Pain and its Metaphors: A Dialogical Approach

Abstract

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.

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Fig. 1

Notes

  1. 1.

    H-G. Gadamer, Truth and Method, trans. by J. Weinsheimer and D.G. Marshall, 2nd revised ed. (New York: Continuum, 1989). Original edition, 1960.

  2. 2.

    Ibid, p. 443.

  3. 3.

    S. Loftus, Language in Clinical Reasoning: Towards a new understanding. (Saarbruecken: VDM Verlag, 2009).

  4. 4.

    J.Z.Segal, Health and the Rhetoric of Medicine. (Carbondale: Southern Illinois University Press, 2005).

  5. 5.

    R. Charon, Narrative Medicine: Honoring the stories of illness. (Oxford: Oxford University Press, 2006).

  6. 6.

    T. Greenhalgh and B. Hurwitz, eds., Narrative Based Medicine: Dialogue and discourse in clinical practice. (London: BMJ Books, 1998).

  7. 7.

    P. Linnell, Rethinking Language, Mind, and World Dialogically: Interactional and contextual theories of human sense-making, (Charlotte NC: Information Age Publishing, 2009).

  8. 8.

    Ibid, p. xxviii.

  9. 9.

    M. Bakhtin, The Dialogic Imagination: Four Essays, trans. by K. Brostrom (Austin: TX: University of Texas Press, 1982) and M. Bakhtin, Speech Genres and other late essays, trans. by V. W. McGee. (Austin: University of Texas Press, 1986).

  10. 10.

    M. Holquist, Dialogism. 2nd ed. (London: Routledge, 2002).

  11. 11.

    See Linnell.

  12. 12.

    See Bakhtin, Speech Genres and other late essays.

  13. 13.

    Ibid p. 9.

  14. 14.

    See Gadamer.

  15. 15.

    M.J. Reddy, Michael 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).

  16. 16.

    The convention in the literature on metaphor is to write metaphors in upper case.

  17. 17.

    R. Rorty, Philosophy and the mirror of nature (Princeton, NJ: Princeton University Press, 1979).

  18. 18.

    Z. Kovecses, Metaphor: A Practical Introduction (Oxford: Oxford University Press, 2002).

  19. 19.

    G. Lakoff and M. Johnson. Metaphors We Live By (Chicago: University of Chicago Press, 1980).

  20. 20.

    A. Ortony, ed., Metaphor and Thought, 2nd ed. (Cambridge: Cambridge University Press, 1993).

  21. 21.

    S.K. Foss, Rhetorical criticism: exploration and practice, 4th ed. (Long Grove ILL: Waveland Press, 2009) p. 268.

  22. 22.

    See Lakoff and Johnson.

  23. 23.

    J.T. Edelson, Metaphor, medicine, and medical education. The Pharos 47 (2):16–21.

  24. 24.

    Ibid p. 21.

  25. 25.

    J.W. Burnside, Medicine and War—A Metaphor, Journal of the American Medical Association 249 (15):2091.

  26. 26.

    P. Hodgkin, Medicine is war: and other medical metaphors, British Medical Journal 291:1820–1821.

  27. 27.

    G,M. Reisfield, and G.R. Wilson, Use of Metaphor in the Discourse on Cancer, Journal of Clinical Oncology 22 (19):4024–4027.

  28. 28.

    See Hodgkin.

  29. 29.

    See Reisfield and Wilson.

  30. 30.

    S. Sontag, Illness as metaphor (New York: Farrar, Straus and Giroux, 1978).

  31. 31.

    S. Sonntag, AIDS and its metaphors (New York: Farrar, Strauss and Giroux, 1989).

  32. 32.

    Lakoff and Johnson.

  33. 33.

    B. Clow, Who's afraid of Susan Sontag? Or, the myths and metaphors of cancer reconsidered. Social History of Medicine 14 (2):293–312.

  34. 34.

    Ibid p. 293.

  35. 35.

    S. Sherwin, Feminist Ethics and the Metaphor of AIDS, Journal of Medicine and Philosophy 26 (4):343–364.

  36. 36.

    Loftus, p. 102.

  37. 37.

    F. Svenaeus, The Hermeneutics of Medicine and the Phenomenology of Health: Steps Towards a Philosophy of Medical Practice, (Dordrecht: Kluwer Academic, 2000) pp. 173–174.

  38. 38.

    A, Verghese, Culture Shock—patient as icon, icon as patient, New England Journal of Medicine 359 (26):2748–2750.

  39. 39.

    See Svenaeus.

  40. 40.

    See Loftus.

  41. 41.

    Reisfield and Wilson, 4024–4027.

  42. 42.

    Loftus, p. 113.

  43. 43.

    Ibid p. 113.

  44. 44.

    Ibid p. 111.

  45. 45.

    L. Wittgenstein, Philosophical Investigations, trans. G.E.M. Anscombe, 3rd ed, Upper Saddle River (N.J.: Prentice Hall, 1958).

  46. 46.

    Ibid #293. Wittgenstein’s work is mostly in the form of numbered aphorisms. It is conventional to refer to the number of the aphorism rather than the page number where appropriate.

  47. 47.

    M. Sullivan, Pain in language: from sentience to sapience. Pain Forum 4 (1):3–14.

  48. 48.

    See Wittgenstein, #246.

  49. 49.

    See Sullivan, 3–14.

  50. 50.

    G.L. Engel, The need for a new medical model: a challenge for biomedicine. Science 196:129–136.

  51. 51.

    R. Melzack and P. Wall, Pain mechanisms: a new theory. Science 150 (699):971–979.

  52. 52.

    D. Moerman, Meaning, medicine and the placebo effect (Cambridge: Cambridge University Press, 2002).

  53. 53.

    D.B. Morris, Illness and Culture in the Postmodern Age (Berkeley: University of California Press, 1998).

  54. 54.

    See Moerman.

  55. 55.

    P. Siddall and M. Cousins, Persistent pain as a disease entity: implications for clinical management. Anesthesia & Analgesia 99 (2):510–20.

  56. 56.

    D. Fish, Appreciating Practice in the Caring Professions: Re-focusing Professional Research and Development (Butterworth-Heinemann, 1998).

  57. 57.

    See Siddall, and Cousins, 510–20.

  58. 58.

    Veterans Health Administration Memorandum, Pain as the 5th Vital Sign: (Veterans Health Administration, 1999).

  59. 59.

    R. Rorty, Against Unity, Wilson Quarterly 22 (1):28–39.

  60. 60.

    D.B. Carr, J.D. Loeser, and D.B. Morris, eds. Narrative, Pain and Suffering, Progress in Pain Research and Management (Seattle: IASP Press, 2005).

  61. 61.

    C. Skott, Expressive metaphors in cancer narratives. Cancer Nursing. 25 (3):230–5.

  62. 62.

    Cited in A.H. Porter The Cambridge introduction to narrative, 2nd ed. (Cambridge: Cambridge University Press, 2008) p. 206.

  63. 63.

    S. Loftus 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, 2010) pp. 85–94..

  64. 64.

    M. van Manen, Researching lived experience: Human science for an action sensitive pedagogy, 2nd ed., (London, Ontario: Althouse, 1997).

  65. 65.

    Ibid p. 49.

  66. 66.

    N. Davey, Unquiet understanding: Gadamer's philosophical hermeneutics (Albany: NY: State University of New York Press, 2006) p. 152.

  67. 67.

    M. Sullivan, Pain in language: from sentience to sapience, Pain Forum 4 (1):3–14; M. Sullivan, Finding Pain Between Minds and Bodies, The Clinical Journal of Pain 17:146–156.

  68. 68.

    J. Higgs, M.A. Jones, S. Loftus, and N. Christensen, eds., Clinical Reasoning in the Health Professions, 3rd ed. (Oxford: Butterworth-Heinemann, 2008).

  69. 69.

    T. Jones, 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.

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Loftus, S. Pain and its Metaphors: A Dialogical Approach. J Med Humanit 32, 213–230 (2011). https://doi.org/10.1007/s10912-011-9139-3

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Keywords

  • Metaphor
  • Language
  • Dialogism