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A psychological basis for indifference to pain


, : A psychological basis for indifference to pain. Psychosomatic Medicine 24: 119-132

Neurological, psychiatric and psychological findings concerning 3 patients showing indifference to pain were reviewed. It was proposed that an early alteration in ego development might account for this symptom. Three alternative hypothetical reconstructions were offered, based upon the theoretically close relationship between defense mechanism of denial and the affect of pain. The 1st of these reconstructions, that pain indifference resulted from a massive use of denial in very early childhood, was felt to be untenable because none of the patients showed psychopathologic changes extensive or severe enough to be consonant with such a gross early ego disturbance. The primary traits of character shared by these patients - their denial of weakness, helplessness, and passivity, and their insistence upon personal invincibility - suggested the possibility of an ego alteration during a somewhat later (i.e., phallic or oedipal) phase of development, similar to that found in counterphobic personalities. A 2d reconstruction, that indifference to pain represented the end product of the conversion process, was rejected because the symptom failed to fulfill one cardinal criterion of true conversion symptoms and it did not seem to be a symbolic representation of repressed instinctual impulses. A 3rd hypothesis, that the symptom arose as a result of the regressive reactivation of denial by the ego under the impact of phallic or oedipal conflicts, seemed to be the most credible. Such a reconstruction, if at all accurate, makes the use of the term "congenital" indifference to pain incorrect, since it would hold that these patients felt pain at one time, but could not recall this experience. Subsequent reaction formations of the ego undoubtedly helped to cement the character structure which was so evident in these cases.

US$19.90

PMID: 13908957

DOI: 10.1097/00006842-196203000-00002


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