Mind your language!


“Words are pale shadows of forgotten names. As names have power, words have power. Words can light fires in the minds of men. Words can wring tears from the hardest hearts.”
― Patrick Rothfuss, The Name of the Wind

So much has been written about language, and I am not a linguist. I am, however, often accused of being pedantic because I like to use words with precision.

In the world of pain rehabilitation/management/treatment/care (see what I did there?!) certain words seem to spark a huge debate. Words like “pain”, “nociception”, “suffering”, “harm”, “avoidance”, “catastrophising” all get a regular hammering in online discussions. Less frequently, words like “guru”, “expert”, “master”, “authority”, “sage” reach the discussion boards and in the same way as “pain”, elicit an almost visceral response.

Before I begin commenting in earnest, I want to preface this piece by making it absolutely clear that I am not commenting on any particular person, organisation, group, business, or endeavour. Please read the whole piece thoroughly before commenting!

I’m not an expert, authority, sage, master or guru. I have years of experience and lots of learning, I’ve studied a lot, I’ve worked with lots of people living with pain, and I’ve worked across a wide range of settings – but they’re all in NZ. I work in an academic institution. I teach postgraduate pain and pain management from a certain perspective. I encourage my students and readers of this blog, as I do all the people I’ve tried to help, to always, always read and be critical of what I say.

I don’t know whether it’s part of growing up in the 1970’s, or it’s the religious upbringing I had, or whether it’s a New Zealand characteristic, but self promotion and the idea that I’m “more important” or more authoritative than anyone else is anathema to me. It’s probably why I give information away, and why I’m not a business owner.  Whatever the case I really dislike the idea of guruism. As a concept. As it is applied to healthcare.

When I think of the word guru, I think of someone who believes he or she knows more than normal people, someone who wants (or has) followers (disciples). It smacks of a lack of acknowledging that the more we know the more questions we have and the less we feel we actually know. The word puts the person on a pedestal.

Some people have been my gurus. People I’ve admired, wanted to emulate, who have influenced the way I think about things. I’ve put those people in a position of influence over me. I need to remind myself to be critical, to think independently, to hold different opinions if I’ve thought about the things they say. That’s not easy to do – highly charismatic people are great at influencing me, and in a field of practice where there is great uncertainty, it’s tempting to grasp what looks like an appealing concept and run with it. At this point I’m reminded of the quote: “For every problem there is an answer that is clear, simple, and wrong” (HL Mencken).

What strikes me is that guru is a term derived from Hindi (Sanskrit, actually) and according to Wikipedia and a few other etymology references, was a term accorded to “one who dispels the darkness and takes towards light, traditionally a reverential figure to the student, with the guru serving as a “counselor, who helps mold values, shares experiential knowledge as much as literal knowledge, an exemplar in life, an inspirational source and who helps in the spiritual evolution of a student.” (Thanks Wikipedia) Wikipedia goes on to say “the term is sometimes used in a derogatory way to refer to individuals who have allegedly exploited their followers’ naiveté.”

I see a couple of risks associated with identifying or being identified as a guru. The first is that we believe it ourselves. That we have the knowledge to “dispel the darkness”, and the right to “mould values… an exemplar, an inspirational source”. This can tempt us to be less aware of our own biases, to accept them or make exceptions for them. It can encourage us to think our view is “right”, to stop constantly asking ourselves those difficult questions.

The second is that our followers may do the same. Follow what we say without thinking independently. To read what we write without reading others. To forget to cross-check our work. Add to this the reality that most people who are adopted as gurus have years of experience and knowledge that underpins their superficially-simple (or should that be deceptively simple?) and readily digested approach. This experience and knowledge often can’t be replicated, or isn’t even explicit to adherents – so rather than a multi-layered and complex emergence of understanding, followers may simply pick and choose sound-bites, and apply them liberally and without the nuances the originator brought to the concept. Tell me you haven’t see this in pain rehabilitation over the years! And then, of course, comes the fighty talk and internet wars and tribalism we’ve seen so often.

The third problem or risk is that the people we try to help, those with pain, can be vulnerable to the hype. They too can believe that they “should” respond to the simple message, and if their own experience doesn’t accord with the “wisdom” of the guru, they can begin to blame themselves – and at times, be blamed by adherents.

There are undoubtedly other risks, but these are my key concerns about anyone being viewed as an expert or guru.

Every word begins with a few meanings within a certain context. Then the words grow a life of their own. Words are sociocultural – they have power despite “sticks and stones will break my bones but words with never harm me”. Words continue to acquire meaning and subtle use-changes over time. People in different parts of the world, of different backgrounds, at different ages and in different settings will use words quite differently. For me, guru is a word I really dislike, but for others it’s a legitimate term to describe themselves and their word. The thing is, whether we like it or not, the word has both good and not-so-good associations for people. And both matter. Guru might speak of “aha! here’s someone who can help”, or “a group I feel comfortable with – my tribe”, or “expert with lots of knowledge”. But it might also just as equally speak of hype, inflated ego, a need to be worshiped and collect adherents, blind allegiance.

Along with thinking hard about how I want to represent myself while writing this blog, I’ve also been pondering a list of various ways to describe pain and the neurobiological and experiential apparatus underpinning the experience.

Defining pain is incredibly difficult – while we’ve all experienced pain, we’ve never been able to share the “what it is like” to experience pain. Our personal experience of pain is within contexts we’re familiar with – for many people it really is a short-term experience, a warning of potential damage or threat to bodily integrity (and social, too), a symptom of “something else” that must be attended to, and something that will be resolved once that “something” is fixed. For others it is a stigmatising experience.

For some it’s an experience used to represent going through an ordeal and coming out the other side having learned something. For still others it’s a deeply scarring, personally disruptive experience that isolates and depresses and angers. For some it’s a mystery to be solved. For others it’s a neutral, uncomfortable yes but not distressing experience because it’s familiar and no longer understood to be representing anything much.

Most of these contextual experiences reflect appraisals of the ineffable experience, rather than distinguishing this experience from other experiences such as joy, hunger, fatigue. And I think it’s useful to remember the purpose of a definition – in the case of IASP pain definition, it has allowed researchers, clinicians, and people living with pain to acknowledge that nociception (and associated processes that contribute to our experience of pain) is not the same as pain. And that behaviours we do when we experience pain are also not pain. And that how we view or appraise our experience influences both the experience itself, and our response to it. And FWIW I use the term “it” as a placeholder for “the experience we know as pain”. 

Given that words are fluid, why on earth am I trying to argue the toss about how I view words like “guru” and “pain”? Because in this context, where people are talking with one another, clarity of meaning aids us to understand the concept we’re discussing. And because this is a particular context. And this is my opportunity to express my opinion. Readers will undoubtedly interpret what I’ve written in their own way. What I would ask is that people don’t interpret this post as having intentions I don’t have. After all, as the author, I’m probably the only person who can determine my intentions for what I write.


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4 comments

  1. Bronnie, I think your contribution to this field of knowledge has been enormous. In your writing you echo the words of John Keats (1795-1821): “Nothing ever becomes real ’til it is experienced – even a proverb is no proverb to you ’til your life has illustrated it.”

    1. You’re very kind John, but I’m very aware that my blog isn’t academic – the space I fit into is the “knowledge translation” space where the “so what” questions and the “how do I” questions and all the messy day to day practice problems make directly applying research so incredibly difficult.

  2. Bronnie
    I think your post is so appropriate in a time when there are so many people wanting to make a buck out of being the “guru” to follow and I think there is so mush out there it is easy to pick up a line here or there and take new perhaps incomplete meanings and use them.

    1. Thank you Lesley, it’s weird how strongly people feel about the word – either it’s very unhelpful (my view) or it’s absolutely fine, no worries! No shades in between. Deep knowledge is the thing I think we should embrace.

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