My passion for medical metaphors dates back to 2006 when we were called to hold a communication course in Japan for public speaking in Congresses of cardiac surgeons in June. We were competing with two other institutions, to win the extraordinary opportunity to work in “Japan”: a Japanese communication society, and a U.S. company. The Japanese Cardiac Surgery Society relied on us of Fondazione ISTUD, as an Italian group, after long telephone interviews (when Skype was in its early days). The main reason why choosing Fondazione ISTUD was maybe that they perceived us as more “symbolic, metaphorical, creative”. At the first telephone call, in February 2006, we asked them why they wanted to give a communication course for cardiac surgeons, and this was their answer: “When our great doctors kick the scenes of international congresses, these two things happen unfortunately too frequently: either Western doctors are bored but politely sit and listen anyway, or they are irritated by the invasive presence of tables, full of illegible data – although they are of great clinical importance – to the point of leaving the conference room”. Well, in the untold, there was a sort of blaming Western behavior: no Japanese doctor would have been acting like that, even listening to the most dreadful Western presentation.
We had four months to design the course and to learn from a distance what was the code of the Japanese scientific communication behavior, slight browsing of basic rules. We went there with our thoughts and methods on creating simple slides, giving a lot of value and sense of ownership to the heart surgeons, telling them that they were presenting their own effortful work. This was almost an act of violence for Japanese culture because the individual ego must be at the service of the community, and so they have more to disappear instead of being proud to be the individual author. While I was preparing the lessons, I came across George Lakoff’s essay on metaphors [1], love as a journey, life as a journey, diversity between local metaphors and universal metaphors. Hence, a fascinating world has opened up for me in the possibilities to communicate with the public, or rather I have given awareness to the other way of speaking that we constantly use in our daily lives, on the words we need to make us understand how we are, what we mean when we don’t find definition, and to enter more into the mind of the Other, the listener or the reader, and to fascinate the public. Forget the handbooks, “Build your own presentation step by step ” with 25 or 15 or 30 words to write as in powerpoint on each slide; I have often had and still have allergies to the PowerPoint because I think that with the logic structures in “bullet points, we simplify too much, to the point of making the speech trivial.
Coming back to Japan, after Lakoff, I was plunging into their extraordinary culture, into their communication code, where one always nods, even if in the end one doesn’t agree; they nod to make the other understand that the listener has understood what the speaker is saying. The idea flashed in my mind deciding to use poetry: I caught up haikus, yes I had a book in my house. Haikus are poetic compositions born in Japan in the 17th century and are the quintessence of metaphors. Generally, a haiku is composed of three verses for a total of seventeen units of sound – phonemes – erroneously called syllables. Here, one of them:
All the voice
eroded by screaming:
a shell of cicada remains
Matsuo Basho
Powerful and synthetic this metaphor of a summer sung and shouted by the cicada; the haiku has the gift of being short and to enter through the symbol into the heart of the story. It does not need a myriad of explanatory data, it is already a lucid and poetic summation
And then I come across Haikus dedicated to the heart:
Ancient soul,
Keep walking,
Red sunrise.
From here I have changed my direction, away from the too strict slides. We decide to work together, Italy and Japan, to reinsert their artistic tradition in medical science: metaphors are powerful vehicles (from the Greek ‘meta’, beyond – ‘ferein’, deliver, so means of transport) that bring us from incomprehension to comprehension, from boredom to pleasure, from the mediocrity of the word and the number to the aesthetics of the lyrics. This skill of “expressing oneself through images” – as Plato already observed in Phaedrus – is a characteristic of human beings, and neurosciences now confirm that within our brains there is a center that creates and interprets metaphors[2].
Therefore, we have worked on this in June 2006 with the Japanese cardio surgeons: concerning this topic, at first we were perplexed and frightened in a land and culture so far from ours, but then we found the weighted balance between the “hard” data such as the survival curves of Evidence-Based Medicine and the metaphorical language. Heart surgeons were deeply involved and enjoyed creating presentations where the heart was a “machine”, “the center of life”, “a flower”, and so on. Surprisingly, for them, it was easy to try to create what they had always done since they were kids, at school…haiku about the heart. Needless to say, the memory of that experience of entering the world of metaphors remained in my soul: happily, we had guessed it. Trying to avoid to render their scientific language even more technical or business code, we had given them or helped in rediscovering a different language code.
In the above case described, a concrete issue was there: the misunderstanding and the annoyance for the excessive technicality that the scientific community perceived. Japanese cardiac surgeons had really opened their minds in that occasion; the extraordinary thing I took home from that Country was the humility without prejudice that we observed in great people we met: always ready to learn new things, and to put themselves out from their comfort zone, to overcome the impasse, arising with credit in scientific congresses.
Changing the field of knowledge, let’s move to physics: physicists explain quantum physics using metaphors because the mathematic language is illegible for us. Actually, it is the same issue emerged for cardiac surgeons and other scientists who want to be deeply understood. The chemist and physicist Maxwell wrote the following thoughts on scientific metaphors in a letter addressed to the British Association: “… it is a method that helps the mind to face some concepts or laws in the scientific field, through another concept or law which doesn’t belong to the science but drives our mind to highlight such a common scheme between science and not-science”.
The physicist Heisenberg, Nobel for the principle of Indetermination, declared: “it is not surprising that our language is unable to describe the processes that take place in atoms since we invented it to describe the experiences of everyday life […]. fortunately, mathematics does not have these limitations[3]. If Bohr’s atomic model, in order to be explained, used the nucleus as the sun and the electrons as planets around it, the Higgs boson, easier to discover than to explain, is so “taken away” from the physicist Francesco Bussola: “ “Think of it that way: imagine a field full of snow and suppose you have to cross it. You have several ways to cross it: you can wear boots, use snowshoes or skis. Of course, depending on what you choose, you will cross the field in different ways. Those of you who pick up your boots will sink into the snow, will have difficulty walking and will go very slowly. Snowshoe wearers will be more agile, walking without sinking too much into the snow. Those who use their skis will be able to speed through the snowpack without any problems. That’s exactly what happens to the particles when they travel in the Higgs field: some particles will speed very fast, without interacting with the field, as if they were wearing skis. They are particles without mass – such as photons, which travel at the speed of light – or with a very small mass – such as neutrinos, which travel almost at the speed of light. Other particles will be slower because they “sink” into the Higgs field. The latter are particles with a large mass, such as muons, tauons, protons, and neutrons. This process in which the Higgs field slows down some particles – and not others – by giving them mass is called the Higgs mechanism. In this metaphor, the Higgs boson is the snowflake, which makes possible for particles to interact with the field”.
Other metaphors explain the Higgs boson as a cosmic molasse, a swimming pool, the sand of a bowling green. Now we realize that it is something extended and spotty and that it influences our molecules, cells, apparatuses, systems, minds and, if we believe, souls on a daily basis.
As in physics, there is the name of the discoverer, Boson of Higgs, also in Medicine, there are many diseases of which there is the name of the discoverer, from the syndrome of Guillian Barrè, to the Prader Willi and countless diseases that bring the name of the scientist who discovered them.
The question remains of how to explain these syndromes, diseases not only among professionals, which we have discovered are perhaps “bored” to speak only “in medical terms,” unless they are young students who have to show off their knowledge in view of the exams. The language is technical, reductive and labeling – smiling I can say that giving a name to a disease is a simple way not to explain it and be evergreen in history; the disease, however, should be explained not only to health professionals but also to patients. On the other hand, we know that the sick themselves, when they want to make them really understand how they feel, use a lot of metaphorical styles, erroneously defined as the language of the ignorant, simply because they don’t know the technical or “discoverer” name. Some professionals listen to them and understand the power of these words and then formulate diagnoses and therapies, others instead are entrenched behind the ‘medical’ language.
In metaphors there is no artifice nor simulation, but through creative skills human beings can make people understand and express complex and unknown concepts in the here-and-now: going back to the heart from which we started, in a recent study with patients suffering from heart failure, after asking them to express their illness with a metaphor, they wrote about a nature or a car that benignly or more often maliciously makes its cycle, “an autumn that arrives”, a car that loses its pieces day after day”. The doctors we asked the same question told us about “struggle”. of unforeseen” “of threat” as if they did not accept the cycles of life and were on a mission to fight the game for life, but that does not fully perceive the “autumn” that patients live.
This is where the metaphors of the caregivers explain what their mental representations are, and therefore, respectively, how they live the effectiveness of the treatment process and the experience with their condition of disease: from this study in publication, it emerges that in several cases there is a conceptual misalignment on what is the “imbalance” between doctor and patient, but thanks to this research will be possible to further improve the code of communication between the two sides.
In mental reformulation it is really useful to change also “one’s own metaphors of reference”, because behaviours change[4]: for example, it has turned out that living with the metaphor of the “fight” means sometimes winning but sometimes also losing, and, in addition to this, even more surprisingly, one does not activate him/herself enough in terms of responsibility, but expects the “weapon” that will make the battle win. With the metaphor of “journey”, on the other hand, it is no longer a matter of victory and defeat, but a daily sense of individual responsibility to take care of oneself is strengthened, starting from one’s own lifestyle, because every day is an extra path of the journey.
The heart is metaphorical of life, spirit, but also love, as in the two following haikus:
“Lost love,
Tired the heart of new
“illusionists.”
or
“Hourglass the heart,
the time of love,
“Shining sand.”
Heart as it marks time, the sand is that of the field of the Higgs Boson, in this dance of minimal particles, with name and no name.
[1]George Lakoff with Mark Johnson. Metaphors We Live By. University of Chicago Press, 1980.
[2] V.S. Ramachandran, The Tell-Tale Brain: Unlocking the Mystery of Human Nature, April 2012
[3] Heisenberg, The Physical Principles of the Quantum Theory, 1930
[4] Rose K. Hendricks et al: Emotional Implications of Metaphor: Consequences of Metaphor Framing for Mindset about Cancer, Metaphor and Symbols: 33:4, 267-279,.2018
