Essayist Susan Sontag alerted us more than 20 years ago to the way in which clusters of metaphors attach themselves to our discussion of certain diseases, and the influence these metaphors exert on public attitudes to the diseases themselves and to those who experience them. This study of feature articles on five diseases—avian flu, cancer, diabetes, heart disease, and HIV/AIDS—published recently in the New York Times reveals distinct patterns of metaphor usage around each. While the metaphors used in relation to the diseases Sontag studied—cancer and HIV/AIDS—have become less emotive and more positively informative, the sensationalist connotations of the metaphor clusters that have formed around two diseases that were not on the agenda for wide public debate in her time—avian flu and diabetes—are hardly congruent with the serious intent of the articles in which they appeared. By contrast, discussion of heart disease involved very limited use of metaphor. The article ends with a call for journalists and medical professionals to become more aware of the impact of the metaphors they use and to collaborate in developing sets of metaphors that are factually informative and enhance communication between doctors and their patients.
Human beings rely on metaphor as a primary cognitive device for interpreting the world around them. Metaphors figure especially strongly in discourse around health, illness, and medicine. It is not just that patients use metaphors to describe their personal experience of being unwell, or that medical professionals employ metaphor to convey a diagnosis, describe a treatment, or explain the function of an organ to their patients. Metaphor, it is argued, lies at the heart of the process of diagnosis. Moreover, diagnosticians employ competing metaphors in the early stages of diagnosis to speculate on alternative ways of viewing a puzzling set of symptoms. Diagnosis is often defined as a process of ordering and classifying, while metaphor is a device for playing with classifications. The medical systems of different cultures depend on different sets of fundamental metaphors. Modern Western biomedicine is organized around a series of basic metaphors: the body as machine, the body as the site of battle, and the body as a communication system. Traditional Chinese medicine, on the other hand, uses images of flow and blockage, balance and imbalance, and works by analogy with five elements: wood, fire, earth, metal, and water. Psychologists are sometimes able to detect from a patient's own use of metaphor, or inability to use or recognize metaphor, clues to a diagnosis of psychosis or autism. With conditions such as anorexia nervosa, therapists may actually work to modify the dysfunctional metaphors by which patients depict themselves, with the purpose of establishing positive metaphors for envisaging recovery.
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Grand claims were made around thirty years ago for the fundamental role of narrative, on the one hand, and of metaphor, on the other, as instruments by which human beings make sense of experience. Hayden White, Jerome Bruner, Roger Schank, Alasdair MacIntyre, and a host of others asserted that narrative is the principal faculty by which human beings interpret the world ("Storytelling and understanding are functionally the same thing" [Schank 1990, 24]), while another team of scholars, under the captaincy of George Lakoff and Mark Johnson, and including Andrew Ortony, Raymond W. Gibbs, and others, made similar claims for metaphor, insisting that human beings are primarily metaphor-making animals ("Our ordinary conceptual system in terms of which we both think and act is fundamentally metaphorical in nature" [Lakoff and Johnson 1980, 3]). Over the last three decades, the tools forged in the workshops of narrative studies and metaphor studies have been taken up by scholars in a wide range of disciplines, from economics, to law, to medicine, to investigate the role of either narrative or metaphor-rarely both together-in the conceptual framing and everyday practice of these disciplines (Hanne 1999). In the case of medicine, it is the narrative perspective that has predominated. The crucial role of narrative in the field of health, sickness, and medical treatment has been amply demonstrated by scholars and practitioners in the narrative medicine movement. Major discussion threads in this movement include patient narratives about the experience of sickness; doctor-patient communication as consisting primarily of an exchange of narratives; acquisition of "narrative competence" in the training of medical professionals; the place of narrative in medical ethics; the narratives by which medical professionals process their personal expe
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