Communication is one of humanity’s oldest and most sophisticated technologies. Narrative is an integral part of the day-to-day transmission of ideas between people. In the medical world, technological and scientific advances have likewise made tremendous advances. And yet, the medical field still lacks the key to success: the effective interpretation of narrative. To compensate for the gap in patient-doctor communication, physicians in training are being taught to be more attentive to their patients through the practice of Narrative Medicine, with the understanding that there is more to a patient than their illness. In fact, the patient has a wound that gives them narrative power. Arthur Frank illuminates why the narrative aspect of medicine is important in The Wounded Story Teller, where he writes, “[patients’] injuries become the source of the potency of their stories. Through their stories, the ill create empathic bonds between themselves and their listeners” (xiii). With narrative an integral part of the medical experience, it’s up to physicians to deepen and enhance patient-doctor communication by becoming interpreters of narrative techniques—particularly metaphors.
Metaphor, the implicit comparison of one thing to another, is one of the most common literary techniques—and naturally so, because effective communication relies heavily on drawing comparisons and parallels to portray the clarity of an idea. Health care practitioners employ metaphors for two main reasons: first, to foster clarity by transferring meaning effectively and economically, and second, to promote diagnostic caution through ambiguity, allowing doctors to circumnavigate making an explicit diagnosis before they are sure how severe a case might be. The use of metaphors in the medical world has stirred up intensive debates and arguments. Are metaphors more detrimental than beneficial to a patient? As scientific professionals, why should physicians rely on literary techniques instead of using scientific facts and terminologies? Moreover, why should patients describe their illnesses metaphorically?
Although metaphors may seem at first to obscure pain, suffering and illness, they more effectively illuminate pain and suffering through the power of analogy between the patient and doctor’s lexicons. As Anatole Broyard describes, “metaphors may be as necessary to illness as they are to literature, as comforting to the patient as his own bathrobe and slippers. At the very least, they are a relief from medical terminology… Perhaps only metaphor[s] can express the bafflement, the panic combined with beatitude, of the threatened person” (206). Thus, metaphors form an integral part of medicine because they bridge the communication gap between the layman and the doctor.
Rather than obscuring medical meaning, metaphors foster clarity and transfer significance effectively and economically. A metaphor (from the Greek root metaphora, to transfer) is a powerful communication tool that draws parallels between seemingly unrelated subjects to clarify the meaning of a complex situation. In medicine, metaphor is often used to elucidate a disease that resists classification. Simply put, metaphors help us to understand our own unexplained present and uncertain future, by putting disease into relation with past experience and present knowledge. The power of comparison to bring consolation is exemplified in an ancient Egyptian poem that describes the intangible concept of death as a physical entity: “Death is before me today/ Like the sky when it clears/ Like a man’s wish to see home after numberless years of captivity” (“Death is Before Me Today”). The similes in this poem allow readers to imagine death as a relief from the storms of the world. The unexpectedly positive connotations of death here encourage the reader to believe that death is not supernatural and threatening.
While this poem employs comparison to elucidate an interpretable physical condition, in other settings, metaphors hide the true nature of disease. In her short story, “The Devil’s Bait,” Leslie Jamison reveals how metaphor confuses practitioners encountering Morgellons. A controversial disease with uncertain origins, Morgellons has sometimes been categorized as a form of psychosis: patients believe they have actual bugs underneath their skin, a notion strongly refuted by scientists and doctors. In Jamison’s story, one of the characters states that the “willingness to turn Morgellons into metaphor —a physical manifestation of some abstract human tendency — is dangerous. It obscures the particular and unbidden nature of the suffering in front of [him]” (Jamison 1). Although the character believes that metaphors obscure the truth of Morgellons, he still relies on comparisons to describe the disease, indirectly highlighting the benefits of metaphors, as readers paint a mental picture of how Morgellons manifests in a body. In this instance, metaphor serves a positive purpose, allowing readers to feel the disease vicariously through the text.
Metaphors are also beneficial to medicine because they foster a sense of caution and promote patient safety through their ambiguity. In other words, they allow doctors to discuss diagnosis in ambiguous ways that help patients remain calm. They also allow doctors to give patients a preliminary diagnosis before a more final diagnosis, reducing the chance of misdiagnosis. Doctors often use metaphors euphemistically to address high-risk conditions or procedures in a nonthreatening manner. Medical metaphors often fall into two registers—war and sports. For example, a patient is said to have “defeated” cancer, which “waged a war” on them. For the practitioner, it is easier to talk about certain concepts such as death or terminal disease when they are likened to sports or war; in fact, such metaphors are intended to empower the patient to be optimistic and strong about the future. Arthur Frank argues that they redirect the patient into a quest narrative—the redefinition of one’s purpose to live with an illness. Through metaphor, cancer patients are empowered to “fight to the bitter end.” Metaphors, then, place power in the hands of the patients by making them feel confident—in an ambiguous way, where the severity of an illness is presented in a more indirect and nonthreatening manner. (But as Susan Sontag points out in Illness as Metaphor , this use of metaphor to describe illness is also inherently destructive, since it can result in victim-blaming on the part of the practitioner.)
We see how metaphor gives a patient a framework for understanding their disease in Rafael Campo’s poem “A Diagnostic Procedure was Performed,” which describes how the cancer in his arm is leading to his demise. Campo asserts that the cancer cells are “growing [as] fast as germs” (9). Through this simile, the reader can appreciate the severity of the cancer, formulating a vivid image of the cancer cells breeding prolifically and feasting on the narrator’s arm. Elsewhere, Campo writes “the words [are] traversing the malignant stage/ Of countless, hungry cells as they divide/ Until [he is] drained of something horrible” (3-5). While foreshadowing the image of malignancy later in the poem, this passage emphasizes that Campo’s words, his choice of metaphors, are navigating and journeying through the multiplying cancer cells in his arm. In other words, the metaphors allow him to describe the progress of cancer; indeed, they are his only effective tools in waging a war against the cancer. By insulating the reader from the disease through language, Campo ensures that the condition of his arm is placed in a safe, nonthreatening and euphemistical—but nonetheless potent—dimension.
Most powerfully, metaphors can evoke empathy between doctors and patients—one of the most necessary vectors of communication for the effective provision of health care. One study, from 2010, found that physicians use metaphors in almost two-thirds of their conversations with patients who have serious illnesses; moreover, the physicians who used more metaphors were seen as better communicators, with patients reporting less difficulty understanding their doctors, feeling as though their doctors ensured that they understood their conditions (Casseret et al. 258). The proper diagnosis and treatment of disease relies on communication, and effective communication relies on figurative language—particularly metaphors. They are a fundamental mechanism through which our minds conceptualize the world around us, especially when there is adversity. Metaphors help to communicate the complexity of disease, and empower the sick to get better.
Charlene Kotei, an aspiring physician and an SAT instructor, is a current second-year student at the Sophie Davis School of Biomedical Education/CUNY School of Medicine, who enjoys traveling, taking photos, cooking, and writing. She seeks to make the medical field a better place by bridging the gap between science and humanities.
Anatole Broyard. “Good Books About Being Sick.” The New York Times, The New York Times, 31 Mar. 1990, www.nytimes.com/1990/04/01/books/good-books-about-being-sick.html?pagewanted=all&mcubz=3. Accessed 1 Oct. 2017.
“Ancient Egyptian: Death is before me today.” Consolatio, Consolatio, 12 June 2009, www.consolatio.com/2009/06/ancient-egyptian-death-is-before-me-today.html. Accessed 1 Oct. 2017.
Campo, Rafael. What the Body Told. Durham: Duke UP, 1996. Print.
Casarett, David et al. “Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?” Journal of Palliative Medicine 13.3 (2010): 255–260. PMC. Web. 1 Oct. 2017.
Frank, Arthur W. The wounded storyteller: body, illness, and ethics. Chicago, University of Chicago Press, 1997.
Jamison, Leslie. The Empathy Exams : Essays. 2014. Print.