POLYPHONYJournal of the Irish Association of Creative Arts Therapists
Poetry Visuals Gallery

A Language of Pain: Visual Mark-Making and Blackout Poetry

Published on Jan 25, 2020 by Niamh McConaghy

The Visualisation of Pain exhibition opened its doors at the University of Atypical Gallery, Belfast on the 28th November 2019, hosting a range of expressive visual art and poetry.

You never know from one day to the next

These artworks, and the process of creating these artworks, aimed to explore to what extent the communication of chronic pain experience could be visually and comprehensively achieved, via a combination of Blackout Poetry (selected words surrounded by blacked out words in an existing text) and visual mark-making.

This exhibition is a part of a wider pain communication research study that aims to develop such specific arts-based methods, to achieve more comprehensive and accessible understanding of the psychosocial side of pain experience, within both clinical and social contexts. This combination of arts-based methods has not yet been explored, either sparsely or extensively within arts and health research, in specific relation to chronic pain communication and understanding.

It’s not so much the pain, but the emotion.

As a biopsychosocial experience, chronic pain can affect a wide range of factors in daily life and reciprocally, can be affected by daily life. This complex relationship between life experience and pain experience is often attempted to be understood through questionnaires and numerically rated scales. However, as an extremely subjective experience these objective measurements are often under attack, presenting as resources that are not extensive or personal enough to fully understand the complexity of the daily balance in life between feeling and experience.

An alternative, and arguably one of the most accessible forms of chronic pain communication is the use of verbal metaphors. However, the prominent psychosocial side of chronic pain experience is often omitted when metaphorical phrases are used e.g. “it feels like a stabbing pain”. A comprehensive methodology is needed that enables both accurate communication and understanding, and which is accessible to a wide range of abilities and experiences.

visualisation of pain - p1
Participant 1. (2019) The Visualisation of Pain. Belfast: University of Atypical.

I just needed to use my hands

Two workshops were conducted with seven participants at the University of Atypical gallery, Belfast, prior to The Visualisation of Pain exhibition. These workshops provided a comfortable space to practice the proposed methods, which the participants would later use at home during a two-week period of visual journaling. The mark-making portion of this combination of methods involved (at this workshop) viewing an artwork and creating a quick and visual response to it immediately.

    Participant 4, 7 & 3. (2019) The Visualisation of Pain. Belfast: University of Atypical.

This could have been how the artwork made the participant feel, what they felt the artist was trying to communicate or otherwise. The resultant marks varied with both smooth and jagged lines, coloured spaces and dashes.

The Blackout Poetry portion of the workshop involved selecting words or phrases from the supporting text of the artwork in the previously used visual journal.


words of painThe participants were asked to choose words or phrases from the selected texts, while both reflecting on the mark that they had just made and of their interpretation of the original piece of selected art. Blackout Poetry originated in the 17th century, as a playful way to publish puns within newspapers (Anon, 2019). It is a process of selecting certain words or phrases of an existing text to create a type of visual poem. This activity’s accessibility was extremely appealing for this study, as a method that is suitable for a wide range of reading abilities and the promotion of literary confidence. Blackout Poetry techniques do not require focused reading of an existing text, but rather offers the choice to ‘skim’ read the text in selecting or highlighting words that most appeal to the person or to the context. No pre-determination is required for word selection, which can often make the literary outcome of this activity a more abstract depiction of what is attempted to be evoked.

Everyone sees it differently

Upon completion of this workshop, participants were instructed to create a visual journal at home over a two-week period. They were asked to consider their total pain experience at the end of each day (inclusive of psychosocial factors) and create a quick, spontaneous and visual mark in reflection of it. By doing so, each participant had a basis for inspiration in which to complete a responsive Blackout Poem. Fourteen publicly accessible texts were given to each participant to create the responsive poem, which was to be a reflection and expression of both their pain experience that day and of their created visual mark.

p7 work
 Participant 7  (2019) The Visualisation of Pain. Belfast: University of Atypical.

Somewhere in the middle

This culmination of methods is rooted in symbol formation and furthermore, the idea of an artist titling his/her created artwork. The most common reason for titling an artwork is to explain or guide a viewer towards the artists interpretation or concept. Without it, the viewers interpretation may not follow the artists wishes or guidelines in how to engage with the artwork and therefore, the work may be misinterpreted or misunderstood (providing the artists’ objective). This hazard of viewer misinterpretation is due to the nature of subjectivity in art. When we view an artwork, our interpretations are placed within our experiences and memories – which makes them unique and personal. The same can be said for visual art in the context of pain communication.

For example, during the workshop phases of this study it was found that the shape of a circle for some people is a form of continuity and comfort, whilst to others it represented claustrophobia or a sense of being negatively bound. Our sense of identity is consistently changing because it is largely shaped by experience, and experience in life occurs daily. Resultantly, our daily interpretation of the circle can constantly alter too. Like many pain communication studies that use visual art, it is often essential for the participant to further explain a chosen or created image in order to avoid viewer misinterpretation and therefore, the understanding of the pain experience that is being communicated. The daily and changing code (the image) needs to be unlocked by verbal explanation, however this explanation is often inaccessible due to a multitude of reasons such as fear, stigma, lack of medical vocabulary etc.

Once a symbol or representation changes from an internal thought to an external concept in which to be understood, it transitions into something to be viewed through a new lens and externally understood. This is exemplified in Segal’s view in that ‘it could be asked what is meant when we speak of people being well in touch with their unconscious’ (Segal, 1957, p. 396).

The pressure to attach words to pain experience or visual representations of pain experience can seem daunting and pressured. Within this combination of methods, Blackout Poetry eliminates this pressure (to an extent) to express the truth of the total pain experience, by reapplying the focus to translate the communicated visual mark. In this study, the marks that were made generally accumulated as a recognized shape or abstract line drawing. In response, the participants selected words or phrases from the texts that they were drawn to (in relation to both the drawing and the pain experience that day). Upon discussion of this process and reflection of each individual’s journal, it appeared that for some participants, the drawings at the beginning of the process acted as a platform to help ease and inspire them into feeling comfortable in finding the language of their total experience, through poetry. While for others, the two methods complimented one another – the language aspect facilitating what was missing in the visual representation and vice versa.

pain visualisation
Mills, S.  (2019) The Visualisation of Pain. Belfast: University of Atypical.

What can most likely be deducted from this study is that every person who suffers with chronic pain has an extremely individualistic and unique experience. This naturally indicates that in order to communicate pain experience accurately and feel that it has been communicated comprehensively, a tailored method of communication is necessary. While most participants felt that both their visual and written journal entries complimented the other, the majority of the participants had a preference between the two methods within both process and outcome.

It was the group coming together as a group

Once extensive discussion and reflection of the journals had been completed, participants were invited to create artworks and titles for a public exhibition within the University of Atypical gallery. The participants were asked to use their visual and written entries as inspiration to create one overall reflective artwork of their pain experience of over the two-week period. They may have chosen to focus upon recurrent shapes, colours, forms, lines or words from their journals to include within their ‘final piece’. The purpose of this acted as a further self-reflective opportunity for the participants to understand their visual and written references, and to consciously acknowledge what they believed to be the most reflective and therefore, potentially communicative language in describing their experience.

The participants were invited to create these artworks using a range of materials and surfaces, including the walls of the gallery. Participants essentially transported a private activity into a communal setting for public viewing. From internal thoughts, to journal entries, to large installation pieces, the physical articulation of the work changed during the course of transcribing their words and images from notebooks to gallery walls.

Mills, S.  (2019) The Visualisation of Pain. Belfast: University of Atypical.

The outcomes were expressive and unique pieces of art that both represented the experiences within visual journals, but on a more powerful scale. This was not only because of the enlarged size of the represented work, but because of the physical movements evoked during the gallery workshop. Participants engaged their bodies in creating their artworks with large gestures and splattering paint that depicted pain, but also the courage to make explicit their determination and stamina.

The gallery workshop also allowed participants to reflectively consider their previously selected words. Conscious thought and reasoning enabled a clarified selection of words, which created an awareness in the group of personal expression and the articulation of pain experiences. One participant commented on developing this sense of pain experience awareness, ‘I think it might help me to realise that I have limitations and watch out for triggers, and build up my awareness’ (Participant interview). It further highlighted the obvious individuation of pain experience. It is the ‘identifying, recognizing, and responding to symbolism that engages the making of visuospatial and cognitive-emotive based connections’ (Hass-Cohen & Clyde Findlay, 2015) that enabled these final artworks to be the truest reflection of pain experience possible.

At interview stage, the engagement with this exhibition was highlighted as an integral part of the methodology, with many participants commenting upon the therapeutic nature of these methods.

There was something very therapeutic about…not having to worry about what [the art] looked like in the end, because finished pieces tend to be what everybody wants and I was trying to throw that out of my head. [It} didn’t matter what it looked like—it’s about the process.
(Participant interview, 2019)

image of pain
Mills, S.  (2019) The Visualisation of Pain. Belfast: University of Atypical.

Pain is such a blocker

Discussion about specific visual journal entries also brought to light a variation of pain vocabulary for some, as individuals began to describe specific days of pain experience in relation to a poetic description and the visual expression as one entity, “Yes, there’s no end to it. Sometimes pain feels like a spiral” (Participant interview, 2019). At the beginning of the interview, the majority of participants described their pain experience using common pain metaphors such as, “my chest felt as if somebody was leaning on me” (Participant interview, 2019). It was particularly interesting at later stages of the interview sessions that this communication transitioned into a visual and more literary descriptor, when participants were asked about their pain experience in relation to specific journal entries, ‘I think the shapes were coming to me but also boxing up pain…pain is such a blocker’ (Participant interview, 2019).

This study has helped to strengthen the argument of the necessity for individualised methods of pain communication, in addressing the wider understanding of the psychosocial needs of a person experiencing chronic pain. While this study focused on pain communication specifically, the therapeutic effects of engagement with these methods are prominent. For some participants, a sense of purpose was alluded to, “I feel as though I’m doing something worthwhile. Just having a purpose. It’s purposeful” (Participant interview, 2019). While for others, it created an awareness of pain triggers and capability. The social impact of the conducted workshops also played an important role within the group, which enabled a sense of positivity and optimism, “we all [have] a connection, without anyone mentioning who has a sore bit where” (Participant interview, 2019). Whereas these factors were not a dominant aim of this study, they strengthen the discussion of arts and health research in relation to the therapeutic benefits of social inclusion, creative connections and camaraderie.


mills s
Mills, S.  (2019) The Visualisation of Pain. Belfast: University of Atypical.

This study has initiated further intrigue, as to what extent, socially immersive environments may correlate with relational outcomes within arts-based research. The final question proposed to participants, which also concluded this study, was what benefits might occur if an individual were to continue with the journaling process in relation to personal/public usage (i.e. personal use for therapeutic gain, public use for the communication of the chronic pain experience). The last participant to be interviewed commented upon their uncertainty about the effects of the study’s purpose, but also shared a sense of therapeutic optimism in persisting to engage with the process. Further studies and analysis will seek to understand the outcomes and process of these methods, more intricately and comprehensively,

I feel as though I’m doing something worthwhile. I loved being part of your project. Just having a purpose. It is purposeful. But for what purpose yet? I don’t know. That is to come. (Participant interview, 2019)

group shot
McKenna D..  (2019) The Visualisation of Pain. Belfast: University of Atypical.

Anon. (2019) The History of Blackout Poetry. Offbeat Poetry. 6th June. Available from: https://medium.com/offbeat-poetry/the-history-of-blackout-poetry-ca8985f04c35 [Accessed: December 2019].
Hass-Cohen, N.H.C. & Clyde Findlay, J.C.F. (2015) Art Therapy and the Neuroscience of Relationships, Creativity and Resiliency: Skills and Practices. New York: W.W. Norton & Company, Inc.
McKenna, D. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 1. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 4. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 7. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 3. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 2. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Participant 6. (2019) The Visualisation of Pain. Belfast: University of Atypical.
Segal, H. (1957). Notes on Symbol Formation. International Journal of Pyscho-Analysis, 38:391-397
Simon Mills. (2019) The Visualisation of Pain. Belfast: University of Atypical.


Niamh McConaghy Niamh McConaghy is a PhD Researcher at Ulster University, Northern Ireland. She has an MFA degree in Contemporary Art Practice from the University of Edinburgh and a BA hons degree in Fine Art from Ulster University. Her research interests focus predominantly on the use of arts-based methods used within health communication research. She maintains a painting practice and holds a studio in County Armagh, Northern Ireland.