The connection between physical and emotional pain
Just as the digital age has ushered in new ways of enhancing human connection, it’s also opened up the scope and range of social rejection. The verb “unfriend” — as in Facebook —was the word of the year in 2009, joining its older cohort “cyberbully,” not to mention the advent of the text breakup or the Facebook status change to tell him or her it’s over. With the yin and yang of digital life in mind, it seems relevant to explore what science knows about emotional pain and its connection to the physical kind.
Language has always mirrored the connection between these two kinds of pain; we suffer from broken hearts as well as bones, and speak of bruised feelings and toes. All of this seems intuitively right because we recognize the common basis of the pain we experience, whether it’s that of missing someone so much that you ache or a throbbing head. Is there anyone out there who actually believed that “sticks and stones may break my bones but words can never harm me?” I somehow doubt it but now science has a bead on the literal harm words inflict.
Sticks and stones may break the bones
But leave the spirit whole,
But simple words can break the heart
Or silence crush the soul.
By Herb Warren
The links between these two kinds of pain goes beyond the metaphorical and what science reveals about emotional pain, and why we feel it is nothing short of fascinating.
1. We’re hardwired to feel emotional pain as well as physical pain.
It’s been hypothesized that it’s not just the human infant’s many years of dependence on i caretakers until he or she finally reaches maturity but also the continued reliance of individuals on others for basic sustenance and protection—from the earliest hunter-gather cultures and forward—that makes feeling the loss of social connections an evolutionary advantage. Human beings don’t thrive going it alone the way snakes do. Just as physical pain signals us that we must withdraw from or flee from something that is hurting us in order to survive, so too the loneliness we feel in isolation or the anxiety induced by abandonment reinforces us to seek out and maintain social connections.
Of course, it certainly doesn’t feel like an advantage, evolutionary or otherwise, when you’re in the throes of emotional devastation —the moment you hear that your ex is madly in love, blissed to the max, and about to get married; when your close friend cuts you off with nary a word of explanation; or at the moment your mother, who never has anything nice to say about you, tells you once again that you’re a horrible disappointment.
2. Social pain may be more like physical pain than not.
While both physical and emotional pain both “hurt,” they seem, on the surface at least, to do so in different ways, right? Well, maybe not as much as we might think. While it’s true that slicing your finger instead of the onion on the cutting board is one kind of experience and being dumped by someone you love is another, there’s evidence that they have more in common than not.
For example, Naomi L. Eisenberger and others used neuroimaging to see what happened in the brain when someone was socially excluded. Participants in the experiment were told they’d be playing an online ball-tossing game with other players; unbeknownst to them, the other “players” weren’t people but computers. In the first round, the subjects were “included” by the other players who tossed the ball to them; in the second round, they were deliberately excluded. The neuroimaging showed greater activity after the exclusion in the regions of the brain associated with the affective component of physical pain, suggesting a shared circuitry.
But another experiment by Ethan Kross and others went even further, positing that there might be more of an overlap if the stimulus were strong enough. Perhaps being “excluded” from an online game just didn’t pack enough of a social wallop. So they conducted an experiment to see whether they could involve the regions of the brain that are involved in both the affective and sensory components of physical pain. The researchers recruited forty participants who’d experienced “an unwanted romantic break-up.” (In other words, they’d been dumped by someone they loved.) During MRI scanning, the participants were put through a number of tasks. They were asked to look at a headshot of their ex and specifically think about their feelings of rejection (OUCH!!) and then at a photo of a friend, someone of the same gender as their ex-partner, and think about the positive experiences they’d shared with that person. The same participants were also given two types of physical pain tests: one a “hot trial” where enough heat to cause discomfort was applied to the left forearm and a “warm” trial applied to the same location which was hot enough to produce sensation but no discomfort.
What the researchers found was that the same parts of the brain were activated by the pain of recalling rejection and the physical pain of heat. Future research will reveal more but it would appear that the connection between emotional and physical pain is much, much more than a metaphor.
3. Words hurt just like sticks and stones
We all know this, despite the adage. When I was writing Mean Mothers, women who were victims of “just” verbal abuse often commented that they wished they’d been hit so that “their wounds and scars would show.” In a series of studies, Martin Teicher M.D., Ph.D. and others have shown that there are physical and emotional consequences of “just” verbal abuse. In one study, the researchers found that the effects of parental verbal aggression were comparable to “those associated witnessing domestic violence or non familial sexual abuse.” In fact, verbal aggression produced larger effects than familial physical abuse. There’s evidence too that exposure to verbal abuse in childhood actually alters the structure of the brain. That was also borne out in another study by Dr. Teicher and his colleagues called “Hurtful Words.” What the researchers found was that especially during the middle school years, when the brain is actively developing, exposure to peer bullying and verbal abuse caused changes to the white matter in the brain.
Just because we can’t see the wounds doesn’t mean they aren’t literally and physically there.
4.. Some of us are more sensitive to pain—social and physical— than others.
It’s called “rejection sensitivity,” and what it means is that some of us expect and anxiously anticipate social exclusion or rejection, are quick to perceive it, and react to it really strongly. You probably know who you are —the person who is anxious about going to a party, who’s prone to read into the text you just got. Rejection sensitivity is connected to attachmentin childhood; insecurely attached people are more likely to be rejection sensitive than those who had loving, attuned, and accepting relationships in their families of origin. Alas, rejection sensitivity tends to be a self-fulfilling prophecy because the person over-reacts and misreads social cues.
Mind you, we are all sensitive to social exclusion, but to different degrees. Studies have shown that people who suffer from high levels of daily pain also experience greater fears of social rejection; similarly, those who have a heightened sensitivity to social pain also report having more physical symptoms, including pain, those whose who are securely attached.
5. Pain, whether it’s emotional or physical, hurts more when it’s deliberately inflicted.
At first glance, this statement seems just like a validation of something everyone knows already but it’s an important thing to remember in the digital age when it’s often not clear whether the person is deliberately rejecting you (“ Did he/she really not see the text I sent three hours ago?”) or when a “conversation” that is conducted without the benefit of tone, nuance, or facial expressions goes badly.
While determining whether a slight or a wound in the real world is deliberate is relatively straightforward, it’s not in cyberspace. And it matters as one study conduced by Kurt Gray and Daniel M. Wegner demonstrated. Participants were grouped into pairs, one of whom would be administered tasks by the other called the “confederate.” There were four tasks, three of which were benign (color matching, number estimation, and pitch judgment) but the fourth was the delivery of an electric shock which the participant would have to rank on a scale from “not uncomfortable” to “extremely uncomfortable. ” In each trial, a computer showed two possible tests and the participant was told that the confederate would determine which test was administered. In one group —the intentional condition —the confederate was told to choose the shock when it was a possible choice; in the other condition the confederate was told to chose the pitch judgment, not the shock, when it appeared on the screen. But the participant was told that, unbeknownst to the confederate, the tasks had been switched so that the pitch judgment would yield to the shock being administered, albeit unintentionally.
The experiment showed that intended pain was perceived as more painful, even though the literal amount of pain administered was the same. Attributing malice to something painful not only makes it hurt more but makes it harder to recover from.
Many of us, alas, know this from experience but it’s good to know that it’s a universal reaction. It’s why the emotional pain inflicted on us deliberately by people who are supposed to love us (parents, siblings, spouses, friends) is so hard to get over.
6. Why “getting over it” is so hard and why you may need help
For all that emotional pain and physical pain have much in common, our attitudes toward them are very different. You wouldn’t find yourself telling someone to “get over” the pain of a broken hip or leg, but you might very well when it comes to a difficult childhood or the painful breakup of a relationship. Understanding the science of pain can perhaps change our cultural attitudes toward social pain and our treatment of it. Consider, for example, a study by C. Nathan De Wall and others that looked at whether acetaminophen (yup, the stuff you buy over-the-counter for fever and pain) could reduce social pain. Can you take two pills to cure the pain of social exclusion the way you might for a headache? In their first experiment, the researchers had participants take either acetaminophen or a placebo every day for three weeks, and report on their hurt feelings daily, as well as positive emotional experiences. Amazingly, those taking acetaminophen reported significantly lower daily hurt feelings of rejection or exclusion.
The results of a second experiment were less clear. The same conditions as the first were applied and then the participants played the cyberball game —the one where the player is first included and then “excluded” by the other players — and then reported on their feelings. MRI scans were then taken. Interestingly, although the pill did reduce activation in the brain regions associated with social pain, all the participants —whether they took the pill or the placebo —reported equal levels of social distress to the exclusion episode. This wasn’t what the researchers predicted.
So, while confirming the close connection between physical and emotional pain, this study shows there might not be an over-the-counter remedy for the experience of hurt. Further research will tell us more but, in the meantime, we’ll just have to focus on causing less emotional pain and helping more when people suffer from it.
Copyright © Peg Streep 2013
Eisenberger. Naomi. “Broken Hearts and Broken Bones: A Neural Perspective on the Similarities between Social and Physical Pain” (2012)http://sanlab.psych.ucla.edu/papers_files/Eisenberger(2012)CDPS.pdf
Kross, Ethan, Marc G. Berman et al. “Social rejection shares somatosensory representations with physical pain” (2011)http://selfcontrol.psych.lsa.umich.edu/papers/Kross_etal_Rejection_PNAS_2011.pdf
Eisenberger, Naomi. “The Pain of social disconnection: examining the shared neural underpinnings of physical and social pain” (2012)http://sanlab.psych.ucla.edu/papers_files/Eisenberger(2012)NRN.pdf
Gray K, and Daniel Wegner. “The sting of intentional pain.” Psychological Science. 2008;19:1260-1262.
Teicher, Martin H. “Wounds that Time Won’t Heal: The Neurobiology ofChild Abuse.”
Teicher, Martin J., Jacqueline A. Samson et al. “Sticks, Stones, and Hurtful Words: Relative Effects of Various Forms of Childhood Maltreatment.”http://psychiatryonline.org/data/Journals/AJP/3768/06AJ0993.PDF
Teicher, Martin H., Jacqueline A Samson, et al. “Hurtful Words: Association of Exposure to Peer Verbal Abuse with Elevated PsychiatricSymptom Scores and Corpus Callosum Abnormalities.”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246683/
De Wall, Nathan C., Geoff MacDonald, et. al. “Acetaminophen Reduces Social Pain: Behavioral and Neural Evidence” (2010)http://sanlab.psych.ucla.edu/papers_files/DeWall(2010)PsychSci.pdf