In lieu of an abstract, here is a brief excerpt of the content:

115 Values, Metaphors, and Health Policy 6 Values, Metaphors, and Health Policy Metaphor is the most rhetorical of figures, and its ubiquity is the best evidence that we are, each of us, everyday rhetorical beings. Metaphor operates lavishly in health and medicine, but it operates, at the same time, somewhat under cover; such is the way of metaphor. Sometimes, metaphors are easily recognizable as metaphors. The person who says, “my love is a rose” is not taken literally to have a disorder involving flowers—rather, to have more fully realized the sentiment of the simile “my love is like a rose.” But even our most ordinary conversation is full of metaphors that cause us to think along certain lines, while we believe that we are just thinking. Indeed, “along certain lines” is a usually unnoticeable spatial metaphor for how we think. Laurence J. Kirmayer writes (and his topic is biomedicine), “When values are explicit, they may be openly debated but rhetoric uses metaphor to smuggle values into discourse that proclaims itself rational, even-handed and valuefree ” (57). While some of the terms we use in debate clearly represent values (when someone calls a foetus a “pre-born child,” we know where we stand), some terms that seem neutral, or even like the only terms available for debate, represent values also, so there is good reason to be most interested in the terms we notice least. The purpose of this chapter is to bring metaphors of health and medicine to light and consider how they behave, especially in the realm of health policy. The chapter points to specific metaphors—some well established (medicine is war), some still emerging (the person is genes). It teases 116 Values, Metaphors, and Health Policy out and mines and also proves a rhetorical principle: that the terms of a discourse constrain not only the outcomes of debate but also what it is possible to argue at all.1 As I write this, I am waiting for the results of a diagnostic ultrasound. The ultrasound technician, who cautioned me, as she studied her monitor , not to draw any conclusions from her grimaces (“It’s not that I’m finding anything; I’m just looking very hard; you can’t find anything if you don’t look very hard”) told me in the end that “something did show up.” She said I should get in touch with my doctor to discuss the results of my test. Of course, the technician did not say what showed up. I do not know if I am due to receive another diagnosis to add to the list of annoying but basically benign conditions that clutter the lives of healthy people past a certain age, or if I am due to receive a diagnosis the very speaking of which, tomorrow morning, will change my life for a time or forever. I can say, though, that I was willing enough to have the test. I report the event because it indicates a way in which diagnosis is a metaphor, an idea in which we have invested a series of meanings transferred from another medical idea, the idea of health itself. We crave diagnoses , most of us, and not just those who are hypochondriacs or who “long for organicity.”2 We visit health professionals in search of diagnoses (as chapter 7 notes, we sometimes desire the diagnosis even more than the relief from symptoms). Given the opportunity, we request all available diagnostic tests and may feel unsatisfied with the medical consultation if we do not get them.3 In our homes, we complete checklists aimed at diagnosis—for depression or premenstrual dysphoric disorder or irritable bowel syndrome—and carry these checklists to our physicians and request specific prescriptions. Recently, we have gone further and fetishized diagnosis: We step out to be diagnosed—at diagnostic centers that have encouraged us to bypass our physicians and at diagnostic resorts (see chapter 4); we equip our homes with the technologies of home diagnostics. Newsweek reports on the availability for home use of both monitoring devices (for glucose levels, cholesterol levels, ovulation, etc.) and diagnostic devices. A company called Home Access Health offers for hiv and hepatitis C, for example, tests in which bodily fluids are collected at home and sent by mail, anonymously, to a laboratory for analysis (Carmichael 67–68). It should go without saying that accurate diagnosis is typically antecedent to appropriate medical treatment—this is certainly true for hiv and hepatitis C—but it is...


Additional Information

Related ISBN
MARC Record
Launched on MUSE
Open Access
Back To Top

This website uses cookies to ensure you get the best experience on our website. Without cookies your experience may not be seamless.