This paper offers a critical response to Fredrik Svenaeus’ use of the Heideggerian uncanny to analyse the experience of illness. It is argued that the uncanny is part of a culture of concepts through which the condition of modernity has been analysed by philosophers, social theorists, writers and artists. All centre upon the idea of alienation, and thus not being at home in the society that should be one’s home. This association will be exploited to offer a reinterpretation of Svenaeus’ (...) thesis as a sociological and political, rather than an ontological, one. By reviewing the work of Hegelian philosophers, Georg Simmel, and novelists, represented by Mann, Camus and McCullers, it will be argued that illness is bound up with social alienation, both as something that is caused by conditions of alienation and as an interpretative response to alienation. Seeing illness as a metaphor of the human condition in modernity allows the medical humanities to inform therapy, that would allow the patient to understand their illness, not as the ontological condition of Dasein, but rather as something mediated by modern social, economic and political conditions. (shrink)

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting (...) thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual''s prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts''the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed. (shrink)

This paper critically examines the metaphorical use of medical terms in philosophy. Three examples selected from distinct philosophical contexts demonstrate that such terms have been employed as metaphors both to describe the practice of philosophising and historically to diagnose philosophical positions. The selected examples are (i) the title of Avicenna’s main philosophical work, The Book of Healing, (ii) the criticism of medical metaphors in Enlightenment philosophy, and (iii) recent historical diagnoses in philosophy. The underlying epistemological assumptions of all (...) three contexts are reconstructed to critically analyse the medical metaphors. Through this tripartite synopsis, I arrive at a normative conclusions medical metaphors, such as the “healing of the soul” or “pathology of reason”, do not stand up to the critique of Enlightenment and are obsolete against the theoretical background of my reference texts. (shrink)

Medical discourse in the contemporary United States is rife with military metaphors. These metaphors have come under vigorous criticism over the last few decades but to no avail; the militaristic tendency has proven tenacious. This essay suggests that its tenacity stems, at least in part, from a dualistic understanding of medicine unaddressed by prior criticisms. For an alternative, this essay turns to Augustine of Hippo, balancing close readings of works that deal explicitly with medical themes—The Catholic Way of (...) Life and the Manichean Way of Life (De moribus) and The Nature of the Good (De natura boni)—with a constructive approach. By adapting Augustine's privative account of evil, we can understand disease as a condition of loss and treatment as a task of restoration. This reconfiguration shifts the focus of our interpretive discourses from malicious invaders to a fuller affirmation of the lived experiences of those who are ill. (shrink)

This paper aims to show how medical scientists may use metaphor in ways closely parallel to poets. Those who believe metaphor has any role at all in science may describe its use in various ways. Associationists think metaphors are based upon likenesses, and collapse the notions of model and metaphor together. But, as an example from the work of Louis Pasteur suggests, metaphor need not be based upon likenesses. Rather it may play a role in (...) making possible a model'sexplanatory significance. Models may presuppose metaphors. The Pasteur example also suggests metaphor may play a part in creating likenesses through its role in classification and reclassification. It is in these ways that the use of metaphor in medical science most closely parallels that in poetry. (shrink)

The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which “normal” is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or (...) treatment. The most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a “normal” appearance or leading a “normal” life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing. (shrink)

The article explores the role of the Spartan example in Guicciardini's political thought, giving a particular attention to his early writings. Examining a series of medical metaphors Guicciardini uses in the analysis of the state, the author uncovers Plutarch as their main source. It is argued that Plutarch, and his description of Lacedaemon, exercised a major influence in the formation of Guicciardini's political ideas. The author focuses on the crucial issue of the usage of “Lycurgus’ knife,” while answering two (...) key questions: (1) the feasibility of constituting a republic modelled on Sparta; (2) the legitimacy of the use of force in the cases of extreme necessity. On (2), Guicciardini's views are compared with Machiavelli's, and the difference in their understanding of necessità pointed out. (shrink)

Metaphors of medicine are common, such as war, which is evident in much of our language about health‐care where patients and healthcare professionals fight disease, or the game, which is one way to frame the nurse–doctor professional relationship. This study analyses six pilot episodes of American (Grey's Anatomy, Hawthorne, Mercy, Nurse Jackie) and Australian (All Saints, RAN) medical television programmes premiering between 1998 and 2009 to assess one way that our contemporary culture understands and constructs professional relationships between nurses (...) and doctors. Analysis shows that these popular television programmes frequently depict conflict, with games, civil war and mutiny between nurses and doctors over patient safety rather than professionals working collaboratively in teams to deliver health‐care. Although the benefit of this televised conflict is the implication that nurses are knowledgeable, skilled professionals, the negative connotations include a dysfunctional and dangerous healthcare system, and also ongoing power struggles. Given that popular culture can sometimes influence the public's understanding of real‐life nursing practice, it is important to explore what these metaphors of conflict are communicating about the nurse–doctor relationship. (shrink)

Metaphors can be used as crucial tools for reaching shared understanding, especially where an epistemic imbalance of knowledge is at stake. However, metaphors can also represent a risk in intercultural or cross-cultural interactions, namely in situations characterised by little or deficient common ground between interlocutors. In such cases, the use of metaphors can lead to misunderstandings and cause communicative breakdowns. The conditions defining when metaphors promote, and hinder understanding have not been analyzed in detail, especially in intracultural contexts. This study (...) proposes an analysis of metaphors identified within an Italian corpus of diabetes care interviews. Through a coding scheme capturing the types and the probative weights of the linguistic evidence that can be used to detect misunderstandings, the communicative effectiveness of metaphors is indirectly assessed. The quantitative and qualitative analyses show a positive correlation between metaphor use and problematic understanding. A more detailed scrutiny of the interlocutors’ roles and topics of the metaphors points out that most of the problematic metaphors are used by patients, while most of the problematic ones used by providers concern non-clinical matters. These results can be explained as resulting from incorrect presumptions of common ground between the interlocutors. (shrink)

Introduction : the existence of mental illness -- The likeness argument -- The categorical argument -- Metaphor -- Two metaphors from physical medicine -- The metaphor of mental illness -- Attention deficit hyperactivity disorder, social construction, and metaphor -- Metaphors and models.

The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic evidence as defeasible as (...) well. It argues that metaphors might be effective communicative devices to let the patients understand the relevant defeasors in the diagnostic reasoning process, helping to improve effective diagnosis communication, and also encouraging a change in patients’ beliefs and attitudes on their own experience of illness and illness’ management. (shrink)

In health communication, metaphor can be considered as a reasoning device to let people understand an abstract concept in terms of a concrete one (Lakoff and Johnson 1980; Bowdle and Gentner 2005). Both the positive and negative communicative effects of metaphors have been largely pointed out in a variety of medical fields, from oncology (Semino et al. 2016, 2018) to mental health (Frezza and Zoccolotti 2019). The use of metaphors in vaccine communication has been less considered, though it (...) might be crucial to let people understand vaccination as an important collective health phenomenon. A previous study (Scherer et al. 2015) focused on the communicative effects of conventional metaphors for vaccination, but not specifically on novel metaphors deliberately used to explain the concept of population immunity in vaccination. We hypothesized that metaphors used to explain vaccination as a collective phenomenon could improve the communicative aims of pro-vaccination texts in many respects, ranging from understandability to trust in expertise. We designed a study to test the hypothesis: two groups of participants were presented with a text about vaccination as a collective phenomenon, described in either literal or metaphorical terms. They were asked to evaluate the text on different communicative aspects from both an individual and a collective point of view. The results confirmed the hypothesis that metaphor is an effective reasoning device and that it also enhances the overall communicative effects of the message, in terms of understandability, persuasion, feeling of control over the health situation, trust in expertise, and uptake of experts’ advice. However, the results show that this effect is significantly nuanced in the individual vs. collective response type. (shrink)

The Renaissance witnessed a proliferation in medical discourse, pedagogical illustration, and popular rhetoric – what I refer to here as “metaphoric botanies” – comparing the human fœtus, or embryo, to a plant. Far from being a mere linguistic inheritance from ancient medicine, such “metaphoric botanies” not only allowed early moderns to conceive of the unobservable development of the human fœtus, but also emphasized the relation of the mother to the unborn child. Much of the “metaphoric botanies” surrounding the fœtus (...) throughout the Renaissance analogize its development to that of a plant “rooting” itself in the mother’s uterus, through which it receives sustenance. Though feminist scholarship has made the important argument that such language has historically been utilized in debates surrounding abortion, these “botanies” might also be placed within a certain representational tradition, through which it might be understood as a meditation on species-being and -continuation in a period fraught with epistemological and metaphysical uncertainty. (shrink)

Background/IntroductionInfertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the cultural backgrounds and conceptions of (...) reproduction are different. Results: Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients. Conclusions: Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary. (shrink)

This paper offers a critical response to the claims of Sivin and Lloyd and Mattice to the effect that Greek and Roman philosophy was characterised by a predominance of combat metaphors. Drawing on Plato and Plutarch, as well as contemporary studies led by Nussbaum, I argue that a host of different metaphors was demonstrably used in the Greek tradition to describe philosophy and its subjects, led by the therapeutic or medicinal metaphor of philosophy as ‘therapy of desire’ or of (...) desiderative opinion. I propose that it was the sophists like Protagoras, at least as they are depicted by Plato, who sought to conceive of philosophising as a strategic, warlike activity. In conclusion, I reflect on the invisibility of the medicinal metaphor, outside of certain dedicated studies in the history of ideas, in contemporary thinking about Western philosophy and its past. (shrink)

Purpose With the increasing sophistication of neuroimaging technologies in medicine, new language is being sought to make sense of the findings. The aim of this paper is to explore whether the brain-reading metaphor used to convey current medical or neurobiological findings imports unintended significations that do not necessarily reflect the genuine findings made by physicians and neuroscientists. Methods First, the paper surveys the ambiguities of the readability metaphor, drawing from the history of science and medicine, paying special (...) attention to the sixteenth through nineteenth centuries. Next, the paper addresses more closely the issue of how metaphors may be confusing when used in medicine in general, and neuroscience in particular. The paper then explores the possible misleading effects associated with the contemporary use of the brain-reading metaphor in neuroimaging research. Results Rather than breaking new ground, what we see in current scientific language is a persistence of both a constraining and expansive set of language practices forming a relatively continuous tradition linking current neuroimaging to past scientific investigations into the brain. Conclusions The use of the readability metaphor thus carries with it both positive and negative effects. Physicians and neuroscientists must resort to the use of terms already laden with abstracted meanings, and often burdened by tradition, at the risk of importing through these words connotations that do not tally with the sought-after objectivity of empirical science. (shrink)

This article delves into the significance and role of metaphors in shaping knowledge, perceptions, and decisions within the healthcare domain. Through a critical analysis of their impact, particularly in the dynamics between healthcare professionals and patients, three dimensions are proposed for unraveling their significance: the political dimension views metaphors as agents of power and tools for legitimizing inequalities; the cultural dimension sees them as cultural residues challenging prevailing biomedical knowledge; and the ethical dimension raises questions about the moral implications of (...) the constructed narratives. This holistic approach aims to enhance our understanding of the intricate interplay between language, cognition, and the experience of illness, ultimately advocating for more comprehensive approaches in healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Nietzsche, Biology and MetaphorBabette E. BabichGregory Moore. Nietzsche, Biology and Metaphor. New York: Cambridge University Press, 2002. Pp. viii + 228. Cloth, $55.00.Gregory Moore's Nietzsche, Biology and Metaphor is a well-written book on a topic of growing importance in Nietzsche studies. Not only concerned with offering an interpretation of Nietzsche in terms of biology and metaphor, Moore's approach offers a literary contextualization of Darwinism in (...) the history of ideas but also in terms of an important reflection on the idea of decadence so important to Nietzsche and so influential in theorizing public health and law in the twentieth century, most perniciously in its deadly expressions in Nazi propaganda. Moore is thus able to bridge the fields of the more specifically linguistic study of metaphor and source-scholarship. To Moore's great credit, he seeks to emphasize the extent to which Nietzsche's thought was developed in active correspondence with the scientific literature and debates of his age. But this reviewer thinks it important to warn those with classical or traditional interest in metaphor that the text presupposes that the reader (and this is also to say that Moore) knows a Nietzschean metaphor when he sees one.Moore begins with the question of Nietzsche's Darwinism, focusing on the physiology of power to explore the relations between Darwin, Spencer, Lamarck, and Rolph, but also Nietzsche's favorites, Malthus and Lange, etc. The discussion of the history of the reception of Darwin's ideas is careful and extensive and offers an insightful clarification of Darwin (necessary to distinguish Darwin from Darwinism, "social" and otherwise). Some readers will find it even more Anglophone than seems justified by Darwin's heritage, despite Moore's passing references to Cuvier and (at rather greater length) Haeckel and Roux.This reviewer notes that the latter references have been well-discussed in the German literature and to some great part Moore is fair to this tradition even if it is also true that the discussion never enters the level of the history of science as this reader, for one, might have wished. In the case of Moore's interpretation of Nietzsche's texts, the readings sometimes suggest a reprise of what has come to be the consensus (and not just among Nietzsche scholars) of views on Nietzsche's thinking. Thus where certain secondary authors are in force in Moore's well-documented account (Pick, Moles, and Ruse), others are missing. Indeed, in the case of Nietzsche and Darwinism, Frederick Gregory's Nature Lost? Natural Science and the German Theological Traditions of the Nineteenth Century (Cambridge, 1992) offers an important supplement. Another book that seems to have been overlooked is Timothy Lenoir, The Strategy of Life: Teleology and Mechanics in Nineteenth Century German Biology (Dordrecht, 1982), and those interested in von Baer and other proponents of teleology in biology will find Lenoir's broader account useful.The second half of the book addresses degeneration and like most contemporary discussions, Moore's book is charged with the political history of the last century. Moore reviews the association of decadence with jazz music and—via physiognomy as its external signifier—to the ugly, the Jew, the Black, and, of course, to women who broke with the family role. As an instantiation, Moore uncovers the nineteenth century antipathy to "allegedly aberrant behavior such as masturbation and homosexuality" in Nietzsche's "restrictive" [End Page 348] (133) view of sexuality and precocious eroticism (134) as degeneration. However, the issue of masturbation is complicated. The nineteenth-century perspective on masturbation was less a matter of prudishness than a judgment backed with considerable social and medical force, which equated the practice with sickness or criminality, the counterpart to which today would be our judgment with regard to an addiction to cocaine or heroine. This censure drove Wagner's "exposure" of Nietzsche's personal dependence on this practice. Readers interested in this question can either take themselves to the easy-to-find because eponymous chapter in Marc Wiener's Richard Wagner and the Anti-Semitic Imagination (Lincoln, 1995) or to David B. Allison's account of this as the occasion for the break between Nietzsche and Wagner in Reading... (shrink)

In the literature, the pragmatic dimension of metaphors has been clearly acknowledged. Metaphors are regarded as having different possible uses, and in particular, they are commonly viewed as instruments for pursuing persuasion. However, an analysis of the specific conversational purposes that they can be aimed at achieving in a dialogue and their adequacy thereto is still missing. In this paper, we will address this issue focusing on the distinction between the explanatory and persuasive goal. The difference between explanation and persuasion (...) is often blurred and controversial from a theoretical point of view. Building on the analysis of explanation in different theories and fields of study, we show how it can be conceived as characterized by a cognitive and a pragmatic dimension, where the transference of understanding is used pragmatically for different dialogical goals. This theoretical proposal will be applied to examples drawn from the medical context, to show how a pragmatic approach to explanation can account for the complexity of the cases that can be found in actual dialogical contexts. -/- . (shrink)

In Machiavelli on Freedom and Civil Conflict: An Historical and Medical Approach to Political Thinking, Marie Gaille rethinks Machiavelli's conception of civil conflict. In complete opposition to the common view of Machiavelli as a defender of tyranny, this analysis brings new elements to the forefront: the use of medical metaphors to describe the body politic, its historical lifespan and its institutional arrangement. This study is also based on a comprehensive approach to Machiavelli's writings, including his most famous works, (...) but also The History of Florence, his correspondence, and his political, military and diplomatic reports. This study allows Marie Gaille to propose an original assessment of Machiavelli's insights for contemporary conceptions of democracy. This is a revised and translated edition of Conflit Civil et Liberté: la Politique Machiavelienne entre Histoire et Médecine, first published in French, in 2004 by Éditions Honoré Champion. (shrink)

One of the most significant philosophical doctrines of Buddhism, and an idea that has remained at the centre of its theory and practice in virtually all historical times and places, is karma. The motivations for being involved in the accumulation of karmic merit in early medieval China were diverse, but one frequently mentioned goal was the health of the physical body. This brief article examines several facets of the relationship between karma and well-being, providing a few examples of the wide (...) range of sources on this subject and reflecting on its role in the popularization of Buddhism in China. I argue that medical metaphors were central to how the doctrine of karma was explained to diverse audiences, that the translation of these ideas emphasized connections with indigenous beliefs and social practices and that medical karma encouraged the self-regulation of behaviour and thoughts in conformity with Buddhist ideology. (shrink)

According to the theory of internal organs in traditional Chinese medicine, the gallbladder has the function of making judgments and decisions in mental processes and activities, and it also determines one's degree of courage. This culturally constructed medical characterization of the gallbladder forms the base of the cultural model for the concept of courage. In the core of this cultural model is a pair of conceptual metaphors: (a) "GALLBLADDER IS CONTAINTER OF COURAGE," and (b) "COURAGE IS QI (GASEOUS VITAL (...) ENERGY) IN GALLBLADDER," which partly constitutive of the understanding of the gallbladder and courage in Chinese culture. A description and analysis of the data from the Chinese language show that numerous conventional expressions are systematically tied to each other and contributive to the underlying conceptual metaphors. The study presents a case in which an abstract concept (courage) is understood in part via a conceptual metaphor grounded in the body, but shaped by a culture-specific metaphorical understanding of an internal organ (gallbladder) inside the body. Although the human body is a potentially universal source domain for metaphors structuring abstract concepts, cultural models set up specific perspectives from which certain aspects of bodily experience or certain parts of the body are viewed as especially salient and meaningful in the understanding of those abstract concepts. (shrink)

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. (shrink)

In the literature, the pragmatic dimension of metaphors has been clearly acknowledged. Metaphors are regarded as having different possible uses, especially pursuing persuasion. However, an analysis of the specific conversational purposes that they can be aimed at achieving in a dialogue and their adequacy thereto is still missing. In this chapter, we will address this issue focusing on the classical distinction between the explanatory and persuasive uses of metaphors, which is, however, complex to draw at an analytical level and often (...) blurred and controversial also from a theoretical point of view. Building on the analysis of explanation in different theories and fields of study, we show how it can be conceived as characterized by a cognitive and a pragmatic dimension, where the transference of understanding is used pragmatically for different dialogical goals - such as informing, making a joint decision, and most importantly persuading. In this sense, the cognitive effects of understanding are not incompatible with a persuasive dialogical purpose. This theoretical proposal will be applied to examples drawn from the medical context, to show how a pragmatic approach to explanation can account for the complexity of the cases that can be found in actual dialogical contexts. (shrink)

This paper investigates offensive animal metaphors in blog comments about the management of donations of money and medical relief during the coronavirus pandemic in China. Rather than understanding the metaphorical usage of language as a cognitive process, we consider its situational usage as a social action and invoke insights from Conversation Analysis. Based on data retrieved from Sina Weibo, we show how discussants use animal metaphors to accomplish varying actions and construct intelligibility between themselves and others about the relationship (...) between actions, moral accountability, and description of social events. We therefore argue that CA with its focus on topicality, action and societal membership can complement the cognitive understanding of the proximity between the source and the target domains. (shrink)

Human beings rely on metaphor as a primary cognitive device for interpreting the world around them. Metaphors figure especially strongly in discourse around health, illness, and medicine. It is not just that patients use metaphors to describe their personal experience of being unwell, or that medical professionals employ metaphor to convey a diagnosis, describe a treatment, or explain the function of an organ to their patients. Metaphor, it is argued, lies at the heart of the process (...) of diagnosis. Moreover, diagnosticians employ competing metaphors in the early stages of diagnosis to speculate on alternative ways of viewing a puzzling set of symptoms. Diagnosis is often defined as a process of ordering and classifying, while metaphor is a device for playing with classifications. The medical systems of different cultures depend on different sets of fundamental metaphors. Modern Western biomedicine is organized around a series of basic metaphors: the body as machine, the body as the site of battle, and the body as a communication system. Traditional Chinese medicine, on the other hand, uses images of flow and blockage, balance and imbalance, and works by analogy with five elements: wood, fire, earth, metal, and water. Psychologists are sometimes able to detect from a patient’s own use of metaphor, or inability to use or recognize metaphor, clues to a diagnosis of psychosis or autism. With conditions such as anorexia nervosa, therapists may actually work to modify the dysfunctional metaphors by which patients depict themselves, with the purpose of establishing positive metaphors for envisaging recovery. (shrink)

Crucial to discussions in organisational ethics is an evaluation of the metaphors and models we use to understand the organisations we are discussing. I briefly defend this contention and evaluate three possible models: the current corporate model, an orchestrator model which puts hospitals in the same class as malls and airports, and a community model. I argue that the corporate and orchestrator model push to the background some important organisational ethics issues and bias us inappropriately towards certain solutions. Furthermore, I (...) argue that the community model allows these to be more easily brought up. I also respond to the likely challenge that hospitals really are corporations by arguing that this is not relevant to evaluations of the appropriateness of the corporate model. (shrink)

The term ‘bioethics’ is commonly associated with debates prompted by innovations in medical technology, yet the issues raised by bioethics are not new. They concern the extent to which medicine and social morality exist in harmony or opposition — issues routinely addressed in the social history of medicine. This paper will argue that historical thinking, understood broadly, has a significant role to play in understanding relations between medicine and social morality, and therefore in contemporary bioethics. It explores past and (...) present uses of metaphor and analogy in shaping perceptions of scientific innovation, and argues for the validity of apparently anachronistic thinking in our judgments of the past. The aims of the paper are ultimately pedagogical: to enable students to look at media reports about developments in medicine and biotechnology in order to problematise what are presented as the self-evident terms of current debate. (shrink)

Dr Caitríona L Cox’s recent article expounds the far-reaching implications of the ‘Healthcare Hero’ metaphor. She presents a detailed overview of heroism in the context of clinical care, revealing that healthcare workers, when portrayed as heroes, face challenges in reconciling unreasonable expectations of personal sacrifice without reciprocity or ample structural support from institutions and the general public. We use narrative medicine, a field primarily concerned with honouring the intersubjective narratives shared between patients and providers, in our attempt to deepen (...) the discussion about the ways Healthcare Heroes engenders military metaphor, antiscience discourse, and xenophobia in the USA. We argue that the militarised metaphor of Healthcare Heroes not only robs doctors and nurses of the ability to voice concerns for themselves and their patients, but effectively sacrifices them in a utilitarian bargain whereby human life is considered the expendable sacrifice necessary to ‘open the U.S. economy’. Militaristic metaphors in medicine can be dangerous to both doctors and patients, thus, teaching and advocating for the critical skills to analyse and alter this language prevents undue harm to providers and patients, as well as our national and global communities. (shrink)

Most analysis of the metaphors of AIDS has considered lay rather than scientific discourse. In general, that analysis has uncovered linguistic strategies that tend to distance the disease from people who are healthy. Moreover, it has criticized those strategies insofar as they categorize and dehumanize the AIDS patient. My own analysis, however, focuses on the writing of Robert Gallo, one of the virologists who claimed credit for isolating the HIV as the cause of AIDS. By examining Gallo's popular and scientific (...) writing, I uncover the metaphor system that underlies his work — and perhaps the work of other virologists studying the HIV. I find in Gallo's writing a system of metaphor that personifies and humanizes the HIV (or the HTLV-III as he originally named it). This system differs significantly from lay systems that tend to objectify AIDS. I argue that the metaphor system that underlies Gallo's work is in fact productive, but that it might preclude other ways of conceptualizing the disease and its causes. The co-factor theory, for instance, entails a different metaphoric system entirely. I suggest that AIDS researchers might examine their own language in an effort to critique the metaphors they use and explore the possibility of using new metaphors. (shrink)

The frequent use of metaphors in health care communication in general and clinical ethics cases in particular calls for a more mindful and competent use of figurative speech. Metaphors are powerful tools that enable different ways of thinking about complex issues in health care. However, depending on how and in which context they are used, they can also be harmful and undermine medical decision-making. Given this contingent nature of metaphors, this article discusses two approaches that suggest how medical (...) health care professionals may systematically and imaginatively work with metaphors. The first approach is informed by a model developed by cognitive scientists George Lakoff and Mark Turner. The second approach is a close reading and thus a text-immanent, hermeneutical strategy. Using the double perspective of an ethics consultant and a researcher in literature studies, we take a case from Richard M Zaner in which a metaphor is central to the clinical-ethical problem. The article shows that the approaches, which focus on creativity and the intersections of form and content, may be helpful tools in clinical ethics, enabling a competent and mindful working with metaphors in complex cases as well as supporting the consultant’s thoughts processes. (shrink)

In her book, Illness as Metaphor, Susan Sontag focuses on metaphors and myths on diseases such as cancer and tuberculosis, which occur in different historical periods. Sontag argues that the metaphors produced related to illness overhaul illness and the things that define illness now have become metaphors produced related to them rather than their concrete and physical aspects. Illness becomes not just an illness, but a phenomenon defined by evil, mystery, fear, evil, madness, passions, wealth and poverty, temporal loginess (...) or speed, and a set of metaphors or myths that are spatially identified with the space. Metaphors and myths turn into means of socially stigmatizing the illness itself rather than giving a meaning to illness. The disease literally turns into a situation that needs to be hidden in order to avoid social stigma. The explanation of mass diseases through metaphors and myths has been seen since ancient times and this understanding of mass diseases continues to exist today. As a matter of fact, the Covid-19 pandemic has also ceased to be the subject of only medical science since it first emerged, and it has turned into an issue that concerns many areas from politics to economics, from sociology to psychology. The metaphors generated on the Covid-19 disease, which we have witnessed its reflections in many areas from the discourses of daily life to the discourse of politicians, from art to literature, have a similar function with the metaphors attributed to diseases like cancer and tuberculosis that Sontag discussed. Covid-19 is not only seen as a disease, but as a disease defined by a series of metaphors such as mysterious, evil, invisible enemy, insidious danger, and democratic virus. The metaphors generated on the disease cause the struggle against the disease itself to be explained with various metaphors. The metaphors derived from Covid-19 such as "invisible enemy" and "biological war" cause the struggle against it to be turned into a military terminology, and the metaphor of "Chinese virus" is a means of social stigmatization / marginalization by racializing the virus directly. This study tackles the issue of how Covid-19, which is the subject of medical science, has become the subject of unscientific myths and metaphors attributed to the disease, and that the disease is perceived through metaphors rather than itself in the context of Susan Sontag's thought. In the study, answers for the questions of what kind of effects appeared due to the stigmatizing power of metaphors derived from the Covid-19 and whether the metaphors are the outcomes of the strategy for coping with the pandemic will be sought. (shrink)

The locked-in syndrome is a state of profound paralysis with preserved awareness of self and environment who typically results from a brain stem stroke. Although patients in LIS have great difficulty communicating, their consciousness, cognition, and language usually remain intact. Medical decision-making by LIS patients is compromised, not by cognitive impairment, but by severe communication impairment. Former systems of communication that permitted LIS patients to make only “yes” or “no” responses to questions was sufficient to validate their consent for (...) simple medical decisions but not for consequential medical decisions such as whether to refuse further life-sustaining therapy. Emerging technologies including computer-tracking assistance of retained partial motor function and brain-computer interfaces promise to improve the communication ability of LIS patients and, when better developed, will allow them to fully exercise their right to actively participate in consequential medical decisions about their own medical care. Although so-called “covert cognition” patients clinically diagnosed as vegetative state that are shown to be aware by functional neuroimaging maybe metaphorically considered locked-in, it is nosologically more coherent not to categorize them formally as LIS. (shrink)

We have never been so aware of masks. They were in short supply in the early days of COVID-19, resulting in significant risk to health care workers. Now they are highly politicized with battles about mask-wearing protocols breaking out in public. Although masks have obtained a new urgency and ubiquity in the context of COVID-19, people have thought about both the literal and metaphorical role of masks in medicine for generations. In this paper, we discuss three such metaphors—the masks of (...) objectivity, of infallibility, and of benevolence—and their powerful role in medicine. These masks can be viewed as inflexible barriers to communication, contributing to the traditional authoritarian relationship between doctor and patient and concealing the authenticity and vulnerability of physicians. COVID masks, by contrast, offer a more nuanced and morally complex metaphor for thinking about protecting people from harm, authentic and trustworthy communication, and attention to potential inequities both in and beyond medical settings. We highlight the morally relevant challenges and opportunities that masks evoke and suggest that there is much to be gained from rethinking the mask metaphor in medicine. (shrink)

In 1997, the poet Judy Rowe Michaels was diagnosed with ovarian cancer. Over the ensuing 20-plus years, she has published four books of poetry and experienced six recurrences of the disease. This double corpus—the body of literary work produced by a body affected by illness, diagnosis, treatment, remission, and recurrence—provides rich insight into experiences of health, disease, and medical care. But I find Michaels's poetry especially significant because it also offers a means to examine what poetry does, and doesn't (...) do, when it intersects with medicine. As a practitioner of medical humanities, I teach and write about how content and approaches from the humanities can deepen our... (shrink)

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi‐structured interviews, collecting nurses' narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (...) (ii) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses' clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a ‘neutral’ experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices. (shrink)

This paper looks at a range of metaphors used within HIV/AIDS discussions and research in support of the claim that bioethicists should pay serious attention to metaphors. Metaphors shape the ways we think about problems and the types of solutions we investigate. HIV/AIDS is an especially rich field for the investigation of metaphor, since the struggles for dominance among different metaphorical options has been very evident. In the field of medical resarch as well as in the area of (...) public policy, different metaphors support different strategies and, therefore, the choice of metaphor has ethical significance. I argue that feminists should engage in these debates since they have an interest in the metaphors selected. They can also learn to be more self-conscious in choosing politically liberating metaphors in other bioethics contexts. (shrink)

Most health professionals are unaware of the extent to which aspects of language, such as metaphor, influence their practice. Sensitivity to metaphor can deepen our understanding of healthcare and, arguably, improve its quality. This is because metaphors, and the linguisticality of which they are a part, shape medical practice in important ways. Examples are the metaphors used in pain management. By exploring the dialogical tension between such metaphors, we can better understand the ways in which they influence (...) medical practice. (shrink)

SummaryThis paper examines the introduction of European anatomy to Japan via translated medical texts in the eighteenth century. It argues how detailed illustrations of the body found in the texts presented a new discourse by which to objectify and control the body, and new metaphors and analogies by which to view society. Inspection of bodily parts through dissection and the reading of anatomical texts marked a transition to Western forms of science, to ‘reliable’ knowledge which was certified by the (...) social status of the author. By looking at one important text, the Kaitai shinsho [A New Book of Anatomy] (1774), it will be shown that changes in representations of the body reflect the social construction of gender. (shrink)

Oncofertility is one of the 9 NIH Roadmap Initiatives, federal grants intended to explore previously intractable questions, and it describes a new field that exists in the liminal space between cancer treatment and its sequelae, IVF clinics and their yearning, and basic research in cell growth, biomaterials, and reproductive science and its tempting promises. Cancer diagnoses, which were once thought universally fatal, now often entail management of a chronic disease. Yet the therapies are rigorous, must start immediately, and in many (...) cases result in premature failure of the body's reproductive ability. In women, this loss is especially poignant; unlike the routine storage of sperm, which is done in men and boys facing similar treatment decisions, freezing oocytes in anticipation of fertility loss is not possible in most cases, and creating an embryo within days of diagnosis raises significant moral, social and medical challenges. Oncofertility is the study of how to harvest ovarian tissue in women facing cancer to preserve their gametes for future use with IVF, thus allowing the decisions about childbearing to be deferred and reproductive choices to be preserved. The research endeavor uses the capacity of the ovarian follicle to produce eggs in vitro. Developing the human follicle to ovulate successfully outside the body is scientifically difficult and ethically challenging. Infertility is linked to long-standing religious and moral traditions, and is intertwined with deeply contentious social narratives about women, families, illness and birth. Is the research morally permissible? Perhaps imperative if understood as a repair from iatrogenic harms? How are considerations of justice central to the work? How will vulnerable subjects be protected? What are the moral implications of the work for women, children and families? What are the implications for society if women could store ovarian tissue as a way of stopping the biological clock? What are the moral possibilities and challenges if eggs can be produced in large quantities from a stored ovarian tissue? (shrink)

Skin as cover: the discursive effects of 'covering' metaphors on wound care practicesThis paper outlines a Foucauldian analysis of interactions between nurses and patients during wound care procedures in a burns unit. It explores the use of Kristeva's psychoanalytic concepts of abjection and the abject body to illuminate the emotional affects of wounds on nurse and patient. In this process, I identify how cultural metaphoric understandings about skin influence and organise the care of burns patients. Such analysis suggests the import (...) of the complete skin, the medical scientific control over the definition of this work, and the emotional forces that resist such control. (shrink)

In the face of documented difficulties in the public understanding of genetics, new metaphors have been suggested. The language of information coding and processing has become deeply entrenched in the public representation of genetics, and some critics have found fault in the blueprint metaphor, a variant of the dominant theme. They have offered the language of the recipe as a preferable metaphor. The metaphors of the blueprint and the recipe are compared in respect to their deterministic implications and (...) other associations. The likelihood of the recipe metaphor framing cognition in more useful ways is called into question. (shrink)

Following a boom in investment and overinflated expectations in the 1980s, artificial intelligence entered a period of retrenchment known as the “AI winter.” With advances in the field of machine learning and the availability of large datasets for training various types of artificial neural networks, AI is in another cycle of halcyon days. Although medicine is particularly recalcitrant to change, applications of AI in health care have professionals in fields like radiology worried about the future of their careers and have (...) the public tittering about the prospect of soulless machines making life‐and‐death decisions. Medicine thus appears to be at an inflection point—a kind of Groundhog Day on which either AI will bring a springtime of improved diagnostic and predictive practices or the shadow of public and professional fear will lead to six more metaphorical weeks of winter in medical AI. (shrink)

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs (...) the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty. (shrink)

Ten years ago there was little talk about adding “professionalism” to the medical curriculum. Educators seemed to believe that professionalism was like the studs of a building—the occupants assume them to be present, supporting and defining the space in which they live or work, but no one talks much about them. Similarly, educators assumed that professional values would just “happen,” as trainees spent years working with mentors and role models, as had presumably been the case in the past. To (...) continue the metaphor, when educators did discuss ethics and values, they tended to focus more on external building codes than on the nature of construction materials. Building codes are designed to ensure the public's safety by establishing procedures and standards. Likewise, the “new” bioethics of autonomy and informed consent that entered the medical curriculum in the 1970s and 1980s was oriented primarily toward protecting human rights by codification. In fact, educators explicitly warned students against acting on their personal or professional values in a misguided way—that is, in the absence of adequate ethical constraints, a type of behavior that came to be labeled, pejoratively, as paternalism. (shrink)