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Mann, D.W. (1992). Psychiatric Pain and Deliberate Suffering. Psychoanal. Dial., 2(4):545-560.

(1992). Psychoanalytic Dialogues, 2(4):545-560

Psychiatric Pain and Deliberate Suffering

David W. Mann, M.D.

In public opinion and in medical practice the suffering of psychiatric patients is often considered self-induced. Freudian psychoanalysis embraced this notion but managed to reconcile it with the pleasure principle only by positing an instinctual craving for death, to which Freud reduced instances of deliberate and repetitive suffering. In a simultaneous but separate line of thought, he also reduced all habits, including self-destructive ones, to masturbation and all inhibitions of constructive drives to inhibitions of masturbation. This article explores this seeming paradox.

The transition from a paranoid-schizoid position to a depressive one begins with the dawning assumption of ownership of certain aspects of one's being, with the correlative attribution of other aspects to the world outside the self. Inevitable errors in this process create tensions that may be discharged by suffering, either by atonement or by assuming ownership of the pain that one's dependency might otherwise inflict on one's objects. Eros serves Thanatos to preserve self-ownership. Pragmatically, owning one's fate can feel more important than enjoying it, a fact the author dubs the “Principle of Ownership” and illustrates with a number of literary and clinical vignettes.

The idea that psychiatric suffering is self-induced contributes to the stigma that so commonly attends it. Ironically, this same idea makes psychological treatment possible: if painful adjustments replace relationships, then new relationships may have the power to correct them.

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