feel pain. For me, it’s maybe a few minutes, but that few minutes of pain explodes into “I have this massive problem” which produces thought loops and rumination, which are themselves very effective distraction techniques.

Relevant related book: The Body Keeps the Score https://www.amazon.com/Body-Keeps-Score-Healing-Trauma/dp/01...

What if it was more widely accepted to use placebos in certain cases where diagnosis is inconclusive?

Much of modern "vagus nerve connection/mind body" books or childhood/adult trauma books talk about this phenomena of the pain "being in your head". There's also John Sarno's book about back pain. What about the untethered soul perspective by Michael Singer?

I was a huge skeptic of this type of "healing" for my whole life. When I was extremely depressed and experiencing immense pain in my chest area on a daily basis for 14 months where cardiologists had no clue what was going on, I started to go through this "unlearning of the pain". Now that I'm on the other end of it, I feel like I have tools for understanding much of the pain/anxiety introduced by our mind.

Until we can say we understand the body completely, we're certainly can't be dismissive of ALL pain. As a chronic pain sufferer and a spouse of a medical professional, we both have observed that hubris in doctors is still a serious problem in the medical profession.

> a culture-bound syndrome in which people who expect whiplash to exist use its symptom profile as a way of expressing their psychological tension.

Surely a more likely explanation is insurance fraud? Plenty of people see being in a car accident as a ticket to a lifetime of disability comp paid by somebody else's soulless insurance company. If you can qualify for disability with some suitable diagnosis like "late whiplash", yet still enjoy a normal quality of life, that's pretty much winning a jackpot.

This is a complicated topic and I think discussion on this topic on a forum like this, there ends up being a divide between folks who impulsively write off Schubiner and Sarno as 'quacks' and folks who have had chronic pain and out of sheer desperation do end up going to Schubiner & Sarno and trying the remedies that are not scientifically vetted, or validated in clinical trials -- and yet finding that they are helped more than conventional medicine. Scott mentions it in his essay: the amazon review page with overwhelming and effusive praise of Sarno's book by people who were helped is hard to ignore.

The theory by Schubiner is basically that some unexplained pains may be rooted in psychophysiologic etiology, and therefore require intervention of, among other things, psychological varieties.

The good news is, finally, large institutions around the world are getting around to conducting randomized controlled trials to evaluate methods proposed by Sarno et al. (https://pubmed.ncbi.nlm.nih.gov/34589642/). They're seeing interesting results, that psychophysiologic symptom relief therapy helps folk manage and relieve their pain to varying degrees.

Also related:

Curable: https://www.curablehealth.com/

The Way Out (2021): https://www.goodreads.com/book/show/50021854-the-way-out

There is actually a two-way relationship between the body and the mind: On the one hand, the mind can cause psychosomatic pain. On the other, pain as well as food, posture, breathing, behaviour, etc. can affect one's psychology and therefore their thoughts.

I'm sure the author knows all this, but if they'd put it in the introduction of the book the effect would be far less prominent.

Does the placebo effect exist? Yes.

Is it helpful to provide patients with dismissive arguments before they undergo placebo treatment? No.

And the idea of giving readers of this dismissive post a free copy of the book if they send back the outcome of the treatment is therefore also not very useful.

“ When someone develops a pain in the buttocks, there may be someone in their lives who is ‘a pain in the butt’.” Someone who develops difficulty swallowing may be reacting to a situation in life that is ‘hard to swallow’. ”

That’s some stupid Chinese medicine level of “if you want hard penis, eat long and hard food”

Related: https://twitter.com/patrickc/status/1559737765566173185

Inside the brain there's a kind of meat computer. In biological systems there isn't a distinction between software and hardware. There's no sharp boundary between psychosomatic and physiological causes. Most (but not all) medical conditions can be seen as communication between the meat computer and the conscious mind (which is a tiny subset of the actual processing going on in the nervous system at any given moment.)

> > the subconscious mind [computer] is unlikely to produce [program] symptoms [output] that will be easily seen [dismissed] as psychological [not a serious fault condition]. But since humans continue to experience great stresses [trauma] and strong emotions, paralysis [ignored signal] has been replaced by [other warning signals] chronic back pain, fibromyalgia, fatigue, irritable bowel syndrome, and many other symptoms.

Sometimes the communication is as simple as "stop drinking" but other times it's something like "This job sucks." or "You forgot you wanted to be an artist."

Another aspect of "psychosomatic" issues is that we develop patterns of chronic tension in the body, which impede the free flow of the various bodily uh, flows of blood, nervous signals, etc., often becoming so severe that numb areas develop where the conscious mind is literally unable to sense some parts of the body. Proprioceptive feedback is distorted or even muted (numbness). In time secondary symptoms develop.

Ergo, directed self-awareness is a kind of panacea. As you "irrigate" these neglected areas of the body with your attention (though whatever method, there are dozens) they heal. Correct the conditions leading to the need for the communication signal and the signal "magically" ceases. The meat computer does not experience subjective pain. It has no interest in hurting you, it literally just does what works. If paralyzing your leg or stabbing you in the lower back keeps you from going back to your shitty job that you hate, that is "Works As Intended" from the POV of the meat computer. The good news is that you can reprogram the computer. You can negotiate less painful signals, or simply incorporate its feedback into your life decisions directly. But you can't fight it. The meat computer runs the physical body, you have no leverage to fight it with, and you are not supposed to fight it anyway. You are supposed to work together.

https://en.wikipedia.org/wiki/The_Blind_Man_and_the_Lame

The ancient tale has a deeper meaning. The meat computer, what we call the "unconscious mind", is the blind giant and the conscious mind is the sighted but helpless lame man.

Related SSC Book Review, which I've probably only read because it surfaced here recently anyways: https://slatestarcodex.com/2017/09/05/book-review-surfing-un...