Undermedication for pain on a burn unit.

As the consultation-liaison psychiatrist for a large burn service, the author investigated the undermedication for pain. This phenomenon could not be adequately explained by the staff's insensitivity, by mistaken ideas about analgesics, or by fears of iatrogenic addiction. For both patients and staff, the pain served to maintain self-object differentiation and to provide reassurance that the patient was alive. Developmental observations and psychoanalytic theory support this unconscious need for pain.