On social pain, social neuroscience and whether aspirin can mend a broken heart. All of which are relevant for therapists, as humans or otherwise.
Everybody Hurts...Sometimes
If you feel like you're alone
No, no, no, you are not alone
If you're on your own in this life
The days and nights are long
When you think you've had too much
Of this life to hang on
Well, everybody hurts sometimes
Everybody cries
Everybody hurts, sometimes
When Michael Stipe sings that 'everybody hurts,' no one mistakes it for a song about physical pain, right? We instinctively understand that he's expressing emotional pain. And much of our sadness and emotional pain is tied to others - whether through rejection, loss, or the absence of connection. It is the social pain.
Broken heart (romantic or otherwise). Feeling embarassed. Feeling ashamed. Feeling lonely. Feeling rejected by one person. Feeling rejected by a group of people. Feeling rejected by the society. Losing someone we love. Feeling that we have been treated unfairly. By one person. By a parent, teacher. Group. Society as a whole. World as a whole. Distress felt through lower social status. Feeling social anxiety. Feeling judged. Feeling dissaproved of by others.
For each of you reading this, you could likely add at least one more significant way we experience social pain to the list above.
And without exception, we've all been there. The pain that feels intangible and undefinable because we can't pinpoint where it hurts. Emotional pain is a deeply personal and intimate experience. Yet, paradoxically, it is one of the things that binds us together as humans. For one who has not felt it has not truly lived.
And ouch. It hurts.
Yet, 'sticks and stones can break your bones, but words can never hurt me'. So why does it then hurt so damn much?
Social Neuroscience: Blurring the Line Between the Metaphorical and the Literal
We speak of a 'broken heart,' giving tangible, physical form to the abstract anguish of rejection. Expressions like 'hurt feelings,' 'social pain,' or a 'broken heart' are widely understood as mere metaphors for the emotional wounds caused by social ruptures. But are they really metaphors?
Social neuroscience is a branch of neuroscience that explores human sociality and the 'social brain'—the areas of the brain involved in social cognition and emotional processing. For psychotherapists, particularly those practicing relational psychotherapy, this field offers some of the most fascinating and relevant insights. Where do I even begin? It's truly a feast for my intellectual senses: neural correlates of mentalising (understanding others' thoughts: think parts of the TA script), social inference (TA games gold), imitation and the mirror neuron system, empathy, altruism, attachment, morality, trustworthiness, agency, self-knowledge, self-reflection, fairness, social rewards, pain, rejection, implicit bias, prejudice - the list of endlessly fascinating concepts of human sociality studied by social neuroscience goes on and on.
To me, some of the most striking, revolutionary, and frankly delightful contributions of social neuroscience to our understanding of what it means to be human - while profoundly insightful - are somehow unsurprising. These insights reveal that social ailments, despite the invisibility of their damage, are far less metaphorical than we’ve traditionally assumed.
For example, positive social feedback and being treated kindly and with respect, activate areas of the brain involved in experiencing intense physical pleasure and reward, such as the ventral striatum. Are you thinking what I’m thinking? Social media, specifically 'likes.' Interestingly, both physical disgust and moral disgust (such as insult) are linked to the same brain region: the anterior insula.
Then, of course, there's social pain. By now, it's not surprising that, while no one confuses physical pain with social pain, their mechanisms are closely linked. In fact, it’s believed that the elements of mechanisms of social pain essentially 'piggyback' on those of physical pain. So, social pain is, in a sense, 'real' pain. That is why it hurts so damn much.
We Feel Pain - But How It Works?
What is pain? We know we don’t like it (sometimes debatable, but generally speaking). We feel an instinctive urge to stop or move away from whatever is causing it (again, generally speaking). We recognise that pain can vary: it can be sharp or dull, intense or mild. We know that physical pain is often localised. But when we really think about it - what is physical pain?
The pain system is known to have at least three components:
Nociception (pain sensation) begins with specialised receptors called nociceptors located at the 'site of pain.' These receptors can be external, on the surface of the body, or internal. For instance, if we cut ourselves, we can localise where the pain is felt. Nociceptors detect the injury and send signals to the brain for processing, with the thalamus playing a key role in this communication pathway.
Conscious perception of pain (pain affect) - what we feel as a painful experience or pain perception, is the result of the brain processing the nocioreception input. Nociceptive input activates a number of brain named the pain matrix. The most prominent areas (but not limited to) involved in pain processing are the insula, the anterior cingulate cortex (ACC), the prefrontal cortex.
Suffering - is the negative reaction to the experience of pain. Our reaction and knock on effects that pain has on our mental states will be influences - for better or worse - by many, confounding, psychological and social factors such as culture, personality, family history, psychological states and many more.
But, what about the emotional pain, or the social pain and the social hurt?
As discussed earlier, referring to 'social hurt' or 'social pain' turns out not to be a complete metaphor. Research from social neuroscience provides body of evidence that the brain's pathways for physical and social pain significantly overlap. Specifically, this overlap occurs at component 2 of the pain system, the pain affect, where the emotional or social experience of pain is thought to align with the neural systems involved in processing physical pain.
Can Aspirin Mend a Broken Heart?
If the social pain system 'piggybacks' on the neurological system for physical pain, is it so far-fetched to think that painkillers could also 'pain-kill' the ache of a broken heart?
Different painkillers act at different points of the pain pathway. Because, the social pain mechanisms seem to overlap with the mechanisms of the pain affect, the painkillers acting at the level of the central nervous system could be potential candidates, right?
Site of Action | Drug |
Peripheral | Opioids Iboprufen Aspirin |
Central Nervous System | Opioids Antidepressants Paracetamol (acetaminophen) |
As it turns out, according to the table above, aspirin does not seem to be a good candidate as its action is peripheral. But don't fret! Opioids, paracetamol and antidepressants all seem to make good candidates.
The urban legends and pop culture myths offer plenty of anecdotal evidence suggesting that morphine and other opioids can temporarily dull the burning sting of a broken heart—albeit at the cost of significant lull and potential long-term harm. Please, do not try it at home!
More surprisingly, paracetamol (acetaminophen) seems to be a good candidate too, without presenting the downsides of its more potent poppy cousin.
And as crazy as it sounds, one study from social neuroscience that confirms just that hypothesis. The participants who had recently experienced social rejection were randomly assigned to take paracetampol or a placebo daily for three weeks. Those in the paracetamol group reported fewer hurt feelings during this period. Brain scans conducted at the end of the treatment showed that paracetamol group had a reduced activation in the anterior insula and anterior cingulate cortex, which we have seen were key regions involved in processing both physical and social pain.
The Bottomline
Learning to face and tolerate the emotional pain, learning to ride the wave and allowing the passage of time to work its magic might well be all we need to mend a broken hear. But, it certainly seems that if things get really bad, popping a paracetamol or two might not be such a bad idea after all. Taking the edge off won't hurt (this pun was intended). I will certainly try. Very soon.
And always remember, you are not alone. As....
Everybody hurts. Sometimes.
As always, thank you for reading. For updates you can follow me on BlueSky or subscribe to my mailing list.
Some resources I used to develop the ideas in this blog post:
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