THE IMPORTANCE OF MENTAL PAIN 357 



as something distinct from his body, and is there, and only there, to 

 be met, handled and helped, if possible. " Give me relief from this 

 awful feeling of inadequacy — from the pain that accompanies every 

 thought — from the dark that clouds all the future. PJease do this, 

 and I will be well," is the cry: and to the sufferer this is all there is 

 that can be described or helped. 



Of course, psychalgia may accompany or succeed every form of 

 physical distress imaginable; but even here, it is characterized by the 

 very same consciousness of intellectual inadequacy and underrating, 

 of emotional unrest instability and depression, as well as persistent 

 vision of future blackness, as elsewhere; and has corresponding need 

 to be regarded and dealt with, so far as possible, as distinctive from 

 the physical distress present. 



AVith these leading characteristics of psychalgia in mind, suppose, 

 by way of still further helpful elucidation, we investigate and follow 

 the course ordinarily taken by a case of so-called " traumatic neurosis." 

 Here there are, especially at first, clearly outlined localities in the. 

 organism whence waves of purely physical distress emanate, whose 

 origin can not be accurately referred except to their organic source. 

 But in time these come to be associated with certain other waves of pain, 

 whose localization is not so apparent, either to the sufferer or to the 

 investigator. In fact, eventually a large proportion of the suffering of 

 the patient is seen to consist in pains which have no locality outside 

 the selfhood that has been so direly and so deeply insulted by the in- 

 jury. Often, too, because of supposed blundering on the part of his 

 own self, or rebellion at " fate " through consideration of his present 

 predicament in connection with previous experiences, or of vengeance 

 against the objective cause of his present trouble, or of fear of possible 

 untoward consequences, or of changes in intellectual strength and 

 acuteness, emotional tone, will-power, self-control or self-direction, 

 there comes additionally an abiding, ever-deepening sense of degrada- 

 tion, which eventually enshrouds him in distress that seems as co- 

 extensive as consciousness itself and as intense as imagination could 

 possibly picture. Surely, if we have no means of absolutely differenti- 

 ating the psychical from the physical pain — the psychalgia from the 

 neuralgia — we are nevertheless not precluded from recognizing such 

 differences at the focal points of the two kinds of distress, as to lead us 

 rightly to deny that these may possibly require very different kinds of 

 estimation, for the highest good of the sufferer. In fact, while splints 

 and plasters and lotions and doses may succeed admirably in relieving 

 the physical consequences of physical trauma, it should not be forgotten 

 that the accompanying psychical trauma is of another order, and has 

 very different needs, as to both estimation and remedy; and this, no 

 matter how clear may be our notions as to the physical distress, or how 

 this may contribute simultaneously to psychical distress, as well. 



