She crumbled like a biscuit

This is an ontological metaphor – use of language to describe/express something which can be difficult to lay words on – things like life, and love and anger or in the case of my friend – sadness and loss. The metaphor theorists have discussed this in detail (Lakoff and Johnson 1980; Kövecses 2010) though not particularly in regard to pain. Of course, pain is another “thing” that often defies language, even analytical thought, especially severe acute pains and many chronic pains. Pain related ontological metaphors such as “I am falling apart at the seams” or ‘I’ve got my Mum’s painful knees” are attempt to objectify pain, to make sense of it, to convey it to others, to help construct a blame source or to set up an escape route – “I need to pull myself together”.
Perhaps we want pain, more than anything, to be objectified. We want to find the non-private parts of pain and share it. It makes you realise how people hang onto the health practitioner’s words or the suggestion of something odd in a scan, even though the image may have been taken years ago – “I might have a little disc bulge in there” says a 75 year old.
Next time someone says to you “I am going to pieces” or “I just feel so fragile today”, or something similar, pause a moment and consider these ontological metaphors and what they may mean. Perhaps the “pieces” allow links to a jigsaw or something broken. Perhaps “fragile” to a glass object or something that does not travel well. These are attempts to objectify.
We have informally sampled around 300 therapists, asking for the metaphors that patients are using. Dozens of ontological metaphors based on a “journey” emerge such as “it’s been a rocky road”, “the pain is dragging me down”, “I was cruising last week”, “I am at a cross road” or “there is light at the end of the tunnel” or more blatantly “I didn’t realise this operation would be such a journey”. The “journey” as discussed by Lakoff and Johnson provided an avenue for verbalising.

But I am a manual therapist not a linguist!
Most of our readers are manual therapists, but not all. More so than our medical colleagues, therapists have time with patients and are also in the unique position where we often talk to patients without looking at each other – this always offers a chance to say things you may not have said face to face. A key part of the Explain Pain work is giving understanding and assisting the emergence of self- explanatory language – an individually tailored description of how the brain works in pain may make someone aware that they are not “coming apart at the seams”. However, there is a risk involved…

A possible problem with Explaining Pain
What I am suggesting above is that we should try to objectify pain and help the patient take it further than their initial attempts. There is no other way than physical imagery (both in our therapeutic stories and in delivery methods) to allow the mind to form a view of pain. But herein lies the problem – if we objectify it, we risk making it an entity i.e. THE pain, MY arthritis, as opposed to a process of which changeability is the most powerful component. We know that many patients come away with the wrong message and, despite our/your best efforts allow their existing mental concepts to twist your message into a flawed concept. (“He thinks it is all in my head, he clearly doesn’t know, makes me sure that the problem is my unstable vertebrae.”)
Our words lead us to what we might become – and that may be all we have. I am left with the “broken biscuit” entity rather than the complexities of an emergent process such as sadness.
These are complex issues – the answer is perhaps to assess existing mental concepts first so that knowledge can be tailored to these neurosignatures. We need help and discussion here – it’s all part of the next phase of Explain Pain and the issues are increasingly appearing in Explain Pain courses.
Further clinical discussion on this topic, a forum to share your patient’s ontological metaphors and a place to discuss the rather complex issue of explaining pain without harmfully objectifying is at the NOIjam blog.

Kövecses, Z. (2010). Metaphor. New York, Oxford University Press.
Lakoff, G. and M. Johnson (1980). Metaphors we live by. Chicago, University of Chicago Press.
Explain Pain – A Second Edition!
The highly regarded book Explain Pain, written by pain specialists Dr David Butler and Professor Lorimer Moseley, sparked the introduction of neuroscience education as therapy a decade ago. The second edition of this book, which is available now, contains the most up-to-date scientific information to help pain sufferers understand and overcome pain.
David Butler, founder of the Neuro Orthopaedic Institute, says that “it is no longer acceptable that pain be just managed: we must expect that it can be treated, and sufferers can alter it themselves through education.”
Explain Pain Second Edition is AVAILABLE NOW at noigroup.com/store

yarn-small

Have a painful yarn to share? Well we want to hear it! In 150 words or less tell your best painful yarn to kat@noigroup.com for your chance to win a Painful Yarns eBook.

“Moseley is pain management’s answer to James Herriot. This book captures that illusive ability to both educate and entertain.” Dr Michael Thacker

“…this is clearly the best book about clinical pain that I have ever read.” Dr John Keltner

“Painful yarns are about life. The way Moseley turns them into metaphors about pain is brilliant. This is a real gem.” Diane Wilkinson

For further clinical discussion on this topic, and others, head over to NOIjam

What else is happening on NOIJAM?
Different Cracks
A problem Shoulder
Kahlo’s Cracked Column
Bob and Neural Tissue
Everyone Needs a Break, Right?

COURSE REPORT… NEXT SIX MONTHS
Where will David Butler be?
London UK 2013
– Explain Pain: 12-13 October
Australia 2013
– Explain Pain: Perth 19-20 October | Melbourne 9-10 Nov (FULL)
– Graded Motor Imagery: Warners Bay 16-17 November | Melbourne 23-24 Nov
USA February 2014, Explain Pain courses with Robert Johnson
– Boston 8-9 Feb| Atlanta 15-16 Feb| Dallas 22-23 Feb

Search for and enquire about NOI courses here

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One Response to “She crumbled like a biscuit”

  1. Are you a process or an entity? | noijam Says:

    […] This blog post links to the recent noinotes […]

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