First published in Positive Health, Issue 78, July 2002.

The Mind, Metaphor and Health

by Penny Tompkins and James Lawley

The use of metaphor and symbol in the healing process stretches back thousands of years. These days, traditionally trained medical practitioners have made use of metaphor and imagery with patients with cancer and other illnesses.^1-3 A new process, Symbolic Modelling (comprehensively explained in our book, Metaphors in Mind: Transformation through Symbolic Modelling.⁴) follows in this tradition.

This article explains why metaphor is a natural way to describe illness and health, the importance of recognising patients'/clients' metaphors, and how working within these metaphors can activate an individual's personal healing process.

Metaphors Define Reality

For a long time metaphors were seen as 'merely figurative' and considered to be an inadequate way of describing experience. Today many cognitive scientists, linguists and philosophers recognise that "In all aspects of life ... we define our reality in terms of metaphors and then proceed to act on the basis of the metaphors. We draw inferences, set goals, make commitments, and execute plans, all on the basis of how we in part structure our experience, consciously and unconsciously, by means of metaphor."⁵ And as many health workers have discovered, metaphors can play a vital role in the healing process.

A barren snow-topped mountain

A dermatologist who makes use of Symbolic Modelling, Dr. Justina Cladatus, reports: "One of my patients had problems of alopecia areata (bald patches). His initial metaphor for his symptoms was a barren mountain with a white snow top. As the process unfolded he found himself tied to a wall by dark brown ropes in a dark, grey cement room with nothing but a little barred window. His metaphor evolved until he was standing beside a white well situated in a beautiful valley full of yellow flowers and green vegetation. The well was a source of refreshing water. In the meantime, the snow melted, and the mountain became a little hill with trees growing on it. And his hair has started to grow back."

Bunny rabbits and cancer carrots

Peter Hettel was diagnosed with cancer of the sinus. Following surgery his cancer returned, and so he started working with imagery and symbol. Peter discovered that his white immune cells were like "bunny rabbits feasting on fields of orange cancer-carrots, which increased their energy and sex-drive, which made them have sex and make more bunnies who were also hungry to eat more." One morning he realised to his surprise that he couldn't find enough carrots for all his rabbits! A few weeks later he literally spat out his tumour. His doctor said "It was like his body had rejected a foreign object, like a transplant rejection, just expelled from his body. I can't account for it."⁶

Metaphor in Health Consultations

Patients often use metaphor spontaneously in conversation to describe their symptoms. One Doctor says "my patients classically describe pain with metaphors like knotted, squeezing, stabbing or burning. I've found patients with cancer use particularly vivid metaphors: 'it 's eating away at me' or 'I'm frightened it will spread like wildfire'."

A recent study of metaphoric expressions used by doctors and patients concludes that "If metaphors are indeed the embodiment of experience, rather than, or as well as, surface analogies for the sake of lucidity, an understanding of metaphor is as important for doctors as it is an understanding of patient health beliefs."⁷ True as this might be, after recording 373 consultations of 39 GPs, the study found that while "there was no significant differences between the doctors and their use of particular metaphors ... there were some clear distinctions between doctor and patient metaphors." Doctors tended to use metaphors which assume the body is a machine (the urinary tract was the 'waterworks', bodies could be 'repaired', joints suffer 'wear and tear'); illness is a puzzle (symptoms are 'clues' to 'problems' that have to be 'solved'); and a doctor is a controller (they 'administer' medication to 'manage' symptoms and 'control' disease).

Patient metaphors, on the other hand, were more vivid, expressive and idiosyncratic (It's 'like Satan's got into her', 'I'm the cotton wool man', It's 'like a Chinese burn, it just gets tighter and tighter', It's 'as though my body has been pummelled'). Even when doctors and patients used the same words (such as 'tension', 'relaxation', 'nerves') doctors tended to use them literally while patients used them metaphorically. Patients used metaphors such as 'dull', 'stabbing' and 'sharp' to describe aches and pains, but these words were never used by the doctors taking part in this study.

Apart from the few metaphors used equally by doctors and patients -- illness is an attack (heart, asthma and panic 'attacks', 'fight' infection, 'painkillers') and illness is fire ('burning' pain, 'inflamed' condition, symptoms 'flaring up') -- we can conclude that doctors and their patients talk different languages. No wonder that so many patients do not feel heard, and that errors of communication occur. An Institute of Medicine report on medical errors estimates that in the USA "between 44,000 and 98,000 hospital patients die each year from preventable medical errors ... that more people die each year from errors than from breast cancer or motor vehicle accidents; more than half of those deaths are preventable ... Errors result from prescribing mishaps, communication gaps and a distracted staff."⁸

If health workers were trained to recognise patient metaphors, to accept them as an accurate description of the illness, and were aware of their own use of metaphor, then those "communication gaps" could be considerably reduced. As Margaret Lock in Uncommon Wisdom says, "In the healing process the most important part of communication takes place at the metaphoric level. Therefore you have to have shared metaphors."⁹

Symptom Description

The British Journal of General Practice study shows how often patients spontaneously use metaphor to describe their symptoms (965 different metaphors were identified). Sometimes, however, they need to be invited to use such language. While giving a Healthy Language course for a group of nurses who specialised in Multiple Sclerosis, we were told that their patients often had difficulty describing the bizarre nature of their symptoms. We suggested they ask them, 'And when it's difficult to describe your symptoms, those symptoms are like what?'. This question acknowledges the patient's difficulty, and then invites them to use metaphor to describe the qualities and characteristics of their subjective experience of their illness.

When the nurses asked this question, they got responses such as "It's like ants running all over my body" and "It's like cheese wire wrapped round my legs." Further questions, such as 'And is there anything else about that [patient's metaphor]?' or 'And what kind of [patient's metaphor] is that?';, encouraged the patients to describe their strange sensations in greater detail. The nurses were surprised at just how relieved the patients felt when they could explain their symptoms in this way. Some patients said it was the first time they felt that someone had really understood what it was like to experience their illness.

Symbolic Modelling

In addition to using metaphors to describe symptoms, clients can benefit from having metaphors for their illness elicited, developed and evolved into metaphors for health. Hejmadi and Lyall maintain that the use of autogenic (self-generated) metaphor can be particularly useful in "functional or stress-related illnesses, those in which no specific micro-organism has been identified as the source of physiological breakdown. This category of dysfunction includes such major catastrophic health problems as cardiovascular disease, some forms of cancer, and the so-called auto-immune diseases, as well as those which are less catastrophic, such as gastric ulcer, many allergic conditions, myofacial pain syndromes, migraine, and PMS. It is estimated that 50 to 80 per cent of all physical illnesses requiring medical attention are stress-related or functional in nature."¹⁰

When developing client-generated metaphors for healing we have found it particularly important to use 'clean' language. This means we do not 'contaminate' the client's experience with our personal preferences for certain types of metaphor or figures of speech. Symbolic Modelling is expressly designed to work in this way.¹¹

There are three features that distinguish Symbolic Modelling from other processes that use metaphor and visualisation. First is its reliance on the client, and only the client, to identify and evolve their own metaphors for illness and health. Second is a particular way of asking questions of their metaphors. This is called Clean Language and was originated by David Grove.¹² And third, while metaphors are commonly expressed as images, Symbolic Modelling also makes use of feelings, gestures, sounds, drawings, physical objects, etc.