The burden of illness is important for patients but complex and difficult to describe, let alone measure. A novel instrument is described that, according to preliminary data, measures what in German is termed Leidensdruck--the perceived burden of suffering due to illness. The measure--Pictorial Representation of Illness and Self Measure (PRISM)--takes less than 5 minutes to complete and is unusual in relying only minimally on language. The PRISM is being developed as a research tool and has been used effectively in routine clinical practice. To illustrate the latter application, three case vignettes are presented, demonstrating how the PRISM can enhance the patient's description and understanding of his/her illness and circumstances, facilitate patient-clinician communication, and help to monitor salient changes with treatment.