doi:10.

1093/brain/awu395 BRAIN 2015: 138; 812820 | 812

DORSAL COLUMN
Occasional Paper
Pictures of pain: their contribution to the
neuroscience of empathy
G. D. Schott

The study of empathy, a translation of the term Einfuhlung, originated in 19th century Germany in the sphere of aesthetics, and

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was followed by studies in psychology and then neuroscience. During the past decade the links between empathy and art have
started to be investigated, but now from the neuroscientic perspective, and two different approaches have emerged. Recently, the
primacy of the mirror neuron system and its association with automaticity and imitative, simulated movement has been envisaged.
But earlier, a number of eminent art historians had pointed to the importance of cognitive responses to art; these responses might
plausibly be subserved by alternative neural networks. Focusing here mainly on pictures depicting pain and evoking empathy, both
approaches are considered by summarizing the evidence that either supports the involvement of the mirror neuron system, or
alternatively suggests other neural networks are likely to be implicated. The use of such pictures in experimental studies exploring
the underlying neural processes, however, raises a number of concerns, and suggests caution is exercised in drawing conclusions
concerning the networks that might be engaged. These various networks are discussed next, taking into account the affective and
sensory components of the pain experience, before concluding that both mirror neuron and alternative neural networks are
likely to be enlisted in the empathetic response to images of pain. A somewhat similar duality of spontaneous and cognitive
processes may perhaps also be paralleled in the creation of such images. While noting that some have repudiated the neuroscientic
approach to the subject, pictures are nevertheless shown here to represent an unusual but invaluable tool in the study of pain and
empathy.

Correspondence to: Dr G. D. Schott, MD, FRCP,

The National Hospital for Neurology and Neurosurgery, Queen Square,
London WC1N 3BG, UK
E-mail: g.schott@ucl.ac.uk

Keywords: history of neurology; pain; pictures; empathy; networks

fuhlen, feeling into, the Germans happily put it)as the

Introduction
In 1873, the German philosopher Robert Vischer introduced
the term Einfuhling in his book Uber das optische
Formgefuhl: Ein Beitrag zu Aesthetik (On the Optical Sense
of Form: A Contribution to Aesthetics), a brief treatise
concerned with the psychology of aesthetics and form percep-
tion. Soon after, the underlying principles behind Einfuhlung
were discussed in a rather rambling fashion by the English art
historian, aesthetician and novelist, Vernon Lee (pseudonym
for Violet Paget): the word sympathy, with-feeling(ein-
word sympathy is intended to suggest, this enlivening . . . is
exercised only when our feelings enter, and are absorbed
into, the form we perceive. A few years later, in 1909, and
when the subject was starting to be studied by Theodor Lipps
and other psychologists, the British psychologist Edward
Titchener rst translated into English the term Einfuhlung
as empathy. The concept and studies of empathy thus origi-
nated in the realms of aesthetics and then psychology, several
decades before neuroscientic studies began (for references
and historical review, see Wispe, 1987).

Received September 18, 2014. Revised November 15, 2014. Accepted November 22, 2014. Advance Access publication January 22, 2015
The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
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Pictures of pain
Only fairly recently have investigations begun on the
neural processes underlying empathy, and intriguingly the
historical wheel has turned full circle, as it is the links be-
tween empathy and aesthetics and art that have been of
renewed interest. But now, however, the subject has at-
tracted the attention of neuroscientists, notably following
Freedberg and Galleses paper in Trends in Cognitive
Sciences entitled Motion, Emotion and Empathy in
Esthetic Experience (Freedberg and Gallese, 2007). The
present paper aims to explore a number of issues concern-
ing the empathetic response to much of art; focuses par-
ticularly on pictures depicting pain; and takes into account
both the nature of the images themselves and the contribu-
tions of art historians to the neuroscientic discussion.
Art and empathy: two
different perspectives
As a preface, it should be noted that a single denition of
empathy has never been agreed, and Leiberg and Anders
(2006) cited nine different denitions, one of their own
being the ability to perceive, share, and understand
others emotions. In the more specic context of pain,
again a number of denitions have emerged, one such def-
inition simply comprising a sense of knowing the experi-
ence of another person with cognitive, affective and
behavioural components (Goubert et al., 2005).
When considering the links between art and empathy,
Freedberg and Gallese (2007) maintained that a crucial elem-
ent of esthetic response consists of the activation of embodied
mechanisms encompassing the simulation of actions, emo-
tions and corporeal sensation . . .. The embodied mechan-
isms comprise the mirror neuron systemin humans
sometimes termed the action-observation network (Shaw
and Czekoova, 2013). Mirror neurons, as rst described 20
years ago in macaques, comprise neurons in the ventral pre-
motor cortex that not only re during execution of goal-dir-
ected activity, but also vicariously during observation of the
same action (for review, see Cattaneo and Rizzolatti, 2009).
Subsequently mirror neurons were found in brain regions
other than the premotor cortex, including the auditory
cortex in songbirds, and evidence emerged for similarly vic-
arious activation in somatosensory and emotional systems
(for review, see Keysers and Gazzola, 2009).
The discovery of this system
illuminates the neural underpinnings of the frequent but hitherto
unexplained feeling of physical reaction, often in apparent imita-
tion of the actions represented within a work of art or suggested by
the implied movements involved in its making; mirror neurons also
offer the possibility of a clearer understanding of the relationship
between responses to the perception of movement within paint-
ings, sculpture and architecture . . . and the emotions such works
provoke (Freedberg and Gallese, 2007).
BRAIN 2015: 138; 812820 | 813
These authors also went further, claiming: . . . no esthetic
judgment is possible without a consideration of the role of
mirroring mechanisms in the forms of simulated embodi-
ment and empathetic engagement that follow upon visual
observation, and no form of esthetic appreciation . . . can
be fully envisaged without considering mirror systems and
their role in embodied and empathetic responses . . .
(Gallese and Freedberg, 2007).
Although these authors thus clearly envisaged a major role
for mirror neurons in the response to art, there had also been
another view that they briey acknowledged but argued
against (Gallese, 2011). This view, which comprised a
fully cognitive and disembodied approach to esthetics, had
been held by several eminent 20th century art historians, not-
ably Ernst Gombrich and others in the eld such as R.G.
Collingwood, for whom Art came to be thought of as a
matter of pure cognition (Freedberg and Gallese, 2007),
and Nelson Goodman who, while acknowledging that he
might invite hot denunciation for cold over-intellectualiza-
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tion, had claimed in aesthetic experience the emotions func-
tion cognitively (Goodman, 1969).
Thus there have been two different approaches to how art
might be processed in the brain: one that implicates simula-
tion, emotion and empathy, and the other that implicates
pure cognition. A cognitive approach to art can nevertheless
elicit an empathetic response, an experience perhaps revealed
most strikingly on viewing abstract or other non-gurative
art. These two approachesone implicating mirror neurons,
the other nottend to be studied differently, by means of
neuro-imaging and psychological techniques, respectively
(see de Vignemont and Singer, 2006). Freedberg and
Gallese (2007) favoured the former approach; they con-
sidered that empathetic responses to art have a precise and
denable material basis in the brain, with mirror and canon-
ical neurons playing a crucial role, and there is now extensive
evidence that mirror neurons are also implicated in numerous
areas beyond their original, and perhaps particular, involve-
ment in movement (Keysers and Gazzola, 2009).
Discussed below, however, many images appear to
engage the viewer empathetically without engaging
mirror neurons, from which it follows that other pro-
cesses must be enlisted. Whether visual and other inputs
into the mirror neuron system then elicit empathy directly,
or indirectly through intermediary processes, remains un-
known. As discussed below, however, many images
appear to engage the viewer empathetically without enga-
ging mirror neurons, from which it follows that other
processes must be enlisted. The nature of these other pro-
cessesand whether they indeed subserve the cognitive
approach of the art historiansremain unknown too,
but both indirect involvement of the mirror neuron
system, and alternative, non-mirror neuron pathways
that lead directly or indirectly to the eliciting of empathy,
remain possibilities. These issues are of more than theor-
etical concern, nowhere more evident than in studies of
pain which, in the light of pains entirely subjective
nature, unpleasant and pervasive features, and ability to
814 | BRAIN 2015: 138; 812820
evoke an empathetic response, attain particular import-
ance. Thus, because teasing out these different approaches
is both revealing and has practical implications, the dis-
cussion that follows mainly focuses on pictures relating to
the depiction of pain.
Pictures of pain: the
involvement of mirror
neurons?
Images of pain have been known to trigger emotional re-
sponses for millennia. For instance, classical sculptors were
extraordinarily adept at depicting pain amongst other emo-
tions, witness famous sculptures such as the Laocoon or
the Flaying of Marsyas. There is no doubt that in these
sculptures we are seeing pain and suffering on an epic
scale, and we can empathize with the protagonists.
Another example from two centuries ago was reproduced
by Freedberg and Gallese, who included in their paper a
picture from Goyas Los Desastres de la Guerra (The
Disasters of War) with the legend Embodied simulation
in esthetic experience: empathy for pain (Freedberg and
Gallese, 2007)although the justication for this legend
is assumed rather than established. And at the other end
of the historical timeline, there are endless contemporary
paintings, photographs and moving images depicting pain
and evoking empathy, even in the medical literature; who
could not be affected by the grainy image of the grimacing,
suffering soldier in World War II clutching his causalgic
limb (Mayeld and Devine, 1945) (Fig. 1)?
Are mirror neurons in the viewers brain enlisted?
Remarkably, that these neurons might indeed sometimes
be implicated in the empathetic responses to art in general
receives support dating back at least 500 years. Leonardo
da Vinci recorded that An artist painted a picture that
whoever saw it at once yawned, and went on doing so as
long as he kept his eyes on the picture, which represented a
person who was also yawning (Richter, 1970). This ac-
count chimes with the observation by the art historian
Bernhard Berenson in respect of the Renaissance nude,
whose taughtnesses of muscle and those stretchings and
relaxings and ripplings of skin which, translated into simi-
lar strains on our own persons, make us fully realise move-
ment (Berenson, 1896). At present, however, the possibility
that mirror neurons are indeed involved when such images
are viewed remains conjectural rather than established.
There seems little reason to doubt that images specically
depicting pain and evoking an empathetic response might
similarly engage the viewer by enlisting the mirror neuron
circuitry. Indeed, according to another distinguished art his-
torian, Aby Warburg, Renaissance artists such as Durer
conveyed expressions of pain and other emotions in their
pictures by drawing on those methods devised by the clas-
sical sculptors, a method which a century ago he termed
Pathosformel (translated now as emotive formula)
G. D. Schott
Figure 1 Photograph showing facial expression of an in-
tensely suffering World War II soldier with causalgia. From
Mayfield and Devine, 1945, reproduced with permission of the
American College of Surgeons.
(Warburg, 1999). Again this is particularly likely when
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those images suggest movement and evoke empathy, and
striking evidence once more dating from the Renaissance
supports this possibility: viewers of the Laocoon statue
. . . cant help but writhe and be moved to pity those sta-
tues as though they were alive (Doni, 1549).
At least partly underpinning movement in pictures is the
phenomenon of Movement without Motion, i.e. the per-
ception of movement in the absence of actual motion,
which long before its investigation by neuroscientists was
studied by art historians, notably Rudolf Arnheim,
Professor of the Psychology of Art at Harvard.
There is neither physical motion nor the illusion of it . . . We
have learned to associate motion with the visual images of a
running man or a waterfall. When we see an image commonly
connected with motion, we supply the element of displacement
where it is absent in the perceptual experience itself (Arnheim,
1967).
The particular engagement of the mirror neuron system
associated such movement may well result from processes
variously termed imitation (Losin et al., 2009) or mimicry
(Hoffman, 2010), which are automatic and preverbal
(Hoffman, 2010), and which lead to simulationthe
reenactment of perceptual motor, and introspective states
acquired during experience . . ., and which provides a gen-
eral mechanism for establishing empathy (Barsalou, 2008).
Pictures of pain: alternative
processes mediating the
empathetic response
There is evidence, however, that images depicting pain can
also engage neural processes that do not involve these neu-
rons, and, crucially, it is predominantly the artist and the
Pictures of pain
Figure 2 Pedro de Mayorga, Master of Palanquinos.
Flagellation of Saint Marina, from the Altarpiece of Saint Marina, c.
1500, oil on board. Reproduced with permission, Museo de Bellas
Artes de Asturias. Coleccion Pedro Masaveu.
art historian who have revealed the importance of what
appear to be alternative, cognitive processes.
Thus, as long ago as the late Middle Ages, religious pic-
tures designed to produce emotional effects sometimes
showed sufferers experiencing pain without the expected
expression. To cite just one example discussed by the cul-
tural historian Javier Moscoso, the Flagellation of Saint
Marina depicted in the Spanish altarpiece in Valladolid,
Spain, and dated around 1500, shows the martyr suffering
extreme violence but without any hint of distress (Fig. 2).
Typical of such images, . . . nothing in their peaceful faces
or their calm gestures allows us to infer any presence of
harm (Moscoso, 2012). It is evident that the terrible pain
and suffering shown in these pictures are unlikely to be
mediated by cerebral processes involving mirror neurons;
rather, it is learned, cognitive processes experienced
within the prevailing culture that mediate the impression
of suffering. Similar processes may well underlie the re-
sponse to those countless images of both sacred and secular
themes depicted over the centuries, which seem to suggest
or allude to rather than explicitly reveal excruciating pain.
BRAIN 2015: 138; 812820 | 815
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Figure 3 The patients back with shattered glass.
Photograph co-created by Deborah Padfield with Nell Keddie from
the series Perceptions of Pain Deborah Padfield. Reproduced by
kind permission of Deborah Padfield and Dewi Lewis Publishing.
Yet, different from these images, depictions of pain, or
relating to pain, need not be gurative at all. Instead they
can be abstract or symbolic, but, like abstract art in general
(Melcher and Bacci, 2013), can be created to evoke an
empathetic response. For example, the contemporary
artist Deborah Padeld, working closely with the patients
themselves, represented their pain through illustration. But
now The resulting images do not so much depict pain as
express it; they help, thereby, to objectify pain (Hurwitz,
2003), and several were reproduced in a photographic col-
lection entitled Perceptions of Pain (Padeld, 2003). Such
images, for instance one that shows fractured glass super-
imposed on the sufferers back (Fig. 3), or anotheren-
tirely disengaged from any suffererwhich features a
piece of burning barbed wire (Fig. 4), cannot generate a
visually mediated impression of pain through processes
involving mirroring, any more than can the Renaissance
altarpiece referred to above. Rather, such images suggest
pain by means of metaphor. Just as patients so often talk
or write about their pain by invoking analogy or metaphor
(Schott, 2004), so too visual analogy implicates intellectual
or cognitive processes, rather than evoking the simulated
actions, postures, emotions or sensations that engage
mirror neurons. And surely the most extreme forms of pic-
tures with pain, which is suggested rather than revealed,
must be cartographic: the markings, symbols and colours
that patients sometimes add to body maps (Schott, 2010).
Here visual pain metaphor is at its most abstract, but these
pictorial adornments nevertheless remain a graphic method
for communicating painful experiences and evoking em-
pathy. In all these examples, mirror neuron involvement
816 | BRAIN 2015: 138; 812820
Figure 4 Burning barbed wire. Photograph by Deborah
Padfield with Linda Sinfield from the series Perceptions of Pain
Deborah Padfield. Reproduced by kind permission of Deborah
Padfield and Dewi Lewis Publishing.
can surely be excluded; whether empathy evoked
through such non-mirror neuron systems might be less in-
tense than that evoked through the mirror neuron system is
unknown.
A particularly revealing anecdote illustrating the seeming
lack of involvement of mirror neurons is that recently re-
ported by Elaine Scarry, Professor of Aesthetics and the
General Theory of Value at Harvard (Scarry, 2007). She
described a crowd of 7-year-old school children who, visit-
ing a museum, were asked to . . . sit in front of the paint-
ing that has the most physical pain in it. . A number of
the children sat beneath Rubenss Prometheus Bound, and
Scarry observed that the children seemed to empathize with
Prometheus, whose chest is being torn open by an eagles
beak (Fig. 5). In some way the children had associated the
drama with pain, in keeping with the known ability of
children to appreciate the facial signs of pain in others by
the age of 5 or 6 (Deyo et al., 2004). Thus arguing against
the view that empathy may be based on mirror-
matching simulation of others state (Avenanti et al.,
2005), very different cognitive processes must be involved;
what mirroring could occur in respect of a Greek demi-
G. D. Schott
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Figure 5 Peter Paul Rubens. Prometheus Bound, c. 16111618,
oil on canvas. Reproduced by permission of the Philadelphia
Museum of Art.
gods chest being torn open by an eagles beak? Recalling
the examples cited in the preceding paragraph, imagination
and appreciation of metaphor, but not memory, must be
implicated, and Scarrys account conrms these cognitive
processes are already well-developed in even young
children.
Pictures of pain as
experimental stimuli
The majority of studies on the processes involved in em-
pathy and the perception of art in general, but here pictures
of pain in particular, have used functional MRI, and less
often transcranial magnetic stimulation and other neuro-
physiological techniques. Apart from the mention below
relating to temporal factors and mirror neuron responsive-
ness, these studies not only shed little light on whether
mirror neuron or other systems are involved in eliciting
empathy, but also raise a number of other issues.
First, pictures used as experimental visual stimuli have
not been made by a creative artist. They are thus inherently
different from pictures with the emotional impact aimed for
by an artist and can appear out of any context and dis-
embodied, and their selection sometimes seems arbitrary.
Furthermore, just as viewing artworks compared with
images from everyday life may engage different neural
networks (Cupchik et al., 2009), so the emotional impact
Pictures of pain BRAIN 2015: 138; 812820 | 817

and empathy achieved by an artist might engage different

neural networks compared with the images used in the ex-
periments. Both the length of time during which a picture is
viewed and contemplated, and the order in which its com-
ponent features are scanned, may also be factors which
inuence the neural networks engaged and the empathetic
response. Thus, in the example of Flagellation of Saint
Marina, observing rst the peaceful Saints expression, or
alternatively the surrounding torturers and their weapons,
might result in inconsistent if not conicting responses.
Another issue concerns the different temporal presenta-
tions of the visual stimuli. While some studies have
involved the viewing of in vivo pain-inducing procedures
rather than images (Singer at al., 2004), many studies have
used brief video clips (Avenanti et al., 2005; Botvinick
et al., 2005; Benuzzi et al., 2008), which are sometimes
edited (Lamm et al., 2007), or still photographs Figure 6 Saint Marinas face. Detail from Fig. 2.
(Jackson et al., 2005; Saarela et al., 2007). The different
temporal presentations may be important in relation to the

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different responsiveness of mirror neurons: observing real
actions evokes the strongest responses in the mirror neuron
system compared with video images, but even observation
of static images of actions evokes responses in that system
(Gallese, 2011)and responses could be even greater when
viewing artists creations, as these tend to be viewed for far
longer than those presented in experiments (Smith and
Smith, 2001).
A further issue is the different nature or character of the
experimental visual image itself. Some have been of images
of painful events such as a soccer player breaking a leg or a
rider falling from a bicycle (Osborn and Derbyshire, 2010),
whereas others have used images of painful insults inicted
on a hand, a foot, or a neutral object (Avenanti et al.,
2005; Jackson et al., 2005; Benuzzi et al., 2008), and yet
others have depicted faces (Botvinick et al., 2005)and
expression is obviously a highly salient feature of a
person in pain. Some of these studies have used profes-
sional actors or pantomime players (Lamm et al., 2007),
and while there are differences between pictures of faces
that show deceptive compared with genuine pain (Hill interrelated and there is considerable feedback, it is impos-
and Craig, 2002), this difference does not exist in pictures
created by artists whose skill lies in revealing the very ex-
perience of pain. And as an aside, while the artist some-
times shows the pain sufferer to be serene and perhaps even
smiling, as in the example of the Saints face in the Spanish
altarpiece discussed above (Fig. 6), there are no functional
MRI studies of pain and empathy that have used smiling
faces although, counter-intuitively, smiles often accompany
pain (Kunz et al., 2009).
Perhaps the most critical issue is whether the visual image
necessarily provides an image of pain at all. Rather, images
sometimes appear ambiguous. For instance, Fig. 7 displays
the images used to elicit pain for the study of pain sensa-
tion evoked by observing injury in others (Osborn and
Derbyshire, 2010), a study that is discussed further
below. On viewing these images without the clarication
that appeared in the accompanying text, the upper left
picture could simply be seen as a nger being icked, and
the gure on the upper right a diver. It appears it is the
context in which the picture appears or is presented, rather
than solely the picture itself, which is sometimes crucial.
The diverse issues raised by these various studies suggest
caution when drawing rm conclusions concerning the
neural networks involved, and these are discussed next.
Some comments on neural
networks subserving
empathy on viewing
pictures of pain
At least 15 brain regions seem to be enlisted in the percep-
tive, cognitive and affective engagement when experiencing
art, and as these engage parallel neural networks that are
sible to describe any meaningful sequence of events
(Nadal, 2013). Nevertheless, there is now hard evidence
that mirror neurons are present in humans in at least ve
regions: the ventral and dorsal premotor cortex, supple-
mentary motor cortex, and inferior parietal and temporal
lobes, and vicarious activity can be detected in not only
motor but also somatosensory and emotional cortical re-
gions (Keysers and Gazzola, 2009). The discussion above
suggests that, at least sometimes, this mirror neuron net-
work mediates the response to pictures of pain and the
empathy evoked. But what of other candidate networks
that might subserve the alternative, cognitive approach
envisaged by the art historians?
In the case of responses to specically pain-related pic-
torial stimuli, functional MRI and transcranial magnetic
stimulation studies (Avenanti et al., 2005) again demon-
strate activation of many different areas of the brain, and
818 | BRAIN 2015: 138; 812820
Figure 7 Images used to elicit pain for the behavioural and functional MRI studies of Osborn and Derbyshire, 2010. Reproduced
with permission of the International Association for the Study of Pain.
at least some of the differences may relate to whether the
response to these pictures engages with the affective or the
sensory components of the pain experience. Thus the af-
fective component has been shown to be mediated by struc-
tures which include the anterior insula, anterior cingulate
cortex, brainstem and cerebellum when viewing actual
painful stimulation (Singer et al., 2004), or pictures
(Jackson et al., 2005) or video clips depicting pain
(Morrison et al., 2004; Botvinick et al., 2005); the sensory
component is mediated by the sensorimotor structures of
the pain matrix (Avenanti et al., 2005), particularly the left
parietal lobe including the parietal operculum, the postcen-
tral gyrus and adjacent parts of the posterior parietal
cortex (Benuzzi et al., 2008); and when both affective
and sensory components of pain are engagedas in the
unusual study of individuals themselves experiencing pain
when observing images of another person in painthe an-
terior midcingulate cortex, anterior insula, prefrontal
cortex and S1 and S2 regions are implicated (Osborn and
Derbyshire, 2010).
Hardly surprisingly, and using somewhat different
terminology, Leiberg and Anders (2006) concede:
Disagreement subsists regarding the implementation of em-
pathy and whether it occurs in a contagion-like fashion or
depends on higher level cognitive processes. The former
the tendency to automatically mimic and synchronize facial
expressions, vocalizations, postures, and movements with
those of another person and, consequently, to converge
emotionally (Hateld et al., 1994)would indeed be con-
sistent with involvement of the mirror neuron system. On
the other hand, the higher level cognitive processes that
include perspective-takingintegrating information from
different sources when inferring the others mental state
G. D. Schott
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and inhibiting ones own perspective if necessary (Leiberg
and Anders, 2006)seem to be important particularly in
complex or ambiguous situations, and probably engage the
temporoparietal regions, but particularly the prefrontal
cortex (Hynes et al., 2006; Leiberg and Anders, 2006).
Which networks are engaged may depend on the extent
of affective versus sensory processing of pain, and it has
been suggested that The key variable is likely to be the
mental attitude of the participants when thinking about
the pain of others (Singer and Frith, 2005).
The parallel spectrum of
creativity
Accepting there are numerous different neural networks
that respond to viewing works of art and which elicit
empathy, so too there seem to be different processes under-
pinning the creation of art, although it is acknowledged
that creativity can hardly be reduced to the functional
properties of specic populations of neurons, mirror neu-
rons included (Gallese, 2011). The inuential art historian
Max Friedlander claimed that
A work of art comes into being in two ways either spontan-
eously, organic, or by deliberate effort . . . Strictly speaking, all
art falls somewhere between these two extremes . . . The two
ends of the scale are marked by the nave genius and the
cold-blooded contriver (Friedlander, 1974).
This suggests a certain parallelism: just as both mirror
processes and those subserving cognition may be implicated
when viewing pictures depicting pain, so too there may be
Pictures of pain
both spontaneous and more deliberate, cognitive processes
involved in the creation of those pictures.
Conclusion
It is almost 150 years since Robert Vischer, when discuss-
ing aesthetics, introduced the term Einfuhlung that was
soon to become synonymous with the English term em-
pathy. The philosopher could not have envisaged todays
neuroscientic studies of empathy and the roles of mirror
neuron and alternative networks, nor that these studies
would also return to investigations of art, including depic-
tions of pain. He would surely be intrigued, however, that
art historians too have now become interested in the neural
processes underpinning the empathetic response to art, as
discussed in the case of the works of the 16th century
Flemish master Jan Gossart (Kavaler, 2013).
The evidence provided here suggests that Freedberg and
Galleses view, which envisaged the primacy of the mirror
neuron network, is too narrow, and other networks, in
particular those subserving cognition, are also likely to be
implicated. In summary, both mirror neuron and alterna-
tive networks are likely to be enlisted in the empathetic
response to images of pain.
But at the same time it is only fair to record that this
entire approach to the subject has been found unconvin-
cing, if not condemnable, by some scientists (Casati and
Pignocchi, 2007; Tallis, 2008, 2012) and philosophers
(Sheets-Johnstone, 2012). Thus for Tallis Works of art
are not merely sources of stimuli that act on some bits of
the brain. More than anything else, they engage us as
human beings (Tallis, 2008). Such a dissenting opinion
unfortunately does not explain how pictures might
engage us as human beings, an issue addressed by neuro-
scientists whoas reasoned abovehave found that pic-
tures may indeed reveal important insights into cerebral
processes mediating empathy. And in respect of pain,
Accepting the denition of pain as a subjective experience
requires that we take a unique approach to the study [of]
the neurobiological basis of pain phenomena (Rainville,
2002). The invaluable but often neglected contributions
of pictures and of artists and art historians to the neuros-
cientic study of pain represent one such an approach.
Acknowledgements
I am most grateful to Professor Javier Moscoso for help in
obtaining Figure 2.
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