ozarque: Linguistics; language in healthcare; choosing a healing metaphor...

memegarden, 2006-03-04 05:40 pm UTC (Expand)

ataniell93, 2006-03-04 05:54 pm UTC (Expand)

(no subject) - (Anonymous), 2006-03-05 04:46 am UTC (Expand)

leora, 2006-03-06 12:54 am UTC (Expand)

the_red_shoes
2006-03-04 02:16 pm UTC (link)

I love the catfish image. As someone who has had chronic health problems, I have been enjoying and appreciating these recent posts on medical language a great deal.

I think you're absolutely right the metaphor is v v deeply ingrained -- it reminds me of reading in Ursula K. Le Guin's Steering the Craft her deep distaste for a how-to-write manual that used the same martial language, and of the "arms race" gene-centric theory of evolution put foward by Dawkins and others. The language about and concept of conflict -- two sides endlessly battling each other -- is at the v heart of a lot of Western ways of thinking and ways of talking, I think.

Do the massive surgeries, the medications with destructive side effects, the intrusive machines, the poisonous chemotherapies, the experimental procedures, make you utterly miserable? Is the treatment as agonizing as the disease? No problem, that's entirely normal and to be expected; war is supposed to be hell.

I'm reminded of when my husband had a heart attack at thirty-three (he's only the second youngest person in his immediate family to have a heart attack -- brother, uncles, mother, grandmother, have all had it, mainly because they suffer from hyperlipidity and have insanely high cholesterol levels) which required an angiogram which turned into an angioplasty with double stents. We hadn't been able to afford insurance for years which would pay for medication to control his underlying condition, plus the doctor's visits that would have been needed to monitor such medication, but due to insurance I had at the time of his heart attack and payment plans we wound up paying v little for an invasive procedure that cost a _lot_ more than a preventive approach would have. It's that old cliche about US (and Western) medicine having a great ambulance system for people who fall off the cliff -- but the cliff edge doesn't have a fence. It's a lot easier in this culture to treat yourself badly and have complicated medical techniques to treat the end catastrophic results rather than do simple things daily which in the end are better for you and produce a lot better results than the end-game catastrophic expensive sophisticated treatments.

(I've always personally really distrusted the "either you or the illness is going to win" approach because, hell, we all die. Looked at that way, it's a zero-sum game and the only way to improve life is to put off death as long as possible, no matter the consequences. What is the point of that?)

starcat_jewel, 2006-03-04 10:38 pm UTC (Expand)

janetmiles
2006-03-04 02:20 pm UTC (link)

Ah! Okay, here's where I confess that I am an idiot and completely missed your earlier point. I'm so accustomed to the "battlefield" metaphor that I read the filk as a ringing, inspirational piece.

This essay on alternative metaphors caught me completely by surprise, and enlightened me in ways I never expected. I thank you, sincerely, for showing me some options I had no idea existed. I think I'm going to be spending some time meditating on them.

carandol
2006-03-04 02:24 pm UTC (link)

I wonder if it's because modern medicine was gaining its vocabulary at the same time as Darwin was writing about the survival of the fittest and the concept of "nature red in tooth and claw" was in the air. It's such a different way of looking at the world than Galen's balancing of the humours.

But for medical battle metaphors, you can't do better than Norman Spinrad's "Carcinoma Angels"...

http://www.scifi.com/scifiction/classics/classics_archive/spinrad/spinrad1.html

spider88, 2006-03-04 02:42 pm UTC (Expand)

the_red_shoes, 2006-03-04 02:50 pm UTC (Expand)

spider88, 2006-03-04 03:00 pm UTC (Expand)

carandol, 2006-03-04 03:10 pm UTC (Expand)

oursin, 2006-03-04 04:08 pm UTC (Expand)

carandol, 2006-03-04 06:49 pm UTC (Expand)

labelleizzy, 2006-03-05 01:40 am UTC (Expand)

archangelbeth
2006-03-04 02:30 pm UTC (link)

Huh.

I... think I have a "well, bother, it's broken, let's fix it" -- at least in regards to my own various ailments. The battlefield of disease is, for me, not the battlefield of that-which-requires-medical-intervention. Possibly because nearly all of them are "incurable" in the sense that there's no huge invasive thing that can be done to "cure." With the exception of the pre-eclampsia (aka Toxemia, aka severe Pregnancy Induced Hypertension), where a C-section was done, but that was because the only cure is delivery, and they were getting minor (?) fetal distress signals and wanted to get the kid out in the least stressy-way to her.

But that was still a case of life -- freeing the kid from an environment which is going downhill fast -- and fixing -- getting the little parasite out where the interaction isn't shutting down Mom's kidneys. Because when the mechanism fails like that, gotta get out the bailing wire and duct tape and do the next best thing so that nothing really breaks.

My hypothyroid? Little pills; the thyroid isn't working properly, and there's nothing to cut out or attack. It's just not producing.

My occular histoplasmosis? The infection that paved the way probably happened years and years ago, from a little-too-close encounter with bat guano in some form. Have to zap the nasty little rogue blood vessels with a laser, yes, but that's a spot repair -- sanding the rust off the car, say. Soldering something back together before it breaks worse.

And the monthly-ish agonies... Much as there've been times when cutting things out with a knife on my own seemed like it wouldn't have hurt much more, it's far easier to take a painkiller. Ibuprofen is my friend!

kelsied, 2006-03-04 08:10 pm UTC (Expand)

aenodia, 2006-03-05 12:27 am UTC (Expand)

leora, 2006-03-06 01:18 am UTC (Expand)

	lillibet 2006-03-04 02:36 pm UTC (link)
	I am reminded of a passage I love from John Crowley's Engine Summer in which the protagonist, Leaf, is describing the game of who's knee and his interviewer asks how you win, which confuses Leaf. "How do you beat the others?" asks the interviewer, and Leaf answers "Beat them? You're not fighting. You're playing a game." (Reply to this)

	snippy 2006-03-04 02:42 pm UTC (link)
	How about a consensus metaphor? I am physically out of consensus and am working to return to consensus (that is, some elements of my physical expression are approaching life one way, and some another way, and reaching consensus on how best to be healthy is important). (Reply to this)

spider88
2006-03-04 03:03 pm UTC (link)

Is this really American-English specific? Does anyone have an example of other cultures using other metaphors for health?

Also, I don't see this metaphor being used in medicine for things other than immunology. Endocrinology's metaphors are one of balance and feedback loops.

I like the catfish imagery. But, catfish, too, are in fact processes of removing/destroying the harmful so the beneficial can grow and prosper. (There are, in fact, many "garbage collection" metaphors in immunology as well. The catfish imagery works well with them.)

The musical tuning metaphor works for endocrinology quite well, but not so much for immunology.

I'm not trying to be argumentative. I'm only concerned that by using less violent language by our discomfort with violence, we may not accurately perceive what it is we are trying to understand.

other methaphors - (Anonymous), 2006-03-05 03:14 am UTC (Expand)

redbird
2006-03-04 03:08 pm UTC (link)

One place where I definitely think your metaphor is better is for living with chronic ailments or the after-effects of old injuries or infections, and especially autoimmune problems.

A person with an autoimmune disease doesn't have an invader to kill--s/he is trying to find ways (which can include but are not limited to medication) to work with or control an overactive immune system that's pulling up the plants s/he needs. Many of those ways are a matter of looking for balance--if I can't do as much as I used to, how do I best spend my energy? What are my priorities? Are there things I can do that will give me more energy, or reduce my pain without harming me in the long term (a friend with rheumatoid arthritis talks about this). Zapping the immune system altogether is a radical approach, and rarely desirable. (I know someone who has had a kidney transplant, and will be on immunosuppressants for the rest of his life, barring major medical advances. Nobody, including his life partner, can visit him if they have so much as a cold. Mike's metaphor for the transplant included "a good friend of mine who I never met died today.")

There is no enemy or invader in the case of my friend who walks with a cane because she was hit by a car as a child, and didn't get proper treatment right for her broken hip.

Even in

dteleki's example, we now deal with polio by vaccination, but "root out the invaders" doesn't work for post-polio syndrome. And I see I'm combining metaphors--when I'm weeding, I have to pull some weeds up by the roots, or they'll just grow back.

Also, in a gardening or scavenging or carpentry metaphor, we aren't telling someone who dies, or who otherwise doesn't entirely eliminate the illness and its effects, that they have lost and the disease has won. "Died after a long illness" has been replaced in obituaries by "died after a battle with cancer." They're trying to say "she didn't give in, she fought," but they say that even if the person decided, at some point, to use hospice care and painkillers instead of another round of painful long-shot treatments, or if there were no further attempts at cure available.

	msandromeda 2006-03-04 05:13 pm UTC (link)
	It's not only unhealthy, but I think makes the patient more powerless - war is a hierarchy & the doctor, not the patient, is the general. (Reply to this)(Thread)(Expand)

starcat_jewel, 2006-03-04 10:43 pm UTC (Expand)

msandromeda, 2006-03-04 11:20 pm UTC (Expand)

the_red_shoes, 2006-03-05 09:53 am UTC (Expand)

that_dang_otter
2006-03-04 05:23 pm UTC (link)

The thing about pathogenic microbes that makes the military metaphor inappropriate is that, in most cases, pathogens don't behave like soldiers - they behave like rude houseguests, who trash the place up and won't leave. They don't want to burn the house down, they just want to live in it.

So while natural selection favors a lot of strategies, it tends towards benign coexistence or cooperation. It's certainly true that there exist pathogens that you can't accommodate and they need to be eradicated, but that doesn't mean that the most aggressive approach is always the best one.

dteleki
2006-03-04 05:27 pm UTC (link)

Interesting that among all the metaphors for illness that you consider reasonable, you do not include either the [[your body is a complex machine, and illness is a breakdown]] metaphor or the [[your body is a community/nation/economy, and illness is a social/economic disruption]] metaphor.

So how's this for waving a white flag of truce? Which I waved the first time around, too? Different illnesses and different types of illnesses lend themselves to different metaphors. A metaphor that makes sense for some illnesses will be wrong for others. No single metaphor, including the [[gardening]] metaphor, makes sense for them all.

As near as I can tell, you are so justifiably alarmed by the misleading and damaging implications of treating all illness as [[war]], that you are unwilling to believe that any illnesses are really like [[war]] or ever were like [[war]]. My hypothesis is that you can luxuriate in your disbelief because you live in a world where, for the most part, the [[war]]-like diseases have already been defeated in battle, with sanitation and especially with vaccines. Leaving only the non-[[war]]-like diseases in existence, as still-existing problems. But just because the [[war]]-like diseases are mostly gone now, that doesn't mean that they never existed, or that they were not like [[war]] when they did.

A lot depends on which illnesses are the extant problems of the day. It's different kinds of illnesses, at different levels of technological development. A proposal for a very rough outline:

When food supplies are inadequate or unreliable, illness tends to revolve around starvation and malnutrition. Those problems don't lend themselves to a [[war]] metaphor. As those problems get solved, bacterial and viral infections get more attention, and those are [[war]]; it is only after those get solved that other problems receive attention, such as workplace injuries and poisonings from chemicals in the workplace, and those don't really resemble [[war]]. As those problems get resolved, problems that tend to be degenerative diseases of various types get more attention. That's where we are now. Degenerative diseases aren't [[war]].

You can't give your body time and trust it to heal, the way you would if you'd only cut your finger; that's for cowards and deserters and losers.

Your body won't heal from AIDS. You'll die. It killed you. Your body won't heal from anthrax. You'll die. It killed you. Your body won't heal from smallpox. Chances are at least 30% you'll die. Your body won't heal from polio. You'll die, or if you live you'll in all likelihood be severely handicapped forever. Most illnesses aren't AIDS or anthrax or smallpox or polio. But AIDS and anthrax and smallpox and polio are AIDS and anthrax and smallpox and polio.

The crucial difference is that with metaphors of gardening and music and lamplighting and scavenging and carpentry there is no winner or loser. No battle, and no battlefield. No obligatory vocabulary of death and destruction and horror and maiming and piles of slaughtered corpses.

In the case of gardening, there is a loser: the weeds.

Yanked up, deep taproots pulled out of the nutrient soil, hacked off with a hoe, poisoned and withered, or whatever. Before the "weeding" process, the weeds are growing peacefully and happily in the garden. Afterward, they're... removed. Eliminated. Ethnic-cleansed. Gone. As if they had never been. In some cases, such as dandelions, even their corpses are disposed of in special ways, to prevent the weeds from reproducing even after they've been murdered.

The weeds are the loser. And, at least in theory, the gardener is the winner.

I realize that this all sounds comically morbid. And gruesome. But there it is.

When I was a child, one of my chores was to get rid of the dandelions out of the lawn. You may scream, you may laugh -- but the tool I was given to do this with was a chemical device boldly printed in huge letters with its dreaded trademark: KILLER KANE.

carbonelle, 2006-03-04 06:10 pm UTC (Expand)

dteleki, 2006-03-05 12:59 am UTC (Expand)

kelsied, 2006-03-04 08:12 pm UTC (Expand)

gipsieee, 2006-03-04 08:18 pm UTC (Expand)

nancylebov, 2006-03-04 11:53 pm UTC (Expand)

ashley_y, 2006-03-05 03:00 am UTC (Expand)

the_red_shoes, 2006-03-05 10:10 am UTC (Expand)

kajunhippie
2006-03-04 06:32 pm UTC (link)

The thing with disease is that it is understood by many in the medical establishment to be a process, not a thing or an invader. Truthfully, our bodies deal with bacteria and viruses and fungus and parasites and cancer cells all the time. The difference between random visitors and the beginnings of disease are that in the first scenario they are kept under control by the immune system and don't get out of hand. (This is why AIDS patients get weird random cancers that almost nobody else gets.) So while, for instance, the germ theory of infection--which utilizes the body-as-battlefield metaphor--does have some usefulness, it isn't the final answer. Neither is the metaphor of cancer as an invader--they're our own cells, fer Pete's sake, only mutated.

I like the altmed community's metaphor of disease as lack-of-ease, as being out of balance, because to me, based on what I've learned thus far, that's closer to whatever ultimate truth there might be.

heisenfeature
2006-03-04 08:57 pm UTC (link)

It's interesting to see people discuss the different ways in which we all approach disease/illness/the "battle" against.

For myself I found (when diagnosed with an autoimmune disorder last year) that focusing on more positive imagery seemed to do more good. That is, while my spleen might be "killing" my platelets, it was more that the "platelet bunnies" weren't doing their job reproducing and needed better food.

(Another metaphor that came up was a collective bargaining one. My body had gone "on strike" and we needed to renegotiate the terms.)

But certainly the imagery used by the hematologist was more war-like. Full of "attack" and "kill" and "destroy".

naamah_darling
2006-03-04 09:55 pm UTC (link)

I think you have a very important point. After reading Staying Well. . ., I gave it some thought, and let the information about metaphor settle in my brain, but didn't have cause to really employ it because I am, thank goodness, in excellent health.

Now a friend of mine is sick, very sick, with something that is threatening not just her health but her life.

And I talked to her about this a little the other day, and I basically gave her the carpentry metaphor for her treatment process itself (which is more frightening to her than her disease):

Your body is the house you live in, and doctors are the electricians, plumbers, carpenters, painters, etc. who help you figure out what work needs to be done, and help you decide when and how to do it. They have knowledge we don't have, so they're needed to give advice and tell us where there's stuff that needs shoring up, and they know how to use specialized tools. Some of those tools are big and scary power tools, true (we were talking about chemotherapy), but they're being used by experts who know how to operate them safely.

This metaphor allowed me to emphasize some things I felt were important for her in particular: first, that doctors and the medpros are working for her, and that she's not a battleground upon which impartial forces fight; second, that ultimately what work gets done on her house is up to her and her alone; and third, that when someone is working on your house, you still have to live in it, and that she shouldn't expect or tolerate unlivable conditions while she's going through all this.

She seemed much reassured. And so did I.

So I thank you for that. Because you had written that book, and I had read it, I discarded the battle metaphor and used something more constructive (heh), and we're both the better for it.

Response to rabidsamfan.... -

	rabidsamfan 2006-03-04 10:13 pm UTC (link)
	Having just gotten a diagnosis of thyroid cancer, I have to say that considering other metaphors is likely to be useful for me in the next few weeks. I don't know if it will lead me to another place, but it's nice not to think of my body as a battleground. (Reply to this)(Thread)(Expand)

other ways to look at it all - (Anonymous), 2006-03-05 03:24 am UTC (Expand)

ozarque, 2006-03-05 01:45 pm UTC (Expand)

Re: Response to rabidsamfan.... -

rabidsamfan, 2006-03-05 01:50 pm UTC (Expand)

leora, 2006-03-06 01:49 am UTC (Expand)

solri
2006-03-04 11:17 pm UTC (link)

Another point is that the metaphor of war is based on a particular view of war - it's all or nothing, kill or be killed, death or glory. Now this may be an appropriate attitude to take to some diseases, or indeed to some battles, but it is not the only way to look at fighting. Consider the following from Laozi:

"A good fighter is not angry."
"I would rather retreat a hundred miles than advance an inch."

And from Sunzi's The Art of War:

"Those who win every battle are not skillful - those who render others' armies helpless without fighting are the best of all."

If I were to pick a metaphor for dealing with a disease, I'd probably choose Go, a game which is also based on warfare - but war waged in a rather different way.

leora, 2006-03-06 01:53 am UTC (Expand)

Make us well, win the battle

kelathefinn
2006-03-05 03:46 am UTC (link)

What was that motto - wieden den Tod is keine geshict? my German is terrible, but basically it means that there is no cure for death. We all die, and the medical war metaphor to my mind implies that there *should* be a cure for everything, including death. According to a recent seminar I attended, where the lecturers were medical people, the 'war' metaphor has created a path that doctors and patients (clients?) have walked down hand and hand, so that nowadays in Great Britain, 75% - yes, three-quarters, according to the British Health Care statistics - of all patients presenting do so with no definable medical problem. Basically they are coming to a doctor and saying things like 'I'm tired and I don't know why' or 'I ache all over' or 'I wake up in the night and have to pee four or five times a night' - and all the physical and blood tests come back normal and scans reveal nothing out of the ordinary. The phenomenon is called 'The Patient with Nothing Wrong'. Doctors are now supposed to fix everything, evidently. 'Psychsomatic' is an unacceptable term for the medical profession, evidently. The placebo effect is curing people (relieving symptoms) and is accepted as a 'cure'. One doctor said he felt like the patients were asking him to 'fix my life'. I'm wondering if Eastern medical practitioners might not have something to offer us here, with their metaphor of 'balance/unbalance' and that you can't get well until *everything* in your life is balanced.

leora, 2006-03-06 01:57 am UTC (Expand)

kelathefinn, 2006-03-06 02:59 am UTC (Expand)

leora, 2006-03-06 03:09 am UTC (Expand)

neonchameleon
2006-03-05 08:25 am UTC (link)

It's taken a few days, but I've finally worked out what I find wrong with "Slaughter is our metaphor for health".

It (I think) is jumping a step and thus missing the cracked one. War is a metaphor for health (or rather dealing with infectious diseases) and slaughter is our paradigm of war. It is not the former I find dangerous but the latter. (Incidently, "slaughter is our paradigm of war" is not out of line with the Soldier's Creed - where the only means of dealing with the enemy is to "deploy, engage, and destroy".)

If slaughter is your paradigm for war, you have a problem when you are going to have to coexist with the enemy after the war is over - a lesson comprehensively demonstrated after the treaty of Versailles and being demonstrated in Iraq now. If your paradigm for war is "the pursuit of diplomacy by other means" then you get a very different pattern emerging - and most of the problems with healthcare (or rather the control of infectious diseases) as war fade into the background (and you get much more of a weight on Public Health - the mainstream diplomacy part...).

Of course, "the pursuit of diplmacy by other means" opens an entirely new can of worms because it makes war somewhat less abhorrent.

nancylebov, 2006-03-05 02:49 pm UTC (Expand)

muffyjo
2006-03-05 01:33 pm UTC (link)

My mother finds herself very motivated by conflict, competition and anger. It seems to help her to push through the harder times. I, on the other hand, find those conditions to be restrictive and limited and while they may work in the short term, they wear me out over a longer span where self-nurturing inner-speak continues to motivate me, envigorates and helps me to push through the harder times.

So for me the idea of nurturing my health, talking to my systemic issues such as asthma in a less confrontational but more embracing fashion helps me to accept the parts of me that I need, even in their less than ideal functioning state.

That we have bacteria and virus' that are vying for the same bodily resources we are using for other tasks is obvious. And sure, even in gardens there is talk about "shoring up" against things that over-grow, vines that wish to "take over" not to mention over-culling by deer, squirrels and other creatures. The garden is hardly impervious to such battle-worthy metaphores but I think it's the balance of terms that's important.

A Deeper Problem

ashnistrike
2006-03-05 11:19 pm UTC (link)

I think that you have, in passing, touched on a problem that goes deeper than choice of metaphor. Neonchameleon and Solri, above, also hinted at it. Our culture seems to be gaining the attitude that winning is worthwhile whatever the means. In fact, as you suggested, it is often considered immoral not to do anything you can to win. (This reaches some sort of absurb epitome in the fact that a corporation that chooses ethical behavior over profit can be sued by its shareholders.) Until we fix this underlying belief, it's going to creep into any metaphor we might use. I've just given the economic version; others above have described the gardening version. And until we get to the point that we genuinely believe that some things are more important than winning, we will continue to be very good at producing harmful successes of all sorts.

If you were to take the battle metaphor from a more honorable standpoint, several objections would fall away. If you turn down a treatment that would make you miserable, it's the same as choosing not to use chemical weapons in your own city. Yes, you might take out a few enemy soldiers (say, cancer cells), but the cost to your own civilians (your own cells and immune system) isn't worth it. There might be courses of action that you would refuse entirely in the same way that an honorable warrior wouldn't ever use torture against an enemy. Preventative medicine could be seen as the sort of diplomacy and trade that make peace possible in the first place. And so on.

	pthalogreen 2006-03-06 01:30 pm UTC (link)
	I personally think that germs are good because they help build an immune system. you can't possibly avoid all of them, so you might as well expose yourself to some of the less harmful ones to give your immune system a fighting chance against the nastier ones. but I'm probably in the minority. (Reply to this)

Health Care Metaphores
(Anonymous)
2006-03-07 04:15 pm UTC (link)

Hi My name is Vickie...I used to subscribe to the Lonesome Node way back when, and I am a friend of Sharla Hardy.
That said, As a woman I think it is particularly important to have a healing metaphor rather than a killing metaphor when dealing with health issues. I think only one person commented on birth in this discussion. Pregnancy and birth have been medicalized and transformed to the point where this country has the highest Cesarean Section rate in the world. Our infant mortality statistics aren't that great, either. I think this could partially be because of the predominant metaphor of "Killing and destruction". A baby is seen as a parasite that is attacking the mother and needs to be cut out or pulled out with forceps rather than being allowed to grow to fullness and come out on it's own.Health encompasses so much more than just "combating" illness.

Re: Health Care Metaphores... response to Vickie... -

ozarque, 2006-03-16 09:25 pm UTC (Expand)

heptadecagram
2006-12-27 10:50 am UTC (link)

(Here via vvalkyri)

The gardening metaphor for health is so incredibly apt, to me. I like gardening, and I try to approach it in as...easy (not quite the right word) a way as possible. Instead of grass that must be mown every week, a clover lawn. Instead of pumping fertilizers into the soil, use compost from various house and yard wastes. Instead of pesticides, various plants (and occasionally anti-pest insects like mantids and ladybugs). Instead of carefully monitoring conditions and plants, use native plants and good soil. Use the seeds of the successful plants of yesteryear to evolve and adapt to my local environment.

I notice now that this makes a very good metaphor for how I approach health care. I try to work with the limits and natural function of my body as much as possible, letting it get strong, occasionally weeding out troublesome parts. Unfortunately, this does make me less likely to go to a doctor (call in a landscaper), since I'd rather let my body take care of itself.

Thanks for a better metaphor!