By Peter Adams

‘Mental illness’ is no longer seen as a metaphor but a taken-for-granted truth. This view acts as a barrier, preventing alternative understandings and interventions being taken seriously

Opinion: I often reflect on the wide range of positive functions metaphors play in our daily lives. When I go to my GP, I describe my various ailments as “a shooting pain” or a “dull” ache, or “a band tightening” around my forehead.

When speaking with an electrician about a wire burning out, we might talk of electricity passing like “water in a pipe then, when it narrows, its “flow becoming constricted”. When seeking forgiveness for angry comments, I might talk of “pressure building up” or “feeling about to explode”.

Of course, pain doesn’t literally “shoot”, nor does body fluid actually “build up” to boiling point, and electricity moves only partly like “water in a pipe”. Being literal is not what metaphors and similes are about.

The power of metaphors lies in the way they stimulate our minds in unexpected ways: at times making things more understandable, perhaps capturing something in a particularly precise way, at times encouraging new perspectives or evoking a wide range of emotions.

Metaphors are indispensable to how we describe, explain and express what is happening around us, but they have a darker side.

Every now and then a particular metaphor latches more firmly in our imaginations and manages to embed itself deep into our minds. Once embedded, the metaphor spreads and grows (I know, I’m speaking metaphorically already) and this growth is continually reinforced through links and associations.

A metaphor that has grown to dominate its terrain then reshapes the language and vocabulary that flows around it. The metaphor becomes part of the dominant narrative, ceases to be seen as a metaphor, and becomes a self-evident truth.

In my recently published book, Monster Metaphors, I look at a set of metaphors that have grown to such a size they dominate their domains, quash alternatives and, based on their supremacy, wreak havoc on those subjected to them. These metaphors include “leader as father” commonly employed by dictators, and “contagion” of terrorism.

Consider also the mental illness metaphor, which has been around for some time and puts forward the idea that psychological distress is best thought of as a physical illness.

There are, indeed, some aspects of being physically ill that resemble psychological distress, such as physiological changes (such as a thumping heart when anxious) and the need for reassurance and guidance (usually from a trained professional).

But psychological distress also differs in many ways from physical illness, as can be seen in the key roles activity and social involvement play in overcoming such distress.

Despite this, over the past two centuries the mental illness metaphor has been continually reinforced by links and associations, in the way mental health services are located in medical environments for example, initially in stand-alone “psychiatric hospitals” and later as part of general hospitals, or in diagnostic procedures, case files, medication reviews and individualised practices that mark and often isolate those affected by psychological distress from their friends and families.

The mental health metaphor remains firmly entrenched within our mainstream approaches to psychological wellbeing

The vocabulary of physical illness applied in the psychological domain has included terms such as “diagnosis”, “treatment”, “recovery”, “therapy” and “prognosis”. The constantly echoing voice of the monster metaphor has meant ‘mental illness’ was no longer seen as a metaphor but more as a taken-for-granted truth.

This has contributed to a string of damaging ‘medical-like’ practices, such as lobotomies, the overuse of seclusion and sedating medication and confining people to life-long isolation in large, bleak institutions.

In my career in psychological practice, teaching and research, I have participated in a range of initiatives attempting to promote alternative understandings of psychological distress. These have included approaches that view it less as an illness and more because of external distress that has had emotional, social, economic and cultural underpinnings and consequences. In these initiatives, the role of families and communities were central.

However, despite our best efforts, whatever we tried soon fell back into line with the monster’s preferences. I became aware that tackling a well-entrenched monster is no easy undertaking and unsettling it would probably take decades of ongoing, persistent and coordinated effort.

Challenging the dominance of a monster metaphor requires a sustained, collective effort that typically emerges in a sequence of social movements that combine over time and will need multiple attempts to unsettle its dominance – just as the emancipation of woman over the past two centuries has taken a sequence of social movements, or ‘waves’, that sought to slowly challenge metaphors of male superiority.

There have been attempts to challenge the mental illness metaphor, including the ‘anti-psychiatry’ movement of the 1960-70s, the ‘psychiatric survivor’ movement of the 1970-80s, the ‘recovery movement’ of the 1980-90s, and the ‘Mad Studies’ movement of the past decade. Though each of these has shaken up the monster a little, the mental health metaphor remains firmly entrenched within our mainstream approaches to psychological wellbeing.

Don’t get me wrong, the metaphor of mental illness does make a contribution, and, for many people facing psychological distress, it can be helpful. What is objectionable here isn’t the metaphor per se, but its dominance, which acts as a barrier, preventing alternative understandings and interventions being taken seriously.

Peter Adams’ latest book is ‘Monster Metaphors: When Rhetoric Runs Amok’ (Routledge, New York). He is a professor of Social and Community Health in the Faculty of Medical and Health Sciences at the University of Auckland.

*Originally published in newsroom. Republished with permission.

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