ABSTRACT
Since the type of pain I am discussing is associated with a loss of a particular state of mind and psychological balance, I first want to consider the nature of this state. I have suggested that the pain is not just anxiety, not just depression. I shall indicate that it is linked with a greater awareness of the self and of the reality of other people, thus that it is linked with a sense of separateness, but it is not just these concepts that I am talking about-I want to explore the experience and the qualities involved. I think that it emerges in patients who, though in many ways living apparently satisfactory lives, have important areas of psychotic anxieties and whose defences have been operating comparatively successfully. They have to some extent achieved peace and freedom from conflict by the use of particular types of relationships with objects, which protect them from realistic emotional experiences. Basically I am describing an aspect of what Melanie Klein subsumes under the heading of ‘projective identification’. When this type of pathological tie breaks down, what they experience is new and unknown and is what they, and I here, are calling ‘pain’. In the earlier stages of the analysis of such patients, anxiety and persecutory feelings are strong when these defences are felt to be threatened; as they are further analysed and progress is made, then I think the experience changes from anxiety to ‘pain’. This movement I shall refer to again later.
