Journal of Medical Humanities

, Volume 32, Issue 3, pp 213–230 | Cite as

Pain and its Metaphors: A Dialogical Approach

  • Stephen LoftusEmail author


Most health professionals are unaware of the extent to which aspects of language, such as metaphor, influence their practice. Sensitivity to metaphor can deepen our understanding of healthcare and, arguably, improve its quality. This is because metaphors, and the linguisticality of which they are a part, shape medical practice in important ways. Examples are the metaphors used in pain management. By exploring the dialogical tension between such metaphors, we can better understand the ways in which they influence medical practice.


Metaphor Language Dialogism 


  1. Bakhtin, M. The Dialogic Imagination: Four Essays, trans. by K. Brostrom. Austin: TX: University of Texas Press, 1982.Google Scholar
  2. ———Speech Genres and other late essays, trans. by V. W. McGee. Austin: University of Texas Press, 1986.Google Scholar
  3. Burnside, J. W. Medicine and War—A Metaphor. Journal of the American Medical Association 249 (15):2091.Google Scholar
  4. Carr, D.B., J.D. Loeser, and D.B. Morris, eds. Narrative, Pain and Suffering, Progress in Pain Research and Management. Seattle: IASP Press, 2005.Google Scholar
  5. Charon, R. Narrative Medicine: Honoring the stories of illness. Oxford: Oxford University Press, 2006.Google Scholar
  6. Clow, B. Who's afraid of Susan Sontag? Or, the myths and metaphors of cancer reconsidered. Social History of Medicine 14 (2):293–312.Google Scholar
  7. Davey, N. Unquiet understanding: Gadamer's philosophical hermeneutics. Albany: NY: State University of New York Press, 2006.Google Scholar
  8. Edelson, J.T. Metaphor, medicine, and medical education. The Pharos 47 (2):16–21.Google Scholar
  9. Engel, G.L. The need for a new medical model: a challenge for biomedicine. Science 196:129–136.Google Scholar
  10. Fish, D. Appreciating Practice in the Caring Professions: Re-focusing Professional Research and Development Butterworth-Heinemann, 1998.Google Scholar
  11. Fordyce, W.E. Behavioral methods for chronic pain and illness. St Louis, MO: Mosby, 1976.Google Scholar
  12. Foss, S.K. Rhetorical criticism: exploration and practice. 4th ed. Long Grove ILL: Waveland Press. 2009.Google Scholar
  13. Gadamer, H-G. Truth and Method, J. Weinsheimer and D. G. Marshall. 2nd revised ed. New York: Continuum, 1989. Original edition, 1960.Google Scholar
  14. Greenhalgh, T. and B. Hurwitz, eds. Narrative Based Medicine: Dialogue and discourse in clinical practice. London: BMJ Books, 1998.Google Scholar
  15. Higgs, J., M.A. Jones, S. Loftus, and N. Christensen, eds. Clinical Reasoning in the Health Professions. 3rd ed. Oxford: Butterworth-Heinemann, 2008.Google Scholar
  16. Hodgkin, P. Medicine is war: and other medical metaphors. British Medical Journal 291:1820–1821.Google Scholar
  17. Holquist, M. Dialogism. 2nd ed. London: Routledge, 2002.Google Scholar
  18. Jones, T. and A.Verghese. On becoming a humanities curriculum: the Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. Academic Medicine 78 (10):1010–1014.Google Scholar
  19. Kovecses, Z. Metaphor: A Practical Introduction. Oxford: Oxford University Press, 2002.Google Scholar
  20. Lakoff, G. and M. Johnson. Metaphors We Live By. Chicago: University of Chicago Press, 1980.Google Scholar
  21. Linnell, P. Rethinking Language, Mind, and World Dialogically: Interactional and contextual theories of human sense-making, Charlotte NC: Information Age Publishing, 2009.Google Scholar
  22. Loftus, S. Language in Clinical Reasoning: Towards a new understanding. Saarbruecken: VDM Verlag, 2009.Google Scholar
  23. Loftus, S., and T.Greenhalgh. Towards a Narrative Mode of Practice. In Education For Future Practice, ed. by J. Higgs, D. Fish, I. Goulter, S. Loftus, J.-A. Reid and F. Trede. Rotterdam: Sense (pp. 85–94) 2010.Google Scholar
  24. Melzack, R. and P. Wall. Pain mechanisms: a new theory. Science 150 (699):971–979.Google Scholar
  25. Moerman, D. Meaning, medicine and the placebo effect. Cambridge: Cambridge University Press, 2002.Google Scholar
  26. Morris, D.B. Illness and Culture in the Postmodern Age. Berkeley: University of California Press, 1998.Google Scholar
  27. Ortony, A., ed. Metaphor and Thought. 2nd ed. Cambridge: Cambridge University Press, 1993.Google Scholar
  28. Porter Abbott, H. The Cambridge introduction to narrative 2nd ed. Cambridge: Cambridge University Press, 2008.Google Scholar
  29. Reddy, M. J. The conduit metaphor: A case of frame conflict in our language about language. In Metaphor and Thought, ed. by A. Ortony. Cambridge: Cambridge University Press, 1993.Google Scholar
  30. Reisfield, G.M., and G.R. Wilson. Use of Metaphor in the Discourse on Cancer. Journal of Clinical Oncology 22 (19):4024–4027.Google Scholar
  31. Rorty, R. Philosophy and the mirror of nature. Princeton, NJ: Princeton University Press, 1979.Google Scholar
  32. ———Against Unity. Wilson Quarterly 22 (1):28–39.Google Scholar
  33. Segal, J. Z. Health and the Rhetoric of Medicine. Carbondale: Southern Illinois University Press, 2005.Google Scholar
  34. Sherwin, S. Feminist Ethics and the Metaphor of AIDS. Journal of Medicine and Philosophy 26 (4):343–364.Google Scholar
  35. Siddall, P. and M. Cousins. Persistent pain as a disease entity: implications for clinical management. Anesthesia & Analgesia 99 (2):510–20.Google Scholar
  36. Skott, C. Expressive metaphors in cancer narratives. Cancer Nursing. 25 (3):230–5.Google Scholar
  37. Sontag, S. Illness as metaphor. New York: Farrar, Straus and Giroux, 1978.Google Scholar
  38. ——— AIDS and its metaphors. New York: Farrar, Strauss and Giroux, 1989.Google Scholar
  39. Sullivan, M. Pain in language: from sentience to sapience. Pain Forum 4 (1):3–14.Google Scholar
  40. ——— Finding Pain Between Minds and Bodies. The Clinical Journal of Pain 17:146–156.Google Scholar
  41. Svenaeus, F. The Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a Philosophy of Medical Practice, Dordrecht: Kluwer Academic, 2000.Google Scholar
  42. van Manen, M. Researching lived experience: Human science for an action sensitive pedagogy. 2nd ed. London, Ontario: Althouse, 1997.Google Scholar
  43. Verghese, A. Culture Shock—patient as icon, icon as patient. New England Journal of Medicine 359 (26):2748–2750.Google Scholar
  44. Veterans Health Administration Memorandum. Pain as the 5th Vital Sign: Veterans Health Administration, 1999.Google Scholar
  45. Wittgenstein, L. Philosophical Investigations, trans by G.E.M. Anscombe. 3rd ed. Upper Saddle River, N.J.: Prentice Hall, 1958. Original edition, 1953.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Education for Practice InstituteCharles Sturt UniversitySILVERWATERAustralia

Personalised recommendations