Ostracism—the Painful Exclusion

Interview With Kipling D. Williams, PhD
Mark Swanson, ND

Have you ever been excluded, ignored, shunned, or purposefully left out? Then you’ve been ostracized, and the hurt is painful and lasting. Ostracism, even when brief and from strangers, is a painful event much like physical bruises, yet it goes largely undetected and often lasts much longer than physical injury.

My very special guest for this issue of The Expert Report and the theme of pain medicine is Kipling D. Williams, PhD, renowned professor of psychology at Purdue University, West Lafayette, Indiana. Dr Williams is undisputedly the world’s leading authority on ostracism. He has devoted much of his career to help further the understanding of ostracism and its connections between social pain and physical pain. According to Dr Williams, a chief difference is that social pain can be relived over and over again, causing pain at each remembered instance. Physical pain can be recalled as being painful but is not painful to relive. Even brief encounters of ostracism with strangers can elicit such excruciating pain that it robs us of esteem and self-control. The pain of ostracism is about the same no matter how tough or resilient we think we are. However, some will tend to cope better than others. Detecting ostracism early allows for a greater chance of preserving self-control, lessening pain intensities and durations, and boosting recovery success. The recovery process from severe ostracism of longer duration can be more of a challenge to bring someone back from isolation and loneliness, depression, and anger. Therefore, successful lasting recovery addresses each stage of ostracism to help restore the fundamental needs of belonging, self-esteem, control, and meaningful existence.1,2

Without further ado, I welcome Dr Williams to The Expert Report as my distinguished guest to discuss this silent and painful epidemic that contributes to a cohort of conditions.

About Dr Williams

What is your educational background and current position?

Dr Williams: I earned my BS in psychology from the University of Washington [Seattle], then my MA and PhD in social psychology from Ohio State University [Columbus]. I am now professor of psychological sciences at Purdue University in Indiana.

What led to your interest in ostracism and your academic and research focus on ostracism and pain?

Dr Williams: While at graduate school, I watched a television documentary about a young West Point [West Point, New York] academy cadet, James Pelosi, who had not put his pencil down when instructed during an exam. He was asked to leave the academy, but he decided not to, so his superiors invoked the unwritten policy of “silencing” on him. When he returned to his living quarters, his roommate had moved out. When he talked to another cadet, they would not look at him or respond. No one initiated conversations with him. When he sat at the lunch table, all other cadets at that table would stand and leave, going to another table. So, he was ostracized by his peers, invisible to all those at the academy. I was struck by how powerful this “nonbehavior” was and how in our field of social psychology we had not really studied it. As I read and accumulated more knowledge about ostracism, I realized how pervasive it was: animals do it, all cultures do it, humans from childhood to the elderly do it. It was later that the idea of “social pain” came about, when theories of pain overlap systems between physical and social pain were developed—that the same neural architecture in the brain that is devoted to detecting and experiencing physical pain is coopted for experiencing social pain. We then observed that the same region of the brain that is activated when people experience physical pain (the dorsal anterior cingulate cortex, or dACC) was activated when participants endured a very short bout of being ostracized on an online game we call Cyberball. This research was conducted using an fMRI [functional magnetic resonance imaging] scanner.

Three Stages of Ostracism

Your groundbreaking work on ostracism describes it as having 3 primary stages: (1) initial acts of being ignored or excluded, (2) coping, and (3) resignation. Please briefly explain each.

Dr Williams: Stage 1 involves this experience of social pain when experiencing even the most minimal forms of ostracism—ostracism that rationally shouldn’t matter. This includes not getting eye contact from strangers looking your way (but “through you” or “beyond you”) or not being included in a ball toss game (real or virtual) by strangers, a computer, even people you dislike. I view this pain as a functional “alarm” that signals the person to attend to what’s going on because, evolutionarily, ostracism has survival implications. At the same time as the pain, the individual experienced a threat to 4 fundamental needs: the need to belong, the need to maintain a reasonably high self-esteem, a need to feel control over one’s situation (including other people in the situation), and a need to be recognized as worthy of attention—what I call meaningful existence.

Stage 2 involves appraising the meaning and importance of the ostracism episode and coping. Coping involves trying to fortify or strengthen the need or needs most threatened. To fortify belonging and self-esteem, individuals try to fit in, to be liked and accepted by others. To fortify control and meaningful existence, they may not care so much about being liked and, instead, want to exert control over others or force others to pay attention to them. This could include antisocial and aggressive acts.

Stage 3 is if a person must endure prolonged episodes of ostracism over weeks, months, or years. When this happens, the resources necessary to fortify thwarted needs are depleted, resulting in essentially giving up and feeling depressed and worthless. Thankfully, not too many people get to stage 3.

What is the most painful stage of ostracism? How long does it last?

Dr Willams: I would say stage 3, and it could last as long as the person lives. Stage 1 is very brief—seconds. Stage 2 can occur within seconds or minutes or a bit longer. But stage 3 can last forever if there is no successful intervention.

Social Pain vs Physical Pain

What are the similarities and differences between the social injury pain of ostracism and physical pain—such as a migraine headache, arthritis joint pain, or a sports injury?

Dr Williams: From the current research coming out, they are highly similar. They affect the same regions of the brain, and they can be just as hurtful, perhaps more so for social pain. When we carefully remember, in detail, instances of physical pain, we don’t feel the pain all over again. But if we do the same for instances of social pain (ie, embarrassment, humiliation, loss or rejection, betrayal, ostracism), then we feel that same acute pain as we are remembering the details of the socially painful experience. Thus, social pain is the pain that keeps on giving—not so for physical pain, unless, of course, it is chronic.

Does ostracism pain lend support for the pain overlap theory3 describing the mechanistic interplay between social pain and physical pain?

Dr Williams: Yes, it does. Ours was some of the first strong evidence for the pain overlap theory.3

How would you characterize the differences in the pain intensity level of ostracism between a brief encounter vs chronic encounters?

Dr Williams: I think the initial pain is similar, but the enduring or prolonged pain is quite different. We can usually get over an acute instance of ostracism if it only happens briefly or infrequently. But for continued ostracism in one’s family, church, workplace, or community, then the pain probably gets worse and worse over time, until perhaps some sort of emotional numbness takes over.

Cyberball

At Purdue, you developed the computer game called Cyberball.1 Describe how this works and how it has contributed to the understanding of ostracism and pain.

Dr Williams: Actually, I developed this with 2 honors students when I was in Australia at The University of New South Wales [Kensington]. Christopher Cheung, Wilma Choi, and I developed an online computer “game” that ostensibly is for the purpose of engaging the participant in mental visualization (this is part of a cover story that involves our interest in the effects of mental visualization on subsequent task performance). Basically, this game evolved from something that actually happened to me. I was, as they say, minding my own business sitting on a blanket at a park, with my dog (in 1985). A Frisbee rolls up to me, and I turned around to see where it had come from. I saw 2 guys waiting, so I threw it back to them. To my surprise, they then threw it back to me, so I joined them. After a few minutes of playing, they suddenly, and without explanation, stopped throwing it to me. It took several tosses before I got the idea that I was no longer going to get the Frisbee, so I sheepishly returned to my dog. It was then that I thought, “Hey, this is how I can study ostracism in the laboratory.” I’d been interested in the phenomenon of ostracism for several years (since 1978, after I’d seen that television documentary I mentioned earlier). I liked the simplicity of the Frisbee toss (which shifted to a ball toss in the lab and then to Cyberball in the late 1990s). No words needed to be said, no elaborate framing or context. And, although I didn’t think about it at the time, it is something that small children through the elderly can play and understand without much instruction. Cyberball presents a computer image that looks like you are throwing a virtual ball with 2 or 3 others. They can be programmed to include the participant or to ostracize the participant. The added bonus of Cyberball is that it can be played in an fMRI chamber, allowing affective and cognitive neuroscientists to observe what is happening in the brain as participants are being ostracized.

Psychological Damage

You have described social exclusion and giving someone the silent treatment as “invisible bullying.” Tell us more about this.

Dr Williams: Well, now I really don’t think it’s bullying, in the sense that it isn’t paying excessive aversive attention to someone (verbally or physically). In some ways, it’s the opposite: it’s getting no attention from others. One might think they are so unimportant that they aren’t even worth being bullied, as some of our interviewees have said. But, like bullying, it is painful and psychologically damaging.

How does ostracism affect mood, depression, and behavior?

Dr Williams: A brief episode increases sadness and anger. Long-term exposure, as revealed in our interviews with those who have experienced being ostracized for months and years, appears to be associated with depression. Those suffering from long-term ostracism give up and don’t even try to meet new people. They have essentially accepted the message that they are unworthy of anyone’s interest or attention.

Can the persistence of ostracism pain lead to medical, social, and behavioral disabilities, similar to posttraumatic stress disorder?

Dr Willams: That’s a good question, and I’d have to say that we really don’t know the answer to it, yet. Memories can be relived and reexperienced as painful, but whether these memories intrude often and without warning, we don’t know.

Ostracism and Children

Does ostracism contribute to childhood obesity? What are its effects on weight gain, food intake, and physical activity?

Dr Williams: Some of our interviewees indicated that obesity, or alternatively anorexia or bulimia, resulted from their long-term ostracism. In the lab, we have found that right after being ostracized people are less able to “self-regulate,” meaning they gorge themselves on more junk food.

Is there a tool for healthcare professionals to help identify ostracism in a vulnerable pediatric population?

Dr Williams: Yes, we have validated and tested a new questionnaire, the BOSS (Bullying and Ostracism Screening Scales4), that has found that ostracism, more than bullying, predicts problems in adolescents. It will soon be published.

Treatment and Recovery

Is there a “socialprofen” on the horizon? What is the best treatment to recover from the pain of ostracism?

Dr Williams: I don’t think that the best way to deal with the pain of ostracism is to eliminate the initial brief pain detected in stage 1. Although investigations indicate that massive amounts of Tylenol (or even moderate amounts of marijuana, apparently) can dull the initial pain of laboratory-induced ostracism (or daily ostracism as reported in diaries), I believe the initial pain is useful; it serves a function. Rather than focus on reducing the initial pain, I would look for methods to speed the recovery in stage 2, especially through the use of social support and other reminders of belonging. It would be good for people not to resort to the provocative and antisocial acts as a method of recovery, and knowing there are others out there who like you or support you is enough, based on my reading of the literature, to prevent that avenue of coping behavior. More work on “solutions” is definitely needed, though.

Guest Appreciation

On behalf of myself and my ND colleagues, we thank you for “painlessly” participating as our special guest on The Expert Report. If we left something out, feel free to add a final comment.

Dr Williams: I think your questions were excellent (better than most interviews I’ve had!). Thanks; I look forward to reading it in the NDNR.

Dr Swanson’s Closing Comments

The science and understanding of ostracism would not likely exist without the academic brilliance of Kipling D. Williams, PhD, and his steadfast devotion to preserving mindful wellness via many years of teaching, research, and publishing. His curriculum vitae5 lists countless published articles, many distinguished awards, and numerous professional affiliations. I was fortunate to share the same high school graduating class with Dr Williams. Without our reacquainting at our 40th year reunion in 2011 and swapping some life stories, this interview would not have been done. Screening ostracism should become more routine in naturopathic practice.


Mark_Swanson_Headshot_2.jpgMark Swanson, ND, writes “The Expert Report” column, which is featured in NDNR.  Dr. Swanson has over 25 years experience as chief medical advisor, research and technical consultant, and products formulations expert to leading practitioner brand supplement manufacturers.  He is a former associate editor for the American Journal of Naturopathic Medicine, national product director, and published researcher. He is a pioneer graduate of Bastyr University, 1984.  Dr. Swanson has his private practice specializing in Preventics Care and Functional Medicine, in Sequim, Washington. Contact: drmarkswanson@gmail.com

References

Williams K. Social Psychology Network. http://www.williams.socialpsychology.org. Accessed May 12, 2012.

Williams KD. The pain of exclusion. Sci Am. January 19, 2011. http://www.scientificamerican.com/article.cfm?id=the-pain-of-exclusion. Accessed May 12, 2012.

Eisenberger NI, Lieberman MD. Why it hurts to be left out: the neurocognitive overlap between physical and social pain. outwww1.psych.purdue.edu/~kip/Announce/Docs/Outcast-Eisenberger.doc. Accessed May 12, 2012.

Saylor CF, Nida SA, Williams KD, et al. Bullying and Ostracism Screening Scales (BOSS): development and applications. Child Health Care. In press.

Vitae: Kipling D. Williams. http://www1.psych.purdue.edu/~willia55/WilliamsCV.pdf. Accessed May 11, 2012.

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