The doctor carefully folds a piece of paper, presses the seam with the flat of his hand as if ironing one of his button-downs, and tears it in half with the precision of a surgeon. He is not a surgeon. He speaks as if he were taller than me — much taller — though he is two inches shorter than my five feet five inches. His lab coat, clean and white, his NYU patch, and his intense, eyeglassed stare offset his height. At the top of one of the halves of paper — I imagine he saves the other half for the next patient — he writes “KNOWLEDGE.” He draws a line across the middle of the page. The space above the line represents the conscious mind; below, the unconscious. He writes “PAIN” in the conscious space and “RAGE” in the unconscious space. He circles “RAGE” and draws three arrows pointing to the circle, each arrow represents a source of this subconscious rage: “childhood anger,” “need to be perfect and good,” and “life pressure.” Accumulated anger becomes rage, he says. He tells me my back pain comes not from spinal stenosis or disc herniation or from playing college lacrosse; it comes from repressed rage. Full stop.
Twenty years later, I find Dr. Sarno’s file in the basement, duly buried in a box wrapped in duct tape, amidst manuals for now-extinct desktop computers, a box of stuff I thought I had no need for.
Over two years, as part of my graduate work, I read nothing but novels written by women featuring angry female protagonists. The inward rage of the obedient spouse in George Eliot’s Middlemarch, the restrained rage of the governess in Charlotte Bronte’s Jane Eyre, the fiery rage of the locked up “mad” Creole in Jean Rhys’s Wide Sargasso Sea, the desperate rage of the seething mother in Toni Morrison’s Beloved, the wounded rage of the abused adolescent in Dorothy Allison’s Bastard out of Carolina, the retaliatory rage of the discarded wife in Elena Ferrante’s Days of Abandonment, the pursed rage of the mistress in Paule Marshall’s Daughters, the primordial rage of the sexualized teenager in Ananda Devi’s Eve Out of Her Ruins, and the unrepentant rage of the middle-aged, unmarried teacher in Claire Messud’s The Woman Upstairs. Pages and pages of accumulated anger. I became a student of rage, documenting each instance when these women had cause for fury, noting if and how they reacted to it, and what the consequences were for expressing it. I noted distinct differences in stakes and outcome depending on social class and race. The whiter and wealthier the woman the higher the expectation to restrain herself, yet the lesser the consequence if she was bold enough not to (see Jane Eyre’s Bertha Mason, the “madwoman in the attic,” to understand this disparity). I became particularly fixated on Brontë’s Jane Eyre and Messud’s Nora Eldridge: though they lived over one hundred years apart and under extremely different social and economic circumstances, it was nonetheless interesting to me the way they worked in emotional opposition, the way Jane learns how to swallow her rage while Nora learns how to bullhorn it across page after fiery page.
Dr. Sarno received his medical degree from Columbia and completed a residency first in pediatric medicine at Columbia-Presbyterian Medical Center and later at the Institute of Physical Medicine and Rehabilitation at NYU. He wasn’t a psychiatrist, but I was sure he was trying to play one on TV (watch him on 20/20 or Larry King Live). According to his June 2017 obituary in The New York Times, Dr. Sarno was “revered by some as a saint and dismissed by others as a quack.” His books apparently sold over a million copies and celebrities like Larry David claimed Dr. Sarno profoundly changed his life. Dr. Sarno was interested in the psychosomatic causes of pain, and believed that our brains prefer to deal with physical pain rather than difficult emotional pain because “the decision maker in the brain has decided that the overt expression of unbridled rage would ruin the person’s life.” In other words, we opt to “quell” emotion. What would Dr. Sarno make of Jane Eyre, a woman who has so much to be angry about, but buries her anger in scene after scene? Jane could check all of Dr. Sarno’s boxes regarding the sources of repressed anger: childhood anger, desire to be good, and pressure to meet social expectations. What did all that hushing of anger do to Jane’s health, if anything?
Dr. Sarno called my condition Tension Myositis Syndrome, or TMS, which occurs when there is decreased blood flow to certain tissues of the body caused by repressed rage. Essentially, it’s oxygen deprivation. He told me I needed to forget about anything I ever knew about my back pain and then he invited me to enter the “program,” which sounded like the type of thing Dr. Phil would offer to the suffering sap on stage in front of a live audience.
Four years before I met Dr. Sarno, I had undergone “bilateral L4-5 Laminotomies, Partial Facetectomies and Partial Foraminotomies with excision Disc Right L4-5” at the Hospital for Special Surgery in New York City. In other words, I had spinal surgery. At twenty, I was young to have this procedure, but I went ahead with it because I wanted — needed, so I thought — to finish out my collegiate lacrosse career. I completed my final season in constant pain, doing no favors to my recovery. Now, scanning the extensive surgeon notes I kept over the two years post-surgery, I am reminded of the lengths I went to get better. I see Torodol, Naprosyn, lumbar stabilization therapy, spinal shots, more Torodol, more Naprosyn, more rehab. My training routine involved endless applications of heat and ice: opposing temperatures reflected opposing opinions about my condition.
The initial diagram-drawing consultation with Dr. Sarno happened in late 1999. I was two years into my five-year stint in New York, and the only consistent thing in my life there was back pain. And cubicles. I sat in a lot of cubicles: from One Dag Hammarskjöld Plaza in Midtown, where I sat around an ad agency until “the creatives” were ready for me to seal an envelope and call the messenger service, to 20 Rockefeller Plaza, where I sat around an auction house and punched in some magical marketing code that produced a list of rich art collectors for a sale, and there was that cube down by the Holland Tunnel, where I sat around an employment agency and wrote copy, and another cube in South Street Seaport, where I sat around a telecommunications company and data-entried my face off. I remember being jealous of the tool-belted technicians because they weren’t sitting around in a cubicle. This sedentary life was not good for my back. I tried acupuncture, more spinal shots, a lot of booze, none of it worked. So, Dr. Sarno, this quirky, unorthodox physician was, I thought at that time, during my twenty-fourth year, my last shot.
I landed in his office via my father who called that summer to tell me about a book I needed to read. Always interested in book recommendations and in my father’s phone calls, I listened. It was called The Mindbody Prescription. When I asked him where he’d heard about this book, he paused. Stern, he said quietly. As in Howard? I asked. Yes, that’s right, he said defensively. Supposedly, Stern’s back pain had been cured by Dr. Sarno and he was proselytizing over the radio in between boob measurements and insults. It offended me that my dad was a loyal listener to a guy whose brand was based on demeaning and sexualizing women. If I were to take Stern’s recommendation, was I not approving of his misogyny?
I kept my comments to myself and contacted this Dr. Sarno.
My letter was long and melodramatic, and could have been confused for Brontë fan fiction (first line: “I am 24 years old — my demise began when I was 17.”). I told Dr. Sarno I was skeptical of his theories, but desperate enough to hear him out. Within weeks, his assistant called to set up my first consultation at NYU’s Rusk Institute of Rehabilitation Medicine on East 34 th Street. Much to my frustration, he declared that all of the extreme measures I had taken for relieving my pain were useless. He explained that part of my problem was that I suffered from “goodism”: the need to be good and nice, the attempt to be perfect. Good? Maybe. Perfect? Hell no.
After our discussion, I entered Phase Two of the program, a large group seminar that seemed a funky hybrid of what I imagined a marriage counseling session and an AA meeting and a pop-up revival would be. I was the youngest attendee by at least fifteen years and I was also one of the few who arrived alone, without a spouse or partner serving as support. Had I known how vocal and diehard the spouses were going to be — they testified that they were benefitting residually from their partner’s rage work, as in allergies were cured, joint pain cured, tennis elbow cured — I would have brought a date. I knew a lot of men in the city who needed healing, though none of them as far as I could tell had a problem with expressing anger. Their problem was the opposite. Call it Dickhead Disorder.
I made it through this initial session without being called out or called on. I was on the edge of buying it all, suiting up and diving into the deep waters of my seething subconscious, some Grendel-like lair where my rage lurked, if it lurked. Maybe back then I thought I had a lot to be angry about — a cheating boyfriend, soul-sucking jobs, a city I couldn’t afford on my own — but it was pretty standard fare and none of that angst was repressed. Phase Three of the program involved small group work (aka therapy). Despite my discomfort with opening up to strangers about my private life, I was willing to try until Dr. Sarno detailed the next steps of our rage-seeking journey, which included purchasing his second book. We were instructed to read it a few times before we could move on to Phase Three. As soon as I heard buy my book, I bailed. Bailed from Dr. Sarno and, eventually, from New York. I left the city and fled to a small woodsy town outside of Boston where I knew no one, rented a studio apartment from a middle-aged couple, got another cubicle job to pay the bills, and started writing. Sarno and Stern appeared briefly in my first published piece of fiction.
I appeared a disciplined and subdued character.2
The word “paroxysm” appears in Jane Eyre (and many other novels of the period) and is used to describe an emotional, sometimes violent, outburst — a fit. Paroxysm is also a medical term and describes a “sudden attack or increase of symptoms of a disease (such as pain, coughing, shaking, etc.) that often occurs again and again.” Perhaps these 19th century paroxysms weren’t strictly emotional; perhaps they were physical, some outward manifestation of inner pain. Jane appeared a disciplined and subdued character because she was good at faking it, at refusing anger; she could have suffered from TMS too. All that oxygen Rochester was sucking for himself had finally gotten to Jane. Maybe she experienced radiating leg pain, numbness, or tingling.
Like Jane, I was quiet, and appeared subdued; however, I absolutely did not believe I was content. I was all discontent. I could call the sudden, stabbing back spasms I was having paroxysms. And yet I was experiencing less of them while living alone in that New England town. Oxygen was not in short supply — this was Walden, by the way — and the physical tension in my back relaxed. I still experienced pain, but nothing like the electrocutions surfing in between disc L4 and disc L5 and the nerve pulses rafting joyously down my right leg. Curiously, as my back pain abated, I began to clench my teeth constantly, as hard as I clenched my fists in New York. Some nights I’d wake up and feel as though my mouth was a vise, and my brain was unable to convince my jaw to unlock. I went to a dentist for the pain and he diagnosed TMJ — temporomandibular joint syndrome — and said I was grinding my teeth while sleeping. It would be years before I learned that Dr. Sarno considered TMJ as one of many soft tissue disorders caused by TMS. I had convinced myself that New York had been the problem — not methat the city had produced my pain and by leaving it I would feel better. I went from being surrounded by millions of people, performing my goodness, to being completely alone, having no one to be good for. But the pain seemed to be moving around my body while the anger settled like ashy sediment.
So they’ll like you.3
Had I stuck with Dr. Sarno, I may have been part of the 8590 percent of patients he claimed he cured (10-15 percent would need psychotherapy). Had I stuck it out, I would have been making a lot of lists. A critical part of the program involved dedicating time each day to thinking about the potential causes of our repressed rage and writing them down in a series of lists. The act of writing was, therefore, an act of accessing and announcing anger. There would be a list about my childhood, my TMS personality traits (i.e. perfectionist, overly conscientious, people-pleaser, chronic caretaker), about life’s pressures, and even a list about the things that might remind me of my own mortality. I refused to make those lists because I didn’t believe there could possibly be anything from my history that would cause my brain to protect my emotional welfare. What could justify my anger, I wondered. The question remained unconsidered until I met Claire Messud’s Nora Eldridge.
Nora’s narration, at times, seems a compilation of Dr. Sarno’s lists, all the things that piss her off: her “carefully ordained” childhood, the constant pressure to be good and predictable and nice, her aching desire to be an artist. In interviews and readings, Claire Messud has talked about how liberating it was to write a book that might seem unacceptable to people because it features an unapologetic angry woman ranting about her life. Reading Nora’s rants was liberating for me because they normalized her anger (and, eventually, mine).
Nora had experienced no extraordinary trauma, but she had muted her responses to troubling events — disappointments in love and career, a death of a parent, betrayal by a frienduntil she couldn’t turn off the noise in her head. In fact, she practically combusts. I’d love to ask Messud if Nora previously suffered from any physical ailments — back pain? carpal tunnel? eczema?–before spewing her anger in gorgeously brazen rants. Nora’s relationship with her parents had me thinking more critically about my own.
You sit quietly where I have placed you.4
My father’s temper was legendary, highly flammable, anything and everything set him off. As kids, we feared these outbursts — paroxysms, really — but as far as I remember, his anger was never truly, existentially threatening. Rarely did we volley with him, respond to his anger with our own. That’s not true. My middle brother did, but since there wasn’t enough space for both of them, my brother was sent to boarding school. My father’s anger was commonly triggered by the act of waiting. Waiting for anything seemed a personal affront to him: waiting to place an order, waiting for the mail, waiting in traffic, waiting for the red light to turn green, waiting for his Scotch, waiting for his golf swing to shape up, waiting for his mother to speak to him again, waiting for traffic to clear, waiting for an email response, waiting for the Cleveland Browns to win a game, waiting for the drawbridge to open, waiting for the morning train to take him into New York and then waiting for it to take him home, waiting for the airlines to offer Coke not Pepsi, waiting to have our undivided attention, waiting for that goddamn car to keep right except to pass.
He kept a handmade sign in his car, sheathed between his seat and the emergency brake. When my brothers and I were still condemned to the back seat, we’d nudge each other when we thought Dad was about to draw the sign as if a concealed weapon. I don’t remember how long he’d wait for the car ahead of him to get over to the right lane, but he’d get awful close to the rear, maybe honk, and if there was no timely reaction, he’d cross over to the right lane and — with wild hand-maneuvering — somehow roll down his window and flash the sign: KEEP RIGHT EXCEPT TO PASS. His rage was not limited to the road — there was airplane rage, restaurant rage, grocery store rage, Beach Boys concert rage, Mets game rage — but it was the only location that got its own placard. I imagine him standing at his workbench, a pencil behind his ear. He’d use a ruler to measure the cardboard and a box cutter to slice it, stencil each capital letter with a pencil first, then go back over it with a red marker. Finally, he’d laminate that sign with clear packing tape.
As adults, we learned to ignore this anger, eventually laugh at it, even mimic it when his gestures — pacing, head in hand, biting lower lip — became material for family charades. But that anger took up a lot of space, and we were trained to accommodate it. My mom accommodated it for forty-three years, though she was no pushover when it came to us. As the Punisher-In-Chief, my mom could inspire fear. Her anger was mostly the silent kind: her cold shoulder was downright arctic. Dr. Sarno would tell my mom that her insomnia was the result of all that repressed anger.
My revolt was silent because I had a lot to lose. I accommodated my father because I was on the dole, a private, exclusive one that required a discrete phone call to let him know how much I needed. I’d listen to the obligatory warning about credit cards and interest rates and living within my means, and then I’d handwrite a profusely thankful note about my gratitude. My mom was on the dole too, and I wanted her to shun it even though she had far less opportunity to do so than I did. I wanted her to tell my father to stop listening to that dirtbag Howard Stern and hand over the checkbook.
I’ve been angry about the lack of choices my mom had, and the strict gender roles my parents adhered to. I suspect I might have been resentful about those roles sneaking their way down to me and my older brothers and terrified they would infiltrate my future. Birth order had something to do with our roles, but gender was far more responsible for the disparity: my duties were largely restricted to the inside of the house, to the domestic. My brothers got into trouble more because my parents expected more from them back then. Boys became men by stepping up; girls became women by stepping aside. As much as the double standard pissed me off, I still benefitted — I got a loving, attentive mother who gave me everything I needed. I couldn’t have it both ways — complain about the inequity and cash in. I think I was mostly pissed off at myself.
I should have warned my mom about all those years of being the dependent, about having no backup plan. But my imagination failed me: I never thought that after forty-three years my father would leave her and not the other way around, and leave her for a woman he had dated when he was seventeen. Or, maybe it wasn’t my failed imagination, but my accommodating nature that misled me. In exchange for silence, I got a college education, a car, credit card debt relief, a wedding reception. And I got two sessions with Dr. Sarno.
After he left, I didn’t speak to my father for six months. My silence may have been painful for him, but evidently it was hurting me more. Soon enough I began to feel a familiar ache in my lower back, like a small brick had fumbled its way down my spine and nestled into the old stomping ground between its favorite discs. When the arrows starting shooting down my leg, I got another spinal injection, which essentially delivered a steroid punch to the inflamed area of the spine. Dr. Sarno would not have been pleased by my decision. Old habits, Evan, he might have said, you’re ignoring the anger in the room. So, I wrote a fury-filled letter to my father, which now I see as another accommodation because he could decide when to read it, if at all. By the time we spoke in person, time had diluted my fury. I missed my dad and I wanted my kids to have a grandfather in their life. Jane was partly right when she said that time hushes rage. It does for some. Time had not hushed my father’s rage and he still consumed most of the oxygen in the room, just with a different woman by his side.
I left that wooded town after several months when my future husband convinced me I was one month shy of losing all verbal and social skills. Over the ensuing years, I experienced periods of relief, but not when I sought it. Wellness seemed to accompany contentment. No pain during our courtship, no pain when I was in graduate school, no pain when I was teaching, and only growing (huge) pains when I was pregnant. The joints began bothering me in 2013, mostly in my hands. Initially, I thought it might be stress-related because I was teaching full-time, parenting three children under the age of six, and preparing to move our family from Washington, D.C. to Philadelphia. The pain would come and go, but at times it was so severe that I had trouble twisting off bottle caps and buttoning things. Blood test results were fine, but I feared some creeping disease and went to see a rheumatologist who ordered a full body bone scan in the beginning of 2015. The scan revealed a very healthy frame, so the doctor chalked up my pain to fibromyalgia. I thanked him for his time, quickly dismissed that diagnosis, and told my husband not to mention this bullshit disease to anyone. I thought it made me look weak, too feminine and fragile, maybe even a liar. Had Dr. Sarno crossed my mind back then, had I stopped to think about my pain and its relationship to anger, I might have saved myself from years of consultations, tests, and worry.
I’m not a girl anyhow, I’m over forty fucking years old.6
My father died two years ago. I loved him — charm and wit and compassion softened his temper — but I depended on him; I don’t know if I accommodated his anger, his flaws, his wrongdoing, because I loved him or because I depended on him. Probably both. Maybe my mom accommodated him for the same reasons, except she was made to believe that she didn’t have any alternatives. I should have demanded more room, I should have taken my fair share of the oxygen, I should have told him how much his constant anger pissed me off. Hell, I should have recommended he write his own goddamn lists. Maybe he had repressed some anger too, which created conditions within his body that encouraged the stroke that eventually killed him. It’s unlikely he would have changed, at least not for very long, but I think he would have at least heard me out. Who knows, Howard Stern changed.
Like Nora, I “put up with my parents’ shit and my brother’s shit.” I foolishly believed the reward for my silence would be worth it. It’s not that I never felt anger or expressed it, it’s that I had been trained to weigh the risk-reward. I’m told I’m soft-spoken — literally–people can’t hear me. I’m starting to think that’s not a genetic trait, but a strategic one, because it’s easier not to be heard, to choose quiet over trouble. Except that quiet is causing me physical pain.
The last time I saw him, my father was in a nursing home. The bleeding in his brain impacted his ability to talk, walk, and eat, but was no match for his temper. The staff got an hourly dose of it. There was no dignity in dying there. Finally, I could understand his anger. It was December, that month bloated with myth. I brought contraband with me — Good and Plentys, his favorite candy, and a thermos of warm chipped beef, a culinary Christmas tradition, one I always found disgusting and each year had happily handed over my portion to him. I wheeled him out to the screened patio and begged one of the kitchen staff to toast the two slices of bread I brought. After a long wait, I slopped the now cool chipped beef onto the barely toasted bread and fed my father, hoping this food, this communion, would bring him back to happier days. It was disastrous — not tasty at all, so hard to eat, and a reminder not of the early days but of this day, of where he was, of who he was. He was frustrated, but subdued. When I got him back to his room, we waited for the staff to get him into his bed. Exhaustion, maybe resignation, had overtaken any anger about all the waiting. Finally, once settled in bed, he began to mumble. I told him to slow down and try again. “I fucked up,” he stuttered. “I’m so sorry, so sorry.” I hugged him gently as he wept, and I stayed quiet this time not so I could collect on anything, but so I could give him something.
Like the sun’s fire in me.7
While maybe not mainstream, Dr. Sarno’s practice has helped (some say cured) a lot of people suffering from chronic pain. His work has influenced research in the field of mindbody medicine and inspired medical skeptics to reconsider their approaches to treating pain. A website dedicated to Dr. Sarno (www.thankyoudrsarno.org) publishes thank you notes and personal stories from believers, one as recent as August 2021, four years after Dr. Sarno’s death. There are confessions and eulogies, even poems and pictures. Many write about dark days leading to light and what sounds like rebirth.
Jane and Nora led me down the stairs, to the basement, and they compelled me to lift those heavy boxes out of the way to find my own buried anger. As I studied Jane’s instinct to turn from anger and Nora’s way of embracing it, I discovered my own pattern. I finally connected the dots: this roving painfrom my spine to my jaw to my fingertips — is a result of accumulated, buried anger. I see a constellation, where each point represents a moment of crisis that alerted my brain it was time to send in the pain brigade. Those spaces in between the dots were periods of time when I was sublimely happy or intensely focused and my pain was practically negligible. Over my dark sky, I trace the starry Phoenix, only visible in the southern hemisphere. I may not be able to see the celestial firebird from where I live, but I know it’s there, telling me it’s time to breathe my fair share of the oxygen and then fucking scream.
“Time quells the longings of vengeance and hushes the promptings of rage and aversion.” -Jane Eyre, Jane Eyre ↩︎
“I had given in allegiance to duty and order; I was quiet; I believed I was content: to the eyes of others, usually even to my own, I appeared a disciplined and subdued character.” –Jane Eyre ↩︎
“When you’re a girl…you put yourself down whenever you can so that people won’t feel threatened by you, so they’ll like you.” -Nora Eldridge, The Woman Upstairs ↩︎
“Well, Jane; not a word of reproach? Nothing bitter — nothing poignant? Nothing to cut a feeling or sting a passion? You sit quietly where I have placed you, and regard me with a weary, passive look.” -Mr. Rochester, Jane Eyre ↩︎
“Millions are in silent revolt against their lot…Women are supposed to be very calm generally: but women feel just as men feel; they need exercise for their faculties and a field for their efforts as much as their brothers do.” -Jane Eyre ↩︎
“I’m a good girl, I’m a nice girl, I’m a straight-A, strait-laced, good daughter, good career girl, and I never stole anybody’s boyfriend and I never ran out on a girlfriend, and I put up with my parents’ shit and my brother’s shit, and I’m not a girl anyhow, I’m over forty fucking years old.” -Nora Eldridge ↩︎
“I’m angry enough…with a great boil of rage like the sun’s fire in me — before I die to fucking well live.” -Nora Eldridge ↩︎