Q&A With Dr. Howard Schubiner and Dr. John Stracks
Video: Watch the full session here →https://www.youtube.com/watch?v=B8irWffqftY
Introduction
Dr. John Stracks: Welcome, everybody, to this Cormendi Health webinar. I'm Dr. John Stracks, here in my office in Chicago. I'm here with Dr. Howard Schubiner, who is in his office in Pleasant Ridge, Michigan. Dr. Schubiner joined our practice a couple of weeks ago, so he's been seeing patients, and we are thrilled about that. We scheduled this webinar as a way to both talk about his movie, This Might Hurt, and answer the questions people write in. We'll be here for the next hour chatting and answering questions. If you have questions, feel free to type them into the Q&A button — we can see those starting to come in already.
Howard, as we get started, first of all — I'm thrilled. Did I mention that I am thrilled that you are working with us?
Dr. Howard Schubiner: Me too. Me too. I was out in the cold.
Dr. Stracks: But we are just so excited to have your expertise, and for people to be able to contact you — and not just people in Michigan, but people from all across the country at this point. So, to celebrate your joining us, we sent everyone the link to This Might Hurt, and a number of people have watched it and have questions about the movie. Feel free to type those into the question-and-answer box. But let's talk about the movie for just a few minutes as we get started. How did that project first come together? How did Kent Marion first contact you about it?
Dr. Schubiner: Well, Kent wanted to make a film after his own personal experience with pain — reading one of Dr. Sarno's books and getting better, and then having pain pop up in lots of other places. That was before he went to film school. He went to film school, became an editor, and then had this nagging idea to make a documentary on this process. He called Dr. Sarno and said, "Dr. Sarno, can I make a movie about you?" And Dr. Sarno said no — I think he'd already had a movie made about him by Michael Galinsky. So Dr. Sarno told him to call Fran Sylvan Anderson or Eric Sherman. I believe he called Fran first, and she said, "You should try Howard." So he called me and asked if I wanted to have a movie made with my patient cohort, and I said that would be fine with me, but did he really think my patients would want to be in a movie? He said, "Well, why don't you ask them?" So I said okay — brilliant idea. I was running groups at the time, so I sent an email to the people in an upcoming group, and they all said yes. So we did it.
That was before Marion Ross Films got fully involved. Kent came to Detroit, hired people for sound and lighting — I don't know all that movie stuff — and we just shot it. He filmed the group members, and a few people became the main characters as the story developed. That was it. Then it took him seven years to edit it.
Dr. Stracks: But it's been out for a number of years now, right?
Dr. Schubiner: Yeah, it debuted at the South by Southwest Film Festival. Then COVID hit and there were no more film festivals for a while. Since then, it's been shown at a few film festivals and mainly streamed to groups — health institutions, some medical schools, professional associations, and Patient Advocate groups across the world. They just had a showing in Belgium — that was fun.
Dr. Stracks: Nice. And your patients ultimately liked being in the film?
Dr. Schubiner: I think they did. There was one woman who didn't love being in the group — I don't know if that had much to do with being in the film or not — but I think, overall, they felt special. I know I felt special.
Dr. Stracks: It's really well done, and I think it nicely captures how you work with people, how we work with people, and these ideas. Anything that helps this message reach a wider audience is worth doing.
Dr. Schubiner: Yeah, they were. Ken was particularly interested in the emotional-processing work, so a lot of the film focuses on that — we didn't focus as much on the writing exercises, the meditation work, or the piece about lowering fear and rewiring the brain. There was some of that, but he felt the emotional work made the film more engaging and compelling, which makes sense.
Dr. Stracks: Good. Well, I'm glad — we got a lot of good feedback from people who were able to watch the movie and hadn't seen it before. We were thrilled to offer people the chance to see it and see how you work, and how that group worked. Very glad people could access it.
We have about 10 questions that have already come in, so let's start working through them — whether people have questions about the movie or Mind-Body medicine in general. We'll answer as many as we can over the next hour. For those of you watching, feel free to keep typing questions into the Q&A box.
When Mind-Body Techniques Aren't Working Right Away
Dr. Stracks: The first couple of questions are about what to do when people understand the concept, try the work, and aren't seeing much improvement. What do you see among people who try this and it's not working as well as they'd like?
Dr. Schubiner: When people aren't coming around — their symptoms aren't improving right away, or even after several months — I want to go back to the basics. Do we have the correct diagnosis? Have we done a full assessment? Has no stone been left unturned? Are we sure this is a mind-body condition — and more importantly, are they sure it's a mind-body condition? Because if there's doubt, and I've seen several people in just the last couple of weeks where there's still some doubt in their mind, that gets in the way.
So it starts with going back to the neuropsychological education, really understanding predictive processing, and making sure people truly understand that the brain is powerful enough to produce these symptoms — because often the symptoms are so overwhelming that it's hard for someone to see them as brain-based. That leads to the second common problem: fear. Continued fear, continued focus on the symptoms, continued frustration, fighting them, trying to figure them out — all of which feed the danger signal.
That leads to a third issue: trying too hard. We see that a lot, and sometimes people need to take a break from trying to fix themselves and instead work on what I call the "outer journey" — their life — instead of trying to fix the problem. And some people have underlying issues — life trauma or other sources of fear. I saw a woman recently who had a ton of fear around her pain, but when we talked, there was also a ton of fear rooted in her childhood. That was another thing pointing to something that might need to be addressed.
Dr. Stracks: What are the "six F's" you mentioned?
Dr. Schubiner: The six F's are: fear of the pain or symptom, focus on it, fixation/monitoring — paying constant attention to it, fighting it, frustration with it, and figuring it out — trying to solve it over and over, every minute of every day. And finally, fixing it. Those are some of the things that drive the danger signal in this vicious cycle.
I also find, when I talk with people who are stuck, that if I ask, "What do you think the pain is doing there?" the answer is almost always "I don't know." So I find it helpful to reframe: the pain is not the enemy. Pain isn't trying to ruin our lives — it's trying to protect us. Pain is a protector. It's significantly helpful if we can figure out where the protection is needed, and then figure out how to get that protection in other ways besides pain. That ties into being frustrated and trying to "fix" it — once we understand nothing is broken, and this is just our brain trying to provide protection, we can figure out how to work with the pain.
Dr. Stracks: Is there a message being sent — something happening in our lives that we need to change, or a way we're treating ourselves that needs to shift?
Dr. Schubiner: Yes — the "if" question I like to ask is, "What would your pain be worried would happen to you if it wasn't there — if it wasn't 'protecting' you? What's it preventing?" There's a lot of insight down that road.
Why Relapses Can Feel Harder Than the First Time
Dr. Stracks: Next question: "I'm dealing with a relapse, and it feels harder than the first time. Why?"
Dr. Schubiner: Usually what happens is people got better quickly the first time, and when symptoms come back, they're surprised — they think, "I already know about this, that should be all it takes." They do the same thing they did the first time and it doesn't work right away, which triggers fear and spiraling. It's not necessarily more difficult — TMS/mind-body symptoms can always recur — but people don't expect it, or they're afraid when it happens, and they may need to go a little deeper into the issues we just discussed.
Dr. Stracks: I interviewed a patient named David Holmes a few years ago. David first learned about this about 30 years ago — he's an attorney here in Chicago. When he first learned about it, he was better in about two days. He'd read Dr. Sarno's book, gave it to his mother-in-law, and then a few months later the pain came back. He'd forgotten how he got better the first time, and he was preparing for a life of pain and no movement. Then he remembered — he describes it dramatically, crawling across the room to his computer because he was in so much pain, pulling up Dr. Sarno's website, and starting to relax. But that second time took him months to get better, because that's when he really recognized what was going on underneath — some family issues and childhood issues he needed to work through. I've heard similar stories from other patients: the first time seemed easy, and the second time is when they really recognize what's driving the symptoms.
Pelvic Pain and "Tight Muscles" After Surgery
Dr. Stracks: "I've had pelvic pain for 13 years after surgery, and physical therapy says my muscles are tight. What can I do?"
Dr. Schubiner: People often ask, "Is it the fascia? The muscles? The ligaments? Has something been damaged?" There's no injury that doesn't heal — acute injuries heal. So when you have pain for months, or 13 years, after a surgery, the injury has healed. Why are the muscles tight? Because the brain is making the muscles tight. It's not that the muscles are damaged or diseased — trying to fix the muscles is missing the point, and it puts more attention on that part of the body, which can sometimes make things worse. If it does help temporarily, the muscles relax, but then it comes back because the underlying danger signal in the brain tightens them again.
There's a well-known study by Lorimer Moseley on back pain, examining in detail which muscles were tight and which were painful. In some places, muscles were tight with no pain; in others, there was pain with no tightness. The correlation between muscle tightness and pain wasn't really there.
Dr. Stracks: So what strategies help, given there is muscle tension?
Dr. Schubiner: It's no different from approaching any other mind-body condition — back pain, pelvic pain, neck pain. We're not making the tightness the issue, because nothing is actually broken. It's about widening the lens: what's going on in your life, how can you calm the brain and lower the danger signal? That's the work — in my books, in the podcast, it's all there. It's the same process regardless of where the symptom shows up. Someone told me today they had pain moving from place to place, and then all the pain went away — but then they got really depressed. Is that a different thing? No — it's the same underlying issue, just a different manifestation.
Dr. Stracks: I just finished with a patient whose pain got better and now he's anxious.
Dr. Schubiner: Exactly — same underlying issue, different manifestation.
How Long Does Recovery Take?
Dr. Stracks: "Do you see more change one year post-treatment, or five years post-treatment?"
Dr. Schubiner: Everyone's different. In terms of life changes — those keep evolving. I was talking to someone today about personality traits: perfectionism, being hard on yourself, never feeling good enough, feeling guilty. Those are lifelong issues to work on. It took me a long time to feel "grown up" — I didn't learn to say no to people, or stand up for myself, or stop caring what others said, or allow myself to make a mistake without beating myself up, until I was in my 50s. It takes time. There's a message in the symptoms — a gift, in a way — and that can be hard to see, especially when someone is in a lot of pain. But if you can find the meaning, it can take years to do that work and change how you relate to yourself and others.
Dr. Stracks: Everybody has their own pace. We've seen people get better in a couple of days, and people get better over a couple of decades — everywhere in between. We interviewed Jody Prado a couple of years ago, and Jody improved about two percent a year for four straight years. Four years sounds like a long time, and she struggled with it, often asking, "Why am I not better yet?" But now she messages me a couple of times a year saying she can't believe how much better she is. Sometimes it can seem slow, but people keep improving for years after they start this work.
Dr. Schubiner: I saw a man recently — it took him two years, but he got better. It was a lot of work.
Fatigue as a Mind-Body Symptom
Dr. Stracks: Let's talk about symptoms beyond pain. What about fatigue?
Dr. Schubiner: One of the fascinating things I've learned in recent years is that when you catch a viral infection, the virus itself causes sneezing, runny nose, cough, or pneumonia — but the fatigue you feel is not caused directly by the virus. The fatigue comes from the brain's warning system telling you to slow down and rest so you can recover. It's shocking to people, because fatigue is such a powerful sensation, yet it's being generated by the brain. There are a few genuine medical causes of fatigue — hypothyroidism, hypogonadism, severe anemia, severe congestive heart failure or lung disease, and so on. But for most people, those aren't present, so we treat fatigue the same way we treat other mind-body symptoms. With long COVID, we've seen a lot of fatigue — and a lot of people get better doing this work.
GI Issues, Food Intolerances, and Bloating
Dr. Stracks: What about GI issues — food intolerances, bloating, stomach pain — where all the tests are normal, and other symptoms have resolved but not these?
Dr. Schubiner: I saw a woman today with exactly that — many different stomach symptoms, all tests normal. When the tests are normal and the symptoms are varied like that, the brain can produce any and all of them. One thing we always do is look for what I'd call "ruling in" a mind-body or neural-circuit problem — paying special attention to the variability of symptoms, the details, the way they shift, move, turn on and off, and the fact that they're triggered by innocuous stimuli. Today I saw a woman with GI issues triggered by several foods, including coffee. I had her close her eyes and simply imagine a coffee cup in front of her — not even drinking it — and she started getting pain and burning in her throat just imagining it. That's a powerful demonstration that it's not the coffee itself — it's the brain's fear of the coffee.
What Percentage of Pain Is Structural vs. Neuroplastic?
Dr. Stracks: People ask this all the time — what's your thinking?
Dr. Schubiner: Everybody needs a proper assessment, diagnosis, and medical testing. But broadly: take headaches — at least 95% are what we call primary headaches (tension headaches, migraine, occipital neuralgia, chronic daily headache, etc.), which are neuroplastic. Fibromyalgia — 99% of the time, once disease is ruled out, it's not something else. Irritable bowel syndrome, pelvic pain syndromes, vulvodynia, interstitial cystitis, pudendal neuralgia — very little of that is structural. We recently completed a study on back pain where a colleague evaluated 220 consecutive people with chronic neck and back pain using our diagnostic model, and 88% were non-structural — a very high number, and one that would surprise many doctors.
Dr. Stracks: We just wrote that up and submitted it to a journal — I found out today it was rejected without even being reviewed.
Dr. Schubiner: Ouch.
Neural Circuit Retraining vs. Emotional Processing — How They Connect
Dr. Stracks: You can retrain the brain, lower fear, and decrease attention — but you can also release emotions. Different techniques — how are they connected?
Dr. Schubiner: They're related to different processes to a large degree, but the connection is fear. The woman I mentioned earlier had a lot of fear in childhood and a lot of fear now — the childhood fear relates to family issues, and the current fear relates to the pain. There's a real connection there. We want to address the fear of the pain, but part of that fear traces back to fear that developed earlier in life.
Another way to think about it: on the neural-circuit/pain-reprocessing side, we want to lower fear of the symptom. On the emotional-processing side, we want to lower fear of emotions — recognizing anger, guilt, or sadness as normal instead of something to fear. Pain is all about fear — when the brain senses more danger than safety, pain is a potentially "appropriate" response. Part of our job is figuring out where that fear is coming from. If it's coming from the pain itself, lowering attention to it and building comfort with our body is the right approach. If the fear comes from emotions we don't let ourselves feel, we need to work on that. If it comes from harsh self-talk, we need to work on self-compassion. Getting a sense of what feels dangerous to you specifically — since that differs person to person — is key.
Following Up on the Film: What Happened to Tony?
Dr. Stracks: Someone's asking about Tony from the film, who had such severe leg pain.
Dr. Schubiner: I've stayed in touch with him over the years, off and on. His life hasn't been easy — you see at the end of the film he's delivering pizzas for a one-cent tip, and things kept happening in his life. But I believe he's doing pretty well now — he's grown up, he has a child, he's making his way. I don't know exactly how his leg is, but the movie was genuinely sad in relation to his story. He's a great kid with a big heart, and my sense is he's doing reasonably well now.
Dr. Stracks: The same person mentioned she's very much looking forward to the sequel.
Can You Recover Without Doing Emotional Work?
Dr. Stracks: "Can you recover without doing any of the emotional work, outside of reducing fear?"
Dr. Schubiner: Yes, absolutely — happens every day. Not everybody needs emotional-processing work, even if there's emotional material underneath, because what may be driving the pain right now is fear of the pain itself.
Dr. Stracks: Do you have an example of someone who only worked on reducing fear and got better?
Dr. Schubiner: Read the book — pain goes away for hundreds of people that way. That's why Dr. Sarno's books are still outselling almost anything from the current generation of authors on this topic.
Dr. Stracks: We were talking earlier today about Ezra Klein — people flooding him with Dr. Sarno's books. For those watching who don't know, Ezra Klein runs a podcast at the New York Times, one of the top 100 podcasts in the country. Today he had Rachel Zoffness, a pain psychologist in San Francisco, on as a guest, and they had a really nice discussion about Mind-Body medicine and how pain is about danger, not damage. She explained it really well. It started because Ezra, who's in his 30s, began complaining about neck and back pain on air a couple of years ago and got flooded with Dr. Sarno's books. It sounds like it's been helping him feel better. If you have access to the Times or Ezra's podcast, it's worth a listen.
Has Mainstream Medicine Become More Accepting?
Dr. Stracks: Since the film came out, has there been more acceptance of these practices by mainstream medicine?
Dr. Schubiner: I don't know that it's specifically due to the film, but over the last couple of decades — John and I have both been doing this for 15 to 20 years now — there's definitely been more acceptance. The word is getting out, but there's a long way to go; mainstream medicine is a huge institution, and turning that around takes a lot of work, time, and effort. But we're definitely moving in the right direction.
Dr. Stracks: I was telling someone earlier — do you remember the conference we did in Ann Arbor in 2009? We invited every practitioner we knew who might be interested, and 30 people came, which felt amazing at the time. We spent the day together and had dinner. But now — most people here know the Curable app — they have a Facebook group for practitioners with thousands of members. The number of practitioners interested in this work has grown by at least a hundredfold in the past 15 years. There are now more than a couple thousand practitioners across the country. There are still people who don't understand it, but interest has grown exponentially, and our goal is to keep that growth going.
Reflux, Cancer, and Autoimmune Disease
Dr. Stracks: A few other conditions worth touching on: reflux, cancer, and autoimmune disease.
Dr. Schubiner: On reflux — I think most reflux symptoms are mind-body related. You can certainly have reflux as a genuine issue, but in cases where antacids or PPI medications control it, that's more straightforwardly medical. When reflux persists and worsens despite medication, and testing shows only mild reflux, it makes much more sense as a mind-body condition.
Dr. Stracks: I've seen data suggesting nearly everyone technically has some reflux into the esophagus, but not everyone has symptoms — similar to disc findings in the back, which are common but don't always cause pain.
I'd put cancer in a different category — what about you?
Dr. Schubiner: I agree. If you read Gabor Maté's writing, he's noted personality traits he associates with cancer patients, and in his work he's discussed a cancer patient using ayahuasca as remission occurred — there are certainly documented spontaneous remissions, and the immune system's relationship to cancer is well established. But in general, cancer doesn't fit the typical story, timeline, or characteristics of mind-body disorders — it occurs in babies, at all ages, and its incidence increases with age. There's no reliable evidence that changing your mindset cures cancer. I've worked with many cancer patients using meditation, and many have used the diagnosis as a catalyst to focus on what matters — which is valuable — but I wouldn't broadly call cancer a mind-body condition.
Dr. Stracks: And autoimmune disease feels like it sits somewhere in the middle.
Dr. Schubiner: Definitely in the middle. There's a whole field called psychoneuroimmunology — the brain's well-documented effect on the immune system. Autoimmune disorders have responded fairly reliably to mind-body treatments in some cases; it's a good example of combining medical and mind-body treatment. I was talking to a woman yesterday whose husband had ulcerative colitis and did mind-body work — he's doing well now. There's no question mind-body work can help with these conditions, though they also often have a real structural/immunological component.
When Is Back Surgery Actually Necessary?
Dr. Stracks: How do you know when it's time for back surgery?
Dr. Schubiner: I'd point people to Dr. David Hanscom's book, Do You Really Need Spine Surgery? — it's a very good resource. In general, back surgery for back pain alone is often not a good idea. Surgery for severe pain radiating down the leg, associated with clear neurologic signs and a disc that corresponds to the symptoms, can absolutely be appropriate. Dr. Hanscom himself wouldn't operate unless he saw a lesion that matches the person's symptoms.
Coming Off Medications and the Nocebo Effect
Dr. Stracks: What about transitioning off a medication like venlafaxine, when symptoms pop up during the taper?
Dr. Schubiner: I generally don't recommend weaning off medication until people are already feeling better, because starting to lower a dose can activate the nocebo effect — where the brain's fear that something will go wrong actually produces symptoms. Online, so many medications are portrayed as dangerous to taper that people wean off in the tiniest possible increments, and yet still get symptoms after reducing by something like one percent — a size of change that couldn't plausibly cause real physiological effects. That's the nocebo effect at work. I'm not against tapering — even tapering slowly — but I recommend people actively reassure themselves throughout the process, reminding themselves they're okay and will be fine. That kind of self-talk really matters.
On Lorimer Moseley's Approach
Dr. Stracks: Someone notes that Lorimer Moseley's questionnaire doesn't seem to emphasize the emotional side of mind-body medicine. Thoughts?
Dr. Schubiner: I love Lorimer — he's a hero of mine. He's done amazing pain research and a great job educating people about pain; I think very highly of him. That said, he's not particularly focused on the emotional side — his emphasis is more on neural-circuit and brain-rewiring concepts, which works well for a lot of people, but not everyone. I don't see any reason not to bring emotional work in as well, which is what we did in the film. He did ask my colleague Mark Lumley — with whom I've worked on Emotional Awareness and Expression Therapy — to write a guest blog post, which I thought was great. I think he'll come around.
We were talking years ago, when you were running one of your first emotional-awareness studies, and I asked how it was going. You said it was slow — hard to explain the emotional concepts, people were slow to get it. I said, "Of course they are — that's exactly why people have pain in the first place; emotions are hard to access." And you clarified you meant the therapists in training, not the patients. Emotions really are hard, and I think that's part of why they show up in our bodies — it's a very human, universal experience. I was at a training once with one of the foremost mind-body therapists in the world, and even he said, "Migraines? No, that's neurological" — meaning even people in the field can find it hard to accept how emotions play a role. The basic science shows emotions activate the same brain regions as a physical injury — so the power of emotions to produce real, physical, severe symptoms is just as strong as any injury. Even today, on that podcast, the guest said pain "can't possibly be only psychological — it's never only psychological." I've had pain that was only psychological, I can tell you that. People want a hedge — they want it to be biological.
Can TMS and a Real Medical Condition Coexist?
Dr. Stracks: Can you have mind-body symptoms and a genuine structural issue at the same time?
Dr. Schubiner: Of course — it happens, though it's not that common. I've seen it, and sometimes it's hard to tease apart. Some people have significant arthritis in their knees or hips and we're working to determine how much of the pain is structural versus mind-body. In the neck-and-back-pain study I mentioned, 88% were purely non-structural, 6% were combined, and 6% were purely structural. All pain and all illness is legitimate — but when you really dig into chronic pain with careful testing and evaluation, purely structural causes are less common than people assume.
Dr. Stracks: Part of what I've seen is that when a real medical issue is present and obvious, it's easy to miss the mind-body layer, or vice versa. David Holmes told a story on air about calling me with a big lump in his throat. Since he's very savvy about all this, I asked if anything stressful was going on — he'd just come back from his father's funeral. I told him we didn't have to be rocket scientists to see the metaphor, but he said the lump was really big, so I told him to come in — and you could see it across the room. We got it evaluated and treated, and he's fine now.
People also frequently worry about neurological symptoms and think they have MS. The times I've actually diagnosed MS, it's been obvious — someone unable to walk across the room without falling, or with a leg testing completely without strength on one side. When medical issues need to be identified, they're usually more obvious than we'd expect — and when it's more of a "maybe yes, maybe no," that leans me toward a mind-body diagnosis.
Sometimes things do get missed, though. I saw a patient with a 37-pound weight loss who'd had an EGD and colonoscopy but no CT scan of his abdomen — he and his wife were convinced it was mind-body, since he wasn't eating much because of pain. We ordered a CT scan, and unfortunately he had pancreatic cancer. It was a very dramatic, severe weight loss.
Dr. Schubiner: I talked to a patient this afternoon with a white blood cell count of 20 who'd been told it was "in her head." I said no — that level of count causes real inflammation, let's get that checked. Part of our job is listening and looking at the evidence. Two things I'm always asking: Is there a physical abnormality so significant that someone won't get better unless we address it medically? And is there a condition it would be irresponsible of us not to identify and treat? If I break my leg and call you, I don't want you telling me to just meditate for half an hour — I want it treated medically. None of us are perfect, but we're both experienced clinicians trying to figure out if something needs to be addressed.
Getting Evaluated Remotely
Dr. Stracks: How do you find someone who can help sort out structural versus mind-body — and can that be done remotely?
Dr. Schubiner: People can and should be evaluated by their regular doctors first. The question often becomes how to interpret results — for example, an EGD showing a hiatal hernia but a normal stomach and normal pH test. We can help interpret that from a distance. We don't have to run all the testing ourselves; if we can get the records and read a neurologic exam, we can make that evaluation remotely because we have the data.
Dr. Stracks: We're happy to help people get on our schedule and get evaluated — reach out to us at CormendiHealth.com.
Getting Worse Before Getting Better
Dr. Stracks: Do people tend to go up and down — get worse before they get better?
Dr. Schubiner: All the time. It's like a child having a tantrum — when you start to ignore it, it can get worse before it gets better. The danger signal in the brain is there to alert and message us, and if it's still worried, it may intensify at first. When it does, that's actually a good sign — it shows the brain is responding to the change in mindset, and it demonstrates a cause-and-effect relationship, which can help people feel even more confident they're on the right track.
When It's Both: A Hip Surgery Story
Dr. Stracks: Someone shared a story about working through hip pain as a mind-body issue, then discovering real joint deterioration — and once she knew surgery was the solution, her pain improved by 50% just from that news. Why is language around these "hybrid" situations so tricky?
Dr. Schubiner: Because we want certainty — black and white — and sometimes it's a shade of gray. I want that certainty too. But the reality is people are complex; there can be real tissue changes and a mind-body layer on top of it. Just because you have a physical disorder doesn't mean you can't also have a mind-body disorder alongside it. I saw a woman with MS who had additional symptoms that weren't actually attributable to the MS — she has MS, and we have to figure out what's MS and what's the mind-body component.
Addressing Skeptics
Dr. Stracks: What do you say to people who call this quackery?
Dr. Schubiner: People can say whatever they want — I've been denigrated, yelled at, called irresponsible. Everyone's entitled to their opinion, but we have randomized controlled trials showing the value of this work, neuroscience showing how the brain constructs what we experience through predictive processing, and thousands of people with documented improvement. Combine the anecdotal evidence, the neuroscience, and the clinical trial data, and I think it's clearly on our side.
Dr. Stracks: Who did the mindset research you mentioned — Alia Crum?
Dr. Schubiner: Yes — she did an interview with Curable, as we both have. One thing she said that stuck with me: we need to stop arguing about whether the mind is involved in physical symptoms — that data is settled. The real question is how we use this understanding to help people feel better.
Dr. Stracks: There are activists who deny the mind can ever affect illness, because the idea threatens them. There was a big piece by Natalie Shure in The New Republic about long COVID, followed by a response from a group of activists explaining why she was wrong, and then her own response to that. It's really a long-COVID "war" — with real financial stakes and a lot of people suffering. We're just doing what we can to make things a little better.
Small Fiber Neuropathy and Interstitial Cystitis
Dr. Stracks: What about small fiber neuropathy?
Dr. Schubiner: I've looked into that closely — small fiber neuropathy is, in my view, a mind-body condition. Many people have positive biopsies for small fiber neuropathy with no symptoms at all, and we've seen many people improve using mind-body techniques.
Dr. Stracks: Interstitial cystitis?
Dr. Schubiner: Same story. People think it's structural because you can find petechiae — tiny areas of bleeding — in the bladder, but that can occur with bladder distension even in people without symptoms. I generally consider it a mind-body condition.
Tension Headaches and Weakness
Dr. Stracks: What about tension headaches that include feelings of weakness in the arms or legs?
Dr. Schubiner: Tension headaches are mind-body syndromes. Weakness needs to be evaluated — is it true neurologic muscle weakness, or is it weakness in the absence of any neurologic disease? What we'd call "objective" weakness (confirmed on exam) versus "subjective" weakness. Subjective weakness without objective neurologic findings fits the mind-body picture.
Explaining TMS to Family and Friends
Dr. Stracks: How do you explain this to family and friends?
Dr. Schubiner: Even my own family doesn't fully buy into it, by and large. Dr. Sarno used to say: don't try to explain it to everyone — some people will just try to undermine you or argue with you. If you have someone you really trust who will genuinely listen, it's worth trying to explain. But trying to convince everyone who's going to reject it can be a losing battle.
Dr. Stracks: One of my patients has a nice approach — she tells people there's really good data at this point, references an evidence-based app, and sends the link. It's worth knowing what is and isn't our responsibility to explain, and knowing there are good resources to point people toward. Sometimes our patients want support from people they love, and that can work great — but sometimes it doesn't, and it's okay to simply say "I'm fine, how are you?" instead of getting into it.
Treating Depression With This Approach
Dr. Stracks: Can you treat depression this way?
Dr. Schubiner: Absolutely — as long as it's not due to a structural cause, like a thyroid or other hormonal issue. The research shows about 75% of people on an antidepressant have a good initial response within six weeks, and about 72% of people on a placebo have a similar response. When medication and placebo produce nearly the same outcome, that tells you this condition is treatable through a mind-body approach — harnessing the power of your own brain.
Numbness, Tingling, and "Neurological" Symptoms
Dr. Stracks: Would numbness and tingling be a mind-body issue, even though it feels neurological?
Dr. Schubiner: Very commonly, yes — small fiber neuropathy involves numbness and tingling, and a lot of people experience it. As long as the neurologic exam is normal — reflexes, muscle strength, sensation all check out — it's not truly neurological; it's neuroplastic.
Dr. Stracks: That's actually how I first discovered this field. Those of you who've heard my 2017 podcast interview with Curable know I developed strange neurological symptoms 25 years ago that nobody could figure out — I saw neurologists, hand surgeons, had EMGs done — nobody had an answer. It turned out nothing was structurally wrong.
Long COVID
Dr. Stracks: Let's talk about long COVID for a minute.
Dr. Schubiner: We've seen a lot of long COVID recently, and a lot of people recover doing this work. There's a great website, PositivelyCovid.org, that I'd recommend — Paul Garner, a British scientist, is featured there; he recovered from long COVID relatively quickly by changing his mindset. There's no evidence the vast majority of people with long COVID have ongoing disease — most had mild COVID, weren't in the ICU, weren't intubated, and don't have ongoing heart or lung disease. Once you set aside the smaller group with severe heart and lung damage, the virus heals, and the after-effects — headache, brain fog, trouble concentrating, fatigue, stomach pain, food sensitivities — are the classic mind-body symptom pattern we treat.
Dr. Stracks: There's even been discussion of tic-like symptoms spreading among teenagers after watching videos on TikTok — hundreds of cases in the last year. It's fascinating and a little horrifying, but real and well documented.
Dr. Schubiner: You could call it mass hysteria, which is a pejorative term, but I'm not sure what else to call symptoms that spread through contagious fear — and long COVID fits that pattern well. There was every reason to be afraid of COVID initially — it killed millions of people worldwide. But the damage the virus causes now is very different from the early pandemic, when it was attacking the lungs; now it behaves much more like a typical upper-respiratory virus. Still, the fear around it is enormous. Most of my patients say, "I'm not that worried about catching COVID anymore, but I'm terrified of long COVID" — the fear is right there in how they talk about it. The first two patients who came to me with long COVID had never actually tested positive for COVID — multiple tests, negative antibodies. That only makes sense if you understand this as a disease of fear.
Dr. Stracks: And once someone understands it that way, it clicks.
Dr. Schubiner: Exactly. One patient told me, after I explained it, "Wait — that's like that doctor from New York, the guy with the studies." I said sorry, I don't know exactly who she meant, but she said, "I love that guy — you mean I'm okay?" And yes, she was. And more broadly, if the message gets out that long COVID is a mind-body condition, it may start to fade — because at some level, people won't develop a syndrome they understand to be driven by the brain.
Dr. Stracks: For people who have it right now — what can they do?
Dr. Schubiner: Same approach as any other mind-body condition: use our websites, read the materials, use the apps, listen to the podcasts. There's a lot of material out there, including PPDAssociation.org (the Psychophysiologic Disorders Association) and TMSWiki.org, along with other practitioners doing this work — the underlying approach is the same regardless of the diagnosis.
Dr. Stracks: I had mono pretty badly in college. I came back to school as a varsity athlete and tried to exercise, and I just couldn't do it. I somewhere knew I was okay, but I couldn't quite find my way through it. I kept putting one foot in front of the other, kept doing the activities, and eventually got back to normal. It took a while, but when we recognize that what we feel in our bodies isn't a reflection of disease but of fear, worry, and uncertainty, we can keep taking those steps forward and trust that we're okay.
Dr. Schubiner: And it may take time — but most people have some kind of mind-body symptom at some point in their lives and recover from it, whether or not they ever realized that's what it was. We have a strong internal mechanism to heal and return to equilibrium.
Closing
Dr. Stracks: We've run a few minutes over, so we don't want to keep you from the rest of your evening. Thank you so much for joining us at Cormendi Health this evening — we got through 28 questions and still have 23 left, so we'll have to do this again sometime and keep helping people sort through this. Many of you are current patients; for those of you who aren't, please reach out to us at CormendiHealth.com, and we're happy to connect you with Dr. Schubiner, myself, or anyone else on our team.
Dr. Schubiner: Nice to see everyone — have a wonderful evening.
Dr. Stracks: Thank you all for joining us this evening and for your insightful questions. It's always an honor to be around a group of people brave enough to look at illness through this nuanced, insightful lens. I hope everybody has a good evening and a good rest of your week. Bye, everyone!
Cormendi Health specializes in mind-body medicine — helping patients understand and resolve chronic pain, fatigue, GI symptoms, long COVID, and other stress-related physical symptoms through neuroscience-based, evidence-informed treatment. To schedule an evaluation with Dr. John Stracks, Dr. Howard Schubiner, or another member of our team, visit CormendiHealth.com.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. Dr. Laura Burke is a certified health and wellness coach specializing in the social dimensions of chronic pain and illness. To learn more about working with Dr. Stracks or the Cormendi Health team, visit cormendihealth.com. You can find Dr. Stracks and Dr. Burke's first interview on the Cormendi Health YouTube page.