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Difficulties in understanding pain are partially implicit in its very nature. Physiological and neurological studies cannot give complete understanding of the problem. The patient frequently finds pain more bearable than guilt and
anxiety and is therefore ambivalent about discussing it with the aim of losing it. Pain can be a disguised representative of sexual and aggressive impulses that the ego rejects. Such disguised representation of unacceptable impulses paralyzes the psyche, since there is an attempt to bind psychic energy. Pain first appears in the oral stage of development; any later pain may reactivate the threat of loss of objects.
The pain of psychosomatic syndromes has special qualities. Ulcer pain is a 'wound of separation'. 'Painful bowel spasm is a characteristic of being cramped in desiring to give but being inhibited in doing so. Muscular pain cramps the individual and restrains him from expression of sexual and aggressive wishes through action. Anginal pain grips the patient when he cannot verbalize anger and guilt. Genitourinary pain galls the patient for his erotic and aggressive wishes.'