The study of pain has a history as long as that of Western medicine. In the 20th and 21st centuries much has been made about the epistemological problem of seeing somatic as well as psychic pain in the clinical setting. The two schools seem to be those which rely on self-reporting and those that rely on the interpretation of visual materials (expression or brain scans) by trained specialists. That this problem was central to the 19th century study of pain is clear as these origins (especially Darwin) are often cited in today’s literature as ‘proof’ of their validity. That the problem was also central to one of the early 20th century thinkers most indebted to Darwin, Sigmund Freud, is less well known and how he resolved this paradox of self-reporting versus seeing seems to have been overlooked.