|Scene from Rabbits by David Lynch|
The latest "elegant and breathtaking"1 paper in Psychological Science presents a rather muddled view of film aesthetics, continental philosophy, surrealism, mortality salience, and stigmatizing attitudes towards sex work (Randles et al., 2013). Oh, and how Tylenol® brand acetaminophen can ease the existential dread evoked by all of these modern horrors.
The authors explained the purpose and implications of their study in the APS press release:
According to lead researcher Daniel Randles and colleagues at the University of British Columbia in Canada, the new findings suggest that Tylenol may have more profound psychological effects than previously thought:
“Pain extends beyond tissue damage and hurt feelings, and includes the distress and existential angst we feel when we’re uncertain or have just experienced something surreal. Regardless of the kind of pain, taking Tylenol seems to inhibit the brain signal that says something is wrong.”
Randles and colleagues knew from previous research that when the richness, order, and meaning in life is threatened — with thoughts of death, for instance — people tend to reassert their basic values as a coping mechanism.
The researchers also knew that both physical and social pain — like bumping your head or being ostracized from friends — can be alleviated with acetaminophen. Randles and colleagues speculated that the existentialist suffering we face with thoughts of death might involve similar brain processes. If so, they asked, would it be possible to reduce that suffering with a simple pain medicine?
No!! I think this is a ridiculous assertion that gets away with using language (and dependent measures) that not only lack precision, but also lack an analogical relation to the real phenomenon under discussion. The leaps of logic were so egregious that I don't know where to begin...
...so let's start with the meaning-maintenance model (MMM) that motivated the work. MMM "posits that any violation of expectations leads to an affective experience that motivates compensatory affirmation" (Randles et al., 2013). Any violation?? So all sorts of psycholinguistics experiments that involve syntactic violations 2 will motivate compensatory affirmation? If that's the case, then David Lynch films will often "motivate compensatory affirmation."
But does a David Lynch film “hurt” you?
...Lynch’s films have the ability to “disturb, offend or mystify” (Rodley, 2005, p. 245). Insofar as it “hurts” to watch some of Lynch’s films, as it arguably hurts whenever one is assaulted by thoughts and experiences that are at odds with one’s expectations and values, the question arises as to how this uncomfortable feeling is represented in the brain.
First, David Lynch is one of my favorite directors, and I have never felt "hurt" by watching one of his films. Second, Randles et al. never, at any point in their experiments, address how Lynch-viewing is represented in the brain.
What did the authors actually do? In brief, they asked ~350 young Vancouverites to participate in one of two experiments. In the first study, 121 subjects wrote about death or about dental pain. In the second study, 228 subjects watched a 4 min clip from Rabbits or from The Simpsons. In each case, half of the participants received acetaminophen, half received placebo. Why? What motivated the choice of acetaminophen, as opposed to aspirin, ibuprofen, or naproxen? This was based on a study by Dewall et al. (2010), another problematic paper3 in Psych Sci. There was no mechanistic reason for the original choice.
Here's the neuro-rationale for the current study (Randles et al., 2013):
The present research is predicated on four key findings in the literature: (a) Both physical and social pain are associated with activation in the dACC [dorsal anterior cingulate cortex]4 (e.g., Eisenberger et al., 2003), (b) the dACC is activated in response to anomalies (e.g., Botvinick et al., 2004), (c) social rejection can produce the same compensatory affirmation as other meaning threats (e.g., Nash et al., 2011), and (d) acetaminophen has been shown to reduce physical and social pain, as well as activation in the dACC (DeWall et al., 2010). These findings led us to predict that acetaminophen may also inhibit compensatory affirmation following meaning threats.
The acetaminophen group in Dewall et al. (dose of 2,000 mg a day for 3 weeks) did show less dACC activity in response to cyberball exclusion, but they did not report lower hurt feelings in that situation. The treatment administered by Randles et al. was quite different: a single acute dose of 1,000 mg Tylenol-brand acetaminophen (Rapid Release formula) or 1,000 mg sugar placebo, given 30 min before the critical manipulation.
In Exp. 1, writing two paragraphs about what will happen to your body after death was designed to trigger mortality salience, or thoughts about the inevitability of death. This in turn would lead to compensatory affirmation of cultural views. How was this measured? By assessing the severity of punitive attitudes towards women who engage in sex work! This is the worst part of the study, in my opinion.
Social judgment survey
Finally, participants read a hypothetical arrest report about a prostitute and were asked to set the amount of the bail (on a scale from $0 to $999). This measure has been used in a number of other meaning-threat studies (Proulx & Heine, 2008; Proulx et al., 2010; Randles et al., 2011; Rosenblatt, Greenberg, Solomon, Pyszczynski, & Lyon, 1989). Participants are expected to increase the bond amount after experiencing a threat, because trading sex for money is both at odds with commonly held cultural views of relationships and against the law. Increasing the bond assessment provides participants n opportunity to affirm their belief that prostitution is wrong.
The study took place in Vancouver, Canada. What are the laws on prostitution?
In Canada, the buying and selling of sexual services are legal, but most surrounding activities, such as public communication for the purpose of prostitution, brothels and procuring are offences under the law.
What are current attitudes towards prostitution in Canada?
The views of Canadians on prostitution vary greatly according to age and gender, with a large proportion of men and older respondents voicing support for some kind of decriminalization, while most women and younger respondents are not as comfortable with the idea...
. . .
As evidenced in surveys conducted by Angus Reid Public Opinion in 2009 and 2010, only about a quarter of Canadians (22%) are aware that exchanging sex for money is legal in Canada, while seven-in-ten (70%) mistakenly believe that the practice is illegal.
. . .
Still, there is no clear consensus on how some of these guidelines are currently applied. While 36 per cent of respondents believe the Criminal Code provisions related to communication and brothels are fair to the purpose of protecting the public good, almost half (47%) think the rules are unfair and force prostitutes into unsafe situations.
Here are my reactions to the Prostitute-Bail dependent measure:
(1) Yay! Let's stigmatize the prostitute, not the johns!
(2) Does the baseline for these bail judgments differ by sex? age? religion? ethnicity? As professional polling can attest, attitudes vary greatly along demographic lines. The participant pool was quite diverse, and we know nothing about age.
We recruited 121 participants (81 women, 40 men). The sample was predominantly of East Asian (45%), European (29%), and South Asian (12%) descent.(3) Participants were randomly assigned to one of four groups, but we don't know anything about the randomization - perhaps the most religious and judgmental people ended up in the mortality salience/placebo condition.
(4) To reiterate, we don't know anything about possible demographic differences in the amount of bail set. And that is the only dependent measure!! We don't know how anyone would allocate money or set a price in another situation that is not "morally laden". Let's say you're selling a used car - what would you charge?
At any rate, the authors reported that the mortality-salience/placebo group punished the "norm violator" by a significantly larger amount than the other three groups, t(112) = 2.33, p = .02, d = 0.52.
Fig. 1 (Randles et al., 2013). Results from Study 1: mean bond value set for the prostitute as a function of group (mortality-salience vs. control condition crossed with placebo vs. acetaminophen condition). The scale ranged from $0 to $999. Error bars represent the standard error for each group.
Moving right along to Exp. 2, we discover that the authors decided to use a different dependent measure for no clearly motivated reason. This makes it impossible to compare the outcome of the salience mortality manipulation to the David Lynch manipulation.
We also changed the dependent measure [in Exp. 2]. This study was conducted 3 to 6 months after a well-publicized local riot that followed the Vancouver Canucks’ loss in their bid for the Stanley Cup, and we expected that most students held a negative view of the riot. Thus, we expected that after a threat, participants would affirm this view by calling for stronger punishment for the rioters. Participants were informed that people were debating whether the rioters should be given sentences more lenient than those for comparable individual acts of vandalism, because the rioters had acted impulsively, or should be given stiffer sentences, because they had taken advantage of the city while it was vulnerable. Participants then marked a spot on a line from 0% to 200%. They were told that 0% indicated that rioters should not be fined, that 100% indicated that rioters should receive a normal fine, and that 200% indicated that rioters should receive a doubled fine.
One initial critique is that the Vancouver hockey riot itself provoked MMM. It was a mob event that people could not explain rationally. The subjects were more likely to have been directly affected by this event (in comparison to the hypothetical sex worker bail), by either knowing someone who participated or who was present, or by witnessing the event live or through social media, or by having a favorite business vandalized. In addition, the assigned fines were relative, not absolute. A 150% fine out of... $100 or $1,000 or $10,000?
At any rate, the authors reported that participants in the Lynch/placebo group wanted to punish the rioters by a significantly larger amount than did participants in the other three groups, t(203) = 2.64 p < .01, d = 0.43.
Fig. 2 (Randles et al., 2013). Results from Study 2: mean preference for the penalty to be given individuals convicted of vandalism or theft during the Vancouver hockey riot as a function of group (threat vs. control condition crossed with placebo vs. acetaminophen condition). The rating scale ranged from 0% (no fine for a conviction), through 100% (a normal fine), to 200% (a doubled penalty).
Collectively, the results were taken as evidence that Tylenol can potentially treat chronic anxiety disorders, a conclusion that filled me with existential dread:
The study demonstrates that existentialist dread is not limited to thinking about death, but might generalize to any scenario that is confusing or surprising — such as an unsettling movie.
“We’re still taken aback that we’ve found that a drug used primarily to alleviate headaches can also make people numb to the worry of thinking about their deaths, or to the uneasiness of watching a surrealist film,” says Randles.
The researchers believe that these studies may have implications for clinical interventions down the road.
“For people who suffer from chronic anxiety, or are overly sensitive to uncertainty, this work may shed some light on what is happening and how their symptoms could be reduced,” Randles concludes.
I have a few final questions for the authors, since this violation of my expectations led to an affective experience that motivated my own compensatory affirmation processes:
- Why wasn't the dose adjusted by weight? A 45 kg woman got the same dose as a 90 kg man.
- Was physical pain assessed in the subjects pre/post-treatment? No it was not.
- Did anyone have a headache or any other physical pain before treatment? We don't know... which would be important to know, since relieving physical pain will make you less cranky and irritable.
- Is there a single neuroimaging study that has administered acetaminophen at the dose and time course used here? No.
- What is the evidence that acetaminophen affects the hemodynamic response in the same exact dACC region hypothesized to control physical, existential, and social pain?
- Has there been a single fMRI study in which subjects have watched Rabbits and Simpsons, counterbalanced in a single session while their brains were scanned?
- What is the Rabbits > Simpsons neural activation pattern?
- Why wasn't there a measure that the Lynch clip was actually "disturbing" or that the Simpsons clip was enjoyable? Actually, none of the manipulations induced changes in affective state on the PANAS.
To ease my existential dread, it's time to watch Rabbits in its entirety.
1 Former Psychological Science Editor Robert V. Kial:
At meetings and via email, authors often asked me, “What sort of paper is a good candidate for Psychological Science?” ... And when feeling particularly candid, I might say that the ideal Psychological Science manuscript is difficult to define, but easily recognized — the topic is fundamental to the field, the design is elegant, and the findings are breathtaking.2 For example: "The metal was for refined by the goldsmith who was honored" (Friederici et al., 1996).
3 For a lengthy exposition on the problematic aspects of the Dewall et al. paper, see Suffering from the pain of social rejection? Feel better with TYLENOL®.
4 At the risk of sounding like a broken record, the dACC has been associated with a wide array of cognitive and emotional control functions (Posner et al., 2007). In the TYLENOL® post, I said:
The "shared neurobiological systems" [for social and physical pain] are thought to be located in the dorsal anterior cingulate cortex (ACC), a brain structure that contains discrete regions responsive to physical pain (Kwan et al., 2000). Interestingly, externally applied vs. self-administered thermal pain activate anatomically distinct areas of the ACC (Mohr et al., 2005). Furthermore, it is not at all clear whether the same regions of ACC represent social pain and the affective components of physical pain. In a study designed to dissociate expectancy violations from social rejection, the dorsal ACC was activated when expectations were violated, while ventral ACC (quite distant from the physical pain regions) was activated by social rejection (Somerville et al., 2006).
Dewall CN, Macdonald G, Webster GD, Masten CL, Baumeister RF, Powell C, Combs D, Schurtz DR, Stillman TF, Tice DM, Eisenberger NI. (2010). Acetaminophen reduces social pain: behavioral and neural evidence. Psychol Sci. 21:931-7.
Randles, D., Heine, S., & Santos, N. (2013). The Common Pain of Surrealism and Death: Acetaminophen Reduces Compensatory Affirmation Following Meaning Threats Psychological Science DOI: 10.1177/0956797612464786
Further Reading on Surrealism, Dread, and Tylenol:
Surrealistic Imaging Experiment #1
Of Mice and Women: Animal Models of Desire, Dread, and Despair
Suffering from the pain of social rejection? Feel better with TYLENOL®
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