Among mother hen and team captains, industrious tailors and investigators: analysis of 500 health care professionals’ metaphors
Many of our narrative researches are addressed to health care professionals, as an opportunity to understand their point of view and give them the possibility to freely and openly express themselves, through tools and languages that are not part of their clinical practice. Among these narrative tools, we use to invite the providers of care to represent their professional role through metaphors, too. This is often considered as a challenging request, as demonstrated by the considerable percentages of not-responses or “not-metaphors”: for example, in the pulmonary field, almost half (46%) of the 140 pulmonologists expert in Chronic Obstructive Pulmonary Disease (COPD) invited to express themselves through a metaphor, didn’t write any metaphors, or used adjectives and descriptions which did not refer to the symbolic language of the metaphor; it was slightly lower the percentage of not-respondents found among the 105 neurologists who treat Multiple Sclerosis (38%).
However, among those who accept this challenging proposal, we discover surprising creativity, sensitivity, and richness of images, very representative of the meaning and most intimate experience of being a health care professional. Metaphors thus become a powerful and effective tool to represent the complexity of several spheres, daily interacting with each other: motivations, emotions, efforts, satisfactions, disenchantments, values. From the analysis of about 500 metaphors from a heterogeneous group of health care professionals, mostly doctors – pulmonologists, neurologists, allergologists, paediatricians, cardiologists, dermatologists, general practitioners, endocrinologists, gynaecologists, oncologists – but also nurses and psychologists, all participants in our research projects, we could identify recurring images and transverse to different professional roles and contexts of care:
The helping, protecting, feeding and close carer.
This image is often represented through animal figures – “the lioness who protects the puppies”, “the mother hen”, “the mother hen with the white coat” – and family members figures – “mother who does not limit to passive help, but who continuously stimulates the other towards a process of personal activation”, “sometimes parental figures with the task of caring for”, “an older sister”, “the Uncle of the People I follow … I do not have the responsibilities of a father, but I can advise, give opinions and receive sometimes strange and intriguing questions that usually are not asked a father ….”. Also the maritime metaphors are frequent: the “port in which to take refuge”, “the anchor to which patients and their families cling, especially on stormy days”, “the landing place” and the metaphor of the garden, with the “gardener who takes care of his flowers”, “gardener who takes care with love of the own plants, helping them to grow in respect of their characteristics, providing the right nourishment, looking for the right exposure to light, recording their progress, combining professional competence, attention, and love”. Still, the spiritual metaphor of the “guardian angel”, the “Linus blanket”, borrowed from the world of comics, of and the figure of the “outstretched hand”, are common.
Being a mentor and a point of reference
Those who want to represent themselves in a mentor role, often resort to sport metaphors – the “sports coach who helps the athlete to give his best and and motivates him”, the “captain of a team”, “a cache of an American team who not only must heal, encourage and motivate my flock of sheep, but also stimulate them to become fighting sheeps” – or, again, to the maritime metaphor, this time represented by “the helmsman in a stormy sea”, “the helmsman of a boat in which the patient is sometimes crew, sometimes passenger”, “the ferryman of patients in times of storm in the middle of the sea, to the mainland”, “the admiral”. There is also the image of the wise figure, through “the teacher “, “the wise and authoritative Indian chief, reference for his tribe”, “the old wise man”, or “the traveling companion of a wayfarer who lost the way, I offer him my help to find his way back..”, and other spiritual metaphors such as “the Comet Star which guides the patients”, “the shepherd of a flock”, “the icon”, or poetics such as “Virgil (me) who fosters Dante (the patient) in a tortuous and complicated path such as Hell (the disease)”.
The hard-working professional.
In these cases, the health care professional is represented through artisan figures – “the restorative”, “an artisan of the health “, “the industrious tailor”, “the apprentice” – or metaphors from the world of mechanics – “the technician who adjusts”, “the mechanic who intervenes when the machine no longer works”, “a diesel car: perhaps slow, but constant and tenacious”, “the Swiss watch”, “a screw of a larger gear”. There are also frequent metaphors from the animal world – “the hard-working ant”, “a hard-working bee, always committed to the individual, with an eye to the community”, “a pack mule”, “a slow and tireless turtle”.
The carer in the complexity.
Furthermore, there are the images representing a complex professional role, made of research and investigation – “an investigator like Sherlock Holmes or Jessica Fletcher who combines reason and creativity”, “an investigator who investigates the evils that afflicts the patient and the social context in which he lives, and an interpreter of the patient’s expressions”, “an investigator at the scene of a crime”, “gold miner”, “A full os surprises universe…with some black holes”, “A truffle dog which tries to understand the cause of the imbalance” – or alchemy, compromise and mediation – “The alchemist”, “Like an alchemy: the attempt to develop the best possible blend of scientific rigor and adaptation to the individual of the valid knowledge in general”, “balance”, “a ring of reunion”, “a mixture among other specialists”, “glue”, “a piece of the puzzle”, “the traffic policeman at the intersection who must seek the best way to make the circulation fluid and effective”.
Strength and resistance.
Talking about strength, the rock is undoubtedly the most recurrent image, together with the metaphors depicting animals such as the lion, the tiger, the Rottweiler. But even simple representations such as the caterpillar, the volcano, the dynamite, the unbreakable diamond, are very effective.
The fighting hero.
There are also heroic figures, often connected to the image of war (yes, even among health care professionals): “an intrepid warrior”, “a gladiator in the arena”, “a soldier”, “a fighting knight”, “hero”, “wounded healer”, “the border doctor”, “besieged fortress”. But also “Don Quixote against windmills”, “crusader”, “paladin”, and, from the entertainment world, “spider-doctor” and “Mc Gyver”.
All this industriousness, strength and heroism, is accompanied by the group of metaphors used to express the daily burden and fatigue, almost considered as requests for help. There are frequent images of the race – “the marathon runner”, “the cross-country race, you run, you get dirty, you struggle, you have to be careful not to fall and get to the finish line healthy”, “an athlete”, “the race against time” – of overflowing – “a vase under a fountain … periodically overflows”, “a river in flood”, “I feel a sponge” – and chaos – “in a blender”, “in a meat grinder”, “a spinning top”. But there are many and varied images evoked: “a good swimmer, tired after a long journey, who is in the middle of the sea”, “support in search of foundations”, “a table without a leg but standing and holding many things”, “a very old person with a curved back that drags with a huge bag on his shoulders”, “a pressure cooker”, “a rowing against the current boat : you can’t stop rowing otherwise the current sweeps you away”, “like a “lion in a cage”, because it is hampered by too much bureaucracy, limited by scarce human resources, conditioned by economic limits set by regional and national economic policies”, “Like leaves on the trees in autumn “.
However, there are also positive images, represented by “fairy goodmother”, sweeter figures than the fighting heroes, the elements of the sky – “shining sun”, “small ray of sun”, “the sun has come”, “growing moon”, “shining like stars in the world”, “serene as the sky in spring” – images of freshness and lightness – “fresh wind that gives relief in summer but can move the oceans”, “a breath of life”, “they are like the sky after the storm: fresh air to breathe”, “an open window”, “a butterfly fluttering in a meadow”, “dancing like a butterfly”, “free spirit” – of hope – “open door”, “light on”, “light at the end of the tunnel” – joy – “happy heart “, “a spinning toplooking around 360°, running, colorful, bringing joy”, “Enthusiastic and amused like a child in front of a showcase of toys”, “a smile”, “the court jester” – and the optimism of the ” half full glass “.
The mission of caring.
Sometimes carer has been represented in its existential meaning of mission – “the mission of my life”, “in the footsteps of Hippocrates” – lived with spirituality – “Aspiring missionary”, “The Good Samaritan” – or love – “a lover returned by his woman”, “heart in hand”, “part of a large family”.
Gender metaphors? Only in some cases
As well as the narrative seems to be a more feminine than masculine attitude – and our activities in narrative medicine, from adherence to research to participate in training courses, bear witness to this – we could also identify some gender differences from the analysis of the metaphors we have collected in recent years. The use of the metaphor itself tended to be more frequent among women, while the group of those who did not respond to this stimulus was more composed of men. There were also differences in the figures used in the metaphors: the figures of protection, support and nourishment, together with the expressions of the positivity of the professional role – the shining sun, the fresh air – and, on the other side of the coin, the expressions representing the daily load – the overflowing vase, the blender, the marathon – resulted to be more frequent among women. Among men, instead, the heroic and missionary vision of their work prevailed a little more, especially warriors, Don Quixote, and Samaritans. Other figures appeared more transversal, such as those that described the industriousness and the guidance role. And in any case, the boundaries are blurred, because we also could read about very protective men and female fighter heroines.
These metaphors are many and beautiful, not always easy to “classify” for their multifaceted. Work, complexity, heroism and mission, for example, can be represented and synthesized in a single image, as well as guidance and protection. More than classifying these images, it is important welcoming them as they are entrusted to us, receiving their messages of strong motivation, transport, passion, but also load, effort, and difficulty.
More gardeners than warriors
The language of clinical practice, as well as that of scientific publications, is full of warlike references around the great “war against the disease”, through the patients’ enrollment, the therapeutic arsenal, the fight, and many other expressions now common among both people in care and health care professionals. From this analysis of the metaphors, however, it has been revealed how the use of a different language, more unrelated to the “medical” one and open to new possibilities of expression, allows to reduce the “army of warriors”, in favor of more reassuring figures such as mothers hens, safe harbors, gardeners, fellow travelers, wise teachers, hard-working ants, tailors. Of course, there are also fighting soldiers and tireless heroes, but they are more tied to the mission of care than to the war against the disease, a remarkable difference. From these metaphors, we derive the health care professionals’ profound values, not only concerning the victory over the patient’s disease but extending to the concept of the person to be welcomed, supported, fostered and treated in all the aspects. In summary, we find more gardeners than warriors, and this is a beautiful discovery.