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Within the framework of the basic principles of psycho-analytic theory, a working hypothesis has been suggested for the study of pain, fear, and anxiety. Pain is the sensation which signals a breach in the integrity of the body in relation to the external world, or a part or function of the body in its balance with the other parts. On the mental level of organization, this disruption of a physiological continuity is experienced as the perception of pain, which is thus 'the psychical adjunct of an imperative protective reflex'. An attempt is made to link up this original perception of pain with the various sorts of painful sensations, ideas, and affects experienced by the ego in sleep and wakefulness.
In physical pain there is a real boundary (between self and outer world), in which there is a real breach, a rupture of a physiological continuity. In contrast to breaches and boundaries which can be encompassed on the mental level alone, without reference to any reality correlates, is the existence in the presence of bodily pain of a breach which must be encompassed on two phenomenal levels simultaneously—the mental and the physical. The distinction between affects of non-bodily pain and the sensations of a bodily pain can perhaps be understood as a representation of the kind of boundary which is being breached. Anxiety is that affect which signals a danger to the integrity of the ego-id boundary, and guilt stands exactly similarly in regard to the relationship of the ego to the superego. In structural terms it becomes possible to trace the relationship of physical pain to mental pain and to point out some of the determinants of natural and pathological pains. It is suspected that the individual capacity to tolerate both would be found ultimately to derive from the same sources.
In genetic terms it is postulated that there is a close relatedness of primary pain and fear experiences to the nature and degree of the subsequent anxiety experiences. That is the prone