‘Fight like a girl’ : Tattoos as identity constructions for women living with illness

In this article, we explore the functions that tattoos worn by women with breast cancer or endometriosis have in constructing identities for the wearer and conceptualise the respective illness. Drawing on previous literature on multimodal communication, tattoos and illness, we analyse a sample of 59 different tattoos for their ideational function in constructing identities. A social semiotic analysis shows that lexemes, images, type fonts and intertextuality work together to construct dominant identities for the women wearing the tattoos: as a fighter or warrior, or as a sufferer. The first, metaphoric, identity shows hybrid gendering and constructs the illness as an adversary, while the identity as sufferer often has religious overtones, particularly for breast cancer tattoos. Subversive identities centre on despair or rationality, and as such constitute an alternative to social imperatives of either staying strong and fighting the illness or accepting one’s fate. We close by discussing in how far the tattoos do justice to the complexity of living with an illness and how our research shows the need to include visual stimuli in medical consultations

Parallel worlds and personified pain: A mixed-methods analysis of pain metaphor use by women with endometriosis.

OBJECTIVES:Endometriosis is a long-term condition in which endometrial-like tissue grows outside of the womb, causing intense chronic pain. Previous work has demonstrated the physical and emotional impact on women who live with endometriosis, and metaphors can play an influential role in communicating the experience of pain, but there exists little understanding of the role and impact of such language for women with endometriosis. DESIGN:A qualitative, semi-structured interview design. METHODS:Conceptual Metaphor Theory (CMT) and Interpretative Phenomenological Analysis (IPA) were utilized in a mixed-methods study to examine the prevalence, types, and meaning of metaphors and metaphor use as a health communication strategy. Twenty-one women aged between 23 and 53 years (mean age 36.1 years) with endometriosis took part in audio-recorded interviews. RESULTS:The women reported experiencing symptoms for an average of 11 years before receiving a formal diagnosis of endometriosis, and the mean age of diagnosis was 27.6 years. Seven distinct conceptual metaphors were identified in 221 metaphorical expressions used across all participants, with most common ones referring to pain as physical properties of elements such as temperature and pressure, physical damage, and an external attacker. IPA revealed three themes pertaining to the feeling of vulnerability and helplessness, pain being incomprehensible, and a drive to manage and conceal pain simultaneously. CONCLUSIONS:This study demonstrates the power of language in facilitating understanding and empathy in the listener, alongside the challenge of communicating endometriosis pain to others. Imagery-based techniques may assist in adaptation to, interpretation, and acceptance of pain to reduce pain-related distress

Clichés as evaluative resources: A socio-cognitive study

In this article, I explore clichés as socio-cognitive resources that enable the expression of attitudinal positioning in interaction. I examine a corpus of 150 clichés collected from a variety of publicly available sources and illustrate their function by exploring how they are used to convey evaluation in institutional meetings. By co-deploying the attitude system of the appraisal framework with socio-cognitive discourse analysis tools, I argue that clichés can be used to provoke evaluation through the socio-cognitive resources they evoke given the shared knowledge contained within them. The findings indicate that the majority of evaluative instances relate to performance or ability of human entities by reference to basic aspects of human experience contained in the socio-cognitive representations evoked. The article also finds that the provoked attitudinal values work in a cumulative way to create a flow of evaluative patterns, which, in turn, contributes to our understanding of the interpersonal function they perform, i.e. persuade, urge action and save face. The paper argues that the co-deployment of both approaches allows the investigation of clichés as resources for covertly expressing evaluation by reference to knowledge shared by the interlocutors

“The bloodiness and horror of it” Intertextuality in metaphorical accounts of endometriosis pain

In this work, I explore pain descriptions by women who live with the life-altering gynaecological disease of endometriosis. This condition causes incapacitating pain, which tends to be dismissed and normalised as part of the female condition (Cumberbatch, 2019). My aim is to explore the general patterns of pain conceptualisation by women with endometriosis and outline how an in-depth examination of salient elements of narrative scenarios may contribute towards providing a comprehensive understanding of the pain experience. I first examine patterns of metaphorical pain collocates from a corpus generated from online forum contributions. Following this, I explore metaphorical scenarios of pain, focusing on stories that reference popular texts or genres from a conceptual integration perspective. I argue that the combination of metaphor analysis of naturally occurring data and conceptual intertextuality and interdiscursivity analysis in the metaphorical scenarios of elicited data constitute a methodological niche that allows a holistic assessment of the pain that can potentially be used in consultations and may help tackle the alarming diagnosis delay of endometriosis, which is currently 7.5 years

Addressing Challenges in Endometriosis Pain Communication Between Patients and Doctors: The Role of Language

Introduction: In the context of the complex medical, social, and economic factors that contribute to endometriosis diagnosis delay and its consequent impact on quality of life, this report focuses on patient-practitioner pain communication and examines the role of language in doctor-patient communication. Our study explored what patients and doctors consider challenging and effective in endometriosis pain communication. It further examined what commonly used metaphors by patients could be suggestive, or not, of endometriosis to doctors. Method: A United Kingdom-based qualitative (open-ended question) survey with women with endometriosis (n131) and semi-structured telephone interviews with general practitioners (GPs) (n11). Survey and interview data were analyzed thematically. Results: Both women and GPs reported the Numeric Rating Scale (NRS) to be insufficient as a standalone tool for communicating endometriosis related pain. Both also found descriptions of the quality, location, and impact on daily life of pain to more effective means of communicating pain symptoms. When presented with common metaphorical expressions surveyed women used to describe their pain, not all GPs recognized such metaphors as indicative of possible endometriosis. Further, some GPs reported some of the expressions to be indicative of other pathologies. Conclusion: Findings reveal the importance of language in pain communication and the need for additional tools to help women and doctors find the most effective way to communicate the experience and elicit appropriate investigative care. They also show the need for further investigation into how metaphor can be effectively used to improve patient-practitioner communication of endometriosis related pain

Visual reconstructions of endometriosis pain: an interdisciplinary visual methodology for illness representation

Objectives Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside of the womb, causing severe chronic pain. Research demonstrates the physical, emotional and quality of life impact on people with endometriosis, but pain is reportedly difficult to communicate, resulting in lengthier diagnosis. This work aimed to gain insight into the value of imagery production as a pain communication strategy through a novel synergy of psychological and linguistic/socio-semiotic approaches. Design A qualitative, multimodal, participant-generated imagery study. Methods Interpretative phenomenological analysis (IPA) and conceptual metaphor and metonymy analysis were utilized to examine visual representations of endometriosis pain. Data were collected in two focus groups with four and six women, respectively; all with a diagnosis of endometriosis, aged 25–40 years old (M = 34.5, SD = 4.2) and a mean diagnosis delay of 8.4 years (SD = 3.6). Results The overarching theme across visual representations was ‘Pain as Physical Violence’ with ‘colour as emotional representation’, ‘texture as sensory qualities’ and ‘materials as sensation’ as sub-themes. These are realized through metaphorical and metonymical relations in both the visual representations as well as the accompanying linguistic representation of the process. Conclusions This study demonstrates the value of a creative mixed-methodologies approach to capture experiential aspects of pain and its impact that are not verbalized in linguistic accounts alone. This can facilitate a deeper understanding of one's pain, acting as a medium for therapeutic adjustment to occur, while facilitating effective and empathic patient–professional conversations surrounding pain

Impressions of lockdown

The project seeks to gain a qualitative understanding of experiences of the current Covid-19 lockdown circumstances in the UK population through an examination of language choices construing experience. The data were collected via a narrative survey which allows an outlet for people's experiences, feelings and emotions. Analytical tools include discourse analysis, Interpretative Phenomenological analysis and corpus linguistic analysis. These will allow for an in-depth understanding of lived experiences of lockdown as construed by language choices. Implications for public health communication will be drawn from the study

“It reminds me that I should stop for the little moments”: Exploring emotions in experiences of UK Covid-19 lockdown.

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. Eighty-eight responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions

A COM-B and Theoretical Domains Framework mapping of the barriers and facilitators to effective communication and help-seeking among people with, or seeking a diagnosis of, endometriosis

Endometriosis is a chronic condition in which tissue resembling the endometrium grows outside the womb, causing severe chronic pain. People with endometriosis report difficulty in help-seeking and communicating with healthcare professionals, contributing to diagnosis delays and ineffective management. The present study aimed to identify barriers and facilitators to effective communication using the Theoretical Domains Framework (TDF) and COM-B model to inform behavior change intervention development. This study was a qualitative semi-structured interview and open-ended survey design. Thematic Analysis was utilized to identify barriers and facilitators to effective communication which were mapped to the TDF and COM-B model. Four women aged 25 to 44 with a formal diagnosis of endometriosis participated in interviews. Thirty-three participants, aged 20–48 years, participated in the online survey, 21 of whom had a diagnosis of endometriosis (12 were currently seeking diagnosis). Five COM-B domains were identified: reflective motivation, social and physical opportunity, physical and psychological capability. Ten TDF domains were reflected in concerns surrounding dismissal, disempowerment, social norms, beliefs about consequences, cognitive resources, reinforcement, and environmental context and resources, among others. This is the first study to identify barriers and facilitators of effective communication and help-seeking in light of established behavioral change theory and frameworks for comprehensive intervention design. This provides a comprehensive explanation of challenges in help-seeking for endometriosis and represents the first step in the development of complex interventions to improve help-seeking and communication for people with endometriosis. Interventions targeting salient barriers will have greater potential to change behavior and improve outcomes

'I feel like I am being stabbed by a thousand tiny men’: The challenges of communicating endometriosis pain

Endometriosis, as a widespread gynecological condition, affects an estimated 1 in 10 women and yet has a worldwide average diagnosis length of 7.5 years. Causing incapacitating pain, among other associated manifestations, the condition severely impacts on women’s lives. This article uses online survey data to investigate how pre-diagnosis endometriosis pain is conceptualized and articulated in order to explore communication challenges reported in early consultations that can potentially be seen to play a role in diagnosis delay. The findings of this study indicate that women feel that they do not have the appropriate tools to describe their pain and, in many instances, feel dismissed therefore prolonging diagnosis. The article finds that the majority of the pain descriptors identified use elaborate metaphorical scenarios to convey the intensity of the pain and concludes with some reflections on the issue of metaphorical language in endometriosis pain communication practices while calling for interdisciplinary work in order to devise appropriate tools for endometriosis pain communication