David Biro M.D., Ph.D.

Listening to Pain

Imagining Pain

Seeing and Communicating Pain through the Weapon

Posted Nov 28, 2011

As I've discussed in recent postings, the major obstacle in trying to communicate pain is its invisibility. It is difficult for the person experiencing pain to see it, just as it is for the person observing pain from the outside, a doctor or family member. But there is a way around this obstacle: Metaphor. By imagining pain to be something else -- something more accessible to both parties -- we can replace what is inside and invisible with what is outside and visible.

By far the most common "something else" is the weapon. When Frida Kahlo paints a picture of the chronic pain she experiences from her spinal injury, she imagines numerous arrows piercing her skin. This is how I feel inside, her painting Wounded Deer says out loud to anyone looking at it. The same is true of many other artists who try to represent the darkness and blankness that surrounds pain. William Styron in depression speaks of a howling storm that batters and suffocates his brain. Joan Didion in grief feels like she's being pummeled by a series of giant waves.

 But reaching for metaphor in times of pain, the weapon metaphor in particular, isn't limited to artists.  Ordinary people use the same language day in and day out.  When a young boy, for example, walks into the Emergency Room wincing and the doctor asks him how it feels -- like a knife stabbing me, he answers, and points to the right side of his belly. An older woman with carpel tunnel syndrome talks of being pricked with tiny pins. Angina or cardiac pain is often described by patients as a massive object pressing down on the chest.

Children too, even when they haven't yet mastered language in all its subtleties, will use metaphor when asked to describe their pain. Only their hammers and bats will more likely be expressed pictorially rather than verbally. Below are drawings by young children with headaches taken from a medical journal:







There is good reason why we gravitate toward the weapon in pain. Weapons injure the body and injury is the way we first come to learn the meaning of pain. The feeling we get - when our hand comes too close to the fire or when we fall and scrape our knee - that is what pain is, our parents explain to us. Over time the connection becomes internalized so that whenever we feel that feeling, even when there is no visible injury, no fire or gaping wound - as in the case of cardiac pain, carpel tunnel syndrome, appendicitis, depression or grief - we assume that there must be some internal injury as well as some object capable of causing such injury - enormous weights, tiny pins, knives, waves, etc.

As Elaine Scarry writes, the weapon allows us to "lift pain and its attributes out of the body and make them visible." But what must be understood is that such lifting is almost always taking place in the imagination. There is no enormous weight pressing down on the cardiac patient's chest, no tiny pins piercing the carpal tunnel patient's hand, no hammer coming down on the child's skull. That is why we can say that the language of pain is metaphorical out of necessity. If we wish to talk of the invisible, the only way to do so is by transforming what can't be seen into what can be, by metaphorically imagining weapons and the injuries they cause even when the weapons and injuries don't exist. Otherwise there will be nothing to say.



Elaine Scarry, The Body in Pain (New York: Oxford, 1985)

William Styron, Darkness Visible (New York: Vintage, 1992)

Joan Didion, The Year of Magical Thinking, (New York: Knopf, 1985)

Carl Stafstrom et al, "The Usefulness of Children's Drawings in the Diagnosis of

Headache," Pediatrics 2002; 109.

About the Author

David Biro, M.D., Ph.D., practices in New York and teaches at the SUNY Downstate Medical Center. His book, Listening to Pain, draws upon his background in the humanities and medicine.

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