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From Words to Worlds. How Metaphors and Language Shape Mental Health

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Metaphors and Analogies in Sciences and Humanities

Part of the book series: Synthese Library ((SYLI,volume 453))

Abstract

Through this contribution I aim to show how language and metaphors shape our mental health, and how overcoming a diagnosis-centred approach in favour of a person-centred approach one may be of great help for the healing journey and in the therapeutic context. Starting from a critical reflection on the theoretical principles at the core of current use of psychiatric language, I propose a richer and more complex use of linguistic patterns through a broader consideration of mental phenomena. To reach these goals, this work is divided into three sections: in the first I scrutinise the task of psychiatry, in the second section I explore psychiatric classifications and their language, and in the third part I attempt to elucidate why and how a hermeneutic phenomenologically informed approach to mental health can be beneficial for the diagnosis of mental health issues. This contribution aims to serve as a critical basis for the dialogue among clinicians and philosophers; for mental health professionals, I hope to bring into discussion the use of language in the diagnostic process, the recourse to a third-person approach to describe diseases, and the use of psychopathological vocabulary. For philosophers, to explore the notion of plurality, an element that has only tangentially been investigated by philosophy throughout its history, but which is central to the understanding of every form of life, including those who are considered pathological.

The humanity we all share is more important than the mental illnesses we may not

Elyn R. Sacks

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Notes

  1. 1.

    See Putnam, H. (1987). The Many Faces of Realism. LaSalle, IL: Open Court.

  2. 2.

    According to the definition provided by the American Psychiatric Association (APA).

  3. 3.

    American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, 5th edition. Washington: American Psychiatric Association, p. 20.

  4. 4.

    Maj, M. (2016). “The need for a conceptual framework in psychiatry acknowledging complexity while avoiding defeatism”. In World Psychiatry 15:1 - February, p. 2.

  5. 5.

    Dilthey, W. (1977). Ideas Concerning a Descriptive and Analytic Psychology (1894), In W. Dilthey, Descriptive Psychology and Historical Understanding. Springer, Dordrecht, pp. 21–120, https://doi.org/10.1007/978-94-009-9658-8_2

  6. 6.

    See Jaspers, K. (1997), General psychopathology (trans: Hoenig, J., Hamilton, M. W.). Baltimore: Johns Hopkins University Press. See also Fuchs, T. (2014), “Brain Mythologies. Jaspers’ Critique of Reductionism from a Current Perspective”, in T. Fuchs et al. (eds.), Karl Jaspers’ Philosophy and Psychopathology, Springer: New York, p. 81.

  7. 7.

    Jaspers, K. (1997), General psychopathology, p. 569.

  8. 8.

    Berrios, G. & Markova I. (2015). “Toward a New Epistemology of Psychiatry”. In L. Kirmayer, R. Lemelson, & C. Cummings (Eds.), Re-Visioning Psychiatry. Cultural Phenomenology, Critical Neuroscience, and Global Mental Health, Cambridge: Cambridge University Press, p. 45.

  9. 9.

    Andreasen, N. C. (2006). “DSM and the Death of Phenomenology in America: An Example of Unintended Consequences”. In Schizophrenia Bulletin, 33 (1), pp. 108–112.

  10. 10.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry. In Kendler K., Parnas, J. (eds.) Philsophical issues in psychiatry. Explanation, Phenomenology and Nosology. Baltimore: Johns Hopkins University Press, p. 240.

  11. 11.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 249.

  12. 12.

    See Maj, M., Gaebel, W., López-Ibor, J. J., Sartorius, N. (eds.), (2002) Psychiatric Diagnosis and Classification, Chichester: John Wiley & Sons.

  13. 13.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 245.

  14. 14.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 245.

  15. 15.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 247.

  16. 16.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 240

  17. 17.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 243.

  18. 18.

    Zachar, P. (2008). Psychiatry, Scientific Laws, and Realism about Entities, in In Kendler K., Parnas, J. (eds.) Philsophical issues in psychiatry. Explanation, Phenomenology and Nosology. Baltimore: Johns Hopkins University Press, p. 44.

  19. 19.

    Zachar, P. (2008). Psychiatry, Scientific Laws, and Realism about Entities, p. 44.

  20. 20.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 249.

  21. 21.

    Zachar, P., Jablensky, A., (2015) The concept of validation in psychiatry and psychology. In Zachar, P., Stoyanov, D., Aragona, M., Jablenski, A. (eds.) (2015). Alternative perspectives on psychiatric validation: DSM, ICD, RDoC, and beyond. Oxford: Oxford University Press, p. 3.

  22. 22.

    Zachar, P., Jablensky, A., (2015) The concept of validation in psychiatry and psychology, p. 5.

  23. 23.

    Zachar, P., Jablensky, A., (2015) The concept of validation in psychiatry and psychology, p. 6.

  24. 24.

    Zachar, P., Jablensky, A., (2015) The concept of validation in psychiatry and psychology, p. 6.

  25. 25.

    See Brencio, F., Bauer, P. R. (2020), “Words matter. A hermeneutical-phenomenological account to mental health”. In Phenomenology and Mind, 18, 2020, pp. 68–77, doi: https://doi.org/10.17454/pam-1805

  26. 26.

    In contrast to the “invisible” genotypic or endophenotypic level.

  27. 27.

    Parnas, J., Sass, L. (2008). Varieties of “Phenomenology”. On Description, Understanding, and Explanation in Psychiatry, p. 239 and p. 243.

  28. 28.

    Zachar, P. (2008). Psychiatry, Scientific Laws, and Realism about Entities, p. 46.

  29. 29.

    Kendler, K. (2012). Introduction. In Kendler, K., Parnas, J. Philosophical Issues in Psychiatry II. Nosology. Oxford: Oxford University Press. p. XIV.

  30. 30.

    Kendler, K. (2012). Introduction, p. XIV.

  31. 31.

    See Moncrieff, J. (2010). “Psychiatric diagnosis as a political device”. In Social Theory & Health, 8(4), pp. 370–382. https://doi.org/10.1057/sth.2009.11

  32. 32.

    Maj, M. (2018). “Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them”. In World Psychiatry, 17, 2, pp. 121.

  33. 33.

    Marinker, M. (1975). “Why make people patients?”. In Journal of Medical Ethics, I, p. 82.

  34. 34.

    Marinker, M. (1975). “Why make people patients?”. p. 82.

  35. 35.

    Marinker, M. (1975). “Why make people patients?”. p. 83.

  36. 36.

    See Boyd K. M., (2000). “Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts”. In Journal of Medical Ethics: Medical Humanities, 26, pp. 9–17.

  37. 37.

    See Svenaeus, F. (2018). “Human Suffering and Psychiatric Diagnosis”. In Bioethica Forum, 11, 1, pp. 4–10

  38. 38.

    At the beginning of nineteenth century first-person accounts of illness, particularly mental illness, were rare. Here I would like to briefly recall some fundamental books on this topic: Schreber, D. P. (2000) Memoirs of My Nervous Illness (original 1903). New York: New York Review of Books; Sacks, E. R. (2008) The Center Cannot Hold: My Journey Through Madness. New York: Hachette Books; Brampton, S. (2009) Shoot the Damn Dog: A Memoir of Depression. London: Bloomsbury Publishing; Sechehaye, M., (2011). Autobiography Of A Schizophrenic Girl: Reality Lost And Regained. Whitefish: Literary Licensing.

  39. 39.

    See Parnas, J. (2000). “The self and intentionality in the pre-psychotic stages of schizophrenia: A phenomenological study”, in D. Zahavi (ed.), Exploring the Self. Philosophical and psychopathological perspectives on self-experience. Amsterdam: John Benjamins Publishing Company, pp. 115–147.

  40. 40.

    See the EASE (2005) and the EAWE (2017) interviews.

  41. 41.

    See Petitmengin, C., Remillieux, A., Valenzuela-Moguillansky C. (2018). “Discovering the structures of lived experience. Towards a micro-phenomenological analysis method”. In Phenomenology and the Cognitive Sciences (4) 691-730; Depraz, Natalie, Desmidt T. (2019). “Cardiophenomenology: a refinement of neurophenomenology”. In Phenomenology and the Cognitive Sciences, 18, pp. 493–507.

  42. 42.

    See Høffding, S., Martiny, K. M. (2015). “Framing a Phenomenological Interview: What, Why and How”. In Phenomenology and Cognitive Sciences, 4, pp. 539–564; Lauterbach, A. (2018). “Hermeneutic Phenomenological Interviewing: Going Beyond Semi-Structured Formats to Help Participants Revisit Experience”. In The Qualitative Report, 23 (11), pp. 2883–2898.

  43. 43.

    See Wagemann J., Edelhäuser F., Weger U. (2018). “Outer and Inner Dimensions of Brain and Consciousness—Refining and Integrating the Phenomenal Layers”. In Advances in Cognitive Psychology 14(4), pp. 167–185.

  44. 44.

    See Zahavi D. (2014). Self and Other: Exploring Subjectivity, Empathy, and Shame. Oxford: Oxford University Press.

  45. 45.

    See Petitmengin C., Bitbol M. (2009). “The Validity of First-Person Descriptions as Authenticity and Coherence”. In Journal of Consciousness Studies, 11–12, pp. 363–404.

  46. 46.

    Petitmengin C., Bitbol M. (2009). “The Validity of First-Person Descriptions as Authenticity and Coherence”, pp. 389-390.

  47. 47.

    Petitmengin C., Bitbol M. (2009). “The Validity of First-Person Descriptions as Authenticity and Coherence”, p. 400.

  48. 48.

    Heidegger M. (2001). Zollikon Seminars, Evanston: Northwestern University Press, p. 19.

  49. 49.

    Strauss J. S. (1989). “Subjective experiences of schizophrenia: toward a new dynamic psychiatry. II”. In Schizophrenic Bulletin, 15, p. 179.

  50. 50.

    Strauss J. S. (1989). “Subjective experiences of schizophrenia: toward a new dynamic psychiatry. II”, p. 180.

  51. 51.

    Gadamer H-G. (1996). The enigma of health. The Art of Healing in a Scientific Age. Cambridge: Polity Press, p. 77.

  52. 52.

    Gadamer H-G. (1996). The enigma of health. The Art of Healing in a Scientific Age, p. 81.

  53. 53.

    Heidegger, Martin. (1971). Poetry – Language – Thought. New York: HarperCollins Publishers, p. 187.

  54. 54.

    Heidegger, Martin. (1971), Poetry – Language – Thought, p. 187.

  55. 55.

    Gadamer, H.G. (1996). The Enigma of Health, p. 166.

  56. 56.

    See Stanghellini, G. (2017). Lost in dialogue, Oxford University Press, Oxford.

  57. 57.

    Wittgenstein, L. (2000). Tractatus Logico-Philosophicus. London-New York: Routledge, p. 68.

  58. 58.

    Heidegger, Martin. (1971), p. 72.

  59. 59.

    Heidegger, Martin. (1971), p. 145.

  60. 60.

    Lakoff, G., Johnson, M. (1980/2008). Metaphors We Live By. Chicago: Chicago University Press, p. 4.

  61. 61.

    See Sontag, S. (1978). Illness as Metaphor. New York: Farrar Straus & Giroux Publ. House.

  62. 62.

    See Brencio, F. (2020). “Mind your words. Language and war metaphors in the COVID-19 pandemic”. In Psicopatologia Fenomenológica Contemporânea. Revista da Sociedade Brasileira de Psicopatologia Fenômeno-Estrutural, 9(2), pp. 58–73, doi: https://doi.org/10.37067/rpfc.v9i2.1083.

  63. 63.

    Hauser, D. J. & Schwarz, N. (2019). “The War on Prevention II: Battle Metaphors Undermine Cancer Treatment and Prevention and Do Not Increase Vigilance”. In Health Communication, pp. 1–7, doi: https://doi.org/10.1080/10410236.2019.1663465.

  64. 64.

    Koch, S., Fuchs, T., Summa, M. (2012). Body Memory, Metaphor and Movement. Amsterdam/Philadelphia: John Benjamins Publishing Company.

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  1. Research Group “Filosofía Aplicada: Sujeto, Sufrimiento, Sociedad”, Andalusian Research Plan, Code: HUM-018, University of Seville, Seville, Spain

    Francesca Brencio

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  1. Albert Einstein Fellow, Caputh & Potsdam, Germany

    Shyam Wuppuluri

  2. New College of the Humanities, London, UK

    A. C. Grayling

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Brencio, F. (2022). From Words to Worlds. How Metaphors and Language Shape Mental Health. In: Wuppuluri, S., Grayling, A.C. (eds) Metaphors and Analogies in Sciences and Humanities. Synthese Library, vol 453. Springer, Cham. https://doi.org/10.1007/978-3-030-90688-7_16

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