PAIN AND GUILT: THE EXPIATION OF GUILT BY PAIN
When there is no clear cause for the condition, patients suffering from chronic pain are sometimes referred to a psychiatrist for his opinion. When these patients really unburden themselves they often disclose that they are preoccupied in thinking about some wrong they have done in the past. Over the years they have thought about it a great deal, and in thinking about it in this way, the wrong becomes greatly magnified. They have never told anyone about it. “This is something that I always thought I would bring with me to the grave.” And all the time there has been the thought, “Of course I shall be punished for it.” In the first place the pain may have arisen from some quite trivial cause; but once the pain is there, it soon becomes fixed. Only
half-consciously he thinks, “This is what I have been expecting; I knew it had to come; I am glad it has come at last and I shall get it over.” In a sense he is glad of the pain. By suffering the pain he will ease his conscience of the thing that he has done, and his mind will be at rest again.
On the one hand a patient in this situation wants to get rid of the pain because it hurts him, but on the other hand he wants to keep it, as it expiates his feeling of guilt. The pain lingers on, unrelieved by the various medicines he is given. Expiation never seems complete, so it continues until brought to light and worked through in psychotherapy.
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