Use of metaphors when treating unexplained medical symptoms

Abstract

The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job (she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.

Keywords: Alexithymia; Burning mouth syndrome; Idioms of distress; Menopause; Metaphors; Pain

Core Tip: Burning mouth syndrome (BMS) is a medically unexplained pain condition of complex aetiology. It is particularly prevalent in menopausal and post-menopausal women. Like many complex disorders, BMS has many treatments, but none work well. The use of metaphor in psychotherapy may aid recovery by increasing patients’ awareness of connections among mouth sensations, taboo emotions, and potential triggers in their personal and social environment.