Recent Press



Frank, Arthur W., Metaphors of Pain
Literature and Medicine 29, no. 1 (Spring 2011) 182-196

       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 all 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. (continue article)



Rosen, Kayla, Speak, Pain
The Pennsylvania Gazette: Arts, Thursday, February 24, 2011

       “It feels like an elephant sat down on my chest.” “Like a ball of flames charring my stomach lining.” “Like a rat gnawing at my skin.” These are a few patients’ responses to the same question: “Can you describe the pain?”
       It is a notoriously difficult question to answer. The challenge of describing a sensation as internal, as elusive, as pain often stretches our capacity to communicate plainly and demands that we use figurative speech. These lyrical descriptions may point toward a specific diagnosis. An elephant sitting on one’s chest, for example, suggests a heart attack more than does a poker stabbing one between the ribs. (continue article)



DasGupta, Sayantani, Review of The Language of Pain.
Bellevue Literary Review: A journal of humanity and human experience

       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. (continue article)



Epstien, Randi Hutter, Review of The Language of Pain.
The Yale Journal for Humanities in Medicine, Saturday, January 8, 2011

       Diane Ackerman, a best-selling author, once wrote about the dearth of words to describe an odor. We are not equipped with a vocabulary to articulate a stench or a fragrance, for that matter. “Our sense of smell,” she wrote, “can be extraordinarily precise, yet it’s almost impossible to describe how something smells to someone who hasn’t smelled it…. Smell is the mute sense, the one without words. Lacking a vocabulary, we are tongue-tied, groping for words in a sea of inarticulate pleasure and exaltation.”
       The very same thing could be said about pain. And it has. Dr. David Biro, a dermatologist who also earned a PhD in literature from Oxford University, calls his book The Language of Pain. I think he’s being ironic because his tome is really about our lack of language for pain. As Dr. Biro tells us—in great depth and with many literary allusions—we are just as tongue-tied when it comes to communicating pain as we are about expressing scent. I would add that not being able to express pain is a much more serious issue (particularly if you are a patient and hurting) than failing to articulate an aroma. (continue article)



Tait, Raymond C., Metaphor and Meaning in the Experience of Pain.
PsycCRITIQUES, Vol 55(33), 2010

       The experience of pain is an intensely personal, subjective phenomenon, one that David Biro describes as the “quintessential private experience.” This book explores how this intrinsically private experience can be communicated so as to be publicly understood, focusing particularly on the need for metaphor if that understanding is to occur. Indeed, the primary thesis of the book is that metaphor is the foundational element for pain to be mutually understood by an external party that, by definition, is incapable of directly accessing the experience. This volume is enlightening as to the form and function of metaphors used to describe pain. Moreover, the book is rich in its philosophic and literary meditations on pain and metaphor. Biro is to be commended for the acuity and sensitivity of his reflections on the patient’s experience in this thoughtful and richly referenced book. Clinicians, especially those who are sensitive to the plight of patients in pain, will come away from their reading of this book with more insight into the isolating consequences of chronic pain and both the challenge and the importance of communicating effectively with pain sufferers. (continue article)



Preeti N. Malani, The Language of Pain: Finding Words, Compassion, and Relief
JAMA, May 12, 2010—Vol 303, No. 18

       Although language can capture a wide range of human experiences, it simply fails when it comes to pain. This shrewd observation forms the basis for David Biro's new book, The Language of Pain: Finding Words, Compassion, and Relief. Pain is not only an academic interest to Brio but a personal journey. After finishing his medical residency, Biro was diagnosed with a rare blood disorder and underwent bone marrow transplantation for treatment (an experience detailed in his earlier work, One Hundred Days: My Unexpected Journey From Doctor to Patient). In addition to his medical training, Biro holds a PhD in English literature. Despite considerable command of language, he experienced what other patients experience—an inability to express pain in words. Biro writes that pain "literally strangled my vocal cords." He cites Edvard Munch's painting, The Scream, when describing his agony: "Silenced, I felt just like Munch's sufferer: wanting to scream as loudly as I could but unable to make a sound."
       Given his experiences as well as those of others, Biro set out to explore the reasons for pain's inexpressibility and to identify ways to overcome them... (continue article)



Perri Klass, Doctors take long looks at pain, dying
The Washington Post, Tuesday, January 26th, 2010

       Pain and death are the physician's familiars,reminders always of the limits of medical capacity and the parameters of human mortality. The desire to prevent or at least alleviate the pain and to evade or at least postpone death guide medical practice, yet doctors have often been accused of failing to take pain seriously and treat it effectively. And when it comes to taking care of patients at the end of their lives, once again doctors don't always do well, either at discussing the realities with their patients or at administering treatment at that critical juncture.
       It is the need for proper care at the end of life that has given rise to David J. Casarett's specialty: He is a palliative-care specialist and the director of research and education for the University of Pennsylvania's hospice, and so he consults on a range of dying patients. "Last Acts: Discovering Possibility and Opportunity at the End of Life" is his rogues' gallery of last-act stories and his attempt to make sense of the variety of ways in which human beings react to the knowledge that death is near.
       David Biro, author of "The Language of Pain: Finding Words, Compassion, and Relief," sees the subject of pain not only as a physician but also as a patient... (continue article)



Jodie C. Liu, Review of The Language of Pain
Zócalo Public Square, Thursday, February 11, 2010

       Pain is universally felt but poorly articulated. Where doctors may dress it in clinical language and medical terminology, writers and other artists rely on metaphor. The two realms may seem disparate, but in The Language of Pain, David Biro chips away at this division.
       Just as Edvard Munch's iconic "The Scream" could only portray a noiseless cry, there seems a built-in deficiency in language that confines sufferers of pain to silence. But Biro, who teaches and practices dermatology, finds instances where art has made pain more comprehensible. John Donne's militaristic description of illness struck a lasting chord with scientists attempting to understand infection, as germs became for the first time "characterized as enemy 'invaders' that 'attacked' the body." Frida Kahlo expressed pain through portraiture, a technique now found in art therapy programs around the world. And in Hemingway's "The Snows of Mount Kilimanjaro," the protagonist, suffering from gangrene, experienced inner turmoil that deeply resonated with Biro, who survived cancer and felt the isolating effect of illness... (continue article)



Adam Swenson, Review of The Language of Pain
Pain for Philosophers, Thursday, April 1, 2010

       Those interested in learning about pain can profit from David Biro's The Language of Pain: Finding Words, Compassion and Relief. It will probably be the most useful to people with chronic pain and those close to them. At the very least, the vast array of nuanced metaphors and literary sources he canvases can serve as raw material for their attempts to communicate and understand the experience of pain. But I expect that his lucid exploration of the structure of these metaphors will provide important conceptual tools for crafting more systematic and effective narratives. Though the applicability of some of his particular insights may be limited by culture and language.
       Clinicians and scientists should be impressed by the conceptual structure that Biro uncovers in the language many sufferer's use to describe their pains. He succeeds in showing that this metaphorical talk, while necessarily imprecise and often obscure, must be taken seriously. In his wake, the same cannot be said for those who dismiss or deride these ways of talking about pain... (continue article)



Review of The Language of Pain
How to Cope With Pain, Friday, January 15, 2010

       Dr. David Biro is a physician, has a PhD in English literature from Oxford, and has experienced severe pain and illness himself. Drawing on this unique collection of experiences, he has written an interesting book, The Language of Pain.
       When we're in pain, "there's nothing but the pain." Our world can shrink and we focus internally into our bodies. When we try to share our experience of pain, we're often at a loss because language doesn't do justice to our very difficult experience. We can't really communicate what it's like.
       As well, our family and friends have a hard time understanding how bad it can be when we say, "the pain is bad." There's a disconnect between exactly what we experience and the language available to us. This can result in our feeling isolated and misunderstood, and family and friends feeling left out, helpless, or questioning our levels of pain... (continue article)



James, Review of The Language of Pain
Headache and Migraine News, Monday, March 29, 2010

       Dr. Biro has done an excellent job tackling a very difficult topic. He's done his research – everything from the literature of Charles Dickens and and James Joyce to the paintings of Frida Kahlo to the expressions of cancer and migraine patients.
       He's also navigated the very tricky waters of philosophy. It's easy to get lost in the never-ending mazes of philosophy, and perhaps he does get a little off-course when he touches on ultimate questions, such as God and pain. But over all, he does a remarkable job sifting through philosophy and coming up with something very practical.
    That practical thing is a box of tools that you or I can use to express – and understand – our pain better. He introduces us to different types of metaphor – different ways to approach the topic... (continue article)