Physical Pain/Psychic Pain

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PHYSICAL PAIN/PSYCHIC PAIN

Pain is not a concept, but rather a psychical state expressed through localized bodily sensation; as such it is a phenomenon that is currently distinguished from nociception (the electrochemical activity of receptors known as "nociceptors" that react only to bodily stimuli, perhaps of traumatic or inflammatory origin).

The properties of pain have continued to challenge the logical and complex corpus that is Freud's psychic apparatus, right up to his final works. Thus is pain organic in origin? Is it perhaps the recollection of suffering or a mnemic symbol for periods of conflict? Pain was also in fact a personal concern for Freud, as it accompanied most of the physical symptoms that afflicted him personally such as migraines, angina, and other cardiac symptoms, but above all the pain in his mouth that appeared around 1899 and which later proved to be cancer. This might explain why he was more interested in cocaine as an analgesic than as an anesthetic.

As early as the "Project for a Scientific Psychology" (1895), where Freud speculates on neuronal and quantitative theory, he acknowledges the limits of this dynamic system and the omissions to his concept of the contact barrier: "Is there a phenomenon which can be brought to coincide with the failure of these contrivances? Such, I think, is pain " (Freud, 1895, p.307). When he later directed his research toward the suffering of hysterical patients their physical pain appeared to him to be the product of the conversion of remembered ethical pain into physical pain, owing to their inability to tolerate, at a psychic level, the memory involved. Since it is not always attached to a representation, pain appears to disengage itself from the notion of the symptom in the "Studies on Hysteria" (1895) and consequently Freud decided to use it as a clinical "compass."

Earlier that same year he had noted that "pain results from a loss" (letter to Wilhelm Fleiss dated January 7, 1895); it comes from a "fixation" (Letter 61, Draft L), and leaves behind "permanent facilitations" (Freud, [1895] 1950, p. 307). This key Freudian hypothesis appears again in his later writings, especially in "Mourning and Melancholia" (1916-1917g [1915]), where the adjective "painful" is characterized as a "mood of mourning" (p. 244). The term "pain," however, is in fact associated with the two states in question in this text; that is to say, it transcends the categories of normal/pathological and the presence/absence of the lost object in external reality. Freud's examination, in "On Repression" (1915d), of the fact that an external event produces an internal excitation led him to define pain as a "pseudo-instinct" (p.146). This hypothesis is crucial because it situates pain within the structure of the speaking subject. In "Beyond the Pleasure Principle" (1920) Freud poses the problem of what is bearable and what is unbearable in a radically different way; thus the "specific unpleasure of physical pain," which "is the result of the protective shield having been broken through in a limited area," generates an "anticathexis on a grand scale . . . for whose benefit all the other psychical systems are impoverished, so that the remaining psychical functions are extensively paralyzed or reduced" (Freud, 1920g, p. 30).

By virtue of the constancy of its influx, pain is indeed "like" a stimulus coming from within the apparatus that generates an attempt to psychically bind this energy. However, a substantial conceptual change had been effected in that, for Freud, the general problem of the instinctual forces was linked, fundamentally, to the notion of the psychical representative. Pain as a "pseudo-instinct" was thus freed from the economic model that had proven to be too limited, even in terms of its interrelationship with neuropsychology.

Despite his explicit return to the dualism of the instincts in 1926, he could again write: "Pain is thus the actual reaction to loss of object" (1926d [1925] Addendum C). It should be recalled, however, that for him there are no unconscious emotions or affects; it is not pain, but rather lack, that is unconscious.

From the numerous metapsychological reflections on pain it should still be remembered that Freud always insisted that pain should be separated from sadomasochism. For example, he notes here: "Psychoanalysis seems to show that the infliction of pain plays no role in the primal aims of the instincts" (1926d [1925] Addendum C). To be sure, pain must be conceptualized beyond the pleasure-unpleasure principle, and these hypotheses can lead to the assumption that logically, pain must be anterior to fantasy and to the symptom in the genesis of unconscious formations.

Pain, as a phenomenon, reemerges not according to the processes of remembering (representation) or reminiscence (trauma), but rather from what might be called the "reliving" of an early experience of loss involving an unconstituted object. In this way, the subject would be restored to a state of insignificance.

Laurence Croix

See also: Pain.