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October 29, 1963. A PSYCHOANALYTIC STUDY OF PAIN OF MENTAL ORIGIN IN RELATION TO SELF AND OBJECT; ITS DIFFERENTIATION FROM ANXIETY. Leo A. Spiegel, M.D.
In this contribution to the metapsychological differentiation between pain and anxiety, the term 'pain' is employed to designate a specific affect, not unpleasure in general. The expressions, 'pain of mental origin' or 'pain of physical origin', emphasize that no stand is taken as to whether there is a difference between the two experiences.
Freud considered the subject of pain as early as 1895, in the Project, as well as in later papers. The paucity of references to pain in psychoanalytic literature may be partly a result of complications in approaching the subject, but is probably more the consequence of the relative rarity of explicit references to pain by analysands. Dr. Spiegel develops the thesis, however, that pain appears in analytic productions of highly narcissistic patients, taking the concealed form of affects such as shame, humiliation, and feelings of inferiority.
The theory of narcissism helps little to clarify this area of narcissistic lesions. Work with patients in whom narcissistic lesions are prominent prompted Dr. Spiegel to propose a guideline for such clinical phenomena, with their correlated affects; they all refer, in one way or another, to actual or potential pain of mental origin.
Reference is made to Freud's notation that observations of infants contending with absence of the object reveal pain as well as anxiety. The source of this pain of mental origin is seen as external, whereas the source of anxiety may be altogether internal—the pressure of instincts. Freud did not make clear why absence of the object may in one instance produce pain, in another, anxiety, in still another, both.
In contrast to Fenichel and others, who considered 'narcissistic needs' to be noninstinctual, Dr. Spiegel advances the thesis that narcissistic affects are also drive derivatives. 'Longing', an important