Williams Amanda C de C
Department of Psychological Medicine, Guy's, King's and St. Thomas' Medical School, University of London, INPUT Pain Management Unit, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
Behav Brain Sci. 2002 Aug;25(4):439-55; discussion 455-88. doi: 10.1017/s0140525x02000080.
This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute and attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, "amplification" could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it.
本文提出，人类在有或没有照顾者在场时的疼痛表达，以及观察者对疼痛的察觉，源自进化而来的倾向。疼痛的功能是引起注意并将逃避、恢复和治愈列为优先事项；在他人能够帮助实现这些目标的情况下，就需要有效地传达疼痛。本文回顾了从婴儿期到老年期独特而特定的疼痛面部表情的证据，这种表情在不同刺激下保持一致，并且能被观察者识别为疼痛。对表情幅度的自主控制并不完全，观察者能更好地察觉到个体试图抑制而非放大或假装的疼痛。在许多临床和实验环境中，疼痛的面部表情与言语和非言语发声活动、姿势及动作共同归为疼痛行为的整体范畴。临床医生认为这受到诸如同情、照料和实际帮助等社会意外情况的操作性控制；因此，强烈的面部表情被假定是通过放大正常表情来构成并试图操纵这些意外情况。操作性表述支持对疼痛的存在或程度持怀疑态度、对装病的判断，有时还支持拒绝给予照料和帮助。然而，就疼痛表达受环境意外情况影响而言，“放大”同样有可能是根据指导行为的进化而来的意外倾向释放抑制作用。疼痛在进化文献和情感表达文献中很大程度上被忽视了，但从进化角度进行阐释能够改进对疼痛及其反应的评估。
