Aspirin for a cold shoulder and an existential crisis

Part 2 of 2 about the overlap between social and physical perception; read Part 1 here.

Recently I wrote about how when someone gives you the cold shoulder, it may actually make you feel cold. On the bright side, there may be a cure, and it’s not just bundling up against the chill. Tylenol does more than treat headaches and muscle aches; it also works on purely emotional pains.

A few years ago, a study demonstrated that taking acetaminophen (more colloquially recognized as Tylenol) could reduce the amount of social pain (hurt feelings) people felt, and change the brain’s response to being given the cold shoulder. Volunteers took 500 mg of acetaminophen – equivalent to one extra-strength capsule of Tylenol – in the morning and in the evening. Gradually, their self-reports of how often their feelings were hurt during the day (e.g., “Today, being teased hurt my feelings”) decreased, compared to those who were taking a placebo. The impact took a little time to build, and the decline was not significant for the first week or so, but at 2 and 3 weeks people on the painkiller regimen reported significantly fewer hurt feelings. I’m not sure whether the participants themselves would have noticed the change, which at its greatest was only a third of a point on a 5-point scale (suggesting that, on average, they reduced their agreement to one item by one point), but it does suggest some connection between physical and emotional pain.

As with the connection between social and emotional warmth, this overlap between physical and emotional pain seems to be due to shared brain networks, including at least one brain region (the insula) that links those two forms of warmth. This was shown with another group of volunteers who took the full extra-strength dose of acetaminophen twice a day for three weeks, and then played a virtual reality game in an MRI scanner. The game was an electronic version of pass-the-ball, with what the volunteers were told were real people, but were in fact computer programs designed to stop throwing the ball to the volunteer in the second round. In response to this perceived social exclusion, people on the acetaminophen regimen showed less activity in two brain regions connected to physical pain perception: our friend the insula, and also the anterior cingulate cortex, a known player in physical pain perception. This time, the painkillers did not change how people actually reported feeling, as both groups were equally likely to agree that they felt accepted by the other players. It could be that the shift in brain processing was not enough to change their subjective experience, or perhaps the questions weren’t getting enough at whether getting the figurative cold shoulder had bothered them.

The combination of slight perceptual shifts on a day-to-day basis and the decreased brain activity in response to social exclusion do suggest that our perceptions of emotional pain do have some foundation in our more tangible, physical pain. And it’s not just the emotional pain of being snubbed or teased; it’s also the emotional pain that comes from purely internal sources such as contemplating our own mortality.

A more recent study showed that acetaminophen also helps us cope with thoughts of our own death. This time, volunteers took just one full dose of extra-strength Tylenol, were kept busy for an hour while it was metabolized, and then got assigned to one of two thrilling essays: what will happen to their body when they die, or going to the dentist. Thinking about your own body after death should be enough to create a minor existential crisis – I’m going to die, these things are going to happen to the body, I can only hope what will happen to my soul – and is not the kind of thing we choose to do on a regular basis. Going to the dentist often involves a bit of discomfort, sure, but is a more common and accepted experience.

The key thing to this study is that they did not measure pain or reactions to mortality directly. Volunteers were simply asked to set bond for a prostitute who had been arrested. In theory, the greater our existential pain, the more money we will think an arrested prostitute should pay: it’s a chance to affirm our cultural beliefs and/or make ourselves feel better by judging others. And acetaminophen appeared to help people cope with confronting their own mortality, because they set a relatively low bond, about $300, just like those who had written about going to the dentist. People who had to confront their mortality without the aid of acetaminophen, however, demanded a higher bond of almost $450.

And sorry for fans of surrealism, but it turns out to be disconcerting enough to lead to a similar kind of pain as contemplating our own deaths, which is helped by painkillers; acetaminophen helped those who watched a surreal film mete out a fine for rioting similar to those who watched The Simpsons, and significantly less than demanded by those who watched a surreal film without a painkiller.

Now, neither study is compelling enough that doctors will start prescribing acetaminophen to take the sting out of slung words, or to help people prepare their wills. I certainly do not advocate self-medicating from the medicine cabinet the next time a date stands you up, either. But I do think this tells us that purely emotional hurts should get their due respect. Critical regions of our brain do not appear to distinguish between slicing your finger open or receiving a cold shoulder, and the basis for emotional pain is physical enough to be alleviated at least a bit by an over-the-counter drug, so perhaps we should not assume that one form of pain is “legitimate” but the other is not. Perhaps some nice social recognition of that pain would be a far more effective painkiller than a pill.

ResearchBlogging.orgDewall, C.N., Macdonald, G., Webster, G.D., Masten, C.L., Baumeister, R.F., …. & Eisenberger, N.I. (2010). Acetaminophen reduces social pain: Behavioral and neural evidence. Psychological Science, 21(7), 931-937. PMID: 20548058
Randles D, Heine SJ, & Santos N (2013). The common pain of surrealism and death: Acetaminophen reduces compensatory affirmation following meaning threats. Psychological Science, 24 (6), 966-973 PMID: 23579320

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