What is the mental pain?

When we think of pain we generally think of something that is related to our body. But there is a devastating form of pain that is not frequently acknowledged and is a topic of a paper by Eliana Tossani (University of Bologna) in the current issue of Psychotherapy and Psychosomatics.

Mental pain is no less real than other types of pain related to parts of the body, but does not seem to get adequate attention. A major problem is the lack of agreement about its distinctive features, conceptualization and operational definition.

This paper examines some suggested descriptions of mental pain, its association with psychiatric disorders and grief, its assessment and the implications that research in this field may entail.

It concludes that there is pressing need of research on mental pain. Some areas that appear to be particularly important are: – even though mental pain always has an individual meaning, consensus should be developed on its operational definition; – mental pain may provide the clinical threshold that is essential for determining the amount of distress that is worthy of clinical attention, in conjunction with diagnostic criteria.

It may offer a better specification of the criterion on 'clinically significant distress' that frequently recurs in DSM-IV; – the balance between mental pain and psychological well-being deserves attention. Engel, in his formulation of the pain-prone personality, outlined how, in some instances, somatic pain is clearly protecting the patient from more intense depression and even suicide, and the psychological profile of the need to suffer; – the neurobiology of mental pain is a fascinating topic that has been addressed only by a very limited amount of research.

It may unravel the brain system that interprets the negative emotional significance of cognitions, with particular reference to the role of amygdala and basal ganglia; – assessment of mental pain may have important implications in intervention research, particularly in psychopharmacology. For instance, depressed patients frequently report that treatment with antidepressant drugs yields substantial relief of their mental pain. Unfortunately, in psychopharmacology research the effects of drugs are measured on a limited range of symptoms.

Clinical and research attention to the issue of mental pain may produce important developments in psychiatry and is in line with recent emphasis on patient-reported outcomes, defined as any report coming directly from patients, without interpretation of physicians or others, about how they function or feel in relation to a health condition or its therapy.