My neighbour said to me “The bloody pain comes from a nerve root and it travels down my leg and gives me pins and needles“
Quick quiz –
1. How many metaphors in this statement?
2. Which ones would you let go?
3. Which ones would you challenge and how?
Keen for a metaphorical discussion in the comments below.
-David Butler
Could you see a metaphor in the brain? We’re going to ask Professor Robert Coghill this very question at EP3 in March 2015. Come along and you could ask him anything you want as well!
David, I see five. Check out James Geary’s TED talk about metaphors. These days I teach image, story, premise and method. Metaphors are all through here. They can’t be avoided. Choosing the best ones is an enormous task.
Barrett
Thanks Barrett,
I am going for 7! although I am sure there will be some discussion on what a metaphor is. At least two of them could require clinical attention.
David
Great TED talk
I would never argue with seven. Metaphors are everywhere and in constant use. They form the stories we tell, the way we communicate and, importantly, the effectiveness of our teaching.
I know there are a lot of people reading this, but just to help a bit – “nerve root” is a metaphor and so is “down my leg”
David
I think there are 7 metaphors ( no arguments entered into around Christmastime) . Barrett is right – metaphors are everywhere. Using the broadest definition – “a word or phrase applied to an object or action to which it is not literally applicable”…….
1. “The” is a metaphor perhaps suggesting disembodiment (ie “the” as opposed to “my”.
2. “bloody” is a metaphor and a very Australian one too.
3. “comes from” is metaphorical in term of orientation
4. “nerve root” is an example of an anatomical metaphor ( other examples may be pelvic floor, shaft of femur)
5. “travels down” – there may be two orientational metaphors here
6. “gives me” ( as though the pain makes pins and needles).
7. “Pins and needles” is a metaphor
Of course, this is normal day to day speech in any clinic . I would be interested in “pins and needles” and “nerve root”. These metaphors are so embedded that we forget they are metaphors – “what do you mean by pins and needles” and “what is your concept of a nerve root” may be worthwhile follow up questions (the idea of nerve root, along with other “root” metaphors such of root canal, root of all things may well contribute to enhanced sensitivity). Over time I would like to see “the back” change to “my back”. The orientational metaphors may change over time but are certainly language to come back to, to meet the patient at their story. The term “bloody” at least in Australia is an invitation to come back with “so something is really bugging you?”
David
Reading your deconstruction I can see how I got 9!
Really glad you completed a satisfactory deconstruction of the statement yourself…..that was the only thing putting me off adding a comment to an interesting observation….that I might have to deconstruct it myself ! Metaphors are a very useful tool for exaggerating an issue which requires attention. They also can be used to de-subjectivise the issue, so that it seems more like a possible ‘shared’ experience, and therefore more worthy of a sensible response. The user of the metaphor will always attempt to express an issue in terms which might seem more familiar to the listener, and thus gain their approval for something which might otherwise be seen as a ‘back-away’ contentious issue. As such, using metaphors closely resembles the intentions of a confidence trick….but only if the original intention was to exaggerate, and thus earn more attention. The common use of metaphors in subjective medical descriptions probably results from an attempt to overcome the taboo-ism of not wanting to seem that one is only interested in their own problems, and thus losing the sought after attention. So, in the end, it’s probably an assumed roundabout method of eliciting advise without offending. There’s also the interesting aspect that if the listener realises the amount of effort put into the metaphorical statement, they might also be prepared to treat the issue with more gravity. I know that in the culture I come from, metaphors are highly respected, perhaps because they create a sense of neutrality and humour in the discourse.
On the downside, in terms of making a value judgement based on a loaded metaphorical statement, the question arises….’If someone is capable of constructing metaphors, they can’t be in too much pain’. So, in theory, a loaded metaphorical statement, whilst attempting to exaggerate, also allows licence for a metaphorically balanced response. The ‘bloody’ metaphor probably takes the whole thing over the edge, unless we allow for a reversal of cultural niceties ….and that’s not just an Aussie thing , it’s more likely an Anglo- Saxon or Scandinavian expression, also common to the Celtic peripheral cultures, and assumed by Aussies for further exaggeration ! And all I can say to that is ‘Good on yer’ (which is probably a direct translation from the Irish ‘Maith is leat’ , but only used today in the Polynesian peripherals ! ).
As long as you heard “What the patient said” and tried to understand “What They meant” ………..
DB London
On location😎☀️🎄🎅🍗
That would be ideal, but perhaps over-reliant on the operator’s skills to de-metaphorise loaded statements. Exaggerations, framed as metaphors, are likely to encourage an ‘opposite’ reaction, and that’s where the imbalances and dissonance are likely to enter the attempted shared understanding. Up to that point, the one using the metaphor is entitled to their own interpretation of what they’re experiencing…..after all, it is their problem. It would seem that translating that into a scientific description which can be acted on with confidence, and with no bias, is vulnerable to variable interpretation because there’s no guarantee that the operator is infallible. There is the possible aspect coming into play, that without 100% trust in the operators skills, the loaded metaphorical statement was created to offset any possible misjudgement that the problem presented might be perceived as less serious than intended…that would point to some cultural habit of defying expected responses before they happen…and difficult to read because all based on supposition. Tangled web indeed !
There’s an expression in the building trade….” Rip it up, and start again”, which is a means towards overcoming ‘builder bias’ and re-applying oneself to the problem from a new perspective. A typical example might be where a continuing damp problem exists, and although the builder has completed the cosmetic remedial works to a good standard, he failed to identify the cause, and thus the problem persists….and that’s the proper use of the term ‘persists’ , unlike the current tendency to replace the term ‘chronic’ with ‘persistent’ ( another issue perhaps, because of the metaphorical context it creates ?). Over the years, I’ve seen many instances of builders being unable to accept the ‘Rip it up and start again’ mantra, mostly because it challenges and undermines their trust in their own abilities to correctly define a problem at outset. Quite often, over a cup of tea, they will admit their mistake, but on the surface, they like to maintain an unquestionable professionalism, and consequently the problem ‘persists’. Those builders who do ‘rip it up’, sleep more soundly !
That entire observation is a metaphor, of sorts. I’m using it in order to avoid a possible adverse reaction, where offence might be taken because of the obvious inherent inferences. As a metaphor, it implies a certain neutrality, and I would hope that it helps to show that metaphors can be useful on both sides of the operator / patient equation…..where, importantly, both parties are capable of translating metaphors as they see fit. I think it’s probably a mistake to assume that only one party is observing in a professional manner, whilst the other party is somehow oblivious to the complex context. It might seem like that, on the surface, but the very fact that a metaphorical context has been created by one party, points to the possibility that a particular reaction was already assumed before any communication was entered into. Perhaps the reason for such assumptions, requiring the creation of a metaphorical context, is really the core issue which needs analysing, rather than the actual translation of the metaphor which is vulnerable to individual bias.