Danziger Nicolas, Prkachin Kenneth M, Willer Jean-Claude
Département de Neurophysiologie, Faculté de Médecine Pitié-Salpêtrière, Paris, France.
Brain. 2006 Sep;129(Pt 9):2494-507. doi: 10.1093/brain/awl155. Epub 2006 Jun 24.
Empathy is a complex form of psychological inference that enables us to understand the personal experience of another person through cognitive/evaluative and affective processes. Recent findings suggest that empathy for pain may involve a 'mirror-matching' simulation of the affective and sensory features of others' pain. Despite such evidence for a shared representation of self and other pain at the neural level, the possible influence of the observer's own sensitivity to pain upon his perception of others' pain has not been investigated yet. The aim of this study was to explore how patients with congenital insensitivity to pain (CIP), who are largely deprived of common stimulus-induced pain experiences, perceive the pain of others. Ratings of verbally presented imaginary painful situations showed that CIP patients' semantic knowledge regarding the pain of others did not differ from control subjects. Moreover, the propensity to infer pain from facial expressions was very similar between CIP patients and control subjects. On the other hand, when asked to rate pain-inducing events seen in video clips in the absence of visible or audible pain-related behaviour, CIP patients showed more variable and significantly lower pain ratings, as well as a reduction in aversive emotional responses, compared with control subjects. Interestingly, pain judgements, inferred either from facial pain expressions or from pain-inducing events, were strongly related to inter-individual differences in emotional empathy among CIP patients, while such correlation between pain judgement and empathy was not found in control subjects. The results suggest that a normal personal experience of pain is not necessarily required for perceiving and feeling empathy for others' pain. In the absence of functional somatic resonance mechanisms shaped by previous pain experiences, others' pain might be greatly underestimated, however, especially when emotional cues are lacking, unless the observer is endowed with sufficient empathic abilities to fully acknowledge the suffering experience of others in spite of his own insensitivity.
同理心是一种复杂的心理推理形式，它使我们能够通过认知/评价和情感过程来理解他人的个人经历。最近的研究结果表明，对疼痛的同理心可能涉及对他人疼痛的情感和感觉特征进行“镜像匹配”模拟。尽管有证据表明在神经层面自我和他人的疼痛存在共享表征，但观察者自身对疼痛的敏感性对其对他人疼痛感知的可能影响尚未得到研究。本研究的目的是探讨先天性无痛觉患者（CIP），他们在很大程度上缺乏常见刺激引起的疼痛体验，是如何感知他人的疼痛的。对口头呈现的想象痛苦情境的评分表明，CIP患者关于他人疼痛的语义知识与对照组受试者没有差异。此外，CIP患者和对照组受试者从面部表情推断疼痛的倾向非常相似。另一方面，当被要求对在视频片段中看到的诱发疼痛事件进行评分，且没有可见或可听的与疼痛相关的行为时，与对照组受试者相比，CIP患者的疼痛评分更具变异性且显著更低，同时厌恶情绪反应也有所减少。有趣的是，从面部疼痛表情或诱发疼痛事件推断出的疼痛判断与CIP患者之间情感同理心的个体差异密切相关，而在对照组受试者中未发现疼痛判断与同理心之间的这种相关性。结果表明，正常的个人疼痛体验不一定是感知和感受他人疼痛同理心的必要条件。然而，在缺乏由先前疼痛经历塑造的功能性躯体共鸣机制的情况下，他人的疼痛可能会被大大低估，特别是当缺乏情感线索时，除非观察者具备足够的同理心能力，尽管自身无痛觉但仍能充分认识到他人的痛苦经历。
