Trippingly on the Tongue

I’ve always liked the poetry of metaphor with its imagery revealing nuances hiding shyly in the background. Words alone sometimes convey their meanings too narrowly, whereas metaphors allow imagination to roam more freely, only loosely tethered to definitions. After all, depending on the context of its use, meaning is often reliant on Weltanschauung. Such is communication; language is only the messenger.

Usually one can imprison meaning, of course -confine it in a cramped little box from which, should it ever escape, it would cease to be useful. Indeed, it would be a Pandora’s box from which it escaped. And yet, even there, what remained inside after all the mischief and malevolence had escaped, was Hope. Maybe that’s what metaphors are: unexpected colours leaking from behind the bars… Liberations.

Of course, metaphor is value-laden as well as culture-dependent. One society’s metaphors do not always translate into that of another -hence the difficulty of truly understanding and appreciating the poetry of another nation, especially if it must be converted into a different language. It made me wonder whether there may be similar disparities with gendered interpretations of metaphor.

There was an interesting article in BBC Future a while ago that caught my eye: It made me realize that there are many ways the genders differ. Of course, it may be that when we hear an unusual expression for the first time, we (either sex) cling too firmly to denotative -definitional- aspects of the words for interpretational safety, when the more imaginative and unexpected connotative sense is what was intended all along. And it’s in the connotation -the metaphoric significance- where we differ…

For example, what is a ‘glass ceiling’? ‘Originally popularised by Gay Bryant at the height of the feminist movement in the 1980s, it’s a widely used term today that describes an invisible barrier that keeps women from occupying executive positions. The metaphor suggests that women should aspire to ‘break through’ the ceiling – but the problem is that it describes only the women reaching up, rather than, say, the men that are peering down from the top. This arguably places unfair responsibility on women to smash the ceiling, rather than focusing on the role of men in creating and maintaining it.’

There are other metaphors in use of course, often involving glass -presumably to convey the idea of invisible barriers to movement for women. So, the ‘glass cliff’ which depicts the idea of  ‘how senior women are often hired for risky and precarious roles at times of crises’ and therefore making them look bad if they fail to succeed. Or, the non-glass example of the ‘sticky floor’, which describes how women often feel stuck in low-wage jobs where career ascension is unlikely.’ 

But, handy as they are in explaining often complex topics, metaphors -in these contexts anyway- tend to oversimplify the problems ‘offering only a specific angle or viewpoint that isn’t the full picture.’ They confine us to viewing the world through a narrow aperture -a spotlight that illuminates only one small part of the stage. ‘“Women are the effect to be explained,” says Michelle Ryan, a psychology professor at the University of Exeter. “We never talk about men being overconfident, we always talk about women being underconfident. And we never talk about men having privilege or finding it easy; we always talk about women finding it difficult.” Ryan believes that the metaphors we’re using to describe women at work reflect the world’s androcentricism [sic] – our insistence that, even in 2017, we consider the male experience as “the norm”’

The issue is not entirely one-gendered, though. There is the concept of the ‘glass escalator’, a term occasionally applied to men in female-dominated industries that ascend to upper ranks more quickly than women. And yet, as Caren Goldberg of Bowie State University in Maryland points out, metaphors are employed when there is an “exception” to the rule or gender stereotype.’ So in the example she cites, it was applied to a male nurse (in a predominantly female dominated profession at the time) and implied that he probably chose nursing because he wasn’t able to get in to medical school.

‘The obvious upside of any these metaphors, however, is that they highlight social phenomena that might otherwise remain invisible and therefore impossible to resolve. But in order to address the circumstances that lead to women being held back, and men rising seamlessly, it shouldn’t be forgotten that metaphors simplify complexity.’

In an admittedly convoluted way, it reminds me of a woman I met the other day at a bus stop. I suppose I only met her by default, really -nobody would stand beside her because she was exhibiting a rather odd behaviour -probably Tourette’s syndrome, I’d thought at the time. She would be standing quietly at the curb, and then suddenly bend forward and seem to be vigorously cleaning and polishing something above her. This would last for a few seconds, often becoming more and more frantic, and then subside, leaving her once again peaceful, although by the look on her face, perhaps not content.

She was in her thirties, I would guess, and dressed quite respectably in a blue pant-suit, with a spotless white blouse and short stubby earrings that would be unlikely to achieve any unwanted momentum during her seemingly randomly timed tics. Her auburn hair was sensibly short and her makeup intact as far as I could tell. Apart from her odd movements, she seemed like a typical business woman on her way home from work.

And, when she moved beside me in the now-disrupted line up, she smiled apologetically. “I’m sorry, sir,” she said -hurriedly, I thought, in order to explain herself before she was once again overcome by the movement. “It’s just my latest tic…”

At that point and without any obvious warning, she launched into another bout of scrubbing something invisible over her head. I tried to pretend I didn’t notice, but she wasn’t fooled.

“I think stuff at work must have kicked this one off,” she said and then blushed.

“What do you mean?” I asked, genuinely interested.

She stared at me for a moment, perhaps wondering if it was something appropriate to confess to a stranger at a bus stop. Then her smile returned briefly before the tic arrived again.

“They’re all used to me at work,” she explained when she was able to. “But the boss isn’t.” She risked a sigh to indicate her frustration. “I mostly just repeat words to myself so they’re not as disruptive. But occasionally a movement takes over, and that’s what he doesn’t understand… Or like. I think he wonders if I’m actually mentally handicapped, or something.

“Anyway, even though I’ve been working there as an accountant for almost ten years, he’s never promoted me. I’m well regarded by my colleagues, and they’re almost all men…but…”

I could see a sudden change in her face as she leaned over the curb and the tic began again.

“But my friend Amrita thinks it’s just the glass ceiling that’s holding me back,” she said, once again in temporary control. “And yet, I’m not certain that reassures me…”

Her bus pulled up suddenly, and she stepped onto it like any other passenger, and was gone. I saw her smile at me through the window when she found a seat though, and I nodded in a friendly recognition of what she’d shared with me. But, like her, I’m not sure her friend was right -ceilings are not the only battles.


The Myth of Medicine

The concept of the myth has always intrigued me. Not, as it is historically characterized – the fabulous stories of gods and heroes- or the more populist idea of an untruth or counterfactual, but rather as a metaphor. Myth as a way of explaining something that is difficult to put into words, that defies rational explanation: the meaning behind the meaning. Like those Russian nesting dolls, they are multilayered, with understanding hiding within significance which is in turn hiding under context hiding behind appearance… A myth is the meaning of a flower. It is a poem.

And yet it need not be so abstract, so elusive. All of us have myths: they are our stories –who we are, or at least how we have come to understand ourselves. As the famous Swiss psychiatrist Carl Jung said in his autobiography: Thus it is that I have now undertaken, in my eighty-third year, to tell my personal myth. I suppose the challenge, however, is to disentangle the reality from the fantasy… Or does it really matter? And are they both merely different colours of the same myth? Joseph Campbell, the author of many books about mythology, said: “…the only way you can describe a human being truly, is by describing his imperfections. The perfect human being is uninteresing… Aren’t children lovable because they’re falling down all the time and have little bodies with heads too big?”

We are, for all intents, our mistakes. Our foibles. Our myths. And that which we appear to be, we are not –or at least that may not be how we see ourselves. So, for the doctor, which is the more important –because to treat the person, we have to find them first?

I am reminded of a patient I saw  long ago when I was a freshly washed gynaecologist just setting up my practice in an era of militant feminism. Ms Debrashen –that was her title, she insisted, just like mine was ‘doctor’- was a frail-looking eighty year old but dressed in jeans and a sweat shirt that had I’m Talking to You written in Gothic script on the front. I suppose I should have been intimidated, but her smile was so disarming, I couldn’t help but return it as I greeted her in the waiting room. She extended a bony hand to shake before I could even free my own from her chart, and would have led me  down the hallway to my office if I hadn’t stepped in front of her to make sure she went through the correct door.

“So what can I do for you Mrs. Debrashen?” I said, still smiling, as she plonked herself down on a chair beside my desk.

Ms Debrashen,” she corrected me, but not unkindly. “I want you to do a pap smear. I haven’t had one in years, and my family doctor refuses to do one on me.” As she said this, she replaced her smile with a flinty stare that brooked no nonsense. I will be obeyed, it said for a moment, and then relaxed into a more Canadian, please. “I don’t know what got into him; I’ve gone to him for years, but he just climbed up onto his doctor horse and said I was too old.” She sighed theatrically and shrugged angrily. “Too old? Too old to be screened for cancer..?” She shook her head in disbelief. “Does he think I’ve lived long enough already?”

I took a carefully disguised deep breath and let it out slowly. Quietly. I decided to start with a thorough history in case there were some extenuating circumstances. Most cancer agencies throughout the world, and certainly the one in my own province here in British Columbia, have said that there is no indication for continuing to do pap smear screening after the age of sixty-nine. Only if there were recent abnormalities in the pap or as a followup to recent treatment for abnormal cells would it be justified. And of course, then it wouldn’t be screening, per se, but followup.

I took what I felt was a complete history and then, as a tactical decision, asked about her pap smear history at the very end. But no, all of her past pap smears were normal, she insisted.

She sat back in her chair, folded her arms across her chest and stared at me with a rather smug but expectant expression on her barely-wrinkled face.

“The Cancer Agency in British Columbia usually recommends not doing any more pap smears after you turn seventy,” I said, rounding it off for simplicity.

A curiously satisfied smile captured her face –as if she were laying a trap for me, but had to be careful not to give it away. “And why is that, doctor?”

“Well…” I started, not totally comfortable explaining to a woman of her age about the increasing belief in those early years of virology, that the abnormalities of the cells of the cervix registered by the pap smears were in fact the result of some sexually transmitted agent.

Her smile turned into a chuckle when she noticed my obvious embarrassment. “We are not always as we appear,” she said, the merriment evident on her face. “We write our own myths, then wear them, you know… Doctors no less than their patients.” I suppose I must have looked puzzled, because she sat back in her chair as if she were settling in to tell me a story. “Both you and I are Matryoshka dolls, and we only unveil the deeper ones when and if it serves our purposes.” She softened the severity of her latest array of smiles. “You are only looking at one of the dolls –the one you expect to see.”

I smiled the tolerant doctor-patient smile, and started to say something, but she waived it away with a flick of her hand.

“You didn’t ask me much about my sexual history, did you?” I think I blushed and she immediately seized upon it. “Too embarrassing, right? And yet had I been twenty or so, you would have jumped on it immediately when I told you I wanted a pap smear.” I didn’t have to answer –she had me. “But despite my age, and my failing eyesight, I can still read…” She pretended to look out of the window behind my desk to ease my discomfort, but I could tell she was actually watching me out of the corner of her eyes. “The current thinking is that abnormal pap smears are the result of sexual transmission, I understand. Like a disease.” She risked at direct glance at my face and when she could see the astonishment on it, she left her eyes resting there. “So, how would you get a new sexual disease, I wonder?” She let her words dangle for a moment to tease me. “I suspect there are only two mechanisms –either my partner is dallying in another realm, or I myself have strayed into a new kingdom.”

I tried to keep my mouth from falling open -I loved her words.

“But suppose I knew all this, but was unwilling, or afraid to share that aspect of my story with you because it didn’t conform to what I have always wanted to believe about who I am? And what you wanted to believe…” She stared at me for a while with innocent cow-eyes. “Or, on your side of the curtain, suppose you didn’t want to risk offending me because it would be like talking back to your grandmother. Belittling her. Disrespecting her…” She straightened herself in the chair as if she were about to get up. “So you see we are both trapped in our stories.” A huge smile spread from ear to ear as she rose to her feet. “But we’re only trapped as long as we don’t recognize them as surfaces. Clothes…”

She pointed at the examining room. “Let’s do the pap smear, now. I’m going to be late for my friends,” she said, and then started for the door, as I still sat immobilized in my chair.

“I was a Social Anthropologist in my previous life,” she said, looking back over her shoulder and winking. “Just thought you’d like to meet one of my deeper dolls…”


I’ve never forgotten Ms Debrashen over the years. She taught me to question assumptions. Interrogate them. But it made me wonder just how much I can know about anybody. Some of those deeper layers are inaccessable even to the person from whom I’m trying to obtain a history. So overlayered with hope and retrospectively altered memories, some are forever hidden in the myths they have become. Perhaps for clearly displayed symptoms and signs, my medicine can work. I can treat a prolapsed uterus, or an elevated blood pressure, but in a way, that is almost like mending a sweater, or washing a shirt. It is hard to see the skin they hide beneath. And I am at a disadvantage peering through the murky water in which they stand to find something they’ve dropped or hidden. …

She made me appreciate the words of Hamlet when he repudiates his mother for insinuating he is pretending grief merely to get attention:

Seems, madam? nay, it is, I know not “seems.” ‘Tis not alone my inky cloak, good mother, Nor customary suits of solemn black, Nor windy suspiration of forc’d breath, No, nor the fruitful river in the eye, Nor the dejected havior of the visage, Together with all forms, moods, shapes of grief, That can denote me truly. These indeed seem, For they are actions that a man might play; But I have that within which passes show, These but the trappings and the suits of woe.

The Mystery of Pain

Obstetricians and midwives are, at times, unavoidable witnesses to pain; they wade through it, explain it, try to alleviate it, but never experience it because the physical sensation of pain cannot be transferred to anyone else. It is the one constant attendant in the labour room, the uninvited guest that, welcome or not, arrives early and departs late. It is the ghost in the room, invisible to all but the patient. Unsharable. Unprovable. Indescribable except by metaphor, analogy – it is like something: a drill, a knife, a pressure… We all realize it is there -but there, not here. We do not share in the pain; we have to believe it exists because we are told it does. It is not an objective thing, pain; it is entirely subjective –an owned phenomenon.

In a way, pain has no voice. As Virginia Woolf put it [and here I will use Elaine Scarry’s paraphrase and elsewhere, quotations from her extremely helpful book The Body in Pain]: “Physical pain does not simply resist language but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned.”

It is a cruel proof of the Theory of Mind: although I realize that you may have different thoughts and feelings from what is in my head, I can only guess what they are; I can never know what they are. Scarry again: “For the person whose pain it is, it is effortlessly grasped (that is, even with the most heroic effort it cannot not be grasped); while for the person outside the sufferer’s body, what is “effortless” is not grasping it (it is easy to remain wholly unaware of its existence; even with effort, one may remain in doubt about its existence …).” And indeed, “… if with the best effort of sustained attention one successfully apprehends it, the aversiveness of the ‘it’ one apprehends will only be a shadowy fraction of the actual ‘it’”.

We can only know something of what the other person is feeling if they can verbalize a suitable metaphor that we all can understand. And given the difficulty of descriptions in the setting of ongoing pain, these can be hard to find, let alone verbalize. Pain Clinics will often use aids such as the McGill Pain Questionnaire that suggest words that do other than merely measure intensity: moderate, severe, or number on a scale of ten, for example. So their vocabulary offers a choice of qualitative descriptions as well as quantitative.

But for most of us following a woman in labour, such questionnaires are unhelpful -and except for the vocabulary, almost useless, in fact. We are still left standing on the outside, trying to sense the existence of something we do not apprehend. It is not like Nietzsche calling his pain ‘Dog’ and saying “it is just as faithful, just as obtrusive and shameless, just as entertaining, just as clever as any other dog –and I can scold it and vent my bad mood on it …” For us, the attendants, this is sophistry.

Pain –the verbal reaction to pain, at any rate- seems to have different ways of expression in different languages, different cultures, even different geographical regions. As Scarry notes: “… a particular constellation of sounds or words that make it possible to register alterations in the felt-experience of pain in one language may have no equivalent in a second language.” And yet it is really all about the same thing, and serves to “… confirm the universal sameness of the central problem, a problem that originates much less in the inflexibility of any one language or in the shyness of any one culture than in the utter rigidity of pain itself: its resistance to language is not simply one of its incidental or accidental attributes but is essential to what it is.”

Empathy, which is as close as an outsider can get to the pain experienced, will have to suffice. Or -far better phrased- Shakespeare’s opinion:

A wretched soul, bruised with adversity,

We bid be quiet when we hear it cry;

But were we burdened with like weight of pain,

As much or more we should ourselves complain.

I suppose it is the ‘why’ of some types of pain that is so puzzling. The etymological root of the word itself is poena: punishment. In the end, is that really what it is: nothing more than an  arbitrary abuse meted out by a blind and indifferent Nature?  We may understand the physiology of pain, the biochemical irritants that cause it, the nerve fibers that fire in response; we may even postulate the evolutionary protective purposes it sometimes purports to serve, and yet… And yet we are still left wondering about more than the physical nature of pain. As Scarry says: “… when one speaks about ‘one’s own physical pain’ and about ‘another person’s physical pain,’ one might almost appear to be speaking about two wholly distinct orders of events… Thus pain comes unsharably into our midst as at once that which cannot be denied and that which cannot be confirmed.”

It is a relief to find that I am not the only one who finds these disparate aspects of pain to be numinous -and the ‘why’ of pain as elusive to others as it is to myself. If the only way to describe one’s own pain, as I have already mentioned, is through metaphor, perhaps the only way to understand pain, then, is also through metaphor. Story. Literature.

Nietzsche once again: “Only great pain, the long, slow pain that takes its time… compels us to descend to our ultimate depths… I doubt that such pain makes us “better”; but I know it makes us more profound… In the end, lest what is most important remain unsaid: from such abysses, from such severe sickness, one returns newborn, having shed one’s skin… with merrier senses, with a second dangerous innocence in joy, more childlike and yet a hundred times subtler than one has ever been before.”

I do not understand Pain, but I do not discount it. I will merely rest my discomfort on another of Shakespeare’s observations: that maybe “Pain pays the income of each precious thing.” It’s a start anyway…