Dr. John Sarno's Commencement Address at Kalamazoo College

In 2000, Dr. Sarno visited his alma mater to give a speech about his unique journey in the medical world. Dr. Sarno himself left college in 1943 to serve in the US Army Medical Department during World War II. In his address to the graduating class of physicians, he shares that his patriotic drive during this time lead him to volunteer for the Air Corps, but his mind and body had other ideas. The title of his speech was "Stronger Than We Think."


A still from the documentary "All The Rage" by Rumor.

In this scene his daughter and Mrs. Sarno state that people approach him all the time saying "you saved my life". Dr. Sarno corrects her by saying "changed [their life]". He was a modest man indeed.

Thank you Dr. Sarno for all the lives you changed saved.
References

Transcript

As usual I have to bring these down. You know when I was here in school, if we didn’t hear that train whistle or if it didn’t go off that is in the middle of the night, we’d wake up and say, “what was that?” It was a part of being there in fact in Hoben hall, that’s where I was at that time. Campus was a little bit different then, the new part of Welles was not here, there was an administration building there, but that wonderful Stetson Chapel was here, and I’m delighted to be here, greetings to you all, all of those that have already been mentioned from this podium. It’s a great honor and privilege to be participating in these commencement festivities. I would never have dreamed when I was scurrying around this campus, that I would be giving the commencement address one day. Speaking of which, commencement addresses can be beamed to a variety of audiences. Not only the graduates, but to all those assembled, or even to a larger audience if the speaker is a politician or a statesman. I shall be talking primarily to the graduates, because my wife Martha and my daughter Christina decided that that would be most appropriate. Nothing hen‐pecked about me. But it also made the preparation of this little talk a bit more difficult. I accepted President Jones’s invitation without giving it a second thought. Of course! What wonderful bomb to the ego! Now I might paraphrase the famous dictum on marriage: Marry in haste and repent in leisure. In other words accept the invitation in haste and struggle with the difficulties of composing the talk at leisure. I composed two talks that I thought were pretty good. Both beamed to a wider audience, both shot down by my family trust, Martha and Christina. However, they didn’t leave me marooned. Christina, my daughter, being very close to today’s graduates in age, and just finishing her baccalaureate, told me what she’d like to hear. Which prompted me to tell her I couldn’t even remember who delivered the address on my graduation from medical school, and I certainly couldn’t remember a word he said. But then that was a Columbia University affair, many schools besides the school of medicine, so it was a different story. She asked me about my three years that Kalamazoo College, and I’ve got a surprise from President Jones. I had to admit that I had probably been too immature to get as much out of them academically as a might have. For me, going to college was just like anything you did. Like going to grade school or high school. A career, life, that was all later. I never thought about them though I was aware that some of my classmates were not so airheaded. They knew where they were going and had a pretty good idea how they were going to get there, and you know as I wrote this I was thinking of two people in particular, some of you in the audience may remember Ralph Curmen and Cynthia Earl they got married, they really knew exactly what they were going to do but I didn’t. Which reminds me of an anecdote and the perfect rejoinder that was never made. Now actually, I have to admit this anecdote has really to do with reminiscing because of the things that went on here. And what it has to do with a performance of Bedřich Smetana’s comic opera, “The Bartered Bride”. Well, when we were preparing for it incidentally we used to refer to it as “The Battered Bird.” Anyway, what—yeah, you know—what really prompted me, I’m glad that I was going to mention this is that in that performance I played the heavy lead, I was the marriage broker, but the romantic lead, the male romantic lead is here today. He’s a former dean of the chapel and his name is Robert Dewey. So I thought that when—I didn’t know he was going to be here and when I learned he was here I certainly have to tell him about this, what’s the anecdote? The following week I was in Physics class and the building was over there I think, and Dr. Hornbeck asked me a question, and I really didn’t know the answer and Dr. Hornbeck who was a very dry, quiet, restrained man said, “Mr. Sarno, Saturday night you sang for a long time without any words or music in front of you, I wonder why you don’t know the answer to my simple question.” Well I was mortified, and I didn’t know what to say but talking about now the perfect rejoinder, wouldn’t it be great if I had said, “Gee Dr. Hornbeck maybe I’ll have to put my Physics homework to music.” Yeah. (Gap in the audio) Surprise for Dr. Jones because I never graduated from college. Listen to this. By May of 1943 there were so few men on campus. I couldn’t stand it. I mean it’s not that the girls—but you get the message. So I enlisted in the army. Being a college boy I was assigned to the medical department. But patriotic fever was sky high in those days, so I volunteered for the Air Corps. That was a mistake. But I didn’t realize it at the time. As part of the early training we had a few hours in a light plane and I thought that was terrific. But one morning I woke up to find my face almost unrecognizable with giant hives. It was starting to get serious now. Testing revealed that I was allergic to many foods, which was a drag, but there wasn’t much that I could do about it. We were at the stage of being classified for pilot, navigator, or bombardier training when word came down from on high too many flyboys, everybody admitted to the Air Corps after a certain date had to go back to where they came from. And so back to the medical department I went. I ended up in what is now known as a M.A.S.H unit in Europe but that’s another story. It wasn’t until many years later that I realized what the hives were all about. I may have been allergic to all those foods, but the real reason for the hives was my unconscious. With that my unconscious was allergic to the idea of flying in combat. As soon as I returned to the medical department, the hives disappeared. My conscious mind told me I wanted to fight Nazis. My unconscious mind was telling me something very different. We really have two minds, you know. Reacting to the things that are going on in our lives and their reactions will usually be totally different. Consciously we may say, I want to do this, I can handle that, piece of cake, I must do this or I should to that. But the unconscious may be saying never mind, this is too tough, too dangerous, or more likely, too much like work, too uncomfortable or unpleasant. That’s reality. The unconscious is motivated strictly by pleasure. Consciously we want to be nice, do things that will make people like us, unconsciously we say I couldn’t care less about anybody or anything. I don’t want to put myself out to be a good guy, this is making me very angry. As a friend of mine said, Jekyll and Hyde. We are all of us examples of Jekyll and Hyde. The good news is that there is almost always a signal that the unconscious is reacting differently. The rub is that we have to learn what those signals are. This is what motivated me to write a series of books for a non‐medical audience describing the major physical and psychological signals. “Did you learn anything in the army?” Christina asked. Well yes, how to scrub up and assist a surgeon. But my ambition was not to become a surgical scrub nurse, mostly the army experience told me that I couldn’t stand being low man on the totem pole. I hated not being an officer. And yet, I had always had feelings of inferiority. How can one figure it? Just like the prince and the pauper. We can be two people at the same time, we can have two different sets of feelings. Although the multiple personalities that one hears about are not overtly manifestly accepted, there are notorious cases that you read about. In reality we are all split personalities, and it’s strange. One of them may lead us to do good things, it’s what got me to apply to medical school for example while I was still in Germany, but the other one, the one that’s mostly inside can get you into trouble. I wish I had known that when I was twenty‐one. From the standpoint of the work I eventually got into something extremely interesting came out of the war. It was described in a medical paper that appeared in the Annals of Surgery in 1946. Written by Dr. Henry Beecher of Harvard, one of the first physicians to become interested in the study of pain. As I recall he was with the American forces when they landed in Southern Italy. The remarkable thing he observed is that many of the soldiers who were severely wounded had little or no pain. He came to realize that although they had injuries that would require large doses of narcotics in civilian life, these men were so relieved to be finished with the dirty dangerous war, so happy to be alive and in caring hands, that their pain was minimal. That’s an example of the power of feelings. And it can work both ways. The victim of an auto accident in civilian life will be beside himself with anxiety about his injury, how it will come out, what about his family, what about his job, and on and on. “How was medical school Dad?” Christina asked. The three years in the army must have matured you, after all you decided to become a doctor. That was a mature decision, wasn’t it? But it wasn’t. I was still going to school. That’s what you’re supposed to do, keep studying. But it’s amazing how things turn out. Because of inferiority feelings I didn’t apply for a prestigious residency after I finished school but chose to go into family practice after what was essentially a very inadequate residency. These days— inadequate internship—these days they actually have special programs for doctors going into family practice which they didn’t have at the time. But I did learn a lot in family practice and I began to realize that most people’s ills had more to do with what was going on in their lives than what was wrong with the machine. Actually feelings, emotions, can cause the machine to malfunction in many ways. During that period I had another revealing experience. I had suffered from migraine headaches ever since medical school. An older medical colleague told me of an article he read in which the author had found a strong correlation between unconscious rage and migraines. Well I thought I’ve got nothing to lose, so the next time I got the visual warning that a migraine was about to begin I sat down and asked myself, what am I angry about? What am I in a rage about? I came up with a blank, but the headache never materialized. And I have never had another one since then, although every once in awhile when something annoys me I’ll get the warning lights but I immediately know that my annoyance consciously is rage unconsciously. Jekyll and Hyde. The mere attribution of the headache to something psychological was enough to keep it from coming on. Amazing. Now, well I mentioned that already. Well where are we now? The prince in me said you can’t remain a family doctor you’ve got to specialize. The pauper said choose something not as prestigious as surgery or neurology, choose something more modest. That decision was made easier by a remarkable not at all modest man named Howard Ruskin, who brought to western medicine the concept of rehabilitation. The very humanitarian idea that the elderly, the chronically ill, and the disabled should not be relegated to back rooms. But deserve the chance to remain active members of society. I was introduced to Dr. Ruskin, the next thing I knew I was in a training program. He was a very charismatic man. Rehabilitation medicine was low on the medical totem pole, but it had great appeal to an idealist. And it was fascinating medically, particularly if you’re interested in brain function as I am, for many of our patients suffered the residuals of brain damage. As things worked out, it was not brain damage, but another aspect of brain function that was to become my major interest. When Dr. Ruskin asked me to head up the outpatient service I found myself seeing large numbers of people with pain problems. Mostly in the back, but anywhere in the muscular‐skeletal system. It was no fun. They were difficult to treat, and most of them didn’t get better. So I took a closer look, and was astonished to realize that most of these pain things were just like heartburn or acid indigestion, irritable bowel syndrome, hay fever, tension and migraine headaches. In other words, physical reactions to emotional things going on in the head, in the mind. And they’re not pathological things. That is these things that are going on inside of us, they are mostly about putting oneself under pressure to be perfect and good. As a matter of fact I think what really characterizes these things is that because we are excessively normal, not because we’re abnormal. Well, 27 years later I’m still trying to fully understand how it works, but we know enough about it now to get a reasonable number of people better. Based on primarily by teaching. By teaching the patients what’s going on, about the interactions of the mind and the body, in some cases augmented by psychotherapy. I am still in awe of the fact that a person can actually eliminate physical pain by learning about its psychological origins. And it’s not a placebo reaction, placebos you know are cures by blind faith. The trouble with placebo reactions is that they don’t last, and so they turn out to be poor treatment in the long run. What lessons have I learned along the way? The young lady who spoke for you graduates today actually mentioned some of those. Sometimes it takes a long way, a long time rather to get where you want to be. I could not have predicted that I would be working in the field of mind/body medicine but that’s where circumstances lead me, and it has been very exciting. You have to be ready to kick over the traces of circumstances warranted. When I found that the conventional diagnoses didn’t make sense, I had to reject them and look for better ones. James Campbell, many of you know his name sure the great mythologist advised his students, “follow your bliss.” That’s very good advice. Perhaps we could add follow your instincts too. If something doesn’t look right, don’t be afraid to question it. It won’t always be comfortable. I rage in my insides because I’ve been ignored by my medical colleagues. That’s hard to take. But it has been compensated by the fun of having discovered something, and most of all, the pleasure of being a successful healer. Know thyself. Famous phrase. I’d always thought that Socrates said it but when I looked it up I found that the words were an inscription at the Delphic oracle. The oracle housed at Apollo’s temple at Delphi. I learned that an oracle was not some profound thing someone said but was a shrine and that the inscription may have been placed there through the influence Plutarch, who became a priest at Delphi at some point in his life. Last week, last weekend, I was reading another book. And the author of this book said it was Solon who said it, well I don’t know who said it, who cares who said it, we know that it’s a very, very wise thing. Whoever said it, if he were alive and working today I think would say, “Know thyself, both inside and out.” Because the inside of you is very important. Whatever you’re going to do, you’re going to want to have a strong body to do it in. Though not a physician, perhaps the best advice about his came from a man named Norman Cousins. He was a writer, publicist, highly intelligent man and while he was on a mission from the United States, came down with the symptoms of acute rheumatoid arthritis. He wrote a book about this—about this experience and the title of it was “Anatomy of an Illness” and he described in this book the failure of conventional medicine to arrest the progression of the disease and his eventual success by recognizing the psychological basis for it. If you haven’t read that book, I think you might enjoy it. “Anatomy of an Illness”. But it was an essay he published in Time magazine sometime before his death that contains a message I would like to leave with you, all of you graduates because you’re just starting out, but this is a message I think could apply to anyone in the audience. He entitled an essay “A Nation of Hypochondriacs” but when I asked his permission to duplicate the essay for my patients, he gave it but suggested changing the title to something a little bit gentler, “We Are Stronger Than We Think”. I’d like to read some of it to you. This is a quote: “The main impression growing out of twelve years on the faculty of a medical school—“ And we was on the faculty of UCLA although he was not a physician, “is that the number one health problem in the United States today, even more than AIDS or cancer , is that we don’t know how to think about health and illness. Our reactions are formed on the terror level, we fear the worst, expect the worst, thus invite the worst. The result is that we are becoming a nation of weaklings and hypochondriacs.“ I think that’s a little strong, but this is Norman Cousins not me. “A self‐medication society incapable of distinguishing between casual every‐day symptoms and those that require professional attention.” He quoted Dr. Franz Ingelfinger, a former editor of the New England Journal of Medicine who noted that almost all illnesses are self‐limiting. That we have a healing system that is beautifully designed to meet most of the body’s problems. He gave some examples of this, and then he concluded. “Plainly, the American people need to be re‐educated about their health. They need to know that they are the possessors of a remarkably robust mechanism. They need to be de‐intimidated about disease. They need to understand the concept of a patient‐physician partnership in which the best that medical science has to offer is combined with the magnificent resources of mind and body.” Yes, we are a lot stronger than we think. Our minds are a lot stronger than we know. To the graduates, in the days ahead you are going to be using your head to get ahead. How about that for a run of clichés. But just think, you can also use your head, your mind, to stay healthy. I hope you’ll find that bit of information helpful as you leave this wonderful place and begin your exciting journey. I want to thank President Jones and the faculty for their gracious invitation, I am very honored to be given the opportunity to share this day with you, to congratulate you, and to wish you buon voyage.