Table Of Content7
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Thinking with Metaphors in Medicine
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r While medical language is soaked in metaphor, and thinking with metaphor is
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b central to diagnostic work, medicine – that is, medical culture, clinical practice
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e and medical education – outwardly rejects metaphor for objective, literal scient-
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o ific language. This thought- provoking book argues that this is a misstep, and
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critically considers what embracing the use of metaphors, similes and aphorisms
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0 might mean for shaping medical culture, and especially the doctor–patient rela-
8 tionship, in a healthy way.
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8: Thinking with Metaphors in Medicine explores:
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• how metaphors inhabit medicine – sometimes for the better and sometimes
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o for the worse – and how these metaphors can be revealed, appreciated and
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e understood;
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O • how diagnostic work utilizes thinking with metaphors;
of • how patient–doctor communication can be better understood and enhanced
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s • how the landscape of medicine is historically shaped by leading or didactic
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v metaphors, such as ‘the body as machine’ and ‘medicine as war’, which
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n may conflict with other values or perspectives on healthcare, for instance,
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[ person- centred care.
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d Outlining the kinds of metaphors that inhabit medicine and how they shape prac-
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d tices and identities of doctors, colleagues and patients, this book demonstrates
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o how the landscape of medicine may be reshaped through metaphor shift. It is an
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w important work for all those interested in the use of language in medicine,
o whether hailing from a humanities, social science or healthcare background.
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Alan Bleakley is Emeritus Professor at the University of Plymouth’s Peninsula
Schools of Medicine and Dentistry, UK.
Routledge Advances in the Medical Humanities
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r New titles
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e Medicine, Health and the Arts Person- centred Health Care
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o Approaches to the Medical Balancing the Welfare of Clinicians
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Humanities and Patients
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0 Edited by Victoria Bates, Stephen Buetow
8 Alan Bleakley and Sam Goodman
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8: Digital Storytelling in Health and
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t Suffering Narratives of Older Social Policy
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Adults Listening to Marginalized Voices
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o A Phenomenological Approach to Nicole Matthews and
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e Serious illness, Chronic Pain, Naomi Sunderland
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O Recovery and Maternal Care
f Mary Beth Morrissey Bodies and Suffering
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y Emotions and Relations of Care
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si Medical Humanities and Medical Ana Dragojlovic and Alex Broom
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ve Education
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n How the Medical Humanities Can Thinking with Metaphors in
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[ Shape Better Doctors Medicine
y Alan Bleakley The State of the Art
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d Alan Bleakley
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d Learning Disability and Inclusion
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o Phobia Forthcoming titles
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w Past, Present and Future
o C. F. Goodey The Experience of
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Institutionalisation
Collaborative Arts- based Research Social Exclusion, Stigma and Loss
for Social Justice of Identity
Victoria Foster Jane Hubert
Thinking with Metaphors in
Medicine
The State of the Art
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2 Alan Bleakley
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First published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 A. Bleakley
The right of Alan Bleakley to be identified as author of this work has been
asserted by him in accordance with sections 77 and 78 of the Copyright,
7 Designs and Patents Act 1988.
1 All rights reserved. No part of this book may be reprinted or reproduced or
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2 utilized in any form or by any electronic, mechanical, or other means, now
r known or hereafter invented, including photocopying and recording, or in
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b any information storage or retrieval system, without permission in writing
m from the publishers.
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v Trademark notice: Product or corporate names may be trademarks or
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N registered trademarks, and are used only for identification and explanation
6 without intent to infringe.
0 British Library Cataloguing i n Publication Data
8 A catalogue record for this book is available from the British Library
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8 Library of Congress Cataloging in Publication Data
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t Names: Bleakley, Alan (Alan Douglas), author.
a Title: Thinking with metaphors in medicine : the state of the art /
] Alan Bleakley.
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o Other titles: Routledge advances in the medical humanities.
g Description: Abingdon, Oxon ; New York, NY : Routledge, 2017. |
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r Series: Routledge advances in the medical humanities | Includes
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bibliographical references and index.
of Identifiers: LCCN 2017005930| ISBN 9781138229440 (hbk) |
y ISBN 9781315389448 (ebk)
it Subjects: | MESH: Metaphor | Physician-Patient Relations | Language |
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r Interprofessional Relations | Education, Medical
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v Classification: LCC R727.3 | NLM W 62 | DDC 610.69/6–dc23
ni LC record available at https://lccn.loc.gov/2017005930
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y [ ISBN: 978-1-138-22944-0 (hbk)
b ISBN: 978-1-315-38944-8 (ebk)
d Typeset in Times New Roman
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d by Wearset Ltd, Boldon, Tyne and Wear
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r I would like to thank my loving family, especially my wife Sue,
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b who puts up with my grumpy behaviour when I am writing;
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e and when I am not writing.
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7
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r Overheard in a hospital corridor:
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e ‘That’s the surgeon who stitched me up.’
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Overheard on the way into theatre from a senior gastrointestinal surgeon:
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8 ‘That bloody medical student’s late again – I’ll have his guts for garters!’
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Contents
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r Forewords ix
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b Preface: forewarned xvi
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e Acknowledgements xix
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0 1 The recovery of metaphor in medicine 1
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8: 2 Metaphors, once down and out, make a comeback 22
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] 3 What do we know about metaphors in medicine and what
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o are the consequences of resisting metaphor? 42
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f 4 ‘Medicine as war’ and other didactic metaphors 54
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it 5 Medical metaphors as resemblances: putting aesthetics to
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er work 71
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6 Functions of resemblances in medicine: ‘food for thought’ 82
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d 7 Metaphors in psychiatry: the embodied mind at its limits 102
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o 8 Metaphors in medical education: the pedagogic
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w imagination 124
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9 Poetry, metaphor and the medical imagination 144
10 ‘Thinking with metaphors in medicine: the state of the art’:
Part I: the odyssey 162
11 ‘Thinking with metaphors in medicine: the state of the art’:
Part II: the tournament joust 182
viii Contents
Summary 203
Conclusion 208
Appendix 1 216
Appendix 2 221
Appendix 3 225
Bibliography 226
Index 244
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Forewords
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r Introduction to forewords
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m Doctors and poets share the attribute of ‘close noticing’. It is the basis of both
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v creative writing and diagnostic acumen. Here is the poet Anthony Hecht: ‘Each
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N hanging waterdrop burns with a fierce/Bead of the sun’s instilling’; and here, the
6 surgeon Richard Selzer (who retired from surgery to write full time): ‘in that
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8 place where he knows the duct to be, there is none. Only masses of scar cur-
4 tained with blood vessels of unimagined fragility.’ Hecht’s waterdrop ‘burns’
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0 (fiercely), while Selzer’s scar is ‘curtained’ – both writers realize close noticing
at as poetic observation. Both waterdrop and blood vessels are pregnant with pos-
n] sibility. Hecht’s observation treats the body of language, whereas Selzer’s has a
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g dual role – treating both the human body and the language that describes it,
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r saving the latter from impoverishment (the given role of the poet, such as Hecht,
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f in the world of lay observation).
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y I am honoured that two poets – both experts in close noticing – have con-
it tributed separate forewords to this book. One is a physician (Shane Neilson), the
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er other an academic (Jeffery Donaldson). Their paths intertwine – Shane is, at the
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i time of writing, a PhD candidate in English (researching and writing about pain)
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U at McMaster University in Canada, where Jeffery is his supervisor. Jeffery has
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y written a groundbreaking book on metaphor and science: Missing Link: The Evo-
b lution of Metaphor and the Metaphor of Evolution (2015). At one time, they had
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e considered writing a joint contribution, but decided on separate forewords to this
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a book. I am the beneficiary of their decisions, receiving a double bounty of cur-
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nl tained scars and fiercely burning waterdrops. They are generous in their observa-
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tions of my work, and go well beyond mere commentary to offer original
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D insights. They are experts in treating otherwise languishing language by shifting
so skilfully into poetic registers that their close noticing in itself shines, some-
times with an unnerving dark glow, as well as shedding light on the surround-
ings. Their work enriches our lives, and their respective forewords substantially
enrich this book.
