Agree so much. I would add, from what I have studied of psychology/psychoanalysis, that the brain preferentially draws on available material rather than absolute invention, however, the psyche Oren chooses material in which it has some deep investment or pressure to work through. Intense preoccupations may be worked through with fantasy as well as reality. Or should I say, there is not always a clear line between fantasy and reality when it comes to working through trauma.
Loio, I like what you did there with the tools and the mouth. That is a great example of how some very intense true material can work its way into a story.
The earlier topic has a long discussion of the burning skull painting, where someone here also brought out his comment about "she had a mouth on her" in connection.
The experts did a trauma analysis on her jawbone. It's possible that he had suppressed fury against her for saying things he didn't like hearing, and that it erupted and targets that part of her physical body to silence her.