It starts like this: you are told that you'll play a game with two other participants. As you, these participants are inside an fMRI machine, and all you have to do is throw a virtual ball in a computer game. Researchers want to look at what happens inside your brain when you play a game. You start throwing the ball, and the other two throw it back to you. However, after a few throws, you don't get the ball anymore. They have rejected you and they're playing as if you didn't even exist. There's a catch: what the researchers didn't tell you is that the experiment was designed for you to feel left out. In fact, there are no other participants. It's just you and the computer.
Naomi Eisenberger and her team published the results of that experiment in a 2003 paper entitled Does Rejection Hurt? An fMRI study of social exclusion. Well, what was the answer? The following excerpt was taken from Intechopen.com and it does a great job summarizing the findings:
In their study, Eisenberger and colleagues (2003) discovered neural activation that was specific to social rejection in three brain regions previously associated with the affective component of physical pain. One of these regions was the dorsal portion of the anterior cingulate cortex (hereafter dACC), a key region for the affective component of pain, which is often conceptualized as an 'alarm system' that monitors the external environment for elements that deviate from the ideal. It then responds by eliciting feelings of distress that motivate the individual to repair or assuage the discrepancy. The second region was the anterior portion of the insula, a cortical structure previously associated with both negative affect and visceral pain. Last, this study reported activation in two voxel-clusters of the right-ventral prefrontal cortex (hereafter RVPFC), an area of the neocortex which functions to regulate aversive experiences. As predicted, activation in the dACC predicted greater levels of social distress, while conversely, the RVPFC predicted lesser amounts of social distress. DACC activation also mediated the inhibitory relationship between the RVPFC and social distress, suggesting that the RVPFC reduces subjective distress to social threat by inhibiting the dACC response to it. Taken together, these results are astoundingly analogous to those from physical pain research, establishing the functional similarity between physical and social pain, which has great implications for the understanding and treatment of various psychopathologies, such as post-traumatic stress disorder (PTSD)
In fact, one of Naomi's colleagues, Matthew Lieberman, has delivered a very interesting TED Talk about the social brain and how social pain affects us.
The other Matthew, the one we loved
Social pain is quite similar to physical pain in many regards and, sadly, we have another Matthew to tell us about it. His name was Matthew Perry and most of us were in love with his character Chandler Bing in the acclaimed sitcom Friends. What made us love him was his wits, his sarcastic comebacks, and his brilliant one-liners. Who doesn't remember that he would often tell people that humor was his defense mechanism?
Hi, I'm Chandler. I make jokes when I'm uncomfortable
In real life, Matthew shared a lot with his character. He even said that he was like Chandler but eventually became more comfortable with his serious side. What some of you may not know is that after he was involved in a jet ski accident in 1997, Matthew became addicted to Vicodin. As a matter of fact, according to The Telegraph:
In his 2022 memoir, Friends, Lovers, and the Big Terrible Thing, he said he was lucky to be alive after years of opioid and alcohol abuse, including a burst colon in 2018 that doctors said gave him just a two per cent chance to live.
"I say in the book that if I did die, it would shock people, but it wouldn’t surprise anybody" he said in an interview with People Magazine in October 2022.
In 2012, Naomi Eisenberger published a study suggesting that:
Research on the neurochemical substrates of physical and social pain has demonstrated that both rely on opioid processes. Thus, opiates, which are potent analgesics, have also been shown to reduce separation distress behaviours in animals
The opioid crisis is so rampant in the United States that executives decided to make two excellent series about it: Dopesick and Painkiller.
Pain, fear, and war
I think it's fairly easy to understand why opioids are so popular. The one thing they do better than other drugs is to stop the pain. Living in pain is a terrible thing. Most people will do anything to stop the pain. When we are in pain or when there's a chance we will be in pain, whether it is physical or social, we become afraid. Fear and pain are intrinsically connected. That explains why something so irrational like war still exists in the modern world.
Interestingly, Mari Fitzduff, an Irish writer, policymaker, and professor, wrote a recent book exploring why people go to war. In Our Brains at War: The Neuroscience of Conflict and Peacebuilding, she discusses the role of fear as an important driver of anger and aggression. In a text she wrote in 2021 published on Medium, she explains that:
Contrary to what most of us think, our human capacity for rational judgement is much (much!) shallower than we think. There is often a significant tension between the parts of our brains that deal with our fears, our instincts, and our memories, and those that serve us using analytic and logical reasoning
This is quite true. We mustn't forget that we are ambiguous. We operate under cognitive biases that blind us to a more objective reality because of political, cultural, and religious differences. We can be incredibly selfless and kind to one another at times. However, our history has shown us that we can also be extremely cruel and wicked. We can inflict pain like no other animal. This duality reminds me of something the famous neuroscientist Robert Sapolsky says at the beginning of his interesting book called Behave to illustrate one of our many human contradictions. He describes his fantasy of arresting and torturing Adolf Hitler:
I've had these thoughts since I was a kid, and still often do, and when I do, my heart speeds up, my breathing gets faster, thinking about what I would do to the most evil, wicked soul in history. But there's a problem—I don't believe in souls or evil and I think the word 'wicked' only belongs in a musical. There are plenty of people who I would like to see killed, but I'm against the death penalty.
Human beings, whether we like it or not, are violent. Given the right circumstances, anyone can be violent. And now it should be clear to anyone that physical and social violence can trigger the same pain response in the brain. Dehumanizing, humiliating, bullying, controlling, and manipulating can have the same effect as punching, slapping, cutting, shooting at, and torturing. And most people will do anything to stop the pain.
It gets more complicated when we realize that, in order to minimize social pain, we look for a sense of belonging. In the words of Mari Fitzduff:
Us and Others
People usually need to ‘belong’ more than to be ‘right’.
The social and biological advantages of group membership pertaining to religion, ethnicity, and social and cultural identities offer us hormonal feelings of safety and belonging. However, they can also increase our suspicion and rejection of others, and enable us to exclude, harm and murder them. We usually understand and relate to other people and groups not by thinking about them but by feelings which are assisted by our mirror neurons as well as by hormones such as oxytocin and testosterone. We are also susceptible to the phenomenon of emotional contagion between groups, which will push people into group behaviour that can be contrary to their ‘normal’ behaviour.
What is happening right now in Eastern Europe and particularly in the Middle East are examples of how this cycle of fear, pain, anger, and aggression can escalate and kill thousands of people in the process. We have witnessed Russia invading Ukraine and now Israel's incursion on Palestinian territory to retrieve hostages taken by the terrorist group Hamas.
Every day I watch on my TV the recurring bombings that have killed more than 8 thousand people in Gaza and around 1.5 thousand in Israel. Hamas has killed, raped, and beheaded family members of people in Israel, which has not given Gaza access to clean water for years, has recently cut off its communications, bombed a hospital, and has been denying humanitarian help. For historical reasons, the creation of the state of Israel to accommodate the many Jews after the Holocaust, the subsequent occupation of Palestine, the apartheid, and other variables, this area has been in pain for decades, with the Palestinian people losing more and more land every year.
Chandler Bing's struggles felt like my own because I felt uncomfortable in social situations. That's one of the reasons why I related to Matthew Perry on such a personal level. He played my favorite character in my favorite sitcom. His tragic death (he drowned in his jacuzzi) may have nothing to do with his addiction. He may have got the treatment he needed and it may have been an accident. The police said they found no drugs in his house. But what he has been through does serve as a poignant reminder of the devastating consequences of living in pain and trying to make it stop.
One of the best scenes in Dopesick was performed by Michael Keaton, who played a doctor who got addicted to OxyContin, and Will Poulter, the sales rep who introduced him to the drug. Keaton's character is in rehab getting treated and he calls this guy who thinks he is getting better only to find out that he wanted to get some drugs. It reminds me of Hugh Laurie's stellar performance as Dr. House and his addiction to Vicodin. Keaton's character had lost his wife and Laurie's character his leg. Both were in pain and opioids can treat sorrow and inadequacy just as much as physical pain. Once they are addicted, they know that what they're doing is wrong and it can be the source of pain for people they love, but they simply can't stop. They want the pain to go away.
Mari Fitzduff's insights about our innate tendencies and the mismatch between our evolutionary instincts and the demands of modern society shed light on the root causes of conflict and aggression. Our genetic and bio-physical tendencies have indeed played a role in shaping our behavior, including our ability to form communities and nations. These instincts, once vital for survival in a different environment, have persisted into the present day. However, in today's interconnected world, these instincts can sometimes lead to fear, suspicion, and conflict between different groups.
The question is: how do we deal with that? Fitzduff says that by acknowledging our innate inclinations, we can work towards overcoming them and fostering collaboration instead of competition. She emphasizes the importance of recognizing our shared humanity and finding ways to interact with others, even beyond our immediate tribes, because we cannot:
[...] base peacebuilding strategies primarily on rational discourse
We need to compromise. We need to be more humane. We need to remember that:
contexts, not character, usually define human behavior
As long as human beings keep oppressing one another, inflicting social or physical pain, people will respond violently and irrationally to make the threat go away or to make the pain stop. Whether it be through improved mental health support, effective pain management strategies, or fostering understanding and empathy among different communities, the road to empathy and peace is a long one. I'm not not hopeful. I'm sad about the innocent lives being lost in wars all over the world (yes, there are others). I'm sad about losing my friend Chandler Bing. I'm sad about how we treat each other. I wish I could end this article by saying something like "I hope we can learn our lesson". But I don't believe in that so much anymore... at least not today.