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Stephen Ginn: Metaphors in medicine

23 Aug, 11 | by BMJ Group

Stephen GinnMetaphors are widely used by both healthcare professionals and lay people when talking about matters of health. Despite this their role is largely unrecognised. This is a shame, I feel, as they can have a powerful effect on the practice of medicine and the experience of illness.

A metaphor is a way of understanding and experiencing one kind of thing in terms of another. Many complex concepts are understood in this way and they are integral to the way we understand things. 

The essayist Susan Sontag was one of the first to identify the widespread use of metaphor in relation to certain diseases. She wrote Illness as Metaphor whilst being treated for breast cancer and visited the topic again in 1988 with AIDS and its metaphors.

Sontag argued that metaphors attach themselves to certain diseases and these metaphors exert influence on patient and public attitudes. With both HIV and cancer Sontag argued that metaphors introduced an unhelpful emotional dimension when a more detached scientific approach was required.

Two main sorts of metaphors have been suggested. (1) “Biomilitary” metaphors represent disease and the body’s response to it in terms of “attack” and “defence.”  By contrast with “bioinformationist” metaphors the body, in both health and disease, is seen as a communication system with “receptors,” “transmitters” etc.

Particular diseases attract metaphorical description more readily than others. Biomilitary metaphors are pervasive in discussions of cancer. By contrast heart disease is discussed almost exclusively in terms of the mechanical metaphor of plumbing.

Arguably metaphors don’t merely describe similarities; they create them. As well as illuminating they can also conceal. It can be hard to think of cancer in a way that is not biomilitary, but wars honour battles which can make the transition to hospice care problematic. Mechanical metaphors for heart disease are also limited as they hold no place for lifestyle modification. I don’t agree with Sontag that metaphor should be eliminated from the discussion of medical illness. In fact I don’t actually believe that it would be possible to talk about disease without them. But they have a hidden power that should be understood.

If you choose a metaphor, choose it wisely.

1. Montgomery SL. Illness and image: on the contents of biomedical discourse. In: Montgomery SL.The scientific voice. New York and London: Guilford Press, 1996:134–95.

Stephen Ginn is the BMJ editorial registrar. He writes a personal blog at: http://www.frontierpsychiatrist.co.uk Follow him on Twitter at: http://www.twitter.com/psychiatrist

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  • http://twitter.com/velogubbed Nasim Marie Jafry

    I wrote an autobiographical novel about the illness ME – The State of Me -  so I know all about metaphors and illness. I agree, it is impossible to write about/describe illness without metaphors. ‘If you choose a metaphor, choose it wisely.’ Yes, I agree with this too. Unfortunately, Prof Simon Wessely, psychiatrist, very much in the media just now, takes this a step further, the illness *becomes* the metaphor. He refers to my illess as ‘a cultural phenomenon, a metaphor for our times’. It actually makes no sense. A neuroimmune illness, a metaphor for our times? Hmm…

  • Alina Hsu

    What about a systems metaphor?  This in fact might be closer to reality than to metaphor.  The body is a system composed of many subsystems, most of which interact with each other in complex ways.  And the body exists in larger social, societal, envrionmental, and medical systems. 

    Systems lend themselves to graphical representations that can greatly facilitate discussion of complex interactions. 

    When we look at heart disease from a systems perspective, we not only see how behavior might contribute to the problem, but we also see the drivers of that behavior, and what other changes might be needed to weaken the drivers … This leads to taking a more holistic view, treating the person rather than the disease. 

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