Metaphors are widely used by both healthcare professionals and lay people when talking about matters of health. Despite this their role is largely unrecognised. This is a shame, I feel, as they can have a powerful effect on the practice of medicine and the experience of illness.
A metaphor is a way of understanding and experiencing one kind of thing in terms of another. Many complex concepts are understood in this way and they are integral to the way we understand things.
The essayist Susan Sontag was one of the first to identify the widespread use of metaphor in relation to certain diseases. She wrote Illness as Metaphor whilst being treated for breast cancer and visited the topic again in 1988 with AIDS and its metaphors.
Sontag argued that metaphors attach themselves to certain diseases and these metaphors exert influence on patient and public attitudes. With both HIV and cancer Sontag argued that metaphors introduced an unhelpful emotional dimension when a more detached scientific approach was required.
Two main sorts of metaphors have been suggested. “Biomilitary” metaphors represent disease and the body’s response to it in terms of “attack” and “defence.” By contrast with “bioinformationist” metaphors the body, in both health and disease, is seen as a communication system with “receptors,” “transmitters” etc.
Particular diseases attract metaphorical description more readily than others. Biomilitary metaphors are pervasive in discussions of cancer. By contrast heart disease is discussed almost exclusively in terms of the mechanical metaphor of plumbing.
Arguably metaphors don’t merely describe similarities; they create them. As well as illuminating they can also conceal. It can be hard to think of cancer in a way that is not biomilitary, but wars honour battles which can make the transition to hospice care problematic. Mechanical metaphors for heart disease are also limited as they hold no place for lifestyle modification. I don’t agree with Sontag that metaphor should be eliminated from the discussion of medical illness. In fact I don’t actually believe that it would be possible to talk about disease without them. But they have a hidden power that should be understood.
If you choose a metaphor, choose it wisely.
Also published on BMJ blogs