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  • BIOETHICS FORUM ESSAY

On Metaphors, Mental Illness, and, Mayhem

My Jewish mother could have gone daughter-to-daughter with any Chinese Tiger Mom. In addition to getting the highest marks in school and playing the piano beautifully, my sister and I were expected to look pretty at all times. Mom, however, strayed from the Tiger Mom doctrine and offered occasional praise, usually on the high marks-piano playing continuum, not on appearance. Each report card was greeted with, “Well, that’s another feather in your cap!” When I was very young, I wondered what she meant, since I did not wear caps with or without feathers. At an “age-appropriate stage of my cognitive development,” I realized that she was using a metaphor.

Metaphors are so much a part of our language that we seldom consider their literal meanings. In response to the Arizona shootings, many talk-show hosts and conservative politicians defended their use of inflammatory rhetoric by saying, in essence, “Talk doesn’t kill people. Crazy people kill people.” There is a link, however, between metaphor and mayhem.

Some people, however, are limited in their ability to move from the concrete to the abstract. These obviously include very young children, but also some individuals with Asperger’s syndrome or other types of autism, a traumatic brain injury (TBI), dementia, or mental illnesses, particularly schizophrenia. There are enormous differences in each of these syndromes, of course, but the capacity to understand metaphor is often part of the diagnostic process. A psychiatrist told me, “If you ask a person with schizophrenia to explain the proverb “People in glass houses shouldn’t throw stones,” he is likely to say, “Don’t throw stones because you will break the windows.”

Unknown to her, my mother’s metaphor likely had a military origin, although one several centuries removed. Warfare is the source of many metaphors common in medical care. In aNew England Journal of Medicine essay, George Annas observed, “Examples are legion [another metaphor]….Treatments are conventional or heroic, and the brave patients soldier on. We engage in triage in the emergency department, invasive procedures in the operating theater, and even defensive medicine when a legal enemy is suspected.”

Even ordinary language is full of military or at least weapons language. We shoot photos. We casually talk about an unpredictable person being a “loose cannon.” We debate a “scattershot” or a “double-barreled” approach while we are “under the gun” to submit a grant proposal asking for our “target population.” After a shooting catastrophe, we learn that the perpetrator “went ballistic,” or was a “ticking time bomb” all along. We are a nation of gun-toters, and we speak gun language, whether we realize it or not.

No single metaphor or image causes a person to perform a violent act. And people with schizophrenia or Asperger’s are not more prone to violence than others and are probably more often victims of it. While people with disordered thinking exist in every time and culture, the content of their delusions or paranoia depends on the social context and the meaning ascribed to their language or behavior. They might be considered saints or prophets or just crazy. In no other time, however, has the environment been so full of instantly available, pervasive, and confusing messages. In my view, it is the cumulative effect of this bombardment of weapons and assault language and images in an environment in which guns are readily available that leads a particularly unstable mentally ill individual to interpret this barrage as an order to take out his perceived enemy. (Metaphors intentional.)

Someone who has trouble making sense of ordinary language must be utterly traumatized by what he believes he hears or sees. Christopher Boone, the autistic boy who is the narrator of Mark Haddon’s novel The Curious Incident of the Dog in the Night-Time explains, “I find people confusing.” One reason is that “People do a lot of talking without using any words” (meaning nonverbal cues, which he does not understand). “The second main reason is that people often talk using metaphors.” His list includes: “He was the apple of her eye,” and “They had a skeleton in the cupboard.” He thinks metaphors should be called “lies” because these statements are not true. And, he adds,” And when I try to make a picture in my head it just confuses me because imagining an apple in someone’s eye doesn’t have anything to do with liking someone a lot and it makes you forget what the person was talking about.”

Since the Arizona shootings, there have been repeated calls for more gun control, better access to mental health treatment, and more civility in political rhetoric. Yes, yes, and yes. But as we debate these goals, it might be well to remember that “civility” means not just “politeness” but “civil” in the sense of “nonmilitary.” People who participate in public forums, whether they sit in state houses, federal agencies, radio or television booths, or just at their computers, should remember that their words carry many meanings. People who talk about guns shouldn’t urge others to shoot, even if they just mean it as a metaphor.

Carol Levine is director of the Families and Health Care Project of the United Hospital Fund and a Hastings Center Fellow.

Published on: January 31, 2011
Published in: Media

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