Mind–Body Symptoms, TMS, and a Depth-Oriented Path to Healing

John E. Sarno, MD, was a pioneer in the understanding of mind–body disorders and is best known for his conceptualization of Tension Myositis Syndrome (TMS), a condition in which chronic pain and other physical symptoms arise in the absence of identifiable structural pathology. Working at the Rusk Institute at NYU for decades, Sarno observed that many patients with persistent pain did not improve with conventional medical interventions, yet showed significant recovery when psychological factors were addressed.

Sarno proposed that the central nervous system can generate very real physical symptoms as a response to unconscious emotional conflict. These symptoms -

commonly involving the back, neck, head, gastrointestinal system, or vestibular functioning - are not imagined or psychosomatic in the pejorative sense. Rather, they reflect alterations in neural signaling and autonomic regulation, often driven by internal pressure, perfectionism, chronic self-criticism, and unresolved emotional states such as anger, grief, or fear.

Although Sarno was at times controversial within mainstream medicine, he was deeply respected and profoundly loved by his patients. His clinical lectures at NYU were famously packed, with standing-room-only audiences, and patients often described him as warm, direct, and unwaveringly confident in their capacity to heal. Many reported dramatic improvement simply from being understood and believed - an experience that in itself appeared to reduce fear and interrupt symptom perpetuation. His books continue to be widely read decades later, frequently passed between patients, clinicians, and even generations within families.

A psychodynamic approach offers a natural clinical framework for working with TMS and related mind-body symptoms. Rather than focusing exclusively on symptom elimination, psychodynamic therapy seeks to understand the emotional meaning, developmental origins, and relational context of symptoms. From this perspective, physical symptoms can be understood as expressions of internal conflict and affective states that have not yet found symbolic or verbal representation.

When psychodynamic treatment is integrated with contemporary models of neuroplastic healing, the clinical picture becomes even more coherent. Repeated fear responses, attentional fixation on symptoms, and avoidance of emotional experience can reinforce maladaptive neural pathways. As patients develop insight, emotional awareness, and a more reflective stance toward their internal world, the brain is given new input - allowing previously learned pain or threat responses to weaken over time.

This form of treatment emphasizes curiosity, emotional tolerance, and the restoration of trust in the body. While symptom relief often occurs, the deeper aim is psychological integration and nervous system regulation rather than rapid symptom suppression. In this way, healing is understood not as a technique, but as a relational and developmental process.

Sarno’s enduring popularity speaks to something patients continue to long for: a clinician who takes their suffering seriously, refuses to reduce them to faulty mechanics, and invites them into a meaningful understanding of their own minds. A psychodynamic, neuroplastic approach carries this legacy forward - offering depth, dignity, and lasting change.