Metaphorical Language and Terminal Illness: Reflections upon Images of Death

A Metaphorical Language and Terminal Illness: Reflections upon Images of Death Jane Marston Describing die limits of philosophical discourse, die linguist Ludwig Wittgenstein ends his Tractatus Logico-Philosophicus on an almost mystical plane: "What we cannot speak about we must pass over in silence."1 The statement is evocative, for one of the subjects that we "cannot speak about" is die ultimate silence, death. Yet people do speak of death (though not after the manner of Wittgenstein), and the images they create of their own deaths form a common ground of interest for students of medicine and literature. Because deatii, the unknown, can be talked about only in terms of known experiences, the phenomenon of death lends itself to metaphorical treatment. Applied to patients' images of their own deaths, the study of metaphorical language reveals the intensely personal nature of illness. It therefore pertains to die branch of medical ethics concerned with die relationship between patient and physidan. For the patient, "body" itself becomes a complex metaphor, standing for the metaphysical realm of consdousness but belonging, paradoxically, to the natural realm of age and deatii. Words understood by die physidan to refer to die physiology of the body are understood by die patient to refer to the inner domain of diought and emotion known through die body and represented by it. Metaphors by their very nature accomplish a fusion of discrete objects or concepts, and, by so doing, deepen our perceptions of reality. More specifically, they can display dimensions of the self not easily accessible dirough medical models, and die study of diem can discover the figurative potential of language used in medical settings. The English metaphysical poets, in fact, remind us diat metaphors traditionally have been used to achieve a linguistic synthesis of mind and body. John Donne, comparing two lovers' souls to beaten gold,2 overcomes die Cartesian Literature and Medicine 5 (1986) 109-121 © 1986 by The Johns Hopkins University Press 110 METAPHORICAL IMAGES OF DEATH separation of mind and body which T. S. Eliot later called "dissodation of sensibility."3 The imaginative impulse of poets to integrate mind with body — more generally, to unify disparate elements of experience — finds its counterpart, in the medical sdences, in psychosomatic medicine. According to Jacob Needleman, medicine's failure to account for diagnosis and treatment of terminal illness in terms of mind as well as body is grounded in Cartesian dualism: "What medicine lacks is any fundamental notion as to the nature of man and any remotely adequate understanding of diat to which we refer as a person. Cartesian philosophy, and therefore die world view of natural science, fails utterly on these questions, and because it fails in this, it cannot come to grips with the idea of death."4 Corroborating this view, Graham Bennette, following earlier researchers , sees a connection between psychosis and malignant disease. He concludes, "we could develop the idea diat invasive cancer results from an internalization of disturbances of identity and communication diat cannot find psychic expression because of the strength of well-differentiated psychic controlling functions . . . ."5 (Conversely, psychosis results when somatic components of the self are strong enough to forestall physiological manifestations of psychological disturbance.) To use Needleman's terms, all medicine, therefore, is psychosomatic medicine, and poetry or any other artifact diat illuminates die relationship between mind and body supports efforts towards holistic mediane. Images of death generated by terminally ill patients reveal the ambiguous role played by the body in the patient's response to illness. One aspect of this response is die equation of loss of body with complete loss of self (Arthur H. Schmale notes that dying is like grieving except that in death, self is the object of loss*). Schwartz and Karasu's example of one patient's depression describes body's becoming a metaphorical substitute for the total self: "[The patient's] trusted 'friend,' her body, was beginning to fail and desert her; she was feeling 'attacked' and becoming angry and depressed."7 Here the body dearly is being regarded figuratively, taking on a life of its own as betrayer of the patient. It is the integral connection between body and mind diat makes possible dûs change...