On the contrary, it is written (Ecclus. 25:17):  “The sadness of the heart is every wound [Douay:  ’plague’], and the wickedness of a woman is all evil.”  Therefore, just as the wickedness of a woman surpasses all other wickedness, as the text implies; so sadness of the heart surpasses every outward wound.

I answer that, Interior and exterior pain agree in one point and differ in two.  They agree in this, that each is a movement of the appetitive power, as stated above (A. 1).  But they differ in respect of those two things which are requisite for pain and pleasure; namely, in respect of the cause, which is a conjoined good or evil; and in respect of the apprehension.  For the cause of outward pain is a conjoined evil repugnant to the body; while the cause of inward pain is a conjoined evil repugnant to the appetite.  Again, outward pain arises from an apprehension of sense, chiefly of touch; while inward pain arises from an interior apprehension, of the imagination or of the reason.

If then we compare the cause of inward pain to the cause of outward pain, the former belongs, of itself, to the appetite to which both these pains belong:  while the latter belongs to the appetite directly.  Because inward pain arises from something being repugnant to the appetite itself, while outward pain arises from something being repugnant to the appetite, through being repugnant to the body.  Now, that which is of itself is always prior to that which is by reason of another.  Wherefore, from this point of view, inward pain surpasses outward pain.  In like manner also on the part of apprehension:  because the apprehension of reason and imagination is of a higher order than the apprehension of the sense of touch.  Consequently inward pain is, simply and of itself, more keen than outward pain:  a sign whereof is that one willingly undergoes outward pain in order to avoid inward pain:  and in so far as outward pain is not repugnant to the interior appetite, it becomes in a manner pleasant and agreeable by way of inward joy.  Sometimes, however, outward pain is accompanied by inward pain, and then the pain is increased.  Because inward pain is not only greater than outward pain, it is also more universal:  since whatever is repugnant to the body, can be repugnant to the interior appetite; and whatever is apprehended by sense may be apprehended by imagination and reason, but not conversely.  Hence in the passage quoted above it is said expressively:  “Sadness of the heart is every wound,” because even the pains of outward wounds are comprised in the interior sorrows of the heart.

Reply Obj. 1:  Inward pain can also arise from things that are destructive of life.  And then the comparison of inward to outward pain must not be taken in reference to the various evils that cause pain; but in regard to the various ways in which this cause of pain is compared to the appetite.