mental pain vs psychic suffering.pdf

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ORIGINAL ARTICLE

Distinction between mental pain and psychic suffering as separateentities in the patients experience

MANUELA FLEMING

Department of Behavioral Sciences, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Portugal

AbstractMental pain and psychic suffering are herein defined as two separate concepts in psychoanalysis. The concept of mental pain

lies at thecore of psychoanalysis;it wasintroduced by Freud andwas furtherelaborated by a numberof investigators, mostlybyBion. Mentalpainrefers to a pain that thepatientreports as being impossible to describe in words, andlacking anyassociations,whereas psychic suffering can be both named and described by the patient. Mental pain is derived from non-tolerance on thepart of the psychic apparatus when it is harmed by very painful emotions. In contrast to psychic suffering, mental pain resistselaboration and transformation by dream-work. How to address and transform the patients mental pain is a major challengefacing the analyst in his clinical work because mental pain may halt or slow the progression of the analytical process. Toovercome this hindrance, the work of the analyst is focused on helping patients to modify their mental pain into psychicsuffering, that is, to reactivate in the patient the chain of transformations that generates thought. The analyst is also challengedwith the mental pain of the patients because he has himself to tolerate the mental patient induced by countertransference.Suggestions for the analyst on how to deal with the mental pain of the patient during psychoanalytic therapy are proposed.

Key words: Alpha function, Wilfred Bion, tolerance, transference, transformation

Introduction

Freuds early training in experimental biology and

neuroanatomy, prior to his pioneering discoveries on

the human mind, probably contributed to his view

that psychoanalysis would benefit from using the

same discipline of thought that is employed by other

sciences. Because a clear definition of concepts is

among the foundations of scientific rationale, our

aim here is to present the advantages for clinical

psychoanalysis that derive from precise definitions of

mental pain and psychic suffering.

Mental pain and psychic suffering are often

employed as synonymous concepts. Instead, the

author proposes that they should be seen as separateconcepts that refer to different kinds of emotional

experience. Clearly, the nature of mental pain has

been the subject of research since the very beginning

of psychoanalysis, and this concept, although it is

seldom referred to as such, has stayed at the core of

the analytical theories of Freud, Klein, and Bion. In

fact, Freud investigated the genesis and dynamics of

mental pain as part of his work on the relationships

between frustration, modification, and thought, andalso on how intolerance to frustration is related to

escape and non-symbolization. Klein addressed

mental pain when she defined the primordial anxi-

eties of the human being, and also the mental

structures to face them (paranoid-schizoid and

depressive positions). The transformation dynamics

of mental pain was described by Bion as part of his

theory of thinking, as well as a component of his

proposals on emotional links.

To discuss mental pain, it is pertinent to present a

more detailed description of some significant con-

tributions to this concept. Previous contributions ofthe author to this subject in articles written in

Portuguese will also be recalled (Fleming 2003

ac; Amaral-Dias & Fleming, 1994, 1998; Pinheiro

et al., 2001, 2003). In a recent paper of mine

published in this journal, I have also considered

how the analyst may be harmed by mental pain

during his clinical work (Fleming, 2005). A personal

Correspondence: M. Fleming, Department of Behavioral Sciences, ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, 4099-003

Porto, Portugal. E-mail: [email protected]

International Forum of Psychoanalysis. 2006; 15: 195200

(Received 3 May 2005; accepted 12 December 2005)

ISSN 0803-706X print/ISSN 1651-2324 online # 2006 Taylor & Francis


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proposal to distinguish mental pain from psychic

suffering will be presented, as well as advantages of

considering this distinction in the clinical practice of

the analyst.

Original concepts of Freud on mental pain

Since his early work on psychoanalysis, Freud

(1954) [1895]) considered that the first pain that is

felt by the newborn is that of the helplessness that

the baby feels when he is separated from his mother,

that is, the experience of the baby seeing himself in

the radical absence of the other. For Freud, help-

lessness thus emerges as the primordial condition of

the human species. To name the non-helpless is to

speak of the negative, the primordial negative on

which the human mind will be structured. Freud was

the first to discover that the primitive psychic

apparatus of humans does not have the capacity to

think or elaborate pain. After this capacity has been

acquired by the mind, Freud (1961, [1911]) pro-

posed that a second mental condition is required to

handle mental pain: that of being able to tolerate

frustration. He also found that the incapacity to

tolerate frustration causes the failure of the symbolic

function, and also that of the thinking process.

Later on, Freud (1997) [1926]) proposed a

distinction between pain and anxiety: pain is thus

the actual reaction to loss of object, while anxiety is

the reaction to the danger which loss entails and, by

a further displacement, a reaction to the danger of

the loss of the object itself (p. 417), and mourningoccurs under the influence of reality-testing; for the

latter function demands categorically from the

bereaved person that he should separate himself

from the object, since it no longer exists (p. 419).

Thus, for Freud, mourning is separated from mental

pain in general, since it is a particular kind of loss of

an object, that of an object that no longer exists.

This clarification of the nature of mental pain led to

new challenges. For instance, what are the factors

that modulate the reaction of the mind to loss of the

object? Does mental pain depend both on the

personality features of the patient and on his inter-action with the lost object?

Bion and the dynamics of mental pain

With regards to the dynamics of mental pain, Bions

contributions deserve to be singled out. In his book

Elements of Psychoanalysis (1963), Bion considered

mental pain as a key element in the workings of

psychoanalysis. In accordance with Freud, he viewed

pain as a constitutive condition of the human psyche:

pain can not be absent from the personality

(p. 174), and also I will consider pain as one of

the elements of psychoanalysis. Thus, for Bion,

mental pain is an element of both mental functioning

and personality. Bion related the genesis and dy-

namics of mental pain with the degree of tolerance/

intolerance of the mind to frustration. For him, the

concepts of frustration and pain were similar, and

he addressed them with his own theoretical tools,in order to understand how a seemingly unbearable

pain is accepted, is elaborated, and acquires meaning

in the mind. Bion challenged psychoanalysis with

new questions on the nature and dynamics of mental

pain. How does the mind that is assaulted by

severe mental pain escape from insanity, false state-

ments, or lies? What makes tolerance to mental pain

greater or smaller in different individuals and in

distinct situations?

Bions answers to these questions were clear:

tolerance to mental pain is a complex operation that

depends on a number of factors at play in the human

mind. For instance, it depends on innate dispositions

of the mind itself, and on the quality and predomi-

nance of the links that relates the self with the object.

Bion considered that the mind works as a sort of

container allowing painful emotions to be taken in

without damage until there is mental space available.

Then, painful emotions that are capable of being

contained in the mental apparatus will be retained in

the mind (by the somatic pathway, through projective

identification or other mechanisms), and digested by

what Bion called the alpha function of the mind.

This function is able to modify the so-called beta

elements, which are toxic to the mind, into the alphaelements that are suitable of being thought by the

mental apparatus (Bion, 1963).

These concepts are present in the container

contained model of Bion that was inspired by

Melanie Kleins concept of projective identification.

The successful transformation of intolerably mental

pain into pain that is both tolerable and capable of

being accepted by the conscience thus depends on

the ability of the mental apparatus to transform

painful emotions. According to Bion, this transfor-

mation can be done either in the spirit of love

(L link), in the spirit of hate (H link), in the spiritof the desire to know (K link) or desire not to know

(K link), and, finally, in the spirit of arrogance,

stupidity, or omnipotence. The predominance of

hate and envy stimulates the attack of the alpha

function. This phenomenon may destroy the rational

contact with the self and impair the relationship of

the self with live subjects, thus removing from the

container its function of cleaning up the toxicity that

is caused by being filled up with mental pain.

In his model, Bion considered that the capacity

of the mental apparatus to handle mental pain

depended, most of all, on the early interaction

196 M. Fleming


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between the child and the maternal object. In

addition, it also depended on the quality of the

relationships of the self with other objects, that is, on

the emotional links that are established by the self

with the goal of tolerating the gap that separates the

self from the other.

Other previous contributions on the specificity

of mental pain

Several other psychoanalysts have favored the con-

ceptual separation of mental pain from other emo-

tions or feelings. Most of these researchers have

accepted the classical Freudian concept of mental

pain as a phenomenon that results from a breach in

the protective barrier of the ego, and they have also

underscored the role of intolerance to (or non-

containment of) painful experiences. Some of these

previous contributions on mental pain are briefly

revisited.

A pioneering interpretation by Weiss (1934) on

the genesis of mental pain proposed that mental pain

occurs when an injury is located within the ego: the

open wound thus produced in the ego just comes to

expression as mental pain (p. 12). Weiss was one of

the first to call for an urgent need to investigate the

different origin of pain (Seelenschmerz ) and suffering

(Seelenleid), and he further suggested, in accordance

with Federn (1926), that the former is associated

with object cathexes and the latter with narcissistic

cathexes. Szasz (1955) saw mental pain as an

emotion coming from how the ego relates to thebody, in contrast with anxiety, which he considered

to be derived from the orientation of the ego toward

the object; he viewed. pain as being located at the

frontier between ego and body, more specifically

as a result of rupture of the ego body integration.

More recently, Ramzy and Wallerstein (1958),

accepting Freuds definition of mental pain as a

breach in the protective barrier of the ego, have

proposed that there is an intimate association

between primary pain and fear experiences, and

the nature and degree of ensuing anxiety phenom-

ena. Both the somatic and mental origins of mentalpain were considered by Spiegel (1966), who

pointed out that mental pain should be viewed as a

specific entity, that is, as different from other painful

phenomena, namely anxiety. He added that mental

pain is derived from a narcissistic lesion: a damage of

the self ascribed to the absence of a constant external

object, creating an internal pain stimulus*the

constant object presentation (p. 90), whereas anxi-

ety resulted from loss of a transient external need or

satisfying object (Spiegel, 1966).

Others have stated that mental pain implies

diffuse emotional states of an uncomfortable, dis-

pleasurable, and distressful nature (Valenstein,

1973, p. 367), or is a sharp, throbbing, somewhat

unknowable feeling of despair, longing and psychic

helplessness (Akhtar, 2000, p. 231). Valenstein also

saw a frontier nature in the concept of mental

pain that would be functionally and developmentally

located between the biological and psychologicaldomains of the mind.

Psychoanalysts of the French school have studied

in particular how mental pain relates to pleasure/

displeasure (Unlust). For instance, Pontalis (1981)

proposed a clear distinction between mental pain

and displeasure: the former is beyond the pleasure/

displeasure principle, whereas the latter is associated

with an experience of disatisfyingness. This author

also stressed the nature of painful feelings: where

there is pain, it is the absent, lost object that is

present (p. 90).

Anzieu (1985) found differences between displea-

sure and mental pain: whereas displeasure does not

alter the functions of the self, mental pain causes self

dysfunction and attenuation of the frontier between

egomind and egobody, as well as between id, ego,

and superego. Pleasure offers the human mind a

release from tension and a recovery of balance,

whereas pain has an opposite effect; Anzieu wrote

that mental pain forces the network of contact

barriers, lowers the unleveling between psychic

subsystems and has a tendency to spread in all

directions, and thus the self does not exist anymore

as self (p. 204). These authors have not, however,

established clear differences between mental painand psychic suffering.

Distinction between mental pain and psychic

suffering

The distinction between mental pain and psychic

suffering is useful in psychoanalysis and finds its

theoretical roots mainly in the work of Bion, namely

in the following statement of his: the patients come

for treatment, of whom I wish to formulate theories,

experience pain but not suffering . . . the intensity of

the patients pain contributes to his fear of sufferingpain . . . pain is inflicted or accepted but is not

suffered, except in the view of the analyst or other

observer (Bion, 1970, p. 19). Bion thus considered

that mental pain emerges when the patient lacks the

capacity to suffer, and suffering is associated with the

capacity of the patient for containment and for the

mental elaboration of painful emotions.

The main goal of this paper is to put forward the

psychoanalytic principle that mental pain is clearly

distinct from psychic suffering, and that this distinc-

tion is of heuristic value in clinical practice. The

author thus proposes that mental pain and psychic

Distinction between mental pain and psychic suffering 197


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suffering should be used to name distinct emotional

experiences of the patient.

Psychic suffering is related by the patient to his

own self (I suffer), whereas the patient who is

under mental pain does not refer it to the self or to

the other (i.e. nobody and no event is charged by the

patient as being the cause of his mental pain). Thisimplies that psychic suffering is suitable for descrip-

tion in words by the patient, in contrast with mental

pain, which is deprived of sense and cannot be

explained in any way by the patient to another. In

psychic suffering, the patient feels some relief when

he talks about his psychic suffering to someone else,

namely the analyst, whereas mental pain is not

suitable for communication and is beyond pleasure

or displeasure. These features indicate that psychic

suffering can be elaborated by the patients mental

apparatus, for instance through the work of mourn-

ing, whereas mental pain resists elaboration by the

patients mind. It is plausible to consider that mental

pain is an emotional phenomenon located at the

frontier between soma and psyche, and is also made

up of undefined sensations that the patient is not

able to name or describe through words or repre-

sentations.

The above definition of mental pain is in accor-

dance with Freuds views (1997 [1926], p. 417):

the only fact that we are certain of is that pain

occurs in the first instance and as a regular thing

whenever a stimulus which impinges on the

periphery breaks through the devices of theprotective shield against stimuli and proceeds to

act like a continuous instinctual stimulus.

Illuminating concepts on the functioning of the

human mind were introduced by Bion. Indeed, he

proposed the concept of alpha function to name

the process of mentalization that digests raw beta

elements (which may emerge in the patient as mental

pain) into elaborated thoughts (Bion, 1962, 1992).

According to Bions followers, for instance Lecours

and Bouchard (1997), mental pain would be de-

scribed as a non-tolerated and non-containedexperience that, though mentalised, fails to be

elaborated by the psychic apparatus and to progress

into symbolization (p. 856).

These two authors considered mentalization to

be an intrapsychic activity that leads to a transfor-

mation and elaboration of experiences into increas-

ingly organized mental phenomena and structures

that progress from representation (first step) into

symbolization and abstraction; psychic tolerance and

containment are central to this progress: elaboration

will be seen to progress with an increasing capacity

for tolerance, containment and then abstraction

(Lecours & Bouchard, 1997, p. 856). They consid-

ered that the levels of emotional tolerance or contain-

ment and abstraction are disruptive impulsion,

modulated impulsion externalization, appropriation

of affective experience, and abstract-reflexive mean-

ing association (p. 857), and also that mentalization

absorbs internal as well as external stresses, trau-matic excesses and internal pressures by mentally

processing their effects on the soma/body and by

elaborating these further (p. 857).

Marty, de MUzan, and David (1963), and also

Luquet (2002), proposed that the channels of

expression of the mental elaboration, going from

less to more complex levels, are somatic and motor

activity, imagery, and verbal expression.

Bions conceptual framework is the foundation the

proposal given here that mental pain is derived from

traumatic experiences (beta elements) that are not

suitable for mental elaboration. This lack of elabora-

tion of traumatic experiences has not allowed their

construction into the contents and structures of

higher level of mental complexity, such as symboli-

zation, appropriation of affective experience, and

abstract association; that is, Bions alpha function

was not activated, and toxic beta elements re-

mained as such, being expressed as mental pain.

In contrast, psychic suffering is the result of a

negative experience that has been tolerated by the

mind and symbolized by the alpha function of

the mental apparatus. Thus, to understand the

origin of psychic suffering and mental pain, it is

useful to consider that there is a personal thresholdfor emotional pain in each patient and that this

threshold will make a traumatic experience lead to

either psychic suffering or mental pain. To consider

this idea of a threshold is also to accept a bimodal

response of tolerance/intolerance (within the limit/

beyond the limit) to pain by the mind.

Clinical illustration

Clinical examples are now presented in order to

illustrate the expression of psychic suffering and

mental pain by patients during psychoanalytictherapy.

Maria is a 32-year-old woman; she is single and a

psychologist. She describes a suicide attempt when

she was a teenager and her parents were getting

divorced. She has always lived with her mother.

When Maria first came to my office asking for

psychoanalytic therapy, she complained of persistent

feelings of emptiness and despair. In a therapy

session, Maria tells me:

today I woke up crying . . . I remembered when I

was a baby that there was nobody near my crib . . .

198 M. Fleming


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My mother was living alone because my father was

in a Portuguese African colony as a soldier fighting

against the liberation army of that colony . . . I

remember seeing my mother standing in a dark

room and not moving at all . . . I think that my

mother was feeling very lonely and afraid that my

father would not come back. Then I let myself cryand numerous images of that time came back to

me . . . Afterwards, although I was suffering, I stop

crying and I felt some relief.

This is a clear example of psychic suffering that

finds words to express the suffering, and the words

chosen by the patient refer to emotions, images, and

remembrances. In contrast, I am now presenting a

transcription of another session with the same

patient.

Maria is now silent and I get the intuition that she

is revisiting the places of a non-tolerated mental

pain and trying to confer emotional meaning to what

she calls something (with no name or image

associated with this something) that is, according

to her words, a something that is always there.

Here is the transcription of that incident:

Maria: Sometimes I feel that I am under a

paralysis, there is a chaos inside me . . . A cold

chaos. I do not know what I am feeling then, or

why I am having that feeling, I do not relate it with

any images or remembrances. It is a white sensa-

tion, an icy one . . . I always had this sensation, but

there is always a cloud, a mask covering something. . . I feel something . . . A permanent pain that I do

not know how to define. I would like you to

explain it to me, that thing . . .

Analyst: What is the name of that thing?

Maria: I do not know its name . . . I just know that

it is bad for me . . . A bad thing that is unbearable

for me.

Analyst [Following my own countertransferential

feelings, I then risk suggesting of a name]: Maybe

the name of the thing is helplessness.

Maria: Yes, helplessness! Like the sensation of

seeing me floating in a void. Now I recall that,when my mother played with me and threw me

in the air, I felt a great terror because it was as

if I was a planet lost in the wide universe, with

nobody holding me, with no limits or shapes that

would impair me becoming lost in an enormous

distance.

This transcription illuminates the nature of mental

pain that is dominated by silences and an inability to

use words or images. It also show that the analysts

suggestions may help the patient to transform mental

pain into psychic suffering, that is, help the patient

to find the words to express what was before a

nameless pain and is now a suffering that can be

communicated with images and representations.

A model of mental pain

Freud considered that the functioning of the mentalapparatus must bear similarities to that of other

biological systems, even though the workings of the

mind are operations of great complexity. Thus, he

envisaged the response of the mind to external

stimuli as obeying thresholds of tolerance. For

instance, when the threshold of frustration is over-

reached, this will result in paralysis of the mental

apparatus. According to Bion (1962), paralysis of the

mental process derives from damage in the transfor-

mational ability of the mind that is expressed by a

loss of its capacity to digest beta, unthinkable

elements into alpha, constructed ones. This paralysis

of alpha function is the result of insufficient toler-

ance to mental pain.

In fact, my clinical experience has shown me

that the patients mental pain can only find a

container in psychoanalytic holding, that is, in

the space/time of a long-term relationship with a

reliable and available other, because the analyst will

not retaliate or allow himself to be damaged by

the destructiveness of the patients mental pain. In

these situations, the analytical space is one of

contention, mental pain emerging as the not told

that aims to be told: the patients long silences

express a search without words for a listener withwhom to enact or rebuild the genesis of the patients

mental pain. Using transference, patients use

the analyst to offer themselves anew the opportunity

to relive, in a different setting, the trauma that

caused their mental pain. Therapy is a work

of mutual construction that involves a labor of

word-searching and, according to Bion, a beta-

into-alpha change.

Mental pain may be so undifferentiated that is

considered by the patient to be located in such a

faraway site that the patient denies feeling mental

pain, and he may even not allow that the wordpain has been said by the analyst, because what

can be shared is not the pain, but the defense against

it (Anzieu, 1985, p. 204). The analyst often has

an intuition of a mental pain that is not referred to at

all by the patient.

Bion saw psychoanalysis mostly as the develop-

ment of a containercontained relationship that

used both transferential and countertransferential

mechanisms: the analyst offers his container and

alpha function to do the mental digesting of the

non-thought contents of the patients mind that

are associated with mental pain. Using his alpha

Distinction between mental pain and psychic suffering 199


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function, the analyst will offer back the contents

of mental pain to the patient, now in a form that will

be tolerable and detoxified of the excess of suffering,

thus recreating cognitive, emotional, and affective

conditions for the autonomous emotional growth of

the patient in search for his inner self.

Several issues in clinical psychoanalysis will gainfrom the use of the concepts presented here of

mental pain and psychic suffering. Upon identifying

mental pain as a key emotional feature of the patient,

the analyst must push the analytical process into a

transformation of patients mental pain into new

organizing myths, rather than searching for the exact

meaning of mental pain. Because the analyst offers

himself as a container of the mental pain emotions,

he must enhance his threshold of tolerance to mental

pain, as was discussed in detail in a recent paper by

the current author (Fleming, 2005). The work of the

analyst must open up to semiotic dynamics, namely

to dream what the patient is not able to dreambecause of the patients mental pain*the alpha-

dream-work of Bion*to listen to the musical

features of the therapeutic setting, and to be

able tolerate doubt and uncertainty in a relation-

ship of emotional contention that is dominated by

mental pain.

References

Aktar S. Mental pain and the cultural ointment of poetry.

International Journal of Psychoanalysis. 2000; /81:/22943.

Amaral-Dias C, Fleming M. La fonction contenante de lanalyste[The container function of the analyst]. Revue francaise de

psychanalyse. 1994;/58:/1391 477.

Amaral-Dias C, Fleming M. A psicanalise em tempo de mudanca:

contribuicoes teoricas a partir de Bion [Psychoanalysis at a

time of change: Theoretical contributions based on Bion].

Porto: Afrontamento; 1998.

Anzieu D. Moi-peau [The Ego-skin]. Paris: Dunod; 1985.

Bion W. Learning from experience. London: Heinemann; 1962.

Bion W. Elements of psychoanalysis. London: Heinemann; 1963.

Bion W. Attention and interpretation. London: Maresfield Li-

brary; 1970.

Bion W. Cogitations. London: Karnac Books; 1992.

Federn E. Some variations in ego-feeling. International Journal of

Psycho-Analysis. 1926;/VII:/1426.

Fleming M. A dor mental, eros e o deserto emocional [The mentalpain, eros, and the emotional desert]. Revista Portuguesa de

Psicanalise. 2003a;/24:

/217.

Fleming M. Dor mental: para alem do representavel [The mental

pain: Beyond the representable]. Revista Portuguesa de

Psicanalise. 2003b; /23:/12332.

Fleming M. Dor sem nome: Pensar o sofrimento [Pain without a

name: The thinking of suffering]. Porto: Afrontamento;

2003c.

Fleming M. The mental pain of the psychoanalyst: A personal

view. International Forum of Psychoanalysis. 2005;/14:/69

75.

Freud, S. (1954 [1895]). Project for a scientific psychology in the

origins of psycho-analysis. London: Imago.

Freud, S. (1961 [1911]). Formulations on two principles of

mental functioning. In J. Strachey (Ed. and Trans.), The

standard edition of the complete psychological works of

Sigmund Freud, SE 12. London: Hogarth Press.

Freud, S. (1997 [1926]). Inhibitions, symptoms and anxiety. In

Selected writings. New York: W. W. Norton.

Lecours S, Bouchard M-A. Dimensions of mentalisation: Out-

lining levels of psychic transformation. International Journal

of Psychoanalysis. 1997; /78:/85575.

Luquet P. Les niveaux de pensee [The levels of thought]. Paris:

PUF; 2002.

Marty P, de MUzan M, David C. L?investigation psychosoma-

tique [Psychosomatic Research]. Paris: PUF; 1963.

Pinheiro R T, Sousa P L, Horta B L, Silva R A, Souza R M,

Fleming M. Cocaine addicts and their families: An empirical

study of the process of identification. International Journal of

Psychoanalysis. 2001;/82:/34760.

Pinheiro R T, Amaral K C, Sousa P L R, Horta B L, Silva R A,

Fleming M. The relationship of cocaine dependence and

parental psychopathology: A case/control study. Canadian

Journal of Psychoanalysis. 2003;/11:/17084.

Pontalis J-B. Frontiers in psychoanalysis: Between the dream and

psychic reality. New York: International University Press;

1981.

Ramzy I, Wallerstein R. Pain, fear and anxiety: A study in their

interrelationships. Psychoanalytic Study of Children. 1958;/

13:/14789.

Schneider M. La tombee du jour [Fall of the day]. Paris: Seuil;

1989.

Spiegel L A. Affects in relation to self and object. Psychoanalytic

Study of Children. 1966; /21:/6992.

Szasz T. The ego, the body, and pain. Journal of the American

Psychoanalytic Association. 1955; /3:/117200.

Valenstein A F. On attachment to painful feelings and the negative

therapeutic reaction. Psychoanalytic Study of Children.

1973;/28:

/36592.

Weiss E. Bodily pain and mental pain. International Journal of

Psychoanalysis. 1934;/15:/113.

Author

Manuela Fleming, Ph.D., is a Titular Psycho-

analyst at the Portuguese Psycho-Analytical Society,

and Associate Professor of Psychology at ICBAS,

University of Porto, Portugal. She received her first

degree of Psychology at University of Paris. She is

senior member, training and control analyst, and has

published several chapters and articles in interna-

tional journals. She has authored seven books,

namely Nameless pain: A reflection on suffering,

recently reviewed in the International Journal of

Psychoanalysis (August, 2006).

200 M. Fleming


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