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An observer feels more empathy for someone in pain when that person is in the same social group, according to new research in the July 1 issue of The Journal of Neuroscience.   The study shows that perceiving others in pain activates a part of the brain associated with empathy and emotion more if the observer and the observed are the same race.

The findings may show that unconscious prejudices against outside groups exist at a basic level.   The study confirms an in-group bias in empathic feelings, something that has long been known but never before confirmed by neuroimaging technology. Researchers have explored group bias since the 1950s. In some studies, even people with similar backgrounds arbitrarily assigned to different groups preferred members of their own group to those of others. This new study shows those feelings of bias are also reflected in brain activity.  

‘Our findings have significant implications for understanding real-life social behaviors and social interactions,’ said Shihui Han, PhD, at Peking University in China, one of the study authors.

More here.

 

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P: Does empathy need a face? 

S: Well, observers of emotional pain faces show some activity in the facial musculature that appears to indicate empathy via mimicry, although inattention to the emotional quality of the expression, as when doubting its sincerity, may impair this response. 

P: Suppose a person with Möebius Syndrome observes a person in pain. There can be no activity in her facial muscles. Is the capacity for empathy for pain thereby reduced or diluted in this individual? 

S:  There is qualitative evidence suggesting that the experience of emotion in some adults with Möebius might be diluted and reduced. In some cases, emotion is intellectualized: people think happy, or think sad. One person told me: 

‘I have to say this thought is a happy thought and therefore I am happy. When there are things that are sad I tell the person that I feel very sorry for you but I’m thinking that rather than feeling it’. 

In other cases, there is an almost disconnection from emotion in oneself and from others, and possibly, a reduced capacity for empathy and sympathy. 

P: Why is this? 

S:  I stated earlier that the face is for human interactions a rich and primary source of information. In these encounters, the face provides a dynamic, embodied representation of emotion, sharing feelings and moods from moment to moment. Human interactions are, in part, facial conversations, usually mutually reinforcing. Through facial conversation, an individual can enter into the subjective experience of another, sharing feelings and moods. 

P: An inability to engage in facial interaction and to receive reinforcement from others may reduce the capacity for empathy. 

S: It appears that congenital facial paralysis reduces self-awareness. Reduced self-awareness with regard to one’s own emotions may diminish empathy for pain in others because the individual’s recognition of her own feelings is the basis for identification with the feelings of others. 

P: Here is a question: is empathy conceived as ‘emotional resonance’ related to the instigation of effective helping behavior? 

S: Certainly, in professional settings dispassionate concern for the patient is encouraged in the interests of objective care. 

P: This may be worth exploring: does similarity in facial expression mean greater similarity in affective responses, thereby affecting helping behavior? By contrast, do children and adults with Möebius typically instigate care? 

S: Earlier, I noted that the reactions of infants to pain are shaped and transformed during development into socially responsive patterns of behavior. I sense that these transformations may answer our question: does empathy need a face? 

Infant reactions to pain are global and non-reflective, as previously mentioned. They experience pain in a ‘catastrophic’ way. Catastrophic pain pushes for direct discharge in fixed responses. For example, apathetic or tense immobility, intense writhing or squirming.

In human development, however, infants can learn to ‘tame’ catastrophic pain patterns. Early to midway in the first year of life, caregivers help babies begin to learn how to transform catastrophic pain into interactive signals. 

The mother turns to look at her baby as he cries out in distress. She approaches him vocalizing concern, and he turns to look at her. She responds with a soft soothing facial expression of ‘what’s the matter’, and, with hands out, an offer to pick him up and cuddle him. Baby moves his head to find her and greets her eyes with a softening of his facial grimace and a look of expectation. Mother responds with soothing sounds and they continue to exchange calming facial expressions and sounds. Later, the parent is holding the baby, snuggling, and patting his back, and the baby relaxes. The tension in his face and body dissipates and he has a look of calm. 

P: Contrast this pattern with one in which signaling does not occur. A baby cries in pain and a mother, preoccupied with her own thoughts, ignores the overture. Baby tries again with more intensity, vocalizing more loudly, and squirming even more, but with obvious strain. The mother still ignores the overtures. Soon, the baby becomes passive and disinterested. 

S: For the signaling to occur in the first case, the baby needs to have been wooed into an intimate relationship with one or a few caregivers so that there is another human being toward whom he experiences deep emotions and, therefore, with whom he wants to communicate. 

P: The baby needs to have his facial display become part of a back-and-forth interaction by being responded to. 

S: Yes. Through his relationship to his caregiver(s), he is becoming more intentional. I think the baby is learning to signal with his emotions to mean intent rather than engage in a catastrophic response. Is that right? 

P: In the first case, facial signaling interrupts a fixed response. Mother responded to the baby’s signal of threat, not intent. He responded back and together they negotiated an outcome characterized by shared soothing calm rather than an intense pain-display. 

In development, the baby becomes better and better able to signal danger and threat without escalating into direct action. 

S: Let’s put it like this: by having his expression of danger responded to, the baby learns to modulate the intensity of his distress and pain. He is learning to regulate his state. The baby is learning to show distress, to negotiate, and to get his needs met. There is less of a tendency to explode into desperate action. Infants and toddlers quickly sense that they and their caregivers are regulating one another when there is a back-and-forth, finely-tuned nuance system of emotional interaction involving lots of mutual exchanges. 

P: How does this relate to empathy? 

S: First, it is likely that excessively empathic observers would be characterized as catastrophic, agonizing unduly and having difficulty in delivering effective helping behavior. 

P: I see. To provide effective care, an observer must have the ability to regulate her own aversive distress, since this may lead observers to focus primarily upon their own needs. 

This is really important in health-care. Health care professionals face the challenge of finding the balance that allows them to pay attention to the details of a patient’s pain experience and resonate with the patient’s pain experience without becoming emotionally over-involved. Catastrophic reactions may well preclude effective medical management and even lead to burnout. 

S: I think effective regulation of empathy, such as keeping distress at a moderate level, may promote other-oriented affective responses. Empathy for others comes from investing other human beings with one’s own feelings. This capacity, I claim, begins with first relationships. It depends on nurturing care that creates, through mutual facial expressions with caregivers, a sense of intimacy. 

P: Since a sense of ‘self’ is crucial for empathy, how does the infant develop it? 

S: When an adult responds reciprocally, the baby makes a discovery: ‘I can make something happen’. This teaches the baby to take initiative: crying in pain gets a concerned look from mom or dad. A sense of ‘self’ is developing, for it’s ‘me’ making something happen. As a toddler’s repertoire of emotional signaling grows richer and she begins to discern patterns in her own and others’ behavior, she adds these observations to the map delineating herself as a person. Her mother usually responds when she is pain, but not when she’s cranky. Her father likes to play, but not to sing lullabies. Grandmother is a good deal less strict than either parent. With the growing capacity to perceive and organize patterns, these types of experiences continue to define a developing sense of self even before words are used. 

P:   Why the interest in facial expression? 

S:   Well, the face is for human interactions a rich source of information: one can often appreciate features of another person’s emotions, motives, thoughts, attention, and intentions by scanning his or her face. 

P:   I think my spouse’s face is a work of fiction. 

S:   At least fiction is more interesting than autobiography. 

P:   Touché. 

S:   Imagine being unable to monitor and correctly interpret the ongoing patterns of your spouse’s facial activity. You would be vulnerable to serious social deficits. 

P:   Like divorce? 

S:   Not exactly. Consider Möebius Syndrome, a congenital condition of facial paralysis. These individuals often have great difficulty detecting and monitoring in others inner states on the face. As a result, they tend to experience rejection and lack of reinforcement from others, and may become withdrawn and highly introspective. 

P:   The plasticity of the face must make it very difficult for them. 

S:   Facial expression matters. There tends to be added value even when others are communicating verbally, as the information conveyed by the face is unlikely to be entirely redundant with the content of speech. 

P:   I see where your interest in pain comes in now. Facial expression may prove useful when attending to others who have been hurt, or another person’s facial grimaces may signal danger and allow one to avoid looming personal threat. 

S:   There is a general tendency to situate oneself so as to be able to attend to facial activity. 

P:   Just think of mothers who become utterly absorbed in their babies’ facial expressions! 

S:   That’s a great illustration. And, infants are equally attentive to their caretakers’ facial expressions. The capacity to attend to and use facial activity persists throughout life. 

P:   The child learns facial expressions in attending to and interacting with a caregiver. 

S:   Children are acculturated to social standards and normative patterns consistent with the social environments in which they grow up. 

P:   This means that behavior – including facial displays – conforms to cultural expectations. 

S:   Through observation, instruction and reinforcement, children learn facial displays that follow familial and social rules. 

P:   Fine. I think this is fairly uncontroversial, however. I mean, what determines the link between subjective states and overt behavior? Do first relationships connect mind and behavior? 

S:   That’s a fundamental question. Consider the response of very young infants to tissue damage. The reactions are relatively global – involve the whole body – and are reflexive in nature. Various studies report that the reactions of infants to pain are shaped and transformed during development into socially responsive patterns of behavior. Facial expressions of pain develop as part of this transformation. 

P:   That is an interesting observation, but uncontroversial. And, you haven’t addressed my question. You seem to be suggesting that the possibility of pain is conditioned by the possibility of its expression. I mean, isn’t the pain given – whether it can be expressed and how it is expressed seem to be further matters. 

S:   I am not certain it is quite so simple to divide facial displays neatly into inner and outer aspects. Isn’t pain given in expressive displays? Facial expression makes pain visible to others, and also for the patient. Facial activity may also contribute to the experience of pain. 

P:     I am not convinced. 

S:   Well, I am speculating that modulation of facial expression may alter the pain-sensation. The vigor of the facial display influences the magnitude of the subjective experience. 

P:   Oh, you mean:  ‘grin and bear it’, and all that? 

S:   Right:  ‘keep a stiff upper lip’. It is relatively easy to acknowledge this point, at least intuitively. 

P:   I can see benefits here: attenuated facial expression of pain decreases subjective distress, and increases pain tolerance. 

S:   Research on individuals with Möebius Syndrome reveals that they have high pain tolerance and decreased distress in pain because they cannot make facial expressions. 

P:   Or, more precisely: ‘…because they cannot experience facial feedback’. 

S:   So, here is an idea: feedback from the face may permit subjective differentiation of inner states. 

P:   This idea may have the following negative consequence, however: if attenuated facial expression of pain decreases inner distress in the individual, is detection of pain in others thereby weakened? Does perception need a face? 

S:   Studies on adults with Möebius Syndrome show that they have no impairment in emotional facial expression recognition. This means that the ability to produce facial expressions is not a necessary prerequisite of their recognition. 

P:   It follows that the inability to experience facial feedback in oneself does not inhibit facial recognition of emotion in others. I guess the same point applies to perception of pain. 

S:    I believe so. We can illustrate this point further. Are you familiar with CIP? 

P:    What is it? 

S:   CIP: congenital insensitivity to pain. It is characterized by dramatic impairment of pain perception since birth. Painless events include wounds, burns, bone fractures, deliveries, and so on. There are some residual pain experiences like headaches and low back pain in these individuals, however. 

What is noteworthy is that these people can perceive pain in others despite their own congenital insensitivity to pain. 

P:   An experience of pain is not required for perceiving pain in others. 

S:   We might put it like this: to perceive pain in others, we do not need a pain, nor even a face, but the concept of pain. 

P:   We do not feel the sensory aspects of another’s pain, but we may resonate with the agony of a person in pain when we encounter facial expression. 

S:   The degree to which we ‘share’ another’s agony depends on empathy. 

P:   Does empathy need a face? 

Joyful or sad smiles expressed after a competition are the same for blind and sighted athletes, according to a new study, showing that certain facial expressions are innate and managed differently depending on the social situation [Journal of Personality and Social Psychology, 96(1): 1-10].

“Spontaneously produced facial expressions of emotion of both congenitally and non-congenitally blind individuals are the same as for sighted individuals in the same emotionally evocative situations.” said study author David Matsumoto, PhD, of San Francisco State University. “We also see that blind athletes manage their expressions in social situations the same way sighted athletes do.”

Our emotional expressions probably come from our genes, and all of us, regardless of gender or culture, are capable of this behavior, he explained. “Blind athletes, and especially those born blind, could not have possibly learned to produce those exact facial configurations from modeling the expressions of others.”

The study compared the expressions of 76 blind judo athletes, some of whom were born blind, with the expressions of 84 sighted judo athletes. The blind athletes competed in the 2004 Paralympic Games. The sighted athletes competed in the 2004 Olympic Games. The matches analyzed consisted of gold- and bronze-medal matches. (Winners of the gold-medal matches got gold and losers got silver. Winners of the bronze-medal matches got bronze and losers got no medal. Two bronze medals are awarded in judo, so the losers of these matches received fifth place.) Both the Olympic and Paralympic athletes represented more than 23 countries.

To track the athletes’ reactions at certain points after the competition in the Paralympic games, the researchers photographed their facial expressions immediately after their match, during the medal ceremonies, and on the podium with other medalists. Each expression was coded according to the displayed emotion. Expressions from the sighted Olympic athletes were taken from another study done the same way by the same authors.

From the photos, the researchers found that the blind athletes produced the same facial expressions involving anger, contempt, disgust, sadness, surprise and multiple types of smiles as the sighted athletes.

More here.

Facial expressions of pain may be useful not only for communication, such as soliciting care from others. They may have a more fundamental, direct use as constituents of writhing pain behavior patterns, functioning to remove pain stimuli or to suppress pain sensations:

pain facial expressions are part of more encompassing pain behaviors such as stretching and throwing the head backwards, and bending the head and torso. They accompany overall tensing of the limbs, clenching of the fists, or other spasmodic movements. All these behaviors can be seen as constitutive of an overall pattern of writhing or squirming. Facial expressions of pain appear to be part of a rather primitive pain response of global flexor contraction, which would seem to serve the function of removing the painful stimulus. It might also serve to diminish the pain sensation by diverting attention or by suppressing the pain sensations. Clenching one’s teeth illustrates that latter function, as does digging one’s nails into one’s palms (Frijda, 2002).

Problems with this view:

1. No such whole body behaviors have been reported in the literature specific to pain in humans or in laboratory or domestic animals (Williams, 2002).

2. Various behaviors are described on infant and child acute pain, one of which is the apathetic or tense immobility (freezing) often ignored in children in pain. Whole body responses to pain do not always involve flexor contractions; hence, facial expressions of pain need not accompany patterns of body or limb movement (Williams, 2002).

3. Mere correspondence between the faces of muscular effort and pain is insufficient to establish direct use as the fundamental function of pain facial displays.

4. It seems conceivable that facial activity accompanying muscular effort could be of communicative value. The view under consideration assumes a sharp break between pain behaviors that have an indirect communicative function and pain behaviors that have a direct protective (pain-management) function (Sullivan et al., 2004). Facial expressions of pain can communicate distress to observers and could provide immediate protection by warding off or eliminating threats, for example, from those who might be violent. But they do not function to protect the face and, we argue, do not contribute to the escape or suppressive functions of contortions and tensing in the body. The view that pain facial expression is of direct use in global homeostatic processes therefore neglects the communicative functions of facial displays. By contrast, behaviors such as writhing, tensing, rubbing or holding can serve a pain management function by protecting the affected body area or by minimizing pain through mechanisms associated with tactile stimulation or increased circulation. Note that even these displays can communicate considerable information to the astute observer. The fidelity with which expressions of pain specifically signal communicative or management functions is limited. Pain displays can assimilate both protective and communicative functions. If this is correct, the explanatory accounts that partition nonverbal pain expression into unambiguous communicative and management functions fail to acknowledge the indeterminacy of facial displays of pain.

5. As an interlocutor between the self and other persons, the human face provides an embodied representation of pain to engage others in care provision (Cole, 2001). The object of effective care is not the writhing or tensed body, but the person whose body it is. As Wittgenstein (1958) put it, ‘…if someone has a pain in his hand, then the hand does not say so, and one does not comfort the hand, but the sufferer: one looks into his face’.

Readings

1. Badali, M. (2008). Sociality of facial displays of pain: Audience effects. Unpublished doctoral dissertation, University of British Columbia.

2. Cole, J. (2001). Empathy needs a face. Journal of Consciousness Studies 8(5-7), 51-68.

3. Craig, K.D. (2009). The Social Communication Model of Pain. Canadian Psychology 50(1), 22-32.

4. Craig, K.D., & Badali, M.A. (2002). Pain in the social animal. Behavioral and Brain Sciences 25, 456-457.

5. Craig, K.D., Prkachin, K.M., & Grunau, R.V.E. (2001). The facial expression of pain. In: Handbook of pain assessment, ed. D.C. Turk & R. Melzack (2nd Edition). New York: Guilford Press, pp. 257-274.

6. Darwin, C. (1999). The expression of the emotions in man and animals. Ed. P. Ekman. Oxford: Oxford University Press.

7. Doherty, E., Yanni, G., Conroy, R.M. and Bresan, B. 1993. A comparison of child and parent ratings of disability and pain in juvenile chronic arthritis. Journal of Rheumatology 20, 1563-1566.

8. Ekman, P., & Friesen, W.V. (1978). Facial action coding system. Consulting Psychologists Press.

9. Frijda, N.H. (2002). What is pain facial expression for? Behavioral and Brain Sciences 25, 460.

10. Goubert, L., Craig, K.D., & Buysse, A. (2009). Perceiving others in pain: Experimental and clinical evidence on the role of empathy. In: The social neuroscience of empathy, ed. W. Ickes & J. Decety. Cambridge, MA: MIT Press, pp. 153-165.

11.  Hadjistavropoulos, T., von Baeyer, C., & Craig, K.D. (2001). Pain assessment in persons with limited ability to communicate. In: Handbook of pain assessment, ed. D.C. Turk & R. Melzack (2nd Edition). New York: Guilford Press, pp. 134-149.

12.  Kunz, M., Scharman, S., Hemmter, U., Schgepelmann, K., & Lautenbacher, S. (2007). The facial expression of pain in patients with dementia. Pain 133, 221-228.

13.  Larochette, A.C., Chambers, C.T., & Craig, K.D. (2006). Genuine, suppressed and faked expressions of pain in children. Pain 126, 64-71.

14.  Loggia, M.L., Mogil, J.S., & Bushnell, M.C. (2007). Empathy hurts: Compassion for another increases both sensory and affective components of pain perception. Pain 136, 168-176.

15.  Nader, R., Oberlander, T.F., Chambers, C.T., & Craig, K.D. (2004). Expression of pain in children with autism. The Clinical Journal of Pain 20, 88-97.

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17.  Prkachin, K. (1992). The consistency of facial expressions of pain: a comparison across modalities. Pain 51, 297-306.

18.  Prkachin, K.M., Berzins, S. & Mercer, S.R. (1994). Encoding and decoding of pain expressions: A judgment study. Pain 58, 253-259.

19.  Prkachin, K.M., & Craig, K.D. (1995). Expressing pain: the communication and interpretation of facial pain signals. Journal of Nonverbal Behavior 19(4), 191-205.

20.  Prkachin, K.M., & Solomon, P.E. (2008). The structure, reliability and validity of pain expression: Evidence from patients with shoulder pain. Pain 139, 267-274.

21.  Salzen, E.A. (2002). The feeling of pain and the emotion of distress. Behavioral and Brain Sciences 25, 471.

22.  Solomon, P.E., Prkachin, K.M., & Farewell, V. (1997). Enhancing sensitivity to facial expression of pain. Pain 71, 279-284.

23.  Sullivan, M.D. (2001). Finding pain between minds and bodies. The Clinical Journal of Pain 17(2), 146-156.

24.  Sullivan, M.J.L., Adams, H., & Sullivan, M.E. (2004). Communicative dimensions of pain catastrophizing: Social cueing effects on pain behaviour and coping. Pain 107, 220-226.

25.  Turk, D.C., & Melzack, R. (2001). The Measurement of Pain and the Assessment of People Experiencing Pain. In: Handbook of pain assessment, ed. D.C. Turk & R. Melzack (2nd Edition). New York: Guilford Press, pp. 3-12.

26.  Vervoot, T., Craig, K.D., Goubert, L., Dehoome, J., Joos, R., & Matthys, D. (2008). Expressive dimensions of pain catastrophizing: A comparative analysis of school children and children with clinical pain. Pain 134, 227-285.

27.  Williams, C. de C, A. (2002). Facial expression of pain: an evolutionary account. Behavioral and Brain Sciences 25, 439-488.

28.  Wittgenstein, L. (1958). Philosophical Investigations. ed. G.E.M. Anscombe and R.Rhees. tr. G.E.M. Anscombe, 2nd edition. Oxford: Blackwell.

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