The Language of Pain: Finding Words, Compassion, and Relief

David Biro  


(W.W. Norton, 2010, 256 pgs.)


Reviewed by Sayantani DasGupta


During moments of crisis—including illness and suffering—stories are the way we human beings make sense out of chaos, meaning out of madness, and form relationships critical to our survival and healing. Over the last two decades, there has been increasing recognition of the importance of narrative in health care. Scholars such as Arthur Kleinman, Arthur Frank, G. Thomas Couser, Alan Radley, and Rita Charon have established intellectual gathering points around notions of self-narration, witness, and testimony. They contemplate how stories function in illness and disability and what stories do to and for both their tellers and receivers.

David Biro’s The Language of Pain: Finding Words, Compassion, and Relief joins this conversation by meditating upon the relationship between language and pain. In doing so, it revisits Elaine Scarry’s assertion that “physical pain does not simply resist language but actively destroys it.” Biro ruminates on the isolation wrought by pain upon the sufferer. Drawing from not only his experience as a physician, but also as a patient during his treatment for a rare blood disorder, he describes the pain of a bone marrow transplant as “strangling my vocal cords. Silenced, I felt just like (Edvard) Munch’s sufferer: wanting to scream as loudly as I could but unable to make a sound.”

Yet, the book relies only slightly on Biro’s life as either patient or doctor; it is instead a philosophical meditation on the use of metaphor to represent illness. Biro argues that the preference in literary and real-life illness narratives for military and similar metaphors (pain as weapon, injury, etc.), is born from a phenomenological need to give pain agency and therefore a place in the world. It is through this granting of (metaphorical) agency, Biro suggests, that sufferers can pinpoint, understand and narrate an otherwise inarticulatable experience.

Biro’s text also focuses, in chapters entitled “The Mirror” and “The X-ray,” on the importance of “imaging”—and I would add “imag(in)ing”—the body through visual representation. From his own reliance on visualization techniques to deal with gastrointestinal tract ulcers, to the work of Frida Kahlo in making interior pain visible, Biro’s discussion of visual art brings to a point his argument that illness narratives must grapple with pain’s “thingness,” its “being in the world.”

Biro’s argument is both nuanced and beautifully written. But what is difficult to understand is Biro’s almost utter refusal to place his text in conversation with certain seminal texts, including Sontag’s Illness as Metaphor. If Biro’s book examines how metaphor can help ill individuals express pain, hers argued how metaphor was socially constructed, and harmful to the ill. Biro’s text similarly misses engaging with Kleinman’s notion of “social suffering,” or understandings of suffering gleaned from Holocaust studies and other scholarship around the sufferings caused by war and trauma. His is ultimately an individual-centric argument about pain as an interior experience.

Biro’s primary premise that pain exists beyond and before language is neither unique, nor uncontested. Both Scarry and Arthur Frank have written about the ‘untellability’ of illness. Frank calls this type of illness story “the chaos narrative”: an experience of suffering so immediate, the sufferer has no distance or ability to reflect upon it.

Despite these issues, Biro’s writing carries the reader through his ruminations. There are moments of sheer beauty here. Biro writes, “the fracturing of the body’s integrity in pain has its counterpart in the fracturing of the self; as the intactness of the body dissolves, so too does the intactness of the person as a whole…pain involves not only a bracketing of the world (putting out of play, in Merleau-Ponty’s words), but a bracketing of the person.”

The notion that pain puts the body, and therefore the self, ‘out of play’ brings only more fervor to the insistence of narrative medicine/medical humanities upon the role of story in health care—story becomes a way of not only communicating one’s interior experience, but giving (re)birth to the self.

David Biro’s The Language of Pain joins rich scholarship in narrative and health care. It does so in beautiful prose and with a careful attention to canonical literary work and visual art. What this reader is left wondering, then, is how to place it. If the book is to be taken as a new voice in the growing field of medical humanities, it seems strange that the work of established scholars is conspicuously ignored. In this light, the book isolates itself in the same way that it argues that pain might isolate the sufferer.

However, as a meditation upon pain, phenomenology, agency, metaphor, imagination, and story, Biro’s new book adds a powerful voice to the ongoing chorus seeking to place narrative and health care in harmony. And as such, it is music to my ears.



Sayantani DasGupta is assistant clinical professor of pediatrics and teaches narrative medicine at Columbia University. She is the author of Her Own Medicine: A Woman’s Journey from Student to Doctor and co-author of The Demon Slayers and Other Stories: Bengali Folktales. She co-edited the anthology Stories of Illness and Healing: Women Write their Bodies. She is currently working on two novels for children.