These conclusions have implications not just when it comes to understanding the disease but also as regards improving communication with patients. "The findings have a very significant potential to change how we approach public and professional mental health discourses and even treatments or therapies. Promoting the positive uses of these metaphors, and reconverting or ditching the negative ones; i.e. those that have a disempowering effect or convey negative emotions such as feelings of desolation, anxiety or vulnerability, can be very useful," said Marta Coll-Florit and Salvador Climent Roca, members of the GRIAL group in the UOC's Faculty of Arts and Humanities.
Key metaphors in mental health narratives
The study was based on the analysis of around one million words contained in the personal blogs of 73 patients diagnosed with one of the four most common serious mental health disorders – depression, schizophrenia, bipolar disorder and obsessive-compulsive disorder – and 22 psychiatry, psychology, nursing and social education professionals. In all, 3,204 war and journey metaphors were identified in the corpus. "All kinds of conflicts are expressed as wars or struggles, with negative aspects presented as enemies. Similarly, many long and costly processes are expressed as paths, hurdles, steps forward, steps back, progress and so on. So, as mental ailments are closely linked to personal and social conflict as well as to the process involved (e.g. the recovery process), we were certain that these two metaphors would similarly be very important in mental health-related narratives," said the researchers.
A way for patients to express their innermost feelings
From a quantitative point of view, the study also found that these metaphors are used more often by the people suffering from a mental health disorder themselves than by mental health professionals. According to the researchers, this "confirms the hypothesis that metaphors are used in this context to express experiences that are complex and emotionally intense".
This ability to gather information on patients' intimate experiences also confirms the effectiveness of the method used in the study (the identification of conceptual metaphors in mental health discourses) to understand illnesses of this type. "The study clearly shows that this analysis method is highly systematic and very useful when it comes to revealing the feelings, thoughts and attitudes of both the people suffering from mental health disorders and mental health professionals. In other words, knowing which metaphors appear most frequently in narratives about mental health disorders provides better insight into what patients really think, feel and experience, thus giving us a better understanding of their suffering," said the researchers.
Affectivity, empowerment and positive emotions
Of the aspects of the mental health discourse that can have positive effects on patients, the researchers pointed out the importance of "conveying a sense of agency and control over the experience (which together define empowerment), as well as conveying positive emotions such as pride or a sense of achievement." One example of such positive use mentioned in the study is viewing mental health disorders "as a travelling companion, a type of metaphor that shows acceptance and can have a positive impact on the patient's experience of their disorder".
War metaphors are not necessarily negative
One of the findings that the researchers found most surprising is that both types of metaphors are linked to both positive and negative uses. "One might assume that war metaphors are inherently negative because they convey the idea of conflict and journey ones are positive because they're all about progress, but this is not the case. For example, war metaphors are often about having a fighting spirit, with agency and empowerment, which can increase patients' self-esteem and have a positive impact on their experience," they explained.
In any case, the researchers also mentioned how the same topic can be discussed using different metaphors, which can have positive effects depending on the aim of the communication. "For example, talking about fighting your fears (an enemy) is not the same as talking about gradually overcoming your fears (an obstacle along the way). The former expression highlights the patient's fighting spirit, whereas the latter conveys a certain degree of control, with the experience presented as a process of gradual improvement," they said.
"The difference is that war metaphors can be useful in situations requiring action and energy, whereas journey-related ones can be used for suggesting an ongoing action plan with a more restrained use of energy."
A tool for therapists
This detailed analysis of metaphors and their meanings could also help healthcare professionals with their therapy strategies. "A suitable use of metaphors is a tool that can facilitate patient-psychotherapist communication and provide the latter with a tool for use in therapy sessions," they said. With this in mind, the researchers have created a repository of metaphors – Diccionario de métaforas de la salud mental – which is now available online.
Coll-Florit, M. & S. Climent (2022). "Enemies or obstacles? Metaphors of war and journey in mental health discourse", Metaphor and the Social World. Online First Article (31 May 2022). DOI: https://doi.org/10.1075/msw.21035.col.
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