E#6: Metaphors- How to Use them Skillfully (to Explain all Kinds of Things)
This episode uncovers how metaphorical language is used daily and how it can impact the way we talk with patients. We use metaphors in our lives all the time, but we can use them more skillfully to re-frame and refocus ideas and emotions.
(This is the core of the transcript from the podcast. The Introduction has been removed and some areas improved for reading ease.)
There are many different effects in the world of magic and illusions. We, Illusionist, can make something vanish and then reappear it somewhere else (we call it a transposition effect); we can change one object into another(transmutation); we can animate an object (like a dancing scarf or silk-animation) and we can levitate (suspension). However, the most commonly performed Illusion we perform is to make something that was seemingly not there before hand, appear (appearance) as if it came from nowhere. In other words, causing the invisible – to become visible!
"That lesion is as hard as a rock, discharge has a fish like odor, the stool is like a red jelly substance"
Now in the world of medicine, metaphorically speaking, we also use this same concept of making something invisible - visible. Now, you may be asking, “how is that possible?” Well, let’s take, for example, when a person has ‘symptoms’ such as pain, discomfort or anxiety which can generally be considered invisible concepts. But, through the investigative process of taking a medical history, physical examination and diagnostic testing, we come up with something more tangible, visible – i.e. the diagnosis. Hence, we have transformed the invisible (an unknown), to the visible (the known). From there, we develop a treatment plan. So, if I continue with the magic metaphor, we are mostly discovering the hidden secrets of what ails the patient in order to make the unwanted symptoms/disease disappear. This idea of making something appear and disappear is a figurative way to describe two unrelated concepts: magic and medicine.
Just as I’ve been using the idea of magic and illusions as a metaphor to talk about uncovering a diagnosis, the same idea of using metaphors (or similes) are examples of how figurative language is used to explain two unrelated concepts by drawing a similarity between them. Because when people speak, they use pictorial communications, stories, images and references to explain difficult or complicated concepts. Metaphors and similes are used all time in the clinical setting.
When people speak, they use pictorial communications, stories, images and references to explain difficult or complicated concepts. Metaphors and similes are used all the time in the clinical setting
For instance, when we are trying to explain a lesion we are examining, we might say that the lump is the size of a walnut; there is a milky like discharge; the urine is tea colored ; the stool is clay like. We even use metaphors when we are asking questions such as: “Does your headache feel like a vice grip squeezing your head?”; “Does your headache feel sharp like an ice pick jabbing your face or temple?”
As I’m sure you know, there are many people with high blood pressure who don’t feel they need treatment because they are asymptomatic. So, I use metaphors to explain high blood pressure and the importance of treatment. I compare their arteries to the plumbing pipes in their house. I’ll say,
“If the pressure in your home water pipes is too high, you won’t know it because the water flows through the taps fine. Your shower pressure feels normal, and everything appears to be great. But at some point, the pipes will burst and then the next thing you know your living room or basement is flooded. That’s similar to the human body. Your blood pressure is a warning system before something goes wrong; before stroke, heart attack, kidney failure, etc., that’s why we need to keep it under control.
"I feel I have this heavy weight on my shoulders"
-What happens if you took that weight off your shoulders and put it down?
This makes the concept of high blood pressure is more understandable to the patient. In medicine we often use metaphors to describe hypertension as the “silent killer” because it can quietly cause damage to a vital human organ.
We also use metaphors to describe how medications work. For instance, I will tell a patient, with a bad rash, to “put this medication on the rash so you won’t feel the burning sensation anymore. It will put out the fire.” In a different clinical scenario I’ll use a medical metaphor by saying “This medication is a clot buster” or “This medication will fight cancer”.
My favorite medical metaphor is to compare our health and body to a financial investment - like a bank account. The small daily deposits of good habits are an investment in increasing our reserve of energy and health. Focusing on how to increase our health account is essential.
Metaphorical language can be used in both positive ways and negative ways. For example, in medicine we use the ‘war’ or ‘battle’ metaphor. We describe disease and illness as the enemy and that we have to fight it. This can have certain implications, so if the patient loses the battle against cancer, which can give a specific connotation about the patient’s character and can even make the doctor feel powerless. In other words, there are losers and winners. You’ll never hear a doctor say “This patient lost their battle against the bacterial infection.” Rather they’ll say, “This person died from sepsis.” Or, if a patient died from a subdural bleed, we don’t say “They lost their war against the dura mater and arachnoid mater.” So, it’s essential to consider the language that we use and how we choose our metaphors in the clinical setting.
The doctor-patient relationship can also be described or be acted out in metaphorical language as well. The relationship could be described as paternalistic where the doctor knows best. The relationship could also be depicted as the technician/mechanic type where the physician ‘fixes’ the patients complaint, as when they ’clean out the arteries’, or ‘remove the clot, tumor, etc. ‘.
Patients also use metaphors to explain their physical symptoms. So, for example, when a patient says, “The pain feels like an elephant sitting on my chest!”, or when they say “The pain is sharp like a knife is cutting me!” it gives us a clear idea of what the pain is like.
Patients will also use a metaphorical language to explain how they feel emotionally:
“I feel weighed down”
“I’m boxed in”
“I feel all knotted up inside”
“I get stuck“
“I feel I have this heavy weight on my shoulders”
“I always feel like I’m in the dark”
As mindful clinicians, it’s useful to listen to our patient’s metaphorical language; because we can help them change the way they see or feel about things. We can do this by reframing, or redefining their metaphor. Here’s an example of what I mean.
A young woman in her 20’s was frustrated and depressed for many reasons in her life. She was focused on all that was unwell in terms of her relationships, career and finances. She felt her life was not going to get better. She could only see what was wrong in her world and that was making her very depressed. In our conversation, she said that “There was a fog in her life and there seemed to be a dark cloud where ever she went.”
So, I asked her “What would it take for the fog to lift and let some sun shine in?” She started to think and was able to come up with a couple of useful solutions. She told me, “I need to do things with my friends and reconnect with my family more, and get back to the gym.”
Another question I asked was: “What would you need to look at or remove to visually see the sunshine or the landscape that is in front of you?” She then came up with strategies that were self-tailored to her. Some other follow-up questions I used were:
“Who could you ask for help to keep the sunshine in and the fog out?”
“What happens if the fog rolls in... how will you open that window?”
She, in her situation, had lost touch with the many things that were going well and was unable to reinstate things that made her grateful. Now she knew what she needed to do, as so many of us do, but by re-framing her metaphor, she could literally make the fog and dark cloud disappear and create room in her life for the sun to shine in.
So often when people are upset, they don’t know how to reframe their vision. As clinicians, we don’t always have to reach for medications to help people get better. Sometimes, simply helping them to look at their situation differently and creating better viewpoints will work wonders. As my good friend, Dr. Chris Hersch would say “Instituting better choice points by creating space and time in the moment.”
Often, I’ll ask my patients who are depressed to keep photos of people who evoke positive emotions or use quotes that inspire and encourage them to change their language and physiology. This in turn allows them to create a more empowering life blueprint or a more empowering metaphor.
So I’ll take some of the earlier examples, and see how we can reframe them:
So, when a patient says:
“I feel I have this heavy weight on my shoulders.”
- What happens if you took that weight off your shoulders and put it down?
“I’m boxed in.”
- What’s keeping you boxed in? How can you get out?
“I feel all knotted up inside.”
- How could you undo those knots?
“I get stuck.”
- What if all the mud dried up? How could you pull yourself out?
- Would you let someone help you?
“They are like a villain!”
-So that makes you the main character, how will the story end? How will you triumph?
“We keep dancing around the issue.”
- Perhaps you need to do a different dance and slow it down.
So, these are some examples of how we can reframe a person’s metaphor so they can get back on track to creating their best life. Those are essentially the main points I wanted to share with you, and I hope you can add them to your patient engagement tool kit.
Here’s a Summary of Today’s Podcast:
Metaphors, Similes and figurative devices can help find similarities between different concepts.
We, as clinicians, also use metaphors to explain ideas, concepts and treatment options. It’s important to know which metaphors we use and how we can build up our tool kit of metaphors.
Patients use metaphors when describing their physical symptoms and the way they feel.
As clinicians, it’s useful to be mindful of a patient’s metaphors so that together we speak the same language. This is essential if we hope to reframe and refocus their ability to choose the way they think, feel and act so they can live a more empowering life.
I would love to hear if you have any metaphors that you find most useful or any interesting stories you have come across.
I hope this podcast served you in some way, if you’ve enjoyed listening to this podcast, please share with a friend or colleague and subscribe to us in Spotify, Breaker or your favorite podcast app. Please don’t forget to leave a rating. I know it seems like a small thing, but it makes a difference in terms of helping others find this podcast. I’m Dr. Lalit Chawla and thank you so much for listening. Let’s together make a greater, more effective community and inspire people to live with Greater Harmony, Joy and Magic in their lives.
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(A special thanks to the talented William Brown who edited the above transcript)