{"id":3043,"date":"2021-06-25T10:00:50","date_gmt":"2021-06-25T09:00:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3043"},"modified":"2021-06-11T10:20:04","modified_gmt":"2021-06-11T09:20:04","slug":"painful-metaphors-enactivism-and-art-in-qualitative-research","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/06\/25\/painful-metaphors-enactivism-and-art-in-qualitative-research\/","title":{"rendered":"Painful Metaphors: Enactivism and Art in Qualitative Research"},"content":{"rendered":"<p><strong>Article Summary by Peter Stilwell<\/strong><\/p>\n<p>There is now widespread consensus that pain is subjective, meaning that it is a private and personal experience. Because pain is experienced from a person\u2019s unique perspective, others (e.g., healthcare practitioners, family, friends) cannot <em>directly<\/em> \u201csee\u201d or fully understand what the experience is like. To somewhat express <em>what it is like<\/em> to experience a particular pain, people rely on figurative language, such as metaphor, to describe their pain experience. Metaphor is understanding one kind of thing (often abstract or unfamiliar) in terms of another (more concrete and familiar). For example, <em>pain is war<\/em>. Pain is more abstract and difficult to describe, so it is compared with war, which is something more concrete, visible, and tangible. In this paper, we explore different types of pain-related metaphors in clinical settings.<\/p>\n<p>Everyone uses metaphor, whether they realize it or not. Metaphors allow us to communicate experiences, while also playing a role in shaping them. Patients use metaphor to express their experiences to healthcare practitioners. For example, a patient may describe their pain as <em>stabbing<\/em>, <em>burning<\/em>, or that it feels like <em>lightning bolts <\/em>down their leg. They are not literally being stabbed, burned, or struck by lightning; it is figurative language to help communicate what their experience is like. In turn, these metaphors help healthcare practitioners better understand the patient\u2019s situation and is a pathway to diagnosis. For example, burning and lightning bolts indicate that nerves or the nervous system may be involved (i.e., neuropathic pain), which helps inform further testing or laboratory investigations. Further, healthcare practitioners use metaphors, often unknowingly, to help patients understand their diagnosis and make sense of their pain experiences. Using qualitative data, our paper focuses on how metaphors used by healthcare practitioners (e.g., physicians, physiotherapists, chiropractors, etc.) are often taken for granted, shaping patients\u2019 experiences and behaviours for better or worse. Below, we present five paintings from our paper representing pain explanations and pain-related metaphors delivered by various healthcare practitioners. The art, metaphors, and associated narratives draw attention to the intertwined nature of language, action, meaning, and the experience of pain. We hope this paper helps healthcare practitioners reflect on the language they use with their patients, and to consider how pain-related metaphors may be reinforced and reconceptualised.<\/p>\n<div id=\"metaslider-id-3049\" style=\"width: 100%;\" class=\"ml-slider-3-109-0 metaslider metaslider-nivo metaslider-3049 ml-slider has-dots-nav ms-theme-default\" role=\"region\" aria-label=\"Painful Metaphors: Enactivism and Art in Qualitative Research\" data-height=\"3024\" data-width=\"4032\">\n    <div id=\"metaslider_container_3049\">\n        <div class='slider-wrapper theme-default'><div class='ribbon'><\/div><div id='metaslider_3049' class='nivoSlider'><img loading=\"lazy\" decoding=\"async\" width=\"1458\" height=\"701\" src=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Muscle-Knot.jpg\" class=\"slider-3049 slide-3050 msDefaultImage\" alt=\"Metaphorical muscle knot.\" data-caption=\"Metaphorical muscle knot. Patients were told they have &ldquo;muscle knots&rdquo; and that they are &ldquo;tight&rdquo; and &ldquo;ropey&rdquo;. Muscles do not literally tie in knots; yet patients were often told this, and that they could &ldquo;release&rdquo; knots with treatment. This represents an oversimplification of anatomy and pain, and may have unintended consequences. In our paper, we outline implications of these types of metaphors.\" data-thumb=\"\" title=\"Stilwell, Peter - Muscle Knot\" rel=\"\" srcset=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Muscle-Knot.jpg 1458w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Muscle-Knot-300x144.jpg 300w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Muscle-Knot-768x369.jpg 768w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Muscle-Knot-640x308.jpg 640w\" sizes=\"auto, (max-width: 1458px) 100vw, 1458px\" \/><img loading=\"lazy\" decoding=\"async\" width=\"1126\" height=\"773\" src=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Hangover.jpg\" class=\"slider-3049 slide-3051 msDefaultImage\" alt=\"Pain hangover analogy\" data-caption=\"Pain hangover analogy. To help a patient understand their fluctuating pain, one clinician described how various activities can contribute to flare-ups and that a decision must sometimes be made if certain activities are worth the subsequent pain. They used the analogy of planning to go to a party and drink tequila - the next morning isn&rsquo;t going to feel that great. Further in line with this analogy, the clinician discussed how the patient could work to develop tolerance or control. Metaphorically, the patient was currently experiencing pain after only a few drinks (shots) and the &ldquo;hangovers&rdquo; were often not expected.\" data-thumb=\"\" title=\"Stilwell, Peter - Hangover\" rel=\"\" srcset=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Hangover.jpg 1126w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Hangover-300x206.jpg 300w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Hangover-768x527.jpg 768w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Hangover-640x439.jpg 640w\" sizes=\"auto, (max-width: 1126px) 100vw, 1126px\" \/><img loading=\"lazy\" decoding=\"async\" width=\"1178\" height=\"770\" src=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Walking.jpg\" class=\"slider-3049 slide-3052 msDefaultImage\" alt=\"Walking on hands and knees\" data-caption=\"Walking on hands and knees. A patient reported their pain as &ldquo;shooting up their spine&rdquo; and a clinician advised them that &ldquo;everybody gets pain because they walk on two feet&rdquo;. In our paper, we discuss how this relates to problematic metaphors regarding spinal intervertebral discs, such as the idea that they &ldquo;slide&rdquo; or &ldquo;slip&rdquo;. We discuss how patients&rsquo; literal interpretations of disc-related metaphors may promote fear and the avoidance of evidence-based therapies, such as exercise.\" data-thumb=\"\" title=\"Stilwell, Peter - Walking\" rel=\"\" srcset=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Walking.jpg 1178w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Walking-300x196.jpg 300w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Walking-768x502.jpg 768w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Walking-640x418.jpg 640w\" sizes=\"auto, (max-width: 1178px) 100vw, 1178px\" \/><img loading=\"lazy\" decoding=\"async\" width=\"1080\" height=\"754\" src=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Spine.jpg\" class=\"slider-3049 slide-3053 msDefaultImage\" alt=\"Burning lumbar spine\" data-caption=\"Burning lumbar spine. A clinician suggested that low back pain is like a fire: buckets of water help put the fire out, and gasoline worsens the fire. The clinician outlined factors that are more like water, and factors more like gasoline. The patient reported that this explanation was helpful in terms of them better understanding aggravating and relieving factors and the need to add more metaphorical &ldquo;water&rdquo; than &ldquo;gasoline&rdquo;.\" data-thumb=\"\" title=\"Stilwell, Peter - Spine\" rel=\"\" srcset=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Spine.jpg 1080w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Spine-300x209.jpg 300w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Spine-768x536.jpg 768w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Spine-640x447.jpg 640w\" sizes=\"auto, (max-width: 1080px) 100vw, 1080px\" \/><img loading=\"lazy\" decoding=\"async\" width=\"731\" height=\"904\" src=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Bricks.jpg\" class=\"slider-3049 slide-3054 msDefaultImage\" alt=\"Pain-related bricks\" data-caption=\"Pain-related bricks. The most complex metaphor used by a clinician was that metaphorical &ldquo;bricks&rdquo; are added to a person&rsquo;s life, resulting in pain or worsening pain. Each brick (stressor) was described as part of an individualised pain &ldquo;puzzle&rdquo;. In our paper, we discuss how this explanation better reflects the complexities of pain and how many factors are always involved.\" data-thumb=\"\" title=\"Stilwell, Peter - Bricks\" rel=\"\" srcset=\"https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Bricks.jpg 731w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Bricks-243x300.jpg 243w, https:\/\/blogs.bmj.com\/medical-humanities\/files\/2021\/06\/Stilwell-Peter-Bricks-640x791.jpg 640w\" sizes=\"auto, (max-width: 731px) 100vw, 731px\" \/><\/div><\/div>\n        \n    <\/div>\n<\/div>\n<h4><\/h4>\n<h4><a href=\"https:\/\/mh.bmj.com\/content\/early\/2020\/10\/18\/medhum-2020-011874.abstract\"><strong>Read the article on the Medical Humanities website.<\/strong><\/a><\/h4>\n<p>&nbsp;<\/p>\n<p><em>Dr. Peter Stilwell is the lead author, and this paper was a part of his PhD research at Dalhousie University that focused on pain and clinical communication. He is currently a Postdoctoral Researcher at McGill University in the Faculty of Medicine and Health Sciences &#8211; School of Physical and Occupational Therapy. He is currently a Ronald Melzack Fellow in Pain Research at the Alan Edwards Centre for Research on Pain (AECRP) at McGill. He has a clinical background working with adults with musculoskeletal conditions, primarily spinal pain, which informs his research questions and interests.<\/em><\/p>\n<p><em>Christie Stilwell is a PhD in Health candidate at Dalhousie University studying healthcare service and supports that promote healthy aging in diverse communities. As a lifelong amateur artist, she recognizes the power of art and creative expression in idea exchange and knowledge translation. In this piece, illustrating the pain metaphors added additional depth to the analysis of the meanings and messages intertwined within complex and surrealistic metaphor use among patients and healthcare practitioners.<\/em><\/p>\n<p><em>The co-authors, Dr. Katherine Harman, PT, PhD and Dr. Brenda Sabo, RN, PhD, were Dr. Peter Stilwell\u2019s PhD co-supervisors. They are now both retired.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Article Summary by Peter Stilwell There is now widespread consensus that pain is subjective, meaning that it is a private and personal experience. Because pain is experienced from a person\u2019s unique perspective, others (e.g., healthcare practitioners, family, friends) cannot directly \u201csee\u201d or fully understand what the experience is like. To somewhat express what it is [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/06\/25\/painful-metaphors-enactivism-and-art-in-qualitative-research\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":345,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15028,15047],"tags":[15044],"class_list":["post-3043","post","type-post","status-publish","format-standard","hentry","category-journal-announcements","category-special-issues","tag-research"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Painful Metaphors: Enactivism and Art in Qualitative Research - Medical Humanities<\/title>\n<meta name=\"description\" content=\"The authors present five paintings of pain-related metaphors and their narratives in today&#039;s article summary.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2021\/06\/25\/painful-metaphors-enactivism-and-art-in-qualitative-research\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Painful Metaphors: Enactivism and Art in Qualitative Research - 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