On metaphors and debate

To the Editor

Stephen Rosenman’s Debate article (2016) is timely and most appropriate.

The use of metaphorical constructs as factual reality could be said to be reductionistic, potentially misleading, arguably anti-scientific and anti-therapeutic. A case in point is the term ‘chemical imbalance’ whether explicated or employed by implication. This is linked with the author’s reference to ‘antidepressant’ and ‘antipsychotic’ as metaphorical terms. Such terms determine if not dominate our collective professional thinking. This has the features of a set of over-valued ideas or indeed an ideology based on fixed beliefs about what does and does not constitute normal and abnormal behaviour.

In failing to recognize metaphors as such and by positing diagnostic and treatment metaphors as reality, we potentially risk failing to maintain open-mindedness. Clinically, this could be in terms of our patients’ presentations, their communications and our responses. Furthermore, as the author points out, we also run the risk of not utilizing alternative conceptual models in understanding the phenomena of observed behaviour.

‘Watch that metaphor!’ is the title of the Debate article. I suggest that the matter has more to do with the recognition and use of terms we employ as constructed beliefs meant to give us understanding, coherence and correspondence of clinical phenomena. The potential limitations and pitfalls as well as the advantages of metaphorical thinking need to be kept in mind.