Metaphors of Pain

The continuing human need for first-person narratives of illness seems to be this: they offer a language—terms of representation—in which disease, pain, and the often surreal impositions of treatment can be reflected upon, integrated into the life of the sufferer, and shared with others. Or, if suffering cannot be integrated into a life, narration allows experience to be held apart as part of one’s life and self. On a primary level, illness narratives are reports; that might be called their ethnographic value. On a moral level they are acts of witness, telling truths that are too often silenced because they speak of what any sane person would rather ignore among life’s possible outcomes. But for most readers, these books are user manuals for the possibility of coherent experience during times when what happens can defy expression, because conventional expressive possibilities fail to feel true to what the body knows.

Illness narratives sometimes offer direct advice, and they are filled with cautionary tales, but they might be best described as providing a pedagogy of expressive possibility. Medical treatment settings teach patients how to offer medically relevant narrations. Each of the authors reviewed here describes the process of learning to speak in terms that physicians can recognize and understand. But each learns that ill people need a second language that can express what medicine ignores. That second language is hard won, and the illness narrative is both the record and the product of winning a coherence that can be called one’s own.

Three of the four books—Biro, Greenberg, and Heshusius—are primarily about pain. Sarah Manguso’s book may be an outlier—her experiences of pain were transitory and caused by treatments, not the disease itself—but she provides a different perspective on the central topic of this review, metaphor. Also, Manguso challenges certain premises about expressing illness and how illness affects lives.

David Biro is the author of a memoir about undergoing a bone marrow transplant that cured him of a rare blood disorder, paroxysmal nocturnal hemoglobinuria.¹ Part of that story is how his early career inclinations were split between medicine and literary studies. Before taking up full time medical practice, he completed a doctorate in literature at Oxford. The Language of Pain is a revised version—and I believe the revisions must be extensive—of the dissertation he wrote before his first book. But his present book shows none of the fragmentation that its circuitous history might suggest. On the contrary, Biro seamlessly integrates both his clinical experience treating patients in pain and his own experiences of pain into his explorations of literary metaphors for pain.²

This integration of critical analysis and experience places The Language of Pain among the core texts for literature and medicine, in my judgment. Biro’s focus is always on literary metaphors of pain, with Anton Chekov, Ernest Hemingway, James Joyce, Jack London, de Maupassant, and Toni Morrison as his most frequent sources of examples. The literary material always serves to address a specific clinical problem—how patients can express pain—and is continually related to either Biro’s own experiences of pain or his patients’ pain. The Language of Pain sets a standard for second-generation literary studies in narrative medicine.

The ability to represent pain has specific clinical value. Biro’s central point is that, “metaphor works like (and in the absence of) medicine; it has the power to alleviate pain” (145; cf. 215). His thinking was first inspired by the work of Elaine Scarry,³ but he juxtaposes her ideas about...