pain and healing

“Mommy come here!” my daughter called from the bedroom.

“What is it sweetheart?”

“Mommy look, I have a big bruise here and it hurts. What can I do to make it better?”

I looked and sure enough Hannah had a big bruise just below her knee. “Honey, there’s nothing you can do for a bruise. You have to just wait for it to go away.”

Yesterday’s incident reminded me of a blithe saying people utter when they don’t know how to respond someone else’s pain:  “Time heals all wounds.” I hate that saying — it couldn’t be farther from the truth. Time is simply not a sufficient cure for any wound. This experience with my daughter, along with a few other things that have happened in 2018, made me want to write about healing. I want to recount my own experiences and weave a story that illustrates the beauty and frustration involved in the healing process. But that story is not meant to be written today. Instead, I was recently reminded of one of my favorite papers in social cognitive neuroscience. It’s not a very well-known paper (it has been cited 23 times) but it has had a significant impact on me. The title before the colon is, “How We Know It Hurts.”

These scientists were interested in empathy and asked, how do we, as humans, recognize when another person is in pain? To better understand this question, they crafted stories featuring protagonists that experience two different types of pain — physical and emotional.

An example of a story that involves physical pain is the following:

Joe was playing soccer with his friends. He slid in to steal the ball away, but his cleat stuck in the grass and he rolled over his ankle, breaking his ankle and tearing the ligaments. His face was flushed as he rolled over.

The following is an example of a story that involves emotional pain:

Judy lives with her teenage daughter. Her daughter wants to have new friends and invites a number of people to her 15th birthday party. Nobody shows up to the birthday. Judy’s daughter goes into her room to cry and Judy stands helplessly.

A pool of subjects rated each story on different attributes including vividness and the amount of physical or emotional pain. Brain activity was measured from a separate group of subjects as they read the carefully crafted narratives in a scanner. The authors discovered that stories rated high in physical pain activated a network of brain regions knows as the “pain matrix.” As a naive student I was surprised to learn that just reading about someone else’s physical pain was enough to activate the pain matrix — especially since the reader did not personally experience any pain herself.

What about the stories that had high emotional pain ratings? There are two possibilities. The first possibility is that when people read stories about the emotional pain of another person, the same brain regions that respond to stories of physical pain will respond to emotional pain. After all, pain is pain. Conversely, it is possible that a completely different cognitive process is required to recognize someone else’s emotional pain and thus a different network of brain regions would be recruited. It turns out the later is true. When people read stories rated high in emotional pain a group of brain regions known as the “Theory of Mind” network are activated. That means that understanding someone else’s physical pain is distinct from understanding her emotional pain. As an undergraduate, I was amazed. For the first time I simply had to write to the author of a paper to find out more. I emailed Emile Bruneau and asked him all of my questions — that was my first experience with the Saxe Lab.

From my perspective this was, and continues to be, one of the most fascinating puzzles social cognitive neuroscience has generated for us. Why would the brain have two separate networks to process pain? Is recognizing someone else’s physical pain really different enough from recognizing someone else’s emotional pain that an entirely separate set of neural resources are required? From these data (and other data) the answer is an unambiguous yes.

What can we learn from these data? Are they applicable to everyday life? I’m not sure. It seems clear that physical pain and emotional pain are two separate phenomena but colloquially (and often even in science) we talk about both types of pain in the same way. Maybe if we begin to disambiguate these two types of pain in our mind — both when we witness other people experience pain and also when we experience pain ourselves — we will be better able to understand and embrace the healing process and recognize that more than just time is required for any wound to heal. Further, since we know that physical pain and emotional pain are processed separately by our brains, this suggests that each type of pain has a unique trajectory that requires a different type of healing. The prescription for healing a broken ankle is quite a bit different than the prescription for healing a broken heart.

So, let’s stop offering friends and family blithe comments like, “time heals all wounds” and instead offer a hand, an ear, and time. Let’s give ourselves and others love, encouragement, and the freedom to be in pain — whether physical or emotional — so that we each may find a path to healing that is appropriate for the wound. Let’s be compassionate and patient as we heal and as we encourage those around us to heal too. Finally, let’s accept that not all human wounds will be healed — that is part of the beauty of the Gospel story.

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