Metaphor and the patient’s world

The Revd Dr David Southall, Healthcare Chaplain, Worcestershire Acute Hospitals NHS Trust, Worcester, UK, explains the background to his longer article published in the April 2013 edition of Palliative Medicine.

Rev'd Dr David Southall

Rev’d Dr David Southall

Like many people, I have always been fascinated with words. I remember as a young boy wondering why a “dog” was called a “dog” and if it would be different if it was given another name. Little did I know that I shared a tradition going back to Aristotle.

My interest in figures of speech (what the academics call tropes) drew me to a sustained study of metaphor and personification in my doctoral thesis. 1 There I discovered a whole new world of postmodern linguistics in which tropes were not just ornamental flourishes to make what was said more pretty, but were actually able to create new ways of seeing the world; a feature which was just not available in normal, flat language. So to say “I was being swept along on a tidal wave beyond my control” engenders more than saying “I have had such and such an illness and life has changed for me.” The picture of a raging sea, a small boat being driven at the mercy of the waves, the thunderous crashing of water against the side of the vessel; and so much more – even the hope of calmer seas.

“I was being swept along on a tidal wave beyond my control.” Rembrandt’s ‘Storm on the Sea of Galilee’ (via Wikimedia Commons)

“I was being swept along on a tidal wave beyond my control.” Rembrandt’s ‘Storm on the Sea of Galilee’ (via Wikimedia Commons)

Metaphor in palliative care literature
Four years ago I moved into Healthcare Chaplaincy and was struck by the way in which pain-free patients described their conditions; more than that I was struck by the frequency of metaphoric language used by people with life-limiting illnesses. Once you’re alert to this, you trip over it so much that you wonder about its importance.

The survey and analysis of metaphor in palliative care literature was, for me, a fascinating study. The reader will note the diversity of metaphors used by patients and the range of situations that they describe. My hope is that this article 2 will give caregivers a contextual framework in which to recognise metaphors when they occur.

So, for example, when asked how he was, a patient said to me, “Last night was terrible. I felt that I was being swept along on a tidal wave beyond my control. Bashed and buffeted by the wind and waves. Not physically just… just in my head. Terrible. No lifeboats.” Now he could have said, “I had a really bad night,” but he didn’t.

This leads to the next question: Do metaphors function in any other way than the descriptive? My argument is that they do: they open up new ways of seeing the world; new vistas on which to embark on the next parts of the human endeavour and journey. And if this contention is true, then it is worth using our skills to recognise metaphors and to engage with the patient at the metaphoric level.

Much more could be said of the tropes, of personification, simile, and even narrative, which function in a similar way. But beware, metaphors take time to hear; and take trust to be given away. It is only after the exertion of really listening that we might be given the privilege of sharing in the metaphoric world of the patient – a world that may even open up new views for us too.

It is a great delight to be selected as the ‘Editor’s choice’ in this edition of Palliative Medicine. I hope that several journeys into the trope rich patient’s world will embark from here. Happy sailing.

1. Southall, DJ. Rediscovering Righteousness in Romans: Personified Dikaiosynē within Metaphoric and Narrational Settings. WUNT, 2.240; Tübingen: Mohr Siebeck, 2008.

2. Southall D. The patient’s use of metaphor within a palliative care setting: theory, function and efficacy. A narrative literature review, Palliat Med April 2013; vol. 27, 4: pp. 304-313. First published on July 24, 2012, doi: 10.1177/0269216312451948. (To download a free copy of this article, please see below).

Read the full article in the April edition of Palliative Medicine

Read the full article in the April edition of Palliative Medicine

Find out more…
EAPC members and registered users of the EAPC website can download a free copy of this article and other ‘Editor’s choice’ papers from the EAPC website. (Just follow the instructions in the top right-hand corner of EAPC homepage to register or login, and scroll down to download the article).  Click here to view other EAPC-originated papers on the EAPC website. 

Click here to read a previous post on Metaphor in End-of-Life Care. 


This entry was posted in EAPC-LINKED JOURNALS, Palliative Medicine: Editor's Choice, SPIRITUAL CARE and tagged , . Bookmark the permalink.

2 Responses to Metaphor and the patient’s world

  1. Elena Semino says:

    This is a fascinating post, thank you. I work with a team at Lancaster University looking at the metaphors that are used by patients, family carers and health professionals to talk about end of life care: Our initial findings are very much in line with what you say: metaphors are used to talk about all aspects of people’s experiences of end of life. For example, family carers talk about their emotions as something that is inside them, and that can only safely ‘come out’ in a safe place, such as a meeting with other carers, where they can ‘open up’ and experience ‘release’. However, if emotions ‘come out’ at home, they can make it difficult to ‘keep going’. In our interviews with hospice managers, the contrast between ‘good’ and ‘bad’ deaths is partly expressed via contrasting metaphors. These include, for example, the contrast between death as the accepted end of a ‘journey’ and death as an opponent against which to ‘struggle’, ‘battle’ or ‘fight’. Similarly, while a good death is described as involving many ‘open’ conversations, a bad death is described as involving problems ‘in the background’ or in a ‘place’ inside the patient that hospice staff are not allowed to ‘reach’.

  2. Chris says:

    This is so interesting. I have heard many people, especially those with a disease or who are in constant pain, describe their symptoms in metaphor. I wonder if it has something to do with wanting people to understand their pain. It is very broad to say “my head hurts”, but if that person says that their head feels “like someone is taking a jackhammer to my skull”, it becomes easier for a person to understand and sympathize.

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