Are Metaphors Key To Understanding Women’s Pain?

Photographed by Anna Jay
There is an unforgettable line in Diane Hoffmann and Anita Tarzian’s 2001 study, "The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain." It reads: "Women are more likely than men to be under-treated or inappropriately diagnosed and treated for their pain." 
Twenty years later, sadly, this is still the case. The gender pain gap has fed into the gender health gap, which sees conditions affecting women and people with wombs go under-diagnosed and underfunded. Far from improving, the situation seems to be getting worse. 
Just last month, the All-Party Parliamentary Group (APPG) on endometriosis released data showing that it now takes, on average, eight years to be diagnosed with the condition. 
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However, new research from two academics at Manchester Metropolitan University may have a solution. Dr Stella Bullo, a linguist, and Dr Jasmine Hearn, a psychologist, joined forces to investigate the language being used by women to describe their pain. 
They interviewed 21 women aged between 23 and 53 who suffer from endometriosis and found that all of them used powerful metaphors to describe their pain. They said things like "it feels like my womb is going to explode" and likened their pain to "a burning golf ball". One woman said that the experience of endometriosis was like having "a machine stuck inside" her. 

It feels like somebody putting barbed wire through your belly button [and] around your pelvis and they're twisting it and pulling it and all your insides are just being squeezed and sort of pushed and pulled and everything is just being twisted. And then they set fire to the barbed wire and it starts getting hot and everything's just being squished inside you basically.

JO

It's as if somebody's driven a knife into my side, or, hammered or screwed something in and it just gets tight and I have to wait for it to pass.

Sue
Metaphors, as George Lakoff and Mark Johnson wrote in Metaphors We Live By, "are capable of creating new understandings and, therefore, new realities." The essence of this sort of language, they also said, is that it enables us to "understand and experience one kind of thing in terms of another."
The work done by Dr Bullo (who herself has endometriosis) and Dr Hearn may, then, go some way to bridging women’s pain gap. They found that women are trying to explain how much pain they are in and that what might sound like an exaggeration is actually an attempt to describe the indescribable, to express the agony they are experiencing in a part of their body that they cannot see or touch because it is buried deep inside them.
The two women academics concluded: "This language was often an attempt to emphasise the urgency of pain and provoke emotional responses, care provision, empathy, and understanding from the listener (usually a doctor or healthcare worker)." 
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This is the first study of its kind and Dr Bullo and Dr Hearn acknowledge that more research is needed but they believe that understanding how women are trying to communicate, express and explain their pain could go some way towards making sure they actually get the treatment they need in a timely fashion. 
The suffering experienced by women with endometriosis has been described by Dr Mathew Leonardi as similar to the impact that having cancer has on a patient's quality of life. However, Dr Bullo and Dr Hearn believe that "if health professionals learned to understand the language used by women it could speed up what is typically a very long diagnosis time for endometriosis" and alleviate some of this suffering. As a first step, they’d like to see doctors and health practitioners acknowledge such expressions and then "explore them further in consultations to better understand women’s experiences of endometriosis pain."
At the moment, this research has only looked at endometriosis pain but the results could be applied to women’s pain more broadly. When it comes to the gender pain gap, there can be no doubt that men and women are treated differently. One study, for instance, found that women in the emergency department who report having acute pain are less likely to be given opioid painkillers (the most effective type of painkiller) than men. Another study, conducted in 2014, found that once in A&E, women waited significantly longer to see a doctor and were less often classified as an urgent case. If women were really, truly listened to, perhaps all of this would change. 

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