Metaphors in Medical Psychology, Medical Care, Applied Psychophysiology, and Health Care Education:

A Guide for Practitioners, Patients, and the General Public Author/Editor: Mark S. Schwartz, Ph.D.
(Additional Co-Authors and Contributors)

Sample Questions Addressed in this Book
  • What can mental health and medical professionals say to patients/clients to help them better understand what is presented to them?
  • As a patient, what can help me better understand many of my questions and topics that health care professionals try to explain to me?
  • What can patients/clients and the public read or listen to for better understanding?
  • Do my patients really understand me? What can I say to better communicate to them?
  • How much will my patients remember? What can I do to help them remember?

Role of Metaphors in Teaching and Communication
  • “It has been used for centuries as a method of teaching and communicating in many fields" (Muran & DiGiuseppe, 1990).
  • "...metaphor allows us to understand ourselves and our world in ways that no other modes of thought can." (Lakoff & Turner, 1989)
  • "Most of us, and our patients...find ourselves cleaving to metaphor to communicate experience that is hard to convey in any other way" (Siegelman, 1990).
  • "Metaphorical communication ….makes it a highly persuasive means of conveying and altering thought.... not only a vehicle for communication but also a vehicle for change." (Muran & DiGiuseppe,1990)
  • Practitioners of cognitive behavioral therapies advocate analogies and metaphors as "...valuable means of communicating some of the complex subtleties of life to certain clients" (McMullin, 1986. p. 139). McMullin (1986) describes in detail many examples of perceptual shift techniques for cognitive restructuring therapy.
    • These techniques "...make a creative use of analogies to help clients who are preoccupied with damaging beliefs to understand the nature of the perceptual transition that they must undergo" (p.73). Examples of the use of analogies in cognitive therapy are found in McMullin (1986).
  • The following is gleaned or quoted from Terry Ruhl, M.D.http://www.altoonafp.org/analogies.htm)
    • Use analogies and metaphors when the information or concept to be communicated is relatively harder to understand by the recipient.
    • Be sure recipient understands the metaphor or analogy. For example, unless the recipient understands how a pump works, the person might not understand the pump analogy for the heart. The person typically needs to understand the analog in order to understand the comparison. One can explain the analog to the person. Otherwise, consider not using it.
    • Explain the specific similarities between the analogy/metaphor comparison with the concept or information being communicated. More details and more visual details often are better.
    • Everyone communicating and everyone using metaphors/analogies for better understanding should be aware of possible misconceptions from the comparison.
    • Be aware and beware of inappropriate use of analogies/metaphors. For example, read(http://www.ufscc.ufl.edu/Professional/content.aspx?section=floatmenu&id=33168)

This book (and web site) focuses on metaphors (and analogies) in communications to patients, their families, to students, to professionals, to the public, as well as for educators and health care professionals. Metaphors are very useful means to enhance communication and education. Metaphors present information, concepts, and plans in ways that are more acceptable, more understandable, more interesting, and more memorable than other methods. Metaphors help simplify information, concepts, and procedures that are complex. Health professionals commonly use metaphors and analogies in their communications with patients. The book includes definitions, rationale, history, approaches to metaphors, uses of metaphors, cautions using metaphors, selecting metaphors for patient education and cognitive preparation of patients, references, and websites. The book rationale includes the assumption that patients and related audiences are very often unfamiliar, skeptical, and/or resistant to communications from health care professionals. Furthermore, patients very often forget much content that is communicated to them. The book contains a wide variety of metaphors for explaining psychological and psychophysiological conditions, standard and complimentary and alternative therapies, stress management, making behavioral/habit and lifestyle changes,adjustment to chronic conditions, and the functioning of body systems including the autonomic nervous system. 

There are several other co-authors and contributors. Over the past few years several were invited and expressed strong interest and a willingness to participate. However, none are obligated to participate and the list of names is temporarily withheld for public access until official. 

Health professionals commonly use metaphors and analogies in communications with patients. In addition to their use in psychotherapy, we use metaphors and analogies to explain to patients about many aspects of health care. Many professionals rely on a variety of analogies and metaphors when discussing the rationale and procedures for therapies. One of the major reasons for using metaphors and analogies is to help simplify information, concepts, and procedures that are complex. [Link to MetaphorsRationaleAbbreviated1.doc] 

What is unique about this book and website
Thus, what does this website and book provide that are not available elsewhere or difficult to locate or not centralized and organized in one place?
  • Many of the metaphors on this website are unique.
  • These metaphors are for explaining topics and concepts that are not explained elsewhere.
  • The format of most of these metaphors is unique. For each, there is a title, list of uses, a brief summary, and a detailed script.
  • An academic and practical rationale for using metaphors in the present context.
Format for Metaphors
Many metaphors will involve a standard format and include titles, purpose, rationale, patient selection, detailed content, and often graphics. Considerable attention will include a wide range of metaphors under several headings. These will include: helping patient accept psychological treatments, helping patients accept medical treatments including medications and surgeries, helping patients understand their symptoms and diagnoses, helping patients make behavioral/habit and lifestyle changes (smoking, obesity, exercise, time management, relaxation), helping patient manage anger, anxiety, and helping patients adjust to chronic symptoms/chronic illness. 

Background The use of metaphors within the psychotherapy process (Erickson & Rossi, 1976, 1980; Combs & Freedman, 1990; Siegelman,1990) would take us down unintended and circuitous passageways. The interested reader can journey to these and other sources for rich, interesting, and lengthy journeys, and vistas. Such a voyage will include stopovers with such notables as the deep roots of Jung (1961), the hypnotherapy of Erickson (1984), and exploration of the caverns of how we think as guided by Bateson (1979). 

You might also traverse the bifurcated and disputed passage of dualistic communication types of literal or metaphorical, known as the Double Language Thesis (Beardsley, 1972). In the latter passageway, you will meet the bicameral mind wherein metaphors are encapsulated within the right hemisphere. You will also meet the familiar but nebulous unconscious mind wherein metaphors live and begin their metamorphosis into consciousness and the left hemisphere domain. Here is where you as the therapist guide meets the patient's transformed cognitions now reaching the stages of affective and behavioral changes.

But wait, you cry out! Please do not send me down into those caverns. It is not an efficient or wise use of my time. Others have ventured down there and come back empty handed. Some have not returned. Others have returned with different appearances and sounding very different from when they entered. I can almost hear the anguished cries of the believers in Dual Language, and related theses. "How dare you treat us like this?"Or, from the more humane, "Poor Schwartz, he knows not of what he speaks. Forgive him." [Link to: MetaphorsBackgroundAbbreviated.doc]

Definitions and Theories of Metaphor
The struggle for a generally agreed upon definition of metaphor is an ancient one.The lack of agreement continues to the present (Ortony, Reynolds, & Arter, 1978; Muran & DiGiuseppe, 1990). I will not attempt to review this long and complex venture as such a discussion would go far beyond the present purposes. The interested reader can immerse themselves in this sea of theory, creativity, and verbosity by reading some of the references. However, some review and discussion of definitions and theories will provide a backdrop for the stage upon which the present cast of characters will convey to readers the melody of this treatise. We need not concern ourselves here with the best definition. A metaphor is:
  • “...the application of a word or phrase to an object or concept it does not literally denote, in order to suggest comparison with another object or concept...." (Random House College Dictionary, Rev.Ed., 1975).
  • A metaphor is a way of writing or speaking figuratively and of describing something in terms of something else" (Morris & Morris, 1985). Synonyms for metaphor include "figure of speech, image, symbol..." [Link to: MetaphorsDefinitionsAbbreviated.doc]

Much of the information provided to patients appears complex and foreign for many, perhaps most, patients. The information includes therapy strategies or procedures, rationales for therapies, physiology, psychophysiology, justification for questionnaires, types of questions asked, and other evaluation procedures. Health professionals usually realize the complexity and difficulty for patients but might not know how to remedy the problem. They might also not know the significance of the problem. The assumption is made here that understanding, indeed good understanding, can improve the acceptance of the concepts and procedures. In turn, greater acceptance can improve satisfaction, compliance, and therapy results.
I assume that analogies present information, concepts, and plans in ways that are more acceptable, more understandable, more interesting, and more memorable than other methods. Analogies can take some of the sting out of the information and draw patients more into the therapy process. Patients are generally more familiar with stories with messages like Aesop's Fables and can more comfortably relate to analogies and metaphors. 


Link to: MetaphorsReferencesAbbreviated1.doc