The Machine Days Are Over: Medicine Metaphors and the Psychiatric Resident

Shalev, Daniel

doi:10.1007/s40596-017-0760-y

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…As a result of their training and clinical practice, many psychiatrists are often highly skilled in metaphorical communication and reasoning (Shalev, 2018). Psychiatrists are also 6…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Models: Reconciling Neurobiology, Metaphor, and Uncertainty

Syed,

Jacob

2023

Preprint

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Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neuroessentialist models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. Despite calls for explanatory pluralism as a philosophical structure for psychiatry, neurobiology continues to hold an elevated status among psychiatrists and the public alike. New approaches are needed to reconcile neurobiological models with the uncertainty of science, clinical practice, and the knottiness of finding language to describe (let alone explain) the experience of mental illness. To address this conceptual gap, we draw upon interdisciplinary sources to examine the meta-cognitive process of explanatory reasoning that clinicians and their patients use to develop models of the mind. We propose a clinical approach to explanatory reasoning based on logical inference, the considered use of metaphor, and the tolerance of uncertainty. Our goal is to bring attention to the possibility that uncertainty, metaphor, and neurobiological models share a common logical framework, and that their reconciliation has the potential to enrich our understanding of mental life and clinical practice.

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“…As a result of their training and clinical practice, many psychiatrists are often highly skilled in metaphorical communication and reasoning (Shalev, 2018). Psychiatrists are also 6…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Models: Reconciling Neurobiology, Metaphor, and Uncertainty

Syed,

Jacob

2023

Preprint

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“…As a result of their training and clinical practice, many psychiatrists are often highly skilled in metaphorical communication and reasoning ( 136 ). Psychiatrists are also already particularly attuned to the importance of holding uncertainty, engendering not only tolerance but curiosity for their patients through this holding.…”

Section: Conclusion: Neurobiology Metaphor and Uncertaintymentioning

confidence: 99%

Languaging psychopathology: neurobiology and metaphor

Syed,

Jacob

2024

Front. Psychiatry

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Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor’s role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.

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“…George Annas argues that military and market metaphors are inappropriate for health care and recommends the ecology metaphor instead 1 . Marlaine Smith rejects the metaphor of “human being as machine” in favor of “human being as organism.” 2 Daniel Shalev also criticizes machine metaphors, but he endorses journey metaphors 3 . Susan Sontag, even more suspicious of medical tropes, famously denounces the use of all metaphors in medical discourse—especially metaphors used to illustrate the experience of having cancer 4 .…”

Section: Articlementioning

confidence: 99%

Your Father's a Fighter; Your Daughter's a Vegetable: A Critical Analysis of the Use of Metaphor in Clinical Practice

Tate¹

2020

Hastings Center Report

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There are two widespread beliefs about the use of metaphors in clinical medicine. The first is that military metaphors are harmful to patients and should be discouraged in medical practice. The second is that the metaphors of clinical practice can be judged by and standardized in reference to neutral criteria. In this article, I evaluate both these beliefs, exposing their shared flawed logic. This logic underwrites the false empiricist assumptions that metaphorical language and literal language are fundamentally distinct, play separate roles in communication, and therefore can be independently analyzed, systematized, and prescribed. Next, using the resources of ordinary language philosophy, I lay out a theoretical view of medical metaphors that is grounded in metaphor use within clinician‐patient relationships. Finally, drawing on the work of philosopher Max Black, I diagram a practical conceptual framework for clinicians to use when they consider whether a metaphor is appropriate for a specific patient encounter.

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The Machine Days Are Over: Medicine Metaphors and the Psychiatric Resident

Cited by 5 publications

References 8 publications

Psychiatric Models: Reconciling Neurobiology, Metaphor, and Uncertainty

Psychiatric Models: Reconciling Neurobiology, Metaphor, and Uncertainty

Languaging psychopathology: neurobiology and metaphor

Your Father's a Fighter; Your Daughter's a Vegetable: A Critical Analysis of the Use of Metaphor in Clinical Practice

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