ABSTRACT
Psychiatry is laced with metaphor – both the conditions it treats and the drugs used to treat such conditions (for example, ‘uppers’ and ‘downers’). Whereas, in other kinds of medicine, language is purposefully stripped of metaphor (such as drug formularies), psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM) multiplies metaphors (such as ‘free floating anxiety’). Indeed, ‘mental illness’ can be read as metaphor. This means that we should take mental illness seriously, but not necessarily literally. The current trend to reduce mental illness to underlying brain mechanisms is worrying in this respect, since it does not allow for the shaping of psychopathology through historical and cultural influences. Metaphor is a diagnostic touchstone in psychiatry; for example, psychotic symptoms typically include taking metaphors literally, or mistaking the literal for florid metaphor. In everyday neuroses, such as depression and anxiety, the layperson typically uses metaphor not simply to describe, but to understand and make meaning of, his or her condition (for example, ‘my head is in a vice’). In turn, psychiatrists carry multiple metaphors for the same condition (such as chemical imbalance, neurological lack, social ‘double bind’). Those who treat people with symptoms of mental illness must learn to inhabit their patients’ worlds for understanding, and can only do this effectively through the medium of metaphor.
