Misery and Empathy

In Misery, a horror tale by Stephen King,

Annie [the unbalanced "number one fan" of Paul Sheldon's romance novels] rescues the injured Sheldon from a car accident and seizes the opportunity to nurse her favorite writer back to health, but her tender loving care soon turns to terrorism as she demands that Sheldon write his latest novel according to her wish-fulfillment fantasies.

Annie the nurse initally offers empathy and narcotics, but her nuturing devolves into brutality... which leads us to today's topic: Is pain the price of empathy? A recent paper in Brain examined whether people born without the capacity to feel physical pain are capable of recognizing pain in others:

Danziger N, Prkachin KM, Willer JC. (2006). Is pain the price of empathy? The perception of others' pain in patients with congenital insensitivity to pain. Brain 129:2494-507.

"I feel your pain"

Empathy is a complex form of psychological inference that enables us to understand the personal experience of another person through cognitive/evaluative and affective processes. Recent findings suggest that empathy for pain may involve a 'mirror-matching' simulation of the affective and sensory features of others' pain. Despite such evidence for a shared representation of self and other pain at the neural level, the possible influence of the observer's own sensitivity to pain upon his perception of others' pain has not been investigated yet. The aim of this study was to explore how patients with congenital insensitivity to pain (CIP), who are largely deprived of common stimulus-induced pain experiences, perceive the pain of others. Ratings of verbally presented imaginary painful situations showed that CIP patients' semantic knowledge regarding the pain of others did not differ from control subjects. Moreover, the propensity to infer pain from facial expressions was very similar between CIP patients and control subjects. On the other hand, when asked to rate pain-inducing events seen in video clips in the absence of visible or audible pain-related behaviour, CIP patients showed more variable and significantly lower pain ratings, as well as a reduction in aversive emotional responses, compared with control subjects. Interestingly, pain judgements, inferred either from facial pain expressions or from pain-inducing events, were strongly related to inter-individual differences in emotional empathy among CIP patients, while such correlation between pain judgement and empathy was not found in control subjects. The results suggest that a normal personal experience of pain is not necessarily required for perceiving and feeling empathy for others' pain. In the absence of functional somatic resonance mechanisms shaped by previous pain experiences, others' pain might be greatly underestimated, however, especially when emotional cues are lacking, unless the observer is endowed with sufficient empathic abilities to fully acknowledge the suffering experience of others in spite of his own insensitivity.

These CIP patients have a rare hereditary sensory and autonomic neuropathy (HSAN) of small nerve fibers that usually transmit painful inputs along sensory nerves. It's really not a good thing (see for yourself, BUT BE WARNED, gory photos)... some cases are associated with self-mutilation in childhood. So these individuals have a problem with the peripheral nervous system, not the all-powerful, centrally-located mirron neuron system. Based on ideas like embodiment, if someone can't feel pain, they can't run a bodily simulation of a painful experience (or at least, its affective component); ergo, they can't identify and empathize with another's pain.

Twelve patients with CIP participated in the study. They showed a dramatic sensory loss for pain since birth, affecting the whole body.

All patients showed a complete lack of discomfort, grimacing or withdrawal reaction to prolonged pinpricks, strong pressure, soft tissue pinching and noxious thermal stimuli (0 and 50 degrees C) applied to the proximal and distal parts of the four limbs and to the face.

The patients (and a large group of control participants) filled out both "self" and "other" versions of the Situational Pain Questionnaire, rating items like "I get a tooth drilled without a pain killer" and "I get a mosquito bite" on a scale of 1 to 10. They also watched video clips from the Accident and Injury categories of Stupidvideos.com, such as...

Skate-board fall on the back
Boxer suffering a severe ankle strain
Woman falling forward on a treadmill
Gymnast falling from horizontal bar
Missed jump from a diving-board

...and then rated the amount of pain experienced by the injured individuals on a scale of 1 to 10. The video clips didn't show the injured parties' facial expressions, but the Sensitivity to Expressions of Pain test did. Finally, a measure of general empathy (the "tendency to feel and vicariously experience the affective experiences of others") was obtained using the Balanced Emotional Empathy Scale and related to the measures of feeling another's pain.

So were the CIP patients impaired in Regarding the Pain of Others? On the Situational Pain Questionnaire, those with CIP did not differ from controls in rating the pain of others. The Sensitivity to Expressions of Pain ratings and emotional empathy scores did not differ between the two groups, either. In contrast, ratings of the Jackass-type video clips (which didn't present visible or audible expressions of pain) were generally lower.

The authors conclude thusly:

In his novel Ingenious Pain, contemporary novelist Andrew Miller created a central character who is born unable to feel pain and who grows into a technically skilled but unfeeling surgeon (Miller, 1997). Contrary to the theory supported by the plot of this novel (Loeser, 2005), our results suggest that a normal personal experience of pain is not necessarily required for perceiving and feeling empathy for others’ pain. In the absence of functional somatic resonance mechanisms shaped by previous pain experiences, others’ pain might be greatly underestimated, however, especially when emotional cues are lacking, unless the observer is endowed with sufficient empathic abilities to fully acknowledge the suffering experience of others in spite of his own insensitivity.

References

Loeser JD. (2005). Pain, suffering, and the brain: a narrative of meanings. In: Carr DB, Loeser J, Morris DB, editors. Narrative, pain, and suffering. Progress in pain research and management, Vol. 34. Seattle, WA: IASP; 34: p. 17–27.

Miller A. (1997). Ingenious pain. San Diego: Harcourt Press.