Tuesday, April 9, 2013

Being Careful About How We Use Evidence for the "Reality" of Social Pain


Images courtesy of the
Social and Affective Neuroscience Laboratory
at UCLA.
Neuroscience is changing the way we view the brain. It is also changing the way we view ourselves. Discoveries announced in journal web pages one day find themselves as fuel for debate on newspaper op-ed pages the next. Some of these discoveries have practical implications and point toward promising new medical therapies. Others suggest new - and often troubling - approaches for dealing with social or legal problems. Many simply shed new light on long-standing questions about human nature.

Like it or not, the evidence that supports these discoveries turns out to be quite persuasive. Wearing the mantle of science, decorated with images that hint at the workings of the human mind, it commands a special, and perhaps not entirely deserved, authority. This evidence is also subject to being appropriated for purposes beyond that supported by conclusions of the research which gave rise to it. Consequently, we must be careful when we enlist neuroscience evidence in the service of even the best of causes, lest we unwittingly find ourselves endorsing the kind of erroneous thinking that we should be trying to correct.

I will offer two examples - one here and another in a blog post to follow - of what I consider to be incorrect applications of neuroscience evidence to well-intentioned efforts to change public attitudes. I will also point out the fallacies that I believe are at play.


Shared underpinnings of physical and social pain
My first example originates with a recent installment of the Emory University Neuroethics journal club that met to discuss the paper The pain of social disconnection: examining the shared neural underpinnings of physical and social pain by Naomi Eisenberger, director of the Social and Affective Neuroscience Laboratory at UCLA. (Here social pain refers to the distress we feel as a result of rejection, the loss of loved one or the unwanted end of an important personal relationship.) Eisenberger reviews evidence in support of the hypothesis that there is significant overlap between the brain structures associated with physical pain and those associated with social pain. Citing a variety of experimental results, she makes a compelling case that specific brain structures, namely the dorsal anterior cingulate cortex and the anterior insula, are implicated in the processing of both physical and pain. Other evidence, unrelated to neural imaging, supports this relationship.

The "reality" of social pain
Some participants in the journal club discussion expressed doubt that this discovery would change how social pain is regarded by the public at large. Others, though, saw it as a demonstration of the “reality” of social pain and welcomed the evidence as a way to alter public attitudes in a constructive way, holding out the hope that, with this evidence in hand, social pain would be taken more seriously. On the surface this appears to be to be a useful application of a neuroscience discovery. But complications are revealed with closer examination.

While I agree wholeheartedly with the need to change public attitudes about social pain in order that it be treated more effectively, I disagree with the idea of applying the evidence cited in the paper to support the claim that social pain has somehow been elevated to the status of “real” pain. My concerns are of two types. The first originates in the limitations imposed by the philosophy of science. The second has to do with how I believe that this application buys into a false dichotomy, one that contradicts the conclusions reached by the author of the paper herself.

Concern from the philosophy of science
With regard to the philosophy of science, I first note that so-called scientific truths do not arise out of necessity. Hypotheses rise or fall on experimental outcomes. Here the hypothesis that physical pain and social pain utilize common brain structures might well have been disproved by experiment. The studies undertaken might have revealed no overlap between social and physical pain. Would this outcome have weakened the resolve of advocates for social pain being taken more seriously? I don't think so.

To compound matters, scientific truths are always provisional. It may indeed turn out that the results of future experiments - or the detection of some flaws in ones that have been conducted - may lead to different, even contradictory, conclusions about the relationship between physical and social pain. (He who lives by the scan, dies by the scan.) Would we then abandon new efforts to have social pain regarded on a par with physical pain? I would hope not.

Although I appreciate the importance of understanding the neurological overlap between social pain and physical pain for a variety of reasons, in my opinion the reality of social pain rests entirely on the reality of our experience of it and not on the existence - or lack - of specific neurological correlates of any kind. I don't believe we should shy away from taking this position.

Concern having to do with an unsupported conclusion
This brings me to my second concern, and that is that, by insisting that the evidence cited in the paper supports the claim that social pain is as “real” as physical pain, we miss the important point made by Eisenberger herself in her conclusion.
… [T]he findings reviewed here highlight the counterintuitive nature of pain. We typically reify physical pain as “real” pain and often dismiss social pain as “psychological,” but the connection between the two kinds of pain suggests that each of these lay theories is only half right. Physical pain is a deeply psychological phenomenon that can be altered by expectations, mood and attention. Likewise, social pain is a deeply biological phenomenon that has been built into our brains and bodies over millions of years of mammalian evolution because of the crucial part it plays in our survival. A better understanding of the commonalities between these two types of painful experience may provide greater insight into the underlying nature of each.
The ecumenical and symmetrical consideration of physical and psychological pain here is noteworthy. This passage itself stands as a small manifesto against the false dichotomy usually associated with physical and psychological pain. By buying into this persistent distinction, even in the service of getting social pain to be taken more seriously, we may be helping to perpetuate a misunderstanding.

The challenge of unification 
The triumph of neuroscience may well be its contribution to our developing a unified understanding of the physical and the psychological. It will be a challenge to educate a public accustomed to seeing a clear cut delineation between these two modes of explanation. More the reason we should be careful about how we make our arguments using neuroscience evidence.


Want to cite this post?

Merlin, M. (2013). Being Careful About How We Use Evidence for the "Realiy" of Social Pain. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/04/being-careful-about-how-we-use-evidence.html

5 comments:

Riley Zeller-Townson said...

Lovely, Marc! I wish I had been able to attend the discussion of this paper.
And since this post is so lovely let me disagree with you: I think there are neuroscience results that could validate a diminished 'respect' for social pain. Specifically, one could imagine a study that demonstrated that circuitry involved in social pain was in some way 'easier' to change than physical pain (more plastic, more responsive to 'conscious choices,' etc). This might lead to a conclusion that social pain is an issue that can be solved on one's own, whereas we humans are more helpless to respond to physical pain and thus require the tribe to intervene on our behalf. A simple utilitarian approach concerned solely with alleviating all forms of pain might allocate more resources to physical pain, and hope that folks can deal with their own social pain. I note that the evidence you've described here suggests otherwise.
That being said, the actual proof of this would be in some sort of evidence that the negative effects of x jigaounces of social pain could be overcome using less cubic splunkometers of willpower than the effects of the same amount of physical pain. Also, I'm willing to bet that the simple utilitarian calculus I suppose here isn't adequate to describe what either of us want in a society.

Marc Merlin said...

Thanks for the comment, Riley! It’s just the kind of disagreement that I was looking for.

It is certainly conceivable that some discovery in neuroscience would lead to low-cost, even DIY, treatments for social pain. And I do agree that a likely result of such a discovery would be a diminished respect for social pain in the sense that you suggest, that society would decide to allocate fewer resources for its alleviation. This kind of decision-making is already reflected in public and private healthcare systems today as they “rationally” try to maximize public health outcomes by assigning resource preferentially to “respected” disorders, to use your terminology.

My position was not that such a shift in attitudes with regard to the treatment of social pain could not occur as a result of a new discovery about the brain, but that the reality of social pain is not contingent on that kind of discovery. The distress that we experience as a result of social disconnection is incontestably real and would remain so in spite of the availability a low-cost treatment. Indeed, the motivation for pursuing the kind of research that would lead to the development of new treatments is the recognition of the reality of social pain.

I should add that my position wasn’t that new discoveries could not be used to alter public attitudes about social pain, but that we should be circumspect in how we go about using them to do so. Your comment, to some extent, underscores this concern, in that it illustrates how a discovery could be used inappropriately to undermine the standing of social pain as a “first class” kind of pain.

You are absolutely right, the public could come to all sorts of conclusions about social pain (or other important matters) based on discoveries in neuroscience. That doesn’t make these conclusions right. Since neuroscience evidence is both powerfully persuasive and subject to misuse, I believe we have an ethical responsibility to lead public opinion and not simply to follow it.

Riley Zeller-Townson said...

hmmmmmmm. The plot thickens.
What do you mean by the 'reality' of a pain, in this case? That distress isn't being 'faked,' or as a defined descriptor of how formidable something is (including whether or not pharmacological interventions are necessary)?
Also, I'm curious (worried?) what sort of neuroscience fueled 'treatments' you have in mind for social pain- an analgesic to take after a bad break up, death in the family/platoon, or to permeate all of middle school?

Marc Merlin said...

Riley, I’m not sure whether the plot has thickened or whether the goal posts have just been moved. I take it that I have substantively addressed the concerns you expressed in your first comment. At least I don’t see you refuting them in your second.

Now for the new goal posts.

What I mean by the “reality” of pain probably is no more and no less than what Naomi Eisenberger was referring to in her conclusion that I quoted from her paper. What I believe that she and I and the people who discussed the matter at the journal club had in mind is that social pain is considered “real” if and only if reports of the distress resulting from social disconnection are taken seriously, that is believed to have value that renders them actionable.

This has nothing to do with the degree (formidability, as you say) of the distress. I think that the use of deception is beyond the scope of this discussion; it compounds the problem too much since such faking (e.g. M√ľnchausen syndrome) may implicate “psychological” distress of other types. Suffice it to say here that deception in the presentation of social pain becomes an element of the diagnostic process that occurs after the pain is reported and appropriately acted upon.

I’m not sure why you think that I have any specific neuroscience-fueled treatments in mind for dealing with social pain, such as “an analgesic to take after a bad break up, death in the family/platoon, or to permeate all of middle school.” I don’t.

I will say this and that is social pain is routinely treated pharmacologically today. Anyone who has been involved with the elements brought to bear to help people who are undergoing bereavement counseling knows this to be the case. Likewise I suspect that most practitioners who works with adolescents and young adults struggling with the aftermath of a bad break up who have lapsed into a sustained and serious depression see antidepressant medication as a therapy that they may choose to use to help their clients.

Neuroscience is already being employed in the treatment of social pain. I think that the approach that we should use in this regard should not be unlike the approach that we should in the treatment of “physical” pain: we should seek out agents that are effective in the reduction of suffering, while balancing concerns about side effects, with the awareness that salutary outcomes may result for emotional health by allowing individuals to deal unmedicated with feelings of loss or of rejection that are not disabling or that do not persist for an extended amount of time. I have no prescription for this balancing act, and certainly can’t do justice to an approximation here.

Riley Zeller-Townson said...

Thanks for the clarification, Marc! To be clear myself, I asked for your definition of 'real' as the idea of any experience as 'not being a real experience' is alien to me (outside of false reporting)(Even illusions I would describe as 'real' experiences that point to non-real events- are you arguing against social pain being an illusion?). Thus, I was assuming that denying the 'reality' of the experience amounted to 'you can take care of that yourself, I don't need to help you'- and one valid method of dealing with ('unformidable') pain is to ignore it (which I'll admit is spoken as a distance runner who's never been in any real danger his entire short life). Is your argument that social pain is 'real' against 'treating' it by ignoring it?
My worry about neuroscience leading to new treatments for social pain is due to a belief that there are other disciplines that might be better suited to finding cognitive or behavioral treatments (eg, psychology or religious traditions), and thus I would anticipate that truly novel NS-fueled treatments would be pharmacological in nature (while also confirming what is already known from other fields). I would love to be wrong on that last point, though! And I'll concede that there are cases where pharmacological interventions for social pain are probably more appropriate than others. (At the very least, grant deadlines won't change just because of a death in the family). I completely agree with your balancing act point.
And to be honest in addition to being clear (hopefully): Underscoring all of this questioning is the fear of losing my will. Supposedly, my perceptions of social relationships are built entirely in my head, and probably in a part that can be manipulated through cognition. Thus, I should be able to alter their internal effects, including pain, fear, pleasure, disgust, by 'changing my mind.' This is something that I should be able to do without pharmacological intervention (an external fix, provided by someone else)- the idea that the best fix isn't the self/cognitive approach is admittedly (an perhaps not appropriately) frightening. This might be in contrast to lacerations and stomachaches, which might activate the same pain circuitry, but through a more direct route (which might be more difficult to alter through cognition).