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Szasz clearly states his conception of pain as an affect and his belief that our concept of the mental apparatus must be modified, and the concept of the ego extended, to bring fuller understanding of what pain is and how it relates to ego functioning. The classical picture of the mental apparatus as superego, ego, and id leaves the position of the body ambiguous. The theoretical framework of object relations, in which the ego is thought of as in interaction with some other system or object, be it breast, mother, superego, or image, permits us to imagine the ego relating to the body also as an object.
The author compares the adult ego's relation to anxiety and its relation to pain. Anxiety is a signal to the ego of danger, originally and fundamentally of danger of loss of an object. Pain is a signal to the ego of danger of damage to or loss of part of the body. Thus the ego relates to the body as an object as well as to other people.
Szasz believes that in the early period before differentiation between ego and nonego, between self and objects, the affect felt is undifferentiated pain and anxiety. In the second stage (four to nine months) when the infant begins to know self from mother, pain begins to be felt in relation to the body and anxiety toward other objects. With maturation, the affects of anxiety and pain acquire many overdetermined meanings.
The distinction between 'organic' and 'psychogenic' pain is meaningless when we consider pain in terms of the relation of the ego to the body; all pain 'refers' to the body. Only as the judgment of an observer in considering the source of the pain do the above terms have meaning. 'Organic' and 'psychogenic' pain correspond to 'objective' and 'neurotic' anxiety, these latter also being observed judgments.