Dr. Sarno was in practice for almost 2 decades when he realized nothing he was prescribing for back pain was working. His developed his highly controversial theory of TMS, or Tension Myositis Syndrome - a psychosomatic condition that causes pain. Back pain, along with GI Tract issues, repetitive stress injuries, or dermatological disorders were a "distraction" by the brain to repress deep unconscious emotional issues. He encourages patients to address these issues and look at the pain as a cover up by the brain. The brain is causing the pain in order to repress these emotions. One the issues get addressed, the pain has no real purpose and thus goes away. So yes, it is all in your head. It seems inauthentic to cast it off as such, as pain is so real. What is important about his work is another way to see and heal pain when assessing chronic issues.