Metaphor use in the ICU: rigor with words!
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Metaphor use in the ICU: rigor with words! Sylvain Langlume1, Fiona Ecarnot2, Gilles Capellier1,2 and Gaël Piton1,2,3* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
A 70 year-old man had been admitted to the ICU 1 week previously after resuscitation of hypoxemic cardiac arrest. The patient had signs of poor neurological outcome, and the ICU team had decided to withdraw life sustaining treatments. The patient’s spouse and children were awaiting a meeting with a junior physician. After introducing himself, the doctor said: “Your husband, your father, will never wake up, he is comatose. We need to stop critical care now. You know, he’s a vegetable.” For the doctor, the family seemed to have understood. The patient died rapidly after extubation and intravenous sedation to treat dyspnea. Three months later, the ICU received a complaint from the family, saying that the meeting with the physician had been a very bad experience. They were deeply shocked by the use of the word “vegetable” to describe their beloved father and husband. One might say that using the word “vegetable” revealed the tactlessness of an inexperienced medical doctor who just wanted to explain the concept of a coma to a family. We think that this type of metaphor is not only tactless, but could have harmful effects for the patients, families, and caregivers themselves. Metaphor has a Greek and Latin etymology, stemming from “metaphora”, meaning “transposition”. Indeed, metaphors make it possible to transpose meaning between two words. It is a linguistic process generally used to replace a complex and abstract idea by a concrete and simple image, thus enabling rapid comprehension. Saying “she’s a rock!” about someone signifies that the person is strong and able to withstand life’s events. It is as if language can be used to confer on the person the properties of a rock, such as solidity and hardness. According to Stewart and Barnes-Holmes who worked on the relational frame theory, construction of *Correspondence: gpiton@chu‑besancon.fr 3 Service de Réanimation Médicale, CHRU de Besançon, Besançon, France Full author information is available at the end of the article
a metaphor consists in four different phases. First, two separate equivalence relations are considered in the speaker’s mind (person—capacity to face life’s difficulties; rock—solidity). The relation between rock and solidity is obvious, whereas the relation of equivalence concerning the person is not. Second, formal similarity between these two relations is proposed by the speaker (“This person is a rock”). Third, the listener discriminates the sameness between these two relations. Fourth, in the listener’s mind, there is a transfer of function (solidity) from the obvious equivalence relation (rock–solidity) toward the second equivalence relation (person-solidity, i.e., this person is able to face difficulties). One can observe that a metaphor only illustrates one aspect of the subject. What characterizes a good metaphor is its efficiency, the strength and
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