Experiencing Metaphor: A Medieval Headache

Experiencing Metaphor: A Medieval Headache  by Jamie McKinstry, Durham University, was first published in Volume 6.1 of the open access medical humanities journal Hektoen International.

“Metaphors have been used extensively in medicine to describe patients, illustrate diseases, and educate students.1 By comparing unlike things that have something in common, they enhance communication in education, science, and clinical medicine.2 Not restricted to the twentieth and twenty-first centuries, their use dates back to areas such as rhetoric and the “age of medical humanism.”3 Yet their didactic and emotive effectiveness can also be identified in the Middle Ages, particularly in the writings of John of Salisbury (c.1120-c.1180), who was influenced by earlier philosophers such as Plato, Aristotle, Hippocrates, Galen and Avicenna.4 The use of metaphor in teaching and explaining medicine and its challenges has therefore a well-established history.

A metaphor is effective when it establishes a credible connection with the person for whom it was created. Such connection was often notably absent in the Middle Ages, when the role of the individual patients was often minimized, despite their obvious importance in the development of a diagnostic medical theory. A case in point is the scale of pain developed by Pietro d’Abano at the University of Padua in the late thirteenth and early fourteenth centuries.5 This presumably was developed with the aid of patients, with the purpose of forming an accurate guide to the severity and quality of the pain suffered so that a diagnosis could be made, followed by treatment. Pain was graded in a manner equivalent to the modern ranges of “zero to ten”, and the metaphors chosen ranged from “stabbing” (pungitivus) to “piercing” (perforativus) and the dramatic “crushing” (contritivus). But as Fernando Salmón has observed, once the theory was developed, the voices of subsequent patients seem to fade.6 The scale, a product of medicine’s negotiation with the academia at Padua, offered no latitude for including symptoms absent from it (there is no term for a burning pain, for example), requiring instead choosing the most appropriate word or metaphor from the scale despite it being only approximate. Can it be, therefore, that metaphor could also distance both physicians and patients from symptoms in the Middle Ages?”

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