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Moebius Syndrome and pain: neurophenomenology and the ‘lived experience of impairment’. 

Extended narrative first-person accounts of the pain-experience in male and female adults with Moebius with attention given to pain facial expression. 

My interest is in shared awareness of pain grounded in empathy, and the extent to which facial expression is a mechanism of empathy and second-person consciousness of pain. Given that the experience of pain as a form of human interaction is partly facial and thus mutually reinforcing, what happens to a person in pain closed permanently to pain facial conversation? Is his pain not more intense? Or, cognitive? How do Moebians typically perceive the link between pain and the threat of danger? Does facial paralysis modify the experience of pain by shaping the magnitude of pain and hence the magnitude of suffering?


The Swiss Society for Neuroscience, July 15, 2008

Scientists in Switzerland and the UK have made valuable discoveries into how the human brain responds to faces, feels empathy for others, and represents the concept of the self. The researchers used functional magnetic resonance imaging (fMRI), which measures brain activity, to understand how the brain works in real time. The results, presented Sunday 13 July at FENS 2008, will be relevant in disorders of social functioning such as autism and low self-esteem.

“Facial expressions play a major role in non-verbal social communication among humans and other primates,” explains Professor Patrik Vuilleumier, based at the Laboratory of Neurology & Imaging of Cognition in Geneva, Switzerland. But the way the brain responds to facial expressions is influenced by each person’s ‘attachment style’ – the way they tend to respond to others during social interactions. There are three main types of attachment style – secure, anxious and avoidant. People with a secure attachment style tend to think their interactions with others are positive and trustful, while those with anxious attachment style may think others are hostile and tend to worry about being rejected. Those with avoidant attachment style prefer to distance themselves from others. The theory of attachment style was developed in the 1960s, but until now it’s not been clear how it relates to brain activity. “For the first time, our work has revealed differences in brain activity that may underlie these individual differences,” says Professor Vuilleumier.

Entire article here.

Approaches to pain assessment typically distinguish between self-report and nonverbal, observational indices, but do not specify criteria or reasoning for the distinction (Hadjistavropoulos & Craig, 2002). Self-report indicators usually employ verbal report to describe the individual’s pain experience, or to communicate qualities of experience through the use of speech (e.g. ‘I have a dull nagging pain in my lumbar region’). The context is important as the exchange is either initiated by the individual in pain or serves as a response to others’ queries. Observational indicators typically focus upon nonverbal, publicly observable manifestations of pain including facial expressions, cry, limb and torso movements and paralinguistic qualities of speech.

The nonverbal behavior that is the focus of observational indices typically can be viewed as primitive in the sense that the behavior represents reflexive patterns of response to actual or impending tissue damage that are not anteceded by introspective awareness or inner observation of private phenomena (Wittgenstein, 1958b; 1980b; 1982). For example, babies’ cries typically alert mothers and caretakers as to children’s needs and initiate required care, even though the infant cannot be characterized as intending or consciously understanding the interaction. While pain is a powerful initiator of attention, introspection does not mediate or modulate primitive behavioral reactions. Instead, we claim that when conscious awareness is employed to influence any form of social communication, the expression cannot be taken as an automatic reaction pattern. For example, to pretend to be in pain, an individual must know how a person who is in pain behaves and focus one’s behavior on that model, intend to reproduce it (Wittgenstein, 1982). Moreover, people tend to experience difficulty suppressing nonverbal expressions of pain and there are subtle differences between spontaneous and feigned expressions of pain (Craig et. al, 1999).

Another important aspect of the primitiveness of pain communication pertains to the experience of conscious awareness of what is happening. Self-report indices typically necessitate attention to the task, including some degree of self-observation. By contrast, the behaviors included in many nonverbal indices occur spontaneously without prior awareness, although the individual likely will monitor the display (Hadjistavropoulos & Craig, 2002). This view ignores the important fact that self-report is used as a partial substitute for automatic nonverbal behaviors (Wittgenstein, 1958b). The exclamation ‘It hurts’, the groan ‘I have a stomach-ache’, the cry ‘I’ve hurt myself’ are reflexive patterns of response, not descriptions; they are comparable to automatic nonverbal behaviors rather than to reports such as ‘He has a back-pain’. In this situation, there is no such thing as my ‘finding out’ that I am in pain, or of my ‘attending’ or ‘recognizing’ my pain-sensations or experiences (Wittgenstein, 1958b).

A primitive expression of pain can be over-ridden to some degree. For instance, facial pain expression can be voluntarily controlled, although the upper face is less amenable to conscious control (Rinn, 1984). Communicative acts often reflect anticipation of consequences. As Wittgenstein (1958b) noted, pain behavior is deeply influenced by conditioning and learning. We claim that the more dependent pain behavior is on learning and conditioning, the more it will be subject to deliberate mediation. Empirical evidence suggests that nonverbal pain expressions that are genuine can be distinguished from masked or exaggerated expressions (Hadjistavropoulos et. al, 1996), possibly because of the greater automaticity of nonverbal expression places limits on the degree to which it can be influenced by learning and conditioning (in contrast to self-report). Observers generally appreciate this and communicate preferences for nonverbal behavior over verbal behavior when assessing the truthfulness of others’ pain behavior (Craig, Prkachin, & Grunau, 1992). This suggests that pain assessment presupposes behavioral manifestations, primarily nonverbal and observational indices, and that ascribing pain in others is possible only where we have criteria for identifying pain, which means that pain must be capable of being expressed (Wittgenstein, 1958b).

The International Association for the Study of Pain (IASP) Committee for Taxonomy defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. They further state that ‘pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life’ (Merskey, 1994).

This definition states that the employment of the word ‘pain’ needs to be learned through experiences in early life: a child has hurt himself and cries; and then adults talk to him and teach him the use (meaning) of ‘pain’. Wittgenstein (1958b) suggests that the child is trained to substitute its primitive, natural expressive pain-behavior first with exclamations and later with sentences such as ‘I have a stomach-ache’. There are other possibilities. One might point at someone who is manifestly in pain and say, ‘There: that is what it is to be in pain’, or That is pain’ (see Wittgenstein, 1958b, §290). On the other hand, it appears that the perception of pain is an intrinsic feature of life itself, is manifested in all living organisms, and while subject to influence by life experiences, does not require previous experience in the first instance. The first experience of tissue injury is painful, in much the same way that touch, smell, vision, or hearing need not be learned in order to occur in the human being. Infants from 25 weeks gestation show a characteristic pain face consisting of eyes squeezed shut, brows lowered, deepening of the nasolabial furrow, open lips, with mouth stretched vertically and horizontally (Craig et al. 1993; Stevens et al., 1994).

The meaning of these sensations, however, will develop with experience through positive, negative, and contextual associations (Anand & Craig, 1996). In other words, learning cannot be separated from the behaving organism: ‘Only of living human being and what resembles (behaves like) a living human being can one say: it has sensations, it sees, is blind; is deaf; is conscious or unconscious’ (Wittgenstein, 1958, §218). As the person develops, so do its behavioral repertoire and the qualitative features of its subjective experiences. As characteristic features of the behaving organism, learning is incorporated into experience as components of a ‘form of life’ (Sullivan, 2001).

An adult, for example, can pretend to be in pain without saying a word, merely by facial expressions, torso movements, or paralinguistic qualities of speech (Wittgenstein, 1982, §944). But for these apparently simple behaviors to constitute pretence presupposes complex motives, intentions (e.g. the intention to deceive), as well as a complicated play of expressions (i.e. numerous nonverbal actions). Can one imagine a new-born child with the play of facial expressions and expressive-behavior of an adult? A new-born child cannot be insincere, but neither can he be sincere. To dissimulate pain, he must first learn to mimic and to intend to mimic (Wittgenstein, 1958b).

Available empirical evidence suggests that by the age of four children are able to use techniques to dissemble non-painful subjective states. This suggests that they may succeed in misrepresenting expressions of pain (Larochette et al., 2006). Cases of illness falsification have been reported in children as young as 8 years (Libow, 2000). Children report that their most common reason for using deception, especially to conceal physical pain in front of their peers, is a fear of negative consequences, and that controlling facial behavior is the most common method of regulating expressions of emotion (Zeman & Garber, 1996). This suggests that a child learns to dissimulate pain only in the course of learning the complicated interpersonal use of ‘having pain’ (Wittgenstein, 1982). He must learn not only ‘He has a pain’, but also ‘I think (believe) he has a pain’ and ‘He thinks I have a pain’ (Wittgenstein, 1980a).

inthenews, July 7, 2008

When mothers see their baby smiling it creates a ‘natural high’, new research has discovered.

The smile creates activity in the reward centres of the brain as well as areas associated with emotion processing, cognition and motor/behavioural outputs.

These areas have been activated in previous experiments associated with drug addiction.

“It may be that seeing your own baby’s smiling face is like a ‘natural high’,” said Dr Lane Strathearn.

He and his colleagues from the Baylor College of Medicine, US, studied 28 first-time mothers with babies aged between five and ten months.

They were asked to watch photos of their own babies and other infants while they were in a functional magnetic resonance imaging scanner (brain scanner).

This machine measures blood flow in the brain, with scans showing ‘lit up’ areas where activity is taking place.

In some of the photos, babies were smiling or happy. In others they were sad, and in some they had neutral expressions.

They found that when the mothers saw their own infants’ faces, key areas of the brain associated with reward lit up during the scans.

The strength of the reaction depended on the baby’s facial expression, with the strongest activation from smiling faces.

There was less effect from pictures of their babies with sad or neutral expressions and the researchers found little difference in the reaction of the mothers’ brains to their own babies’ crying face compared to that of an unknown child.

They argue that their findings, published in the journal Pediatrics, have important implications for understanding the bond between mothers and children and how it can go wrong.

“The relationship between mothers and infants is critical for child development,” said Dr Strathearn.

“For whatever reason, in some cases, that relationship doesn’t develop normally. Neglect and abuse can result, with devastating effects on a child’s development.

“Understanding how a mother responds uniquely to her own infant, when smiling or crying, may be the first step in understanding the neural basis of mother–infant attachment,” he added.

It is usually nice to arrive some place new, but equally important to acknowledge when the experience has run its course and that it is time to move on. For some reason, this tends to be rather difficult to do. 

Those who do stay behind typically share a common fate: they offer their whole being over to comfort and being comfortable, and eventually, they stop thinking and creating. Nothing saps the larger desires more than the desire for comfort.

By Beth Azar, Monitor on Psychology, January 2000

After 30 years of renewed interest in facial expression as a key clue to human emotions, frowns are appearing on critics’ faces. The face, they say, isn’t the mirror to emotions it’s been held out to be.

The use of facial expression for measuring people’s emotions has dominated psychology since the late 1960s when Paul Ekman, PhD, of the University of California, San Francisco and Carroll Izard, PhD, of the University of Delaware, reawakened the study of emotion by linking expressions to a group of basic emotions.

Many took that work to imply that facial expressions provided the key to people’s feelings. But in recent years the psychology literature has been sprinkled with hotly worded attacks by detractors who claim that there is no one-to-one correspondence between facial expressions and emotions. In fact, they argue, there’s no evidence to support a link between what appears on someone’s face and how they feel inside.

But this conflict masks some major areas of agreement, says Joseph Campos, PhD, of the University of California at Berkeley. Indeed, he says, “there is profound agreement that the face, along with the voice, body posture and hand gestures, forecast to outside observers what people will do next.”

The point of contention remains in whether the face also says something about a person’s internal state. Some, such as Izard, say, “Absolutely.” Detractors, such as Alan Fridlund, PhD, of the University of California, Santa Barbara, say an adamant “No.” And others, including Campos and Ekman, land somewhere in the middle. The face surely can provide important information about emotion, but it is only one of many tools and should never be used as a “gold standard” of emotion as some researchers, particularly those studying children, have tended to do.

“The face is a component [of emotion],” says Campos. “But to make it the center of study of the human being experiencing an emotion is like saying the only thing you need to study in a car is the transmission. Not that the transmission is unimportant, but it’s only part of an entire system.”

Entire article here.

By Temma Ehrenfeld, Newsweek, June 9, 2008

When James J. Newberry started doing police work in California 30 years ago, questioning suspects often amounted to one thing: tossing the guy against the wall. “I decided there had to be a kinder, gentler way,” he says. Newberry began studying the faces of the people he was interrogating. He got so good at picking liars from truth tellers that psychologist Paul Ekman, of the University of California, San Francisco, began studying Newberry in the late ’80s. His talent, it turned out, was for detecting those faint or fleeting expressions in a suspect’s face that seemed inconsistent with what he was saying or other clues. Ekman called them “microexpressions.”

Since then, Ekman has been teaching law-enforcement officers how to catch microexpressions and has written a book about them–“Emotions Revealed.” He even trained Newberry to get perfect scores recognizing liars on videotape. Now the U.S. Defense Department and the CIA are funding work to incorporate Ekman’s research into software that would analyze facial movements captured by digital cameras. Terry Sejnowski, a neurobiologist at the Salk Institute in La Jolla, California, wants to develop an airport-security system that in a few years could notify airport workers of peculiarities around your lips (suppressed anger, perhaps?) while you’re answering questions.

More here.

By Eliza Strickland, Discover Magazine, June 16, 2008

When confronted with something truly terrifying (say, for example, an irritated grizzly bear), most human faces assume the same expression, with bulging eyes and flaring nostrils. Researchers have long suspected that those facial adjustments serve some evolutionary purpose, but the mechanism has been unclear for over a century.

Now, a study presents an answer that seems rather obvious in retrospect. Those wide-open eyes and flared nostrils take in more sensory information, which helps when you’re trying to figure out how to evade swiping bear claws. 

Curiosity about the purpose of facial expressions goes back to Charles Darwin. In 1872, Darwin published The Expression of the Emotions in Man and Animals, which discussed the similar facial expressions found across human cultures and in some animal populations, and theorized that the expressions must have some evolutionary benefit. He guessed that the advantage lay in the ability to communicate emotions, which could reduce misunderstandings and help a group function efficiently.

Later scientists followed Darwin’s train of thought and discovered that the expression of emotions is strikingly similar across cultures – horror and disgust look pretty much the same on the face of a New Yorker as they do on a Nigerian, and people from different cultures can recognize emotions such as happiness, anger and surprise on others’ faces, even if they don’t share a language. The fact that emotional expressions seem to be universal led scientists to believe they weren’t used only for communication and social purposes, but also served an additional adaptive biological function.

More here.

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