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

Abstract

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.

Understanding Youth’s Lived Experience of Anxiety through Metaphors: A Qualitative, Arts-Based Study

“…. each is contextual" [36,37]. The literature supports the use of metaphors as a communication tool for clinicians to enhance patients' comprehensibility [38], and inversely for patients to meaningfully express themselves [36].…”

An Evolutionary Concept Analysis of the “Fighter” in the Intensive Care Unit

“…As a patient embodies the role of a fighter, those conscious throughout their critical illness may report less pain for fear of seeming not brave or less tough, which may also be influenced by culture. 7 Frequent pain assessments need to be performed to minimize physical pain and suffering, and pain needs to be treated diligently and timely. 35 The interdisciplinary medical team, with the help of palliative care specialists, needs to frequently assess for depression, anxiety, and signs of existential distress.…”

“…The literature does not support the use of military metaphors in this context; on the contrary, military metaphors are thought to silence patients' voices and dehumanize their experience. 7 The Rodgers evolutionary method for concept analysis best fits the concept of "the fighter" in the ICU due to its emphasis on dynamic interrelationships among microand macro-level factors such as the goals of the individual and family unit as well as the healthcare institution and country's healthcare system that shape this concept. This evolutionary method also recognizes that concepts change over time and must be seen within the greater sociocultural context.…”

Are Metaphors Ethically Bad Epistemic Practice? Epistemic Injustice at the Intersections

“…In these cases, a definitive conclusion as to whether a metaphor constitutes ethically bad epistemic practice is complicated, but these questions guide reasoning about the ethical and epistemic implications of metaphors and the various ways epistemic injustice is reproduced and challenged by them. This process helps to unify ongoing discussion about the ethics of a highly debated metaphor: the “illness is war” metaphor that is commonly employed in healthcare (George, Whitehouse, and Whitehouse 2016; Nie et al 2016; Tate and Pearlman 2016; Sontag 1990a; 1990b; Chapman and Miller 2020; Tate 2020).…”

“…This is effectively an argument that metaphors promote hermeneutical injustice. On the other are those who argue metaphors can be empowering and facilitate communication, particularly when the patient and healthcare provider do not have a shared language (Tate and Pearlman 2016; Tate 2020). This is effectively an argument that they promote testimonial justice.…”