PsycCRITIQUESAugust 17, 2011, Vol. 56, No. 33, Article 1

Alienation Hurts, but Why?

A Review of

Social Pain: Neuropsychological and Health Implications of Loss and Exclusion

by Geoff MacDonald and Lauri A. Jensen-Campbell (Eds.)

Washington, DC: American Psychological Association, 2011. 258 pp. ISBN 978-1-4338-0874-6.

$69.95

doi: 10.1037/a0024128

Reviewed by

Lauren S. Seifert, Ian D. Roberts

Being left out of a friend’s birthday gathering can throb like a smashed finger, and a new volume on social pain helps usto understand why. Proven experts and promising newer scholars summarize key findings and present them inapproachable and informative ways in Social Pain: Neurophysiological and Health Implications of Loss and Exclusion,edited by Geoff MacDonald and Lauri Jensen-Campbell.

In the nascent field of social neuroscience, mammalian responses to social stress, loneliness, separation, and socialevaluation are drawing considerable attention. Researchers have warmed to a notion that Panksepp and his colleaguessuggested in the 1970s: that social separation produces pain akin to the pain from a physical injury (Herman &Panksepp, 1978; Panksepp, 2003). Some researchers have gone so far as to claim that physical pain is basically “anemotion with sensory features” (Chapman & Nakamura, 1999, p. 416).

Neuroscientists are enthusiastic about the possibility that the two types of pain share neurophysiological underpinnings.Furthermore, there is mounting evidence for some common genetic links between physical and social pain (Boomsma,Willemsen, Dolan, Hawkley, & Cacioppo, 2005).

Regarding neurophysiological and behavioral associations, this new book provides an excellent overview of the researchto date. Readers learn about key regions in the mammalian nervous system that process the “PAIN/GRIEF” (see Chapter1 by Panksepp) associated with physical and social injuries. In addition, in Part I, the book offers a synopsis of geneticlinks to social pain in language that is basic enough for non-neuroscientists and nongeneticists.

In Part I readers naïve about genetics might not discriminate between terms like gene (e.g., OPRM1) and polymorphism(e.g., A118G), but we feel confident that they will use Way and Taylor’s guiding paragraph (p. 97) and, perhaps, willseek further information from among Chapter 4 references. Admittedly, a tutorial about types of polymorphisms (suchas minisatellites and microsatellites) would be hard to give in this relatively brief book of just 258 pages.

Numerous mentions, across chapters, of Eisenberger’s work emphasize its criticality. To experts, these multiple citationsmight seem slightly redundant, but they are complementary. Moreover, they are most certainly warranted, as the studyby Eisenberger, Lieberman, and Williams (2003) was defining—harking back to Panksepp’s contention that all pain isemotional and heralding in a new era of understanding about the role of the anterior cingulate cortex (ACC; seePanksepp, 2003).

Are people with high trait-aggression less or more sensitive to socioemotional slights? With her colleagues, Eisenberger(see Chapter 2) has demonstrated that those with genetic variant MAOA-L (reduced expression of MAOA receptors) mayvery well be more sensitive to social pain, as is indicated by higher levels of dorsal ACC activity when they are excluded

during an experimental task (i.e., the “cyberball game”; Eisenberger, Way, Taylor, Welch, & Lieberman, 2007).

Some hormones (e.g., oxytocin) and neurotransmitters (e.g., catecholamines) most certainly play a part in theexperience of social pain. When one is denied social contact, these chemicals might also affect one’s response to beingalone. Puzzling—and fodder for additional research—are some gender differences relating to single genetic variants.There appear to be gender-by-gene interactions leading to higher social sensitivity for women and lower socialsensitivity for some men. Several chapter authors discuss genetic determinants of the reactions to social loss and/orexclusion.

In keeping with the theme that there are common neurophysiological underpinnings of social and physical pain,Panksepp (Chapter 1) cites the evidence for opioid involvement in social pain. He contends that buprenorphine might beused to treat depression from separation/social loss without producing sedation. Also nicely situated in this volume isthe well-publicized work of DeWall, Pond, and Deckman (Chapter 5) about taking acetaminophen to squelchpsychological hurt and implicating cannabinoid receptors (CB1) in social pain (e.g., Association for Psychological Science,

2009; Brittany, 2009; Grohol, 2009).

Going beyond neurophysiological and genetic foundations, authors in Parts II and III address critical applications of theresearch in development, health, and education—such as interactions between biology, psychology, and the social self inphysical pain; associations between health and social stress; and social pain links to peer bullying. Adeptly integratedfrom developmental psychology (e.g., Bowlby, 1982) and from social psychology (e.g., Williams, 2001), the discussionof attachment issues in adulthood highlight their potential influence on one’s tendency to approach social interactionswith hypersensitivity to threat or to avoid them—being biased to expect low reward potential (as in MacDonald, Borsook,and Spielmann’s Chapter 6).

Overall, the best use of this book might be to quickly deliver a review of the literature to nonexperts (e.g., beginningstudents in social neuroscience, researchers, and/or clinicians who want a quick, readable summary). Students andpsychologists in many subdisciplines will find this book helpful, and a particularly interesting feature of several authors’contributions is embedded research questions within the text of content paragraphs. The effect is to bring a reader backto the critical issues in an engaging, active manner. These can be talking points when the book is used as a course text.

Most chapters accent evidence for common underlying mechanisms in physical pain and social pain—something that hasbeen a hard sell to some (physical) pain researchers and some social psychologists. Chapter 7 by Chen and Williamsmakes an intriguing departure by indicating some differences between physical pain and social pain. We are curiouswhether chronic pain from a mild/moderate injury (i.e., even after physical wounds have healed) is akin to“remembering” a social slight or loss?

Chen and Williams (p. 168) have argued, consistent with numerous studies, that “social pain is more easily relived thanphysical pain.” However, there are copious accounts in many journals (Pain, Headache, and European Journal of Pain)devoted to the study of chronic physical pain—when all signs of one’s physical wounds are gone. We suggest thatchronic pain represents an important aspect of a “memory” for physical pain: being the sensory “reexperience” of thepain (Morley, 1993).

Studies comparing pain memory for social and physical pains typically use verbal/textual cues for remembering—cuesthat are unlikely to trigger the sensory component of a chronic (physical) pain response (Morley, 2007). It is rare to finda study that assesses somatosensory aspects of pain memory (e.g., Katz & Melzack, 1990) and, perhaps, even moreunusual to find a study in which an attempt is made to trigger physical pain by touching or applying pressure to an areaof the body that was previously wounded (Morley, 2007).

We wonder whether studies that attempt to trigger pain memories should compare cues that are consistent with theoriginal injury: (a) for social pain, being primarily cognitive (as in deducing that one has been excluded after learningthat friends attended a party to which he or she was not invited); and (b) for physical pain, being primarily sensory(such as applying touch or pressure to a foot that has since healed after being broken during a fall). Thus, a study toassess commonalities between memories of social and physical pain should include conditions with cognitive triggers andconditions with somatosensory triggers.

References

There are many points of agreement in this book, but at least one area of contention becomes apparent: the effects ofsocially painful events on subsequent painful experiences. Is an instance of social pain followed by a period of increasedpain sensitivity or by numbing? Multiple chapters present different reactions to a study conducted by DeWall andBaumeister (2006), who presented a “fortune-telling” scenario after a fake personality inventory had been administered.Some subjects were informed that they would face the future alone. Those participants displayed higher thresholds topain, greater physical pain tolerance, more of a tendency toward neutral affect when forecasting the future, and lessempathy (i.e., compared with subjects who were informed that they would spend the future in a good relationship orwho were told they would be accident prone in the future).

In an attempt to reconcile this finding with other existing research, Eisenberger (Chapter 2) proposes that mild pain mayincrease sensitivity, while analgesia may result from more severe pain (e.g., a future alone). On the other hand,Dickerson (Chapter 3) and Knack, Gomez, and Jensen-Campbell (Chapter 10) suggest that repeated, intense, acutesocial pain and chronic social pain may be related to increased sensitivity.

Furthermore, Chen and Williams’s (Chapter 7) evidence for a difference in ability to forecast social versus physical painis used to question DeWall and Baumeister’s (2006) use of a predicted physically painful future as a control condition.These varied opinions highlight the need for additional research about changes in pain sensitivity immediately followingsocial versus physical pain—with intensity and repetition of the pain-inducing stimulus having the potential to influencesubsequent experiences of pain.

Overall, we have praise for this timely volume that will undoubtedly serve as a manual for beginning social painresearchers and as a text for seminars on social pain. Too, it has great promise as a work that will energize cross-talkbetween social, health, and neuroscience fields. Does the inherited mammalian physiology invoke a pain “emotion”whether one’s foot has been broken snow-boarding or one’s heart has been broken by a friend? The authors and editorsof this book seem to be responding with “mostly, yes.”

Association for Psychological Science. (2009, December 25). Could acetaminophen ease psychological pain?ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2009/12/091222154742.htm

Boomsma, D. I., Willemsen, G., Dolan, C. V., Hawkley, L. C., & Cacioppo, J. T. (2005). Genetic and environmentalcontributions to loneliness in adults: The Netherlands twin register study. Behavior Genetics, 35, 745–752.doi:10.1007/s10519-005-6040-8

Bowlby, J. (1982). Attachment and loss (2nd ed.). New York, NY: Basic Books.Brittany. (2009, December 25). Acetaminophen linked to reducing psychological pain. Retrieved from

http://helpingpsychology.com/acetaminophen-linked-to-reducing-psychological-painChapman, C. R., & Nakamura, Y. (1999). A passion of the soul: An introduction to pain for consciousness researchers.

Consciousness and Cognition, 8, 391–422. doi:10.1006/ccog.1999.0411DeWall, C. N., & Baumeister, R. F. (2006). Alone but feeling no pain: Effects of social exclusion on physical pain

tolerance and pain threshold, affective forecasting, and interpersonal empathy. Journal of Personality and SocialPsychology, 91, 1–15. doi:10.1037/0022-3514.91.1.1

Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003, October 10). Does rejection hurt? An fMRI study of socialexclusion. Science, 302, 290–292. doi:10.1126/science.1089134

Eisenberger, N. I., Way, B. M., Taylor, S. E., Welch, W. T., & Lieberman, M. D. (2007). Understanding genetic risk foraggression: Clues from the brain’s social response to exclusion. Biological Psychiatry, 61, 1100–1108.doi:10.1016/j.biopsych.2006.08.007

Grohol, J. M. (2009, December 22). Acetaminophen for mental health relief. Retrieved fromhttp://psychcentral.com/news/2009/12/22/acetaminophen-for-mental-health-relief/10357.html

Herman, B. H., & Panksepp, J. (1978). Effects of morphine and naloxone on separation distress and approachattachment: Evidence for opiate mediation of social affect. Pharmacology, Biochemistry, and Behavior, 9, 213–220. doi:10.1016/0091-3057(78)90167-3

Katz, J., & Melzack, R. (1990). Pain “memories” in phantom limbs: Review and clinical observations. Pain, 43, 319–336.doi:10.1016/0304-3959(90)90029-D

Morley, S. (1993). Vivid memory for “everyday” pains. Pain, 55, 55–62. doi:10.1016/0304-3959(93)90184-QMorley, S. (2007). Thanks for the memory . . . [Editorial]. Pain, 132, 231–232. doi:10.1016/j.pain.2007.08.036Panksepp, J. (2003, October 10). Feeling the pain of social loss. Science, 302, 237–239. doi:10.1126/science.1091062Williams, K. D. (2001). Ostracism: The power of silence. New York, NY: Guilford Press.