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The personal experience of pain produces a reliable effect on facial behavior in humans and in nonhuman mammals. Why should pain have a face? What is it for? I will attempt to head towards answering this question by invoking a theoretical framework: polyvagal theory (Porges, 2001, 2006).

1 Polyvagal Theory

According to polyvagal theory (Porges, 2001, 2006), evolution of neural control within the autonomic nervous system (ANS) has tracked three stages, each revealing a specific behavior, and a specific function:

In the first stage, the ancient unmyelinated visceral vagus nerve that enables digestion could respond to danger and pain only by reducing metabolic output and producing immobilization behaviors.

In the second stage, the sympathetic nervous system (SNS) made it possible to increase metabolic activity and inhibit the visceral vagus nerve, thus allowing fight/flight behaviors following perceived threat or pain.

The third stage, which is uniquely mammalian, involves a myelinated vagus that can rapidly control cardiac and bronchi output to enable spontaneous interaction (i.e., engagement or disengagement) with the environment. The interaction of the autonomic nervous system (ANS) with the hypothalamo-pituitary-adrenal (HPA) axis, nervous and immune systems change to maximize response to stressors such as nociception. During nociception, the ANS operates together with nervous, endocrine and immune systems to produce stress (Chapman et al. 2008; Porges, 2001, 2006). In terms of polyvagal theory, pain facial expression is a dynamic autonomic response caused by noxious signaling. In terms of polyvagal-type identity mechanistic theory pain facial expression is a type of behavior that is identical to a type of neurophysiological mechanism; namely, the phylogenetically recent brain-heart-face mechanism.

The expansion of cortex in the third stage increased innervation and neural control of the mammalian face: upper face innervation is bilateral and arises from the supplementary motor area (M2) and the rostral cingulate motor area (M3). Lower face innervation is contralateral and arises from primary motor cortex (M1), ventral lateral premotor cortex, and the caudal cingulate motor cortex (M4) (Morecraft et al. 2004). Human pain facial movements of the eyebrows and upper lip are type identical with negative emotional aspects of pain and activation of M1, M2, M3, whereas facial movements around the eyes are type identical with somatosensory aspects of pain, and activation of M2 and M3 (Kunz et al. 2011). Thus, evolution of cranial anatomy enabled a highly integrated facial representation of the multidimensional experience of pain.

2 Why Pain Should Have a Face

In clinical and experimental settings, the pain face is observed to rapidly appear following noxious stimulation, and diminish concurrent with cessation of the noxious stimulus, or when analgesics are administered (e.g., Craig & Patrick, 1985). The brain-heart-face mechanism is an integrated system with both a somatomotor part controlling the striated facial muscles and a visceromotor part controlling the heart through a myelinated vagus nerve (Porges, 2001, 2006). When the vagal tone to the cardiac pacemaker is high, the myelinated vagus acts as a brake or restraint limiting heart rate. Rapid inhibition and disinhibition of vagal tone to the heart supports the rapid mobilization of facial muscles and formation of the pain face concurrent with pain onset. In humans and nonhuman mammals, the main vagal inhibitory pathways in the myelinated vagus originate in the nucleus ambiguus.

The vagal brake supports the low-metabolic requirements involved in the rapidly appearing and disappearing pain face. Withdrawal of the vagal brake is strongly correlated with the rapid appearance of the pain face; reinstatement of the vagal brake is strongly correlated with the rapid diminishing of the pain face. These correlations are not unique to pain facial expression; similar relationships hold with regard to the vagal brake and the timing and duration of aversive, but non-noxious emotional facial expressions (e.g., Pu et al. 2010), and positive emotional facial expressions (e.g., Kok & Fredrickson, 2010).

In terms of the function of rapid pain face onset and offset, the vagal brake makes it possible for the individual in pain to quickly disengage from source of wounding and pain, concurrent with the rapid appearance or diminishing of pain facial expression, which may offer temporary access to additional metabolic resources to aid healing, recovery and self-soothing behaviors, with likely involvement from care givers.

Concerning aid from others, the vagal brake reliably maps onto specific interaction types observed in mammalian pain events. In pain events comprising the individual in pain and care givers, mammalian behavior is typed according to interpersonal communication through facial expressions, vocalizations, head and hand gestures (Hadjistavropoulos et al. 2011; Porges, 2001, 2006; Williams, 2002). A relevant feature is the rapid ‘switching’ of temporary engagement to temporary disengagement behaviors between the individual in pain and care givers. This interaction type may involve care givers speaking to the one in pain, and then quickly switching to listening; for the one in pain, looking into the face of the care giver, and then quickly switching to vocalizing (Craig et al. 2011; Hadjistavropoulos et al. 2011; Porges, 2001, 2006; Williams, 2002). The brain-heart-face mechanism thus allows the one in pain and the care giver to get the timing right. Some philosophers and neuroscientists claim that evolutionary neurobehavioral solutions to timing problems such as these are implicated in the origin of empathy and ultimately consciousness itself (Churchland, 2002; Cole, 1998; Engen & Singer, 2012; van Rysewyk, 2011).

However, if pain is severe or chronic and the vagal brake is withdrawn (or dysfunctional), the concurrency of increased pain facial expression, cardiac output, and other mobilization behaviors (i.e., increased SNS and HPA output), means that, if care giving is to succeed in promoting healing and recovery, the care giver’s vagal brake must be dynamically reinstated. By applying their own vagal brake, care givers may regulate their own visceral distress and thereby succeed in allocating valuable metabolic resources to communicate safety to the one in pain (and themselves) through calming facial and head behaviors, eye gaze, and prosodic vocalizations (i.e., increasing the vagal brake decreases SNS and HPA output). Since the vagal brake of the person in pain has been provisionally withdrawn, the care giver is effectively an integrated external brain-heart-face mechanism (cf. Tantam, 2009, the ‘interbrain’).

Thus, the pain facial muscles function as neural timekeepers detecting and expressing features of safety and danger that cue the one in pain to quickly disengage from the source of wounding and pain, simultaneous with the rapid appearance or attenuation of pain facial activity, and also cue others who can help.


Chapman, C. R., Tuckett, R. P., & Song, C. W. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. Journal of Pain, 9(2), 122-145.

Churchland, P. S. (1989). Neurophilosophy: Toward a Unified Science of the Mind-Brain. Cambridge, Mass.: MIT Press.

Cole, J. (1998) About face. Cambridge, Mass.: The MIT Press.

Craig, K. D., & Patrick, C. J. (1985). Facial expression during induced pain. Journal of Personality and Social Psychology, 48(4), 1080-1091.

Craig, K. D., Prkachin, K. M., & Grunau, R. E. (2011). .The facial expression of pain. In D. C. Turk, & R. Melzack, Handbook of Pain Assessment, 2nd Edition (pp. 117-133). New York: The Guilford Press.

Engen, H. G., & Singer, T. (2012). Empathy circuits. Current Opinion in Neurobiology, 23, 1-8.

Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., Mogil, J. S., Rainville, P., Sullivan, M. J. L., de C. Williams, Amanda C., Vervoort, T., & Fitzgerald, T. D. (2011). A biopsychosocial formulation of pain communication. Psychological Bulletin, 137(6), 910-939.

Kok, B. E., & Fredrickson, B. L. (2010). Upward spirals of the heart: Autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biological Psychology, 85(3), 432-436.

Kunz, M., Lautenbacher, S., LeBlanc, N., & Rainville, P. (2011). Are both the sensory and the affective dimensions of pain encoded in the face? Pain, 153(2), 350-358.

Morecraft, R. J., Stilwell-Morecraft, K. S., & Rossing, W. R. (2004). The Motor Cortex and Facial Expression: New Insights From Neuroscience. The Neurologist, 10(5), 235-249.

Porges, S. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42(2), 123-146.

Porges, S. W. (2006). Emotion: An Evolutionary By‐Product of the Neural Regulation of the Autonomic Nervous System. Annals of the New York Academy of Sciences, 807(1), 62-77.

Pu, J., Schmeichel, B. J., & Demaree, H. A. (2010). Cardiac vagal control predicts spontaneous regulation of negative emotional expression and subsequent cognitive performance. Biological Psychology, 84(3), 531-540.

van Rysewyk, S. (2011). Beyond faces: The relevance of Moebius Syndrome to emotion recognition and empathy. In: A. Freitas-Magalhães (Ed.), ‘Emotional Expression: The Brain and the Face’ (V. III, Second Series), University of Fernando Pessoa Press, Oporto: pp. 75-97.

Williams, A. C. D. C. (2002). Facial expression of pain: an evolutionary account. Behavioral and Brain Sciences, 25(4), 439-455.

Call for Chapters: Machine Medical Ethics, Edited Collection

You are warmly invited to submit your research chapter for possible inclusion in an edited collection entitled Machine Medical Ethics. Target publication date: 2014.

The new field of Artificial Intelligence called Machine Ethics is concerned with ensuring that the behaviour of machines towards human users and other machines is ethical. This unique edited collection aims to provide an interdisciplinary platform for researchers in this field to present new research and developments in Machine Medical Ethics. Areas of interest for this edited collection include, but are not limited to, the following topics:

Foundational Concepts

What is medical ethics?

What is machine medical ethics?

What are the consequences of creating or not creating ethical medical machines?

Can medical machines be autonomous?

Ought medical machines to operate autonomously, or under (complete or partial) human physician control?

Theories of Machine Medical Ethics

What theories of machine medical ethics are most theoretically plausible and most empirically supported?

Ought machine medical ethics be rule-based (top-down), case- based (bottom-up), or a hybrid view of both top-down and bottom-up?

Is an interdisciplinary approach suited to designing a machine medical ethical theory? (e.g., collaboration between philosophy, psychology, AI, computational neuroscience…)

Medical Machine Training

What does ethical training for medical machines consist in: ethical principles, ethical theories, or ethical skills? Is a hybrid approach best?

What training regimes currently tested and/or used are most successful?

Can ethically trained medical machines become unethical?

Can a medical machine learn empathy (caring) and skills relevant to the patient-physician relationship?

Can a medical machine learn to give an apology for a medical error?

Ought medical machines to be trained to detect and respond to patient embarrassment and/or issues of patient privacy? What social norms are relevant for training?

Ought medical machines to be trained to show sensitivity to gender, cultural and age-differences?

Ought machines to teach medicine and medical ethics to human medical students?

Patient-Machine-Physician Relationship

What role ought imitation or mimicry to play in the patient-machine-physician relationship?

What role ought empathy or caring to play in the patient-machine-physician relationship?

What skills are necessary to maintain a good patient-machine-physician relationship?

Ought medical machines be able to detect patient fakery and malingering?

Under what conditions ought medical machines to operate with a nurse?

In what circumstances should a machine physician consult with human or other machine physicians regarding patient assessment or diagnosis?

Medical Machine Physical Appearance

Is there a correlation between physical appearance and physician trustworthiness?

Ought medical machines to appear human or non-human?

Is a highly plastic human-like face essential to medical machines? Or, is a static face sufficient?

What specific morphological facial features ought medical machines to have?

Ought medical machines to be gendered or androgynous?

Ought medical machines to possess a human-like body with mobile limbs?

What vocal characteristics ought medical machines to have?

As a new field, the target audiences are expected to be from the scientists, researchers, and practitioners working in the field of machine ethics and medical ethics. The target audience will also include various stakeholders, like academics, research institutes, and individuals interested in this field, and the huge audience in the public sector comprising health service providers, government agencies, ministries, education institutions, social service providers and other types of government, commercial and not-for-profit agencies.

Please indicate your intention to submit your full paper by email to the editor who emails you with the title of the paper, authors, and abstract. The full manuscript, as PDF file, should be emailed to that same editor by the deadline indicated below. Authoring guidelines will be mailed to you after we receive your letter of intent.

Please feel free to contact the editors, Simon van Rysewyk or Dr. Matthijs Pontier, if you have any questions or concerns. Many thanks!


Intent to Submit: June 10, 2013

Full Version: October 20, 2013

Decision Date: November 10, 2013

Final Version: December 31, 2013


Simon van Rysewyk

School of Humanities
University of Tasmania
Private Bag 41
Tasmania 7001


Dr. Matthijs Pontier

Post-Doctoral Researcher
The Centre for Advanced Media Research (CAMeRA)
Vrije Universiteit Amsterdam
Buitenveldertselaan 3
1081 HV Amsterdam
The Netherlands


serious-man-tr1.jpg (239×307)

A very serious-minded man visited his happy family after a long time away, and was shocked. He was shocked because he found it quite impossible to interact with his family. All of his normal reactions and behaviors were out of line with his family’s reactions and behaviors. Sure, the family talked and laughed, but it seemed stilted and awkward-sounding. Tense looks were received, but none acknowledged, at least when he was in the conversation. And there was that disquiet. Such palpable disquiet.

It was terrible.

So, the very serious-minded man, who loved his family very much,  decided that the next family visit would have to feel very different.

Before the next visit, the man had a good idea: he would do the things his family members normally do. He wasn’t sure why it was a good idea, but it made sense to him. His father loved to play indoor bowls. So, he joined a bowls club and played bowls every day. He observed the behavior of the other bowls players and also what they talked about. He gave particular attention to how they talked about what they talked about. And, he copied them. It was difficult at first for the serious-minded man to copy the bowls players, but the players always encouraged him with knowing looks and happy talk. And, the man copied these behaviors too. Soon, conversations were easier and fun. He became more relaxed around others at the club, and more relaxed within himself.

The once-very-serious-now-more-relaxed man felt that copying the bowls players had really made him more like them, and that the players also saw it this way and didn’t mind at all. Maybe they saw it as a kind of complement. He wasn’t sure. It just felt positive. The man was encouraged by this promising first result, and decided to do other things his family liked. His younger brother plays the piano. So, the man took piano lessons. He wasn’t very good at it, and he had a hard time making his fingers work together to create music. But, the man was pleased because he understood that his brother would appreciate the effort, and they could share this experience together.

The once-very-serious-now-empathetic man did visit his very happy family again, and was pleasantly surprised.

‘You’ve changed’, his family soon noticed.

‘I have changed’, he breathed happily. ‘I am a different person now. I am like you’.

One day, artificial thought will be achieved.

An artificially intelligent computer will say, “that makes me happy.”

Will it feel happy? Assume it will not.

Still: it will act as if it did.  It will act like an intelligent human being. And then what?

My hunch is that adult human beings will view intelligent computers as simplified versions of  themselves (child-like). Human children will view them as peers; ‘friendships’ will form between children and intelligent computers.

Why? I am reminded of Wittgenstein’s remark: ‘The human body is the best picture of the human soul’.

Look at this video of ASIMO.

How would you interact with ASIMO? What would your reactions be?

It is also remarkable that ASIMO does not possess any physiology.


John Donne was partly right: A person is an island. But – every island is surrounded by water.

I am half myself, half you.

I am surrounded by your facial expressions. I adopt them as my own.

Apparently, human beings who wish to be only happy in life, are the same people who the next moment willingly listen to sad music and make themselves become sad. Why?

Does such a person think to himself: ‘This music is sad; I want to be sad; therefore, I listen to this music to be sad’? No, of course not. A person in this situation does not need to inform himself why he acts as he does. In addition, there is typically no such thought process preceeding a musical experience, during it, or following it. It is not characteristic of listening to or performing music to bethink to oneself such motivating factors as if the experience must be accompanied by a spoken soliloquy to make sense. Isn’t this true of routine human behaviours generally? Second, such a thought process cannot inform me in the same way as it informs you. For you, it is information. For me, a point of emphasis? Let me develop this last idea.

A human being may talk to himself inwardly while the music is on, but not to give himself information. Then, what is the meaning of this internal monologue, and how should it be described? The words used may convey the the level of interest in the music (a melody, a recurring theme, how the trombones sound, etc), and may function more like an exclamation than a descriptive statement. Certainly, one can imagine this occurring in upbeat or joyful music. In sad or melancholic music, self-talk is expressive of the sad quality perceived in the music. Again, it stresses what is noteworthy in the music. The music merits attention. It really did amaze me.

We want to be sad for a time; at least, sad for as long as the music lasts. The listener follows the sad music as he follows the sad face which changes expression. Music is like a familiar face, and we resonate with it in understanding as long as we are interested. The music plays on, the face moves predictably. On occasion, the music is too predictable. So, we stop it in mid-flight, like an uncomfortable human conversation, and move to something else. Typically, however, the sad piece of music I know completely by heart is a rewarding experience as though I listen to it for the very first time. It really is like empathy for a fellow human being, or parity in facial expressions exchanged between close friends during conversation. Now – is your closest friend entirely predictable? No. Even deep rapport between human beings harbours dark regions. I do not even wish to say that we aim in music listening to recreate sadness, happiness, or any such fleeting emotional response. What human beings do, I believe, is empathize with what is perceived in the music as expressive of our shared human interests, wants, desires, hopes, etc. We find it there in music, and return to it habitually, just as we find it in the faces of other people.

A human corpse cannot respond to a living human being, but a living human being can respond to a corpse. For example, a living human can imitate a corpse, can show to others that a corpse cannot respond to questions put to it, and so on.

A living human may address the corpse of a loved one in speech and speak of the suffering and grief of personal loss. Is the person speaking to the corpse itself? No. But, the living human animates the corpse with personal memories, sensations and emotions that instead replace the corpse with the living, dynamic person that once was, and give the spoken words their point. I don’t think this is an act of make-believe, since the memories are real.

‘Is the person speaking to the corpse itself?’ What does the child address when it talks to dolls? Is the child engaged in make-believe? My hunch is that toy-play is imitation: the child animates the toy with human behaviors and thoughts.

Living and shared human experiences. Is living based on shared human experiences? Why do human beings grieve the loss of a loved one? 

Here is one reason: A living human being cannot imitate a corpse.

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