Tension myositis syndrome (abbreviated TMS) is a name given by Dr. John E. Sarno to a condition he describes as characterized by psychosomatic musculoskeletal and nerve symptoms, most notably back pain. According to Sarno, TMS is a condition in which emotional stress causes physical pain and other symptoms. Sarno states that the underlying cause of the TMS symptoms is the mind's defence mechanism against unconscious mental stress and emotions such as anger, anxiety and narcissistic rage. The conscious mind is distracted by the TMS symptoms, as the psychological repression process keeps the anger/rage contained in the unconscious and thereby prevented from entering conscious awareness.
In his books Healing Back Pain: The Mind-Body Connection (1991) and The Mindbody Prescription: Healing the Body (1998), Sarno talks "about these lights that he sees just before the onset of a migraine... Dr. Sarno sees this as a TMS equivalent and treats it the same way he would treat other TMS related pain symptoms" (shawnsmith, TMS Help forum, December 20, 2006). In fact, "that was Sarno's first personal experience with TMS that started him on his theory of TMS. He was able to stop the migraines it their tracks at their on-set of the visual snow stage, by shifting his thoughts, from physical to psychological" (tennis tom, TMS Help forum, December 20, 2006).
By analogy to Sarno's interpretation of his own transitory migraine aura symptoms as TMS equivalent, one user of the TMS help forum suggested persistent visual snow (of unspecified etiology) as representing another TMS equivalent, too. "SO I really think we can add this to the TMS equivalents and since we Snow vision people seem to become more and more everyday, maybe Sarno acknowledges it sometimes" (Alpha, TMS Help forum, December 20, 2006).
The TMS diagnosis and treatment protocol are not accepted by the mainstream medical community because they don't comply with the standards of evidence-based medicine. Critics in mainstream medicine state that neither the theory of TMS nor the effectiveness of the treatment has been proven in a properly controlled clinical trial. Considering the application of the TMS diagnosis to phenomena of migraine aura, more specific objections can be made. From a neuropsychiatric viewpoint, Sarno's notion of TMS is modelled after Sigmund Freud's doctrine of conversion, a defence mechanism whereby emotional stress is repressed and "converted" into physical symptoms (Freud and Breuer, 1895). However, in migraine with aura, stress just acts as trigger or precipitating factor, not as cause. Migraine is not a psychological or psychiatric disease but one which results from biological and physiological alterations. Therefore, Sarno's interpretation of migraine aura in terms of a conversion disorder, and its expansion to include persistent aura, have to be rejected from a neuropsychiatric point of view. Moreover, as Sarno has included lack of known physical cause among the diagnostic criteria of TMS, the making of this diagnosis to explain either transitory or persistent migraine aura phenomena can be rejected on the grounds of Sarno's own diagnostic criteria, as the neurological disorder migraine with aura has to be considered as a known physical cause which is an exclusion criterion for TMS.
Freud S, Breuer J. Studien über Hysterie. Franz Deuticke, Leipzig and Wien 1895.
Sarno JE. Mind Over Back Pain. Berkley Trade 1982.
Sarno JE. Healing Back Pain: The Mind-Body Connection. Grand Central Publishing 1991.
Sarno JE. The Mindbody Prescription: Healing the Body, Healing the Pain. Warner Books 1998.
Sarno JE. The Divided Mind: The Epidemic of Mindbody Disorders. Harper Paperbacks 2006.
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