Pain

A recent experience of severe pain has prompted a few reflections which seem perhaps worth communicating although they are probably not original. A moderate pain is always localized: one says 'My arm or leg hurts.' When, however, the white-heat peaks of intense pain are reached this localization disappears, and the entire self is filled with nothing but pain. When the ego is thus invaded defensive reactions enter strongly into play. There is evidently the dread of being surprised by unbearable stimuli breaking through the defensive barrier which Freud called the Reizschutz, the institution which played such an important part in his theory of the mind from the beginning to the end. Instinctively the whole body becomes taut and one's breath is held. Like some other 'natural' reactions, however, such as the clamour for warmth when one is shivering from shock, this attitude is not the most advantageous one. One gains more if one can relax and confine oneself to as shallow breathing as possible. The ability to do this depends on the extent to which one has been able to cope with the profound dread of destruction, which was presumably the reason for first erecting the defensive barrier in question. With pain of the lancinating type, such as the lightning stabs of trigeminal neuralgia, the same problem does not arise, since any defensive response can only follow the pain; in bad cases one can recognize the sufferers from their attitude of constant flinching.

Another consideration emphasizes this close association between pain and fear. I refer to the attempt to correlate two commonly made observations. The first is that it is very hard to imagine severe pain or to recall in one's imagination the memory of it. One knows about it intellectually but one cannot reproduce it. The second observation is that repeated experiences of pain confer no immunity. On the contrary, one is dismayed to find that the fortitude of which one has been proud diminishes with further