Terms and Theories of Pain

Abstract

All writers and all psychiatrists make mistakes. This applies even to the greatest names of past and present. If I pick out one such error, by a deservedly famous man, it is not meant to detract from his achievement or to cast a posthumous slur on his reputation. It is meant, rather, to show the insidious and universal nature of the error which he made. In saying this I have in mind a remark by Jaspers (1963) that “severe pains need not be felt”. Perhaps all of us, at some time, have made the observation about a sick or injured person “He did not feel the pain”. Usually this is done when someone has an injury which seems likely to give rise to pain but does not provoke any signs which ordinarily accompany severe pain such as wincing, gasping and the like. We are all, incidentally, well aware that although trauma normally gives rise to pain there are some striking instances in which it does not do so, or else the pain sustained is much less than expected. Such instances include patients with a congenital or acquired inability to experience pain either for unknown reasons (Ogden et al., 1959) or because of nervous system disorders such as the Riley-Day syndrome or Tabes Dorsalis. They also include trauma in battle (Beecher, 1956) and the very important examples of anaesthesia or local analgesia.