About 'The Hidden Psychology of Pain'

I became a psychologist after the harrowing experience of being nearly killed by a drunk driver in a head-on car accident as an 18 year old. This included being trapped in the car wreck, severely injured and bleeding profusely for 2 1/2 hours before being freed. The ensuing psychological trauma saw me sink into the pits of despair before discovering self-help psychology books in my father’s bookshelf. From reading these, I managed to halt my psychological ‘free-fall’, and within the year decided to become a psychologist so that I could help other similarly traumatized people. I undertook the required years of study and training, and since the late 1980s, have been providing counseling/clinical services to those in need.

For many of these years, I also suffered from chronic pain which physical therapists believed was caused by the physical trauma which my body underwent in the car accident. None of them viewed the emotional trauma as being relevant to my physical pain. In my late 30’s, I stumbled across the notion that emotional trauma is often highly related to subsequent chronic pain. Such pain has been referred to as The MInd/Body Syndrome (TMS), and PsychoPhysiological Distorders (PPD). This approach is credited to Professor of Rehabilitation Medicine at New York University hospital, Dr John Sarno, however it can be traced back to Hungarian psychoanalyst, Professor Franz Alexander; and even to the originator of psychoanalysis, Sigmund Freud. But of course, these ideas (such as the unconsious mind) have been a part of our culture for millenia- it is only in the modern era that some health professionals, both in psychology and medicine, have attempted to use these ideas in a scientific manner.

(For  a thorough bibliography of research evidence in support of the main themes of The Hidden Psychology of Pain- click here)


It strikes me as ironic that the contemporary psychology in which I was trained, cognitive-behavior therapy (CBT), had dismissed such notions as the unconscious mind decades ago. Surely, psychology would have trained its students in such a basic psychological notion that the mind can affect the body (and vice-versa)? But, no, the modern approach to psychology, for the most part does not, as this requires a focus deeper than just the surface level- much of the relevant psychology is operating at a less than conscious level, and approaches like CBT are both unaware and uninterested in these possibilities. As such, in addition to being a self-help book, The Hidden Psychology of Pain is also the journey of a contemporary psychologist discovering the historical legacy of his discipline- that which had been largely dismissed during the second half of the 20th century.


I believe that it is time for psychologists to reclaim our discipline’s legacy, and to get about the business of helping people in both psychological and physical distress by reclaiming the depth-psychology baby that was thrown out with the Freudian bath-water. This book is a step in that direction.

Overcoming my chronic pain after nearly 20 years, utilizing only the psychological approach described in the book, encouraged me to introduce these ideas to other sufferers of chronic pain. Having seen many people also overcome chronic problems, such as back, neck and shoulder pain, inspired me to write a book about it so as to bring help to many more people. I also want to introduce the healing capacity of this psychological approach to other treating professionals, such as psychologists and physicians, physiotherapists, chiropractors and massage therapists. All health professionals, with access to the right information, can become healers of chronic pain.


Readers are advised to always be medically assessed and cleared of more serious health conditions before considering the possibilities described on this website or in 'The Hidden Psychology of Pain'.


Overall theme of the book    

Chronic pain is a huge problem in contemporary Western culture. As long as we leave it to the health professionals who want to only approach it from a bio-mechanic point of view, it remains largely untreatable, and the best people can hope for is to learn to get used to it. The psychological approach promoted in this book suggests that repressed emotional material (eg. dilemmas, conflicts, traumatic memories, distressed emotions) can trigger biological pathways to generate very real physical pain. It is only by addressing the largely unconscious distressed emotions that we can actually overcome chronic pain, rather than simply adjust to it. Psychological trauma often plays a large role in the causation of chronic pain. As such, a treatment of the whole person (psychology and physiology) is required, and the prospect of using chronic pain as a vehicle for the healing of the whole person arises.


Cultural theorist and Professor of both Medicine and English, David B. Morris, states that chronic pain is “the invisible crisis at the centre of contemporary life”. This statement refers to the fact that our culture, and our models of science in particular, have settled on a view of the human being as though we are cleverly built machines. The health professions have also come to view the human form, and the spine in particular, as weak and fragile. Despite these ‘truisms’, we humans are neither fragile, nor are we a clever collection of nuts and bolts. Rather, we are living, growing organisms which, in our current physical form have, for countless thousands of years, undertaken heavy burdens with nothing like the epidemic of chronic pain which we currently witness. Something has gone wrong, but it is not likely to be our bodies. The way in which our culture makes sense of the human organism in general, and of chronic pain in particular, is a very large part of the problem. We are laboring under demonstrably false beliefs about the mind/body connection, and these misconceptions are a large part of the problem. In addition, our own personal forms of emotional distress, the depths of which are largely at an unconscious level, combine with chronic pain myths to produce the current epidemic.


People can overcome chronic pain, as it is not the untreatable blight on modern life which the ‘pain industry’ has led us to believe. In order to overcome chronic pain, sufferers need to delve into its causes in the form of psychological dilemmas, emotional distress and other repressed unconscious material. Chronic pain is not all in the head as it is a genuine physical experience, however by approaching it from a psychological angle, we are able to retrain our mind/brain towards healing the whole person.


The way forward, and out of chronic pain, is to become aware of the falsities which the pain industry usually promotes, and to see the connection between these, our unconscious forms of distress, and the experience of our own bodies. Much of this can achieved for many people by reading The Hidden Psychology of Pain- a self-help book which takes the reader through the psychological factors which can result in chronic pain, as well as a guided journey of self-exploration which can shed light onto the true causes. Knowledge is power, and The Hidden Psychology of Pain aims to empower sufferers through scientifically based knowledge. 


The message is that chronic pain is highly treatable. Most people can have a positive impact on it if they are willing to look at the psychological factors behind it. This need not be daunting or overwhelming, and the reader can be walked through the process via this self-help book. If your psychological issues are more substantial, eg arising from significant trauma, then advice is given in the book as to what type of psychological help is likely to be the most beneficial.

The book is also available in e-book form (at a much lower price than the hard copy) from Amazon.com, Barnes & Noble, The Book Depository, and the Balboa Press website.


As a positive development in the physiotherapy treatment of chronic pain, Cognitive Functional Therapy was announced in the media during 2023. While not entailing the awareness of unconscious psychological factors, this approach is an advancement for physiotherapy in that it gives primacy to psychological factors in the causation and maintenance of chronic pain- there are other important factors which it omits, however any acknowledgement of psychological factors is to be applauded. One can only hope that as a profession, physiotherapy embraces this development and ceases ineffective physical treatments for chronic pain. For an ABC radio interview with Prof Peter O'Sullivan, the lead researcher of Cognitive Functional Therapy, click here.  Watch a 15 min interview with Prof O'Sullivan here.


Dr Brian Broom, Professor of Psychiatry in Auckland NZ independently offers a complementary approach to Professor John Sarno's TMS approach. Broom began his medical career as an immunologist, and began seeing coherent meaning in patient's illnesses and symptoms as they related their psychological experiences in life. As a result, he trained in psychiatry and has been working with people presenting with chronic pain and health conditions ever since. His program (Wellness Explorer) is offered on-line for free (I havent done it yet, but having read his excellent book 'Meaningful Disease' I am familiar with his views and am happy to endorse his program).

link to Dr Brian Broom's on-line program


Chronic Pain workshop recordings 2014- (downloadable MP3 files)


10 facts every person should know about back pain (short video)

Professor Sarno's chronic pain lecture

Adverse effects on mood from Lyrica

Chronic Pain success story of a professional athlete


Readers are advised to take a look at the TMS Wiki and the TMS Help websites. You will find an abundance of information there, as well as discussion forums which can play an important role in your recovery from chronic psycho-physiological  pain.


Testimonials for The Hidden Psychology of Pain

"I highly recommend his book- it should have appeal to pretty much everyone. Professionals will be particularly interested in the rich overview he provides for working with chronic pain and everyone who suffers from chronic pain will benefit from the self help exercises and the two pain questionnaires hes included... You need to get this very authoritative and insightful book".

Dr David Van Nyes- Shrink Rap Radio


"The Hidden Psychology of Pain is a comprehensive psychological book which heralds a new paradigm shift in the way we can look at chronic pain. This book challenges the readers to change their beliefs and understanding about chronic pain as we explore the psychological basis of pain. The author presents a theory that chronic pain is psychologically based in the unconscious mind. Fortunately readers are also given the psychologically based solutions to eliminate chronic pain, or radically reduce it. This book is hugely relevant today in a world where we find many suffers with chronic pain, depression, poor sleep, anxiety and stress related disorders that are not being adequately treated by current therapeutic practices. The Hidden Psychology of Pain gives psychologists, medical practitioners and the suffering patients a new pathway to treat chronic pain".

Dr Karel Hromek, President of ACNEM

Australasian College of Nutritional and Environmental Medicine.


"A Doctor is a teacher. Dr James Alexander is a gifted, erudite teacher and healer who straddles several disciplines to explain why the medical model, a bio-chemical-mechanical model, does not elucidate chronic pain. Nor do anatomy, pathology or radiology explain its origins or mechanisms. The Hidden Psychology of Pain provides take home messages, insights and gems. It also has essential insights for psychologists, pain therapists, and those who want to heal and be healed. It is not just a self-help book. It is an education. Understanding one's pain can make a substantial difference".

Dr Yolande Lucire. PhD MBBS DPM FRANZCP

Forensic Psychiatrist. Author of 'Constructing RSI'


"The Hidden Psychology of Pain is an engaging and information-rich exposition on how to heal chronic pain. Dr James Alexander skillfully weaves together his own healing journey from chronic pain, and the history of Western philosophy and medicine. He shows how the latter relate to cultural assumptions about pain, and explores the meaning and unconscious purpose of pain, that, as sufferers know, often exists independent of a defined physical cause. Dr James examines chronic pain myths and various healing modalities, some of which may be new to readers. As an ex-sufferer of decades-long chronic pain, I highly recommend this book to any who wish to take responsibility for their own health. I know from personal experience that the information presented provides an invaluable opportunity for healing and wholeness".

Catherine- former sufferer of chronic pain


"I honestly dont know how to thank you enough for putting me on to these ideas. After seven months of pain, and two months of disability, in only four weeks I am back to normal. Im riding my bike again, studying full time at uni, essentially doing everything I used to do, and also more. As terrible as the pain was, getting over it psychologically has also given me the opportunity to address a number of other areas in my life which I was neglecting. Through the EMDR therapy, I have been able to look at a number of childhood events which I hadnt properly dealt with, and essentially reprogram my brain into adult mode. All of this has given me a dizzying sense of control over my own life which I now realize I had been lacking. So, thank you, thank you, thank you. All of this has really given me a new start at my life.

'Rebecca'- former sufferer of chronic pain


"As Dr James Alexander stresses throughout his book, The Hidden Psychology of Pain, providing solid information is what the pain sufferer needs first. He has succeeded at this goal brilliantly. By first introducing the Hidden Psychology of Pain as having purpose, he normalizes what all humans do: having pain distract us from unconscious emotional dilemmas. He then offers many approaches that can help people work toward eradicating chronic pain and dealing with emotional issues that if suppressed, maintain the pain. There are many self help techniques, as well as solid information about psychotherapy, oft en needed to deal with serious, underlying trauma. This book is a comprehensive guide to the understanding of the central role of emotion in the development and maintenance of pain".

 Carol Forgash, LCSW, BCD. EMDR Institute Consultant & Facilitator, & Author


"This is a very good book. I wish it had been one of the text books when I trained to be a physiotherapist in the 1980s. It should be a required text for present students studying to be doctors or allied health workers. I feel that the true nature of what is going on for the majority of chronic pain sufferers is not being understood by most doctors and allied health workers. This failure of understanding results in ongoing frustration for the sufferers and the earnest people trying to assist them. I feel that my 25 year career as a physiotherapist, with a special interest in back and neck problems, would have been much more rewarding if those chronic pain patients were directed towards the knowledge available in The Hidden Psychology of Pain. This could have prevented some of them being labelled malingers, becoming depressed, or continuing with manual treatment and/or medication, sometimes for many, many years without resolution of their chronic pain".

Terry Paige. B. Applied Science (Physiotherapy)


"In The Hidden Psychology of Pain, Dr James Alexander guides us through the labyrinth of previously-hidden information with clarity, expertise and profound knowledge on the subject of chronic pain. The subject is so relevant to current issues, as we move from a place of educated guess work to an actual understanding of the true origins of chronic pain. Dr Alexander has produced a book of crucial information for all health professionals. As I read each chapter, I was nodding my head in agreement. I have been working with chronic pain and trauma for many years, and I know the premise of The Hidden Psychology of Pain to be absolutely true. I thoroughly enjoyed reading this book."

Deirdre Middlehurst. Clinical Psychologist


"I believe that the information in The Hidden Psychology of Pain is vital to unlocking the mystery of chronic illness and the pain-body, as well as helping us evolve emotionally as a culture. Healing = Hearing."

Dr Jacqueline Boustany- General Practitioner. MBBS, Dip. Peads. MPH.


"Most of us know someone whose life is limited by chronic pain. The Hidden Psychology of Pain clearly describes why we have this form of pain, and how we can free ourselves of it. This book provides an evidence-based argument from pain research into why the techniques described can work so effectively. The scope of the book is not limited to physical pain, but it also provides useful information and instruction about the psychological pain of Post-Traumatic Stress Disorder and chronic depression. The book is easy to read and would be of benefit to professionals as well as to their clients and patients. I have personally tried the techniques to manage arthritic back pain and have found that they work." (Author of Procrastinate Now!, and Teaching Creative Writing to Reluctant Writers.)

Rowena Harding Smith. MA , M Ed, BA (Psych). Author/Memory expert/Clinician/Educator