Pain As Metaphor: Metaphor and Medicine Shane Neilson

JMH Online First, published on August 7, 2015 as 10.1136/medhum-2015-010672 Original article Med Humanities: first published as 10.1136/medhum-2015-010672 on 7 August 2015. Downloaded from Pain as metaphor: metaphor and medicine Shane Neilson Correspondence to ABSTRACT is based on destructive metaphors should make Shane Neilson, Department of Like many other disciplines, medicine often resorts to anyone suffering from pain circumspect. English and Cultural Studies, Chester New Hall 321, metaphor in order to explain complicated concepts that In Metaphors We Live By, a seminal text on meta- McMaster University, 1280 are imperfectly understood. But what happens when phor, Lakoff and Johnson define metaphor as “a Main Street West, Hamilton, medicine’s metaphors close off thinking, restricting way of conceiving of one thing in terms of another, ON L8S 4L9, Canada; interpretations and opinions to those of the negative and its primary function is understanding”.2 All [email protected] kind? This paper considers the deleterious effects of disciplines resort to metaphor for the means of Accepted 17 July 2015 destructive metaphors that cluster around pain. First, the their understanding, and Lakoff and Johnson dem- metaphoric basis of all knowledge is introduced. Next, a onstrate how pervasive metaphorical thinking is, particular subset of medical metaphors in the domain of but also that much of our metaphorical thinking is neurology (doors/keys/wires) are shown to encourage based on arbitrary conventions that aren’tpre- mechanistic thinking. Because schematics are often used served across cultures. Nietzsche contributed a in medical textbooks to simplify the complex, this paper strange property of metaphor in “On Truth and traces the visual metaphors implied in such schematics. Falsity in their Extramoral Sense”: Mechanistic-metaphorical thinking results in the accumulation of vast amounts of data through What therefore is truth? A mobile army of metaphors, metonymies, anthropomorphisms: in short experimentation, but this paper asks what the real value a sum of human relations which became poetically of the information is since patients can generally only and rhetorically intensified, metamorphosed, expect modest benefits – or none at all – for relief from adorned, and after long usage seem to a nation chronic pain conditions. Elucidation of mechanism fixed, canonic and binding; truths are illusions of through careful experimentation creates an illusion of which one has forgotten that they are illusions”.3 vast medical knowledge that, to a significant degree, is metaphor-based. This paper argues that for pain Disciplines progress according to the strength of outcomes to change, our metaphors must change first. their metaphors, and those metaphors are fated to become so familiar that they transform into illusions, if even thought of at all. Nietzsche adds that in an earlier age, it was For most patients, pain is transient, lasting as long as the causal illness does. Then pain disappears. For language which has worked originally at the con- other patients, pain transforms into a chronic struction of ideas; in later times it is science. Just as problem that usurps identity. Both types of patients the bee works at the same time at the cells and fills want release, for their ordeal to end. But in the lan- them with honey, thus science works irresistibly at ‘ ’ ‘ ’ that great columbarium of ideas, the cemetery of per- guage I just used, that of patients and illness and http://mh.bmj.com/ ‘problem’ and ‘ordeal,’ I have perpetuated a ceptions, builds ever newer and higher storeys; sup- ports, purifies, renews the old cells, and endeavors ‘problem’ that is consolidated in language. In her above all to fill that gigantic framework and to landmark study The Body in Pain, Elaine Scarry arrange within it the whole of the empiric world.4 memorably pointed out that pain finds its way into language almost exclusively through metaphors of The scientific edifice will stretch past the sky like weaponry and damage.1 I build on this observation an endless erector set but it is still built on a core by arguing that pain is conceptualised and of metaphor. But what if the metaphors are inher- on October 2, 2021 by guest. Protected copyright. expressed through negative and destructive meta- ently limiting, or even counterproductive? phorical systems that have been appropriated by The problem the man of science faces is that ‘the physicians and entrenched with supplementary impulse towards the formation of metaphors, that neurological metaphors. I argue further that the fundamental impulse of man’ withstands and is incredible accumulation of detail concerning pain even used to interpret the ‘regular and rigid new pathways is dependent upon these destructive meta- world’ that comes from the pursuit of knowledge phor systems. The medical understanding of pain is and truth according to the scientific method. reliant upon certain theoretical constructs that Scientific ideas, Nietzsche explains, are constantly might be distant in time yet are influential in effect; confused by the construction of ‘new figures of elaborations upon these theories with experimental speech, metaphors, metonymies’ such that the knowledge and minute elaboration of physical ‘existing world of waking man’ is ultimately ren- detail—the so-called ‘mechanistic’ view of pain— dered ‘motley, irregular, inconsequentially incoher- do not change the metaphors we use to understand ent, attractive, and eternally new as the world of the physiological information. Because the benefit dreams is’.4 Part of the problem inherent to this of seeing a medical practitioner skilled in the treat- marriage of metaphor and scientific knowledge is To cite: Neilson S. Med ‘ Humanit Published Online ment of pain is modest, the accumulation constitu- that individual metaphors exist within a whole First: [please include Day tes a meaningless ubiquity, an authoritative edifice system of metaphorical concepts—concepts that we Month Year] doi:10.1136/ of medical knowledge that is an illusion of author- constantly use in living and thinking. These expres- medhum-2015-010672 ity. That the authority derives from knowledge that sions, like all other words and phrasal lexical items Neilson S. Med Humanit 2015;0:1–8. doi:10.1136/medhum-2015-010672 1 Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence. Original article Med Humanities: first published as 10.1136/medhum-2015-010672 on 7 August 2015. Downloaded from in the language, are fixed by convention’.2 The scientific disci- more than an electrical impulse speeding along the nerves”.6 plines use their own cosmologies of metaphor with which to Medicine and the public use hegemonic metaphors to compre- produce and disseminate understanding, and medicine’s central hend pain. Morris’ text proceeds to examine how an inherently pain metaphors that marshal a mobile army of truth are of metaphorical understanding of pain absorbed by the larger weapons and damage, as per Scarry, but also metaphors of neur- public came into effect. There are problems with this wholesale ology that include doors, keys, wires and circuitry.i relegation of pain to medicine and I will consider these pro- Pain was first codified by the International Association for the blems at length in another forum. For now, the following Study of Pain (IASP) in 1979 as “an unpleasant sensory and summary of pain theories and their bases in metaphor constitu- emotional experience associated with actual or potential tissue tes a real narrative of progress. Textbooks like John Bonica’s damage, or described in terms of such damage”5ii. A single sen- The Management of Pain, considered a standard in the field, tence long, this abstraction cannot convey what pain is, what it briefly narrate the history of pain medicine in a single chapter feels like. Textbooks that recount medical history often point before voluminously providing modern management princi- out that the definition includes the parameter of emotion, ples.7 In their abbreviated historical sections, such textbooks taking pain back from the clinical, hyperphysiological viewpoint present pain as moving from primitive to a sophisticated under- of the 19th, 20th and 21st centuries. The discipline’s definition standing. In anatomical, physiological and biochemical terms, is a negative one restricted to metaphors of damage. That this this is incontestable. Yet in a paradoxical way, the progress nar- definition is consistent with the concept of pain operating in rative has been, qua Nietzsche, obliterated by the metaphor of general society—pain as a negative experience—does not mean progress. Progress becomes the narrative, obscuring a truth it is an adequate definition, for as Lakoff and Johnson show, our which I hope to show is one of vast, systematic and elaborate metaphors can work to increase or decrease understanding. It oversimplification as encouraged by metaphorical understanding may be that the popular discourse around pain—pain as nega- that conceals its nature as metaphor. Though neurological meta- tive experience as expressed by metaphors of weaponry and phors have assisted with the accumulation of scientific knowl- damage—is, in metaphorical terms, the ‘wrong road.’ If pain edge, their enshrinement as the means of understanding pain can only be negative, then pain will only be used for negative has had a terrible cost. We think of pain in terms of nerves, but purposes and have negative effects. This is an inherent obstacle nerves

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