Botox and Emotion: It’s Complicated

February 27, 2014

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Botox and Emotion


When anyone has suggested Botox for the deep lines between my brows (yes, they’re that bad–I worry a lot), my stock reply has been, “Are you kidding? I have teenagers at home—I need to be able to look disapproving!” Besides, I’m (theoretically) opposed to age-erasing cosmetic procedures. But I perked up when I recently came across findings that Botox can be effective in treating—go figure—depression. Huh–if I were less grumpy, I might not need to scowl at the kids so much. Maybe I could justify a round of shots, uh, strictly for medicinal purposes. It turns out, however, that exactly such visual communication of emotion is at the heart of a burgeoning debate about the effects of Botox, for better and worse, on feeling in all its forms. The last few years have seen a flurry of research into the process by which we feel emotion and show it in our faces—and not necessarily in that order.

The mechanism by which Botox may lift mood stems from a counterintuitive aspect of emotion-generation. Good things happen, you feel happy, so you smile; bad things, you feel sad, you frown. Sure, but it works in the other direction, too—your body helps your brain figure out what to feel.

“Forty years of studies have conclusively shown that manipulation of facial muscles can, to some extent, create emotions,” notes  Eric Finzi, dermatologic surgeon at the Chevy Chase Cosmetic Center and author of “The Face of Emotion: How Botox Affects Our Moods and Relationships.” Subjects in an experiment who are told to smile even if they don’t feel like it, for instance, judge a cartoon as funnier than do those told not to smile. If you are directed to frown, your brain interprets events more darkly than it would otherwise. Sounds primitive. Exactly—it’s been bred into us through eons of evolution.

There are two routes for sensory input to reach your brain, explains Dr. Finzi. One is via the thalamus up to the cortex where the conscious, intellectual part of your brain can analyze it—sophisticated, but relatively slow. Meanwhile, the info has also raced much (i.e., milliseconds) faster along a “low road” straight to the amygdala, an older, more primitive part of the brain responsible for emotions, which has  already sent directives back to the body—crude, maybe inaccurate, but a potentially crucial edge if you’re jumping away from what may be a snake, for example. Since your body is already exhibiting emotion  (e.g., sweating, pulse racing, blood diverted to muscles) while the cortex is still reading the memo, the “high road” uses that data, too, to piece the picture together. Heart pounding, muscles clenched? Apparently, I’m scared. Or: No furrows between the brows—guess I must feel okay. Causes of depression are varied and no treatments work for everyone, but in Dr. Finzi‘s series of studies since 2003, more than half of subjects had their depression significantly lightened by disabling frown muscles.

So people with forcibly unfurrowed brows may be less capable of feeling down—that’s the point, isn’t it? What’s the problem? The controversy arises in their dealings with other people. The Botoxed are less able to “read” emotions in others’ faces, according to a study from the University of Southern California and Duke University (supported by similar findings from several other small studies). The key again is “thinking” with our bodies, which issue orders to our brains. Part of the mechanism by which we understand what someone else is feeling is by (often unconsciously) mimicking or “mirroring” their facial expressions. As above, that triggers our brains to feel what our faces are showing, which in turn becomes empathy toward the person whose face we are reflecting, according to USC psychology professor David Neal. If we can’t make the expressions, we are less capable of feeling those same emotions, and empathy takes a hit. News stories about the phenomenon appeared with headlines like, ”Botox may deaden ability to empathize,” reporting that “people with frozen faces have little idea what we’re feeling”; some accounts railed against the “heavy costs” of “deadened emotions,” of “not caring what your loved ones feel,” against the danger that babies’ emotional growth will be stunted by stony-faced moms. Well….

“If you do a careful experiment, you can show that people who’ve had Botox to inhibit their frown may take fractions of a second longer to read a sentence about anger, for example,” counters Dr. Finzi. “We’re talking about slight differences, a few percentage points, nothing you would see with the naked eye.” As Dr. Neal himself commented in response to one article, the Botox recipients showed “about a 6 percent drop in their  ’emotional mind-reading ability’…significant, but no one is at risk of becoming a sociopath from receiving Botox.”

Furthermore, Dr. Finzi asserts, it applies only to negative emotions: “No one treats their smile or anything that would interfere with empathy for fun, laughter, positive feelings.” And the dark side itself is not utterly at the mercy of a smooth brow. “There’s body language, tone of voice and, even in the face, many other ways of showing negative emotions,” he continues. “The muscles around your mouth will tense, you may grimace, or bare your teeth; a muscle on the lower lid of your eye tenses, your eyes narrow.” So Botox would not impair the fearsome parental authority projected by my deep brow creases? “I daresay that if you’ve had Botox for your frown lines and you’re angry at your children, they will be able to see it.”

And since the overarching point is the inability to separate “mind” from “body,”  who’s to say where the back-and-forth stops? If I feel less negative empathy and look less troubled, will that influence the sad person talking to me to mirror my more serene face, causing him or her to feel a little cheerier? Do other antidepressants cause a decrease in empathy for negative emotions? Do naturally sunny people tend to exhibit a bit less empathy for malcontents? Will my kids turn out better if I spend less time looking worried and angry? I think I know the answer to that last one.

— Catherine Clifford



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