Journal of the American Psychoanalytic Association 3, 1955, No. 2: Thomas S. Szasz. 'The Ego, the Body, and Pain.'

Szasz suggests that the scarcity of psycho-analytic studies on pain reflects the possibility that the theoretical framework of psycho-analysis does not allow of a simple integration of the phenomenon of pain into its structure. He proposes that the ego

must be considered in its relation not only to external objects but also to the body as an object. Pain must be regarded in the same way as are other affects. Just as anxiety is a danger signal warning of the possible loss of an object, so pain acts as a signal warning of the danger of loss of part or the whole of the body. To understand fully the experience of pain the concept of over-stimulation must be added to the danger of loss of bodily parts. Considered from the developmental point of view pain has characteristic features dependent upon the integrative level of the ego. During the earliest phase of the ego the affect experienced is a type of undifferentiated pain-anxiety. When the infant has achieved some degree of distinction between self and objects which facilitates the recognition of the body as an object, an awareness of the sensation of pain as distinct from the earlier pain-anxiety appears. Finally there is the experience of pain appropriate to the adult ego. The ego defences against pain have not been given attention commensurate with that given to the defences against anxiety. The principal defence against pain can be said to be that embodied in medicine, surgery, and anaesthesia. Medicine may be regarded as a socially structured defence against pain in much the same way as religion is a socially structured defence against anxiety.

Szasz continues with a discussion of varieties of pain—'organic', 'psychological', and 'experimental'. If pain is considered in terms of the relationship of the ego to the body the distinction between 'organic' and 'psychogenic' pain disappears. The terms 'organic' and 'psychogenic' do not refer to the pain experience, but describe the judgement of what the obs