Understanding the suffering of others: The sources and consequences of third- person pain

Abstract

First-person pain (the subjective sensory and affective experiences that we associate with tissue damage) motivates changes in the sufferer’s behavior that communicate the experience to others. The ability to infer features of another person’s pain by observing a sufferer’s behavior can be characterized as third-person pain. This chapter reviews research into the nature and determinants of third-person pain, focusing primarily on studies of the interpretation of facial expressions. Existing communication frameworks that attempt to organize thinking in this area are reviewed. Emerging conceptions of empathy and its role in third-person pain processes are described, including neuroimaging studies suggesting that first- person and third-person pain share common features of processing. Based on a review of the existing literature, a new organizing framework focused on the link between encoding of a pain signal by the sufferer and its decoding by the observer is developed. Components of this framework include preattentive processing, detection and registration, evaluation, differential responding (including the fact that the behavioral response to a sufferer may not necessarily be prosocial), and effects upon the observer. Finally, clinical implications of work in this field are considered.