For the Week of February 5, 2017: The Necessity of Metaphors in Illness

Inside every patient, there’s a poet trying to get out.—Anatole Broyard, 1990

Poetry and medicine share a long history, dating back to the Greek god Apollo, who was responsible for both healing and poetry.  Today, The use of metaphor, a poetic tool and figure of speech comparing two things seemingly unrelated, is common not only in poetry, but illness and everyday life.  Consider the sports talk that dominates this Super Bowl Sunday, one example of how metaphors permeate our everyday lives, in the language we use and in the way they influence our thoughts and actions.  For example, we use sports metaphors almost unconsciously to describe experiences in our daily life.  In the workplace, you strive to be  a “team player” or be encouraged to “run with a good idea.”  In budding romance, a boy might ” “make a pass at someone,” or in an emotional argument between two people, one is told he or she is “way out of bounds.”

There’s little doubt that our metaphors are visual and illustrative, but they also run the risk of creating stereotypes or confusion, even becoming clichés.   Some, like sports and military metaphors are so common in our daily language, they are used routinely to describe medical experience.  In “The Trouble with Medicines’ Metaphors,” (The Atlantic, August, 2014)  author Dhruv Khullar, MD, wrote:

The words we choose to describe illness are powerful. They carry weight and valence, creating the milieu in which goals of care are discussed and treatment plans designed. In medicine, the use of metaphor is pervasive. Antibiotics clog up bacterial machinery by disrupting the supply chain. Diabetes coats red blood cells with sugar until they’re little glazed donuts. Life with chronic disease is a marathon, not a sprint, with bumps on the road and frequent detours...  Military metaphors are among the oldest in medicine and they remain among the most common. Long before Louis Pasteur deployed imagery of invaders to explain germ theory in the 1860s, John Donne ruminated  on the “miserable condition of man,” describing illness as a “siege…a rebellious heat, [that] will blow up the heart, like a Myne” and a “Canon [that] batters all, overthrowes all, demolishes all…destroyes us in an instant.”

As Khullar points out, “…we’ve internalized these metaphors, so much so that we often may not recognize how they influence us.”  Yet metaphors help us understand one another.  They offer a way to make sense of the emotional chaos accompanying a cancer diagnosis and communicate our feelings to others. Khuller referred to a 2010 study that found physicians use metaphors in nearly two-thirds of their conversations with patients with serious illness.  “Physicians who used more metaphors were seen as better communicators. Patients reported less trouble understanding them, and felt as though their doctor made sure they understood their conditions.”

Metaphors get our attention.  They’re visual, sometimes visceral and offer us a shorthand route to emotions and a vivid way to communicate and understand the experience of illness.  They help the listener or reader understand and appreciate what we are experiencing.

Consider the poem, “The Ship Pounding,” by former poet laureate, Donald Hall.  He offers us a glimpse into the final months of poet Jane Kenyon (his wife) and her struggle with leukemia through metaphor, creating a visual image of a ship filled with passengers, heaving in rough waters:

Each morning I made my way   

among gangways, elevators,   

and nurses’ pods to Jane’s room   

to interrogate the grave helpers   

who tended her through the night   

while the ship’s massive engines   

kept its propellers turning…

At first, the narrator is hopeful:

The passengers on this voyage   

wore masks or cannulae

or dangled devices that dripped   

chemicals into their wrists.   

I believed that the ship

traveled to a harbor

of breakfast, work, and love.   

But Kenyon’s illness cannot be cured, evident in the final lines, as the narrator waits to hear his wife call and knows he must be ready to:

… make the agitated

drive to Emergency again

for readmission to the huge

vessel that heaves water month   

after month, without leaving   

port, without moving a knot,   

without arrival or destination,   

its great engines pounding.

(From “The Ship Pounding,” In Without, 1998))

Hall has given us a powerful image in his metaphor, and by comparing one thing to another, we see and understand it conceptually and emotionally.

When Anatole Broyard, whose book, Intoxicated by My Illness and Other Writings on Life and Death (1993), his experience of terminal prostate cancer, wrote:  Always in emergencies we invent narratives. . . Metaphor was one of my symptoms.  I saw my illness as a visit to a disturbed country. . . I imagined it as a love affair with a demented woman who demanded things I had never done before. . .   When the cancer threatened my sexuality, my mind became immediately erect. 

Arthur Frank, sociologist and author of At the Will of the Body:  Reflections on Illness (1991), a memoir of his experiences of cancer and heart attack, describes his illness and recovery as a “marathon.”  Not surprisingly, Frank is a runner, and the physical and mental demands of the marathon were apt comparisons to describe his experiences of illness.

Kat Duff, diagnosed with chronic fatigue and immune system dysfunction syndrome, wrote The Alchemy of Illness, (1993) exploring illness narratives as a way to gain insight into the nature of illness.   She compared her illness to a landscape, a wilderness, or coral reef, and health as an adventurous voyage through it.

Macklin Smith, diagnosed with leukemia, compares the hospital to a prison in his poem, “Independence:”

Even incarcerated men and women can achieve some independence
Through their choice of TV programming, wardrobes, even e-mail,
Depending on the warden’s policy and type of prison,
Although in the super-max federal system they cannot choose
Any of these things: they’re in solitary 23 hours a day, strip searched
prior to their hour of exercise, and never go outside, no
window, and they’re under artificial lighting night and day…

(In:  Transplant, 2002).

These are only a few examples of the metaphors others have used to describe and communicate their experience of illness, but, as Anatole Broyard reminds us, metaphors do not belong solely to the world of poetry and literature, rather,  “Metaphors may be as necessary to illness as they are to literature, as comforting to the patient as his own bathrobe and slippers.”

Writing Suggestion:

  • This week, explore the metaphors you use to describe your cancer experience—or any other difficult and painful chapter of life. What images do our metaphors convey?
  • Begin with a phrase such as “Cancer is a…” or “illness is like a…” and finish the thought, noting what image or word emerges.  Remember, write quickly, without editing.  Set the timer for five or ten minutes and keep your pen (or fingers) moving.
  • Once you’ve finished, read over what you’ve written.   What surprises you?  Do you discover any unexpected metaphors?  How do they help to describe and explain your experience of illness or hardship? Perhaps your metaphors can inspire a poem or a story that describes your experience of illness or hardship in greater detail.

About Sharon A. Bray, EdD

Best known for her innovative work with cancer patients and survivors, Sharon is a writer, educator and author of two books on the benefits of expressive writing during cancer as well as personal essays, a children's book, magazine articles and the occasional poetry. She designed and initiated expressive writing programs at several major cancer centers, including Breast Cancer Connections, Stanford Cancer Center, Scripps Green Cancer Center and Moores UCSD Cancer Center. She continues to lead expressive writing groups for men and women living in the San Diego area and teach creative writing workshops and classes privately for UCLA extension Writers' Program. She previously taught professional development courses in therapeutic writing at Santa Clara University and the Pacific School of Religion, was a faculty member of the CURE Magazine Forums and at the Omega Institute in 2014. Sharon earned her doctorate from the University of Toronto and studied creative and transformative writing at Humber School for Writers, University of Washington, and Goddard College.
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