1
|
Syed A, Jacob MS. Languaging psychopathology: neurobiology and metaphor. Front Psychiatry 2024; 15:1320771. [PMID: 38374980 PMCID: PMC10875027 DOI: 10.3389/fpsyt.2024.1320771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor's role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.
Collapse
Affiliation(s)
- Adnan Syed
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael S. Jacob
- Mental Health Service, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
2
|
Shi J, Khoo Z. Words for the hearts: a corpus study of metaphors in online depression communities. Front Psychol 2023; 14:1227123. [PMID: 37829080 PMCID: PMC10566633 DOI: 10.3389/fpsyg.2023.1227123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/18/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose/significance Humans understand, think, and express themselves through metaphors. The current paper emphasizes the importance of identifying the metaphorical language used in online health communities (OHC) to understand how users frame and make sense of their experiences, which can boost the effectiveness of counseling and interventions for this population. Methods/process We used a web crawler to obtain a corpus of an online depression community. We introduced a three-stage procedure for metaphor identification in a Chinese Corpus: (1) combine MIPVU to identify metaphorical expressions (ME) bottom-up and formulate preliminary working hypotheses; (2) collect more ME top-down in the corpus by performing semantic domain analysis on identified ME; and (3) analyze ME and categorize conceptual metaphors using a reference list. In this way, we have gained a greater understanding of how depression sufferers conceptualize their experience metaphorically in an under-represented language in the literature (Chinese) of a new genre (online health community). Results/conclusion Main conceptual metaphors for depression are classified into PERSONAL LIFE, INTERPERSONAL RELATIONSHIP, TIME, and CYBERCULTURE metaphors. Identifying depression metaphors in the Chinese corpus pinpoints the sociocultural environment people with depression are experiencing: lack of offline support, social stigmatization, and substitutability of offline support with online support. We confirm a number of depression metaphors found in other languages, providing a theoretical basis for researching, identifying, and treating depression in multilingual settings. Our study also identifies new metaphors with source-target connections based on embodied, sociocultural, and idiosyncratic levels. From these three levels, we analyze metaphor research's theoretical and practical implications, finding ways to emphasize its inherent cross-disciplinarity meaningfully.
Collapse
Affiliation(s)
- Jiayi Shi
- School of Foreign Studies, Xi’an Jiaotong University, Xi’an, China
| | - Zhaowei Khoo
- School of Mathematical and Computer Sciences, Heriot-Watt University, Putrajaya, Malaysia
| |
Collapse
|
3
|
Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study. BMC Psychiatry 2022; 22:433. [PMID: 35761306 PMCID: PMC9235099 DOI: 10.1186/s12888-022-04083-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD). METHODS Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. RESULTS Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth. CONCLUSIONS These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts. TRIAL REGISTRATION Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
Collapse
Affiliation(s)
- A Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424, Oslo, Norway.
| | - JI Røssberg
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - T Dammen
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - T Wilberg
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - A Løvgren
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway
| | - R Ulberg
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway ,grid.413684.c0000 0004 0512 8628Department of Psychiatry, Diakonhjemmet Hospital, Vinderen, Box 85, 0319 Oslo, Norway
| | - J Evensen
- Nydalen Outpatient Clinic, Nydalen, P.O. box 4959, N-0424 Oslo, Norway
| |
Collapse
|
4
|
Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy. BMC Psychiatry 2021; 21:533. [PMID: 34706691 PMCID: PMC8555134 DOI: 10.1186/s12888-021-03551-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. METHODS Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. RESULTS Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. CONCLUSIONS Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. TRIAL REGISTRATION Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
Collapse
Affiliation(s)
- A Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway.
| | - J I Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - T Dammen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - A Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
| | - R Ulberg
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Box 85 Vinderen, 0319, Oslo, Norway
| | - J Evensen
- Nydalen Outpatient Clinic, P.O. box 4959 Nydalen, N-0424, Oslo, Norway
| |
Collapse
|
5
|
Wołońciej M, Wilczewski M, Kreitler S. “Don’t praise the day before the sunset”: Paremiology in the study of depressiveness. CULTURE & PSYCHOLOGY 2021. [DOI: 10.1177/1354067x211025704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychology and psychiatry are in a constant search for an adequate model of affective disorders. Psychology has classified depression as a mood disorder, but a growing literature links mental disorders with socioculturally relevant ways in which people experience and express distress. With this study, we link depression with proverbs as omnipresent narrative structures and mini-theories that help people interpret reality and categorize personal experience. Proverbs are omnipresent narrative structures that describe, explain, and prescribe human behavior. Hence, we offer a paremiological approach to better understand the minds of the depressed. Our tenet is that proverbs may also reflect people’s mental states and attitudes by conveying different levels of optimism versus pessimism. We evidence empirically that proverbs convey optimistic and pessimistic attitudes and, thus, have the capacity to capture peoples’ mental states. Moreover, we show that this capacity is limited for people with high depressiveness. Finally, we discuss how proverbial thinking links collective experience and wisdom imprinted in proverbs with an individual’s mental states, which has important research and practical implications.
Collapse
Affiliation(s)
- Mariusz Wołońciej
- Department of Psychology, John Paul II Catholic University of Lublin, Lublin, Poland
| | - Michał Wilczewski
- Faculty of Applied Linguistics, University of Warsaw, Warszawa, Poland
| | | |
Collapse
|
6
|
Metaphorical expressions originating from human senses: Psycholinguistic and affective norms for German metaphors for internal state terms (MIST database). Behav Res Methods 2021; 54:365-377. [PMID: 34240337 PMCID: PMC8863705 DOI: 10.3758/s13428-021-01639-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
Internal states, e.g., emotions, cognitive states, or desires, are often verbalized by figurative means, in particular by embodied metaphors involving human senses, such as touch, taste, and smell. The present paper presents a database for German metaphorical expressions conveying internal states with human senses as their source domains. 168 metaphorical expressions from the source domains of vision, hearing, smell, taste, touch, and temperature combined with literal equivalents were collected and rated by 643 adults. The agreement between the metaphor and an equivalent literal expression, as well as emotional valence, arousal, and familiarity values were assessed using a 7-point Likert scale. Between the metaphorical expressions and their equivalents, familiarity, but not valence or arousal differed significantly while agreement ratings indicated high similarity in meaning. The novel database offers carefully controlled stimuli that can be used in both empirical metaphor research and research on internal state language. Using part of the stimuli in a sentence completion experiment revealed a significant preference for literal over metaphorical expressions that cannot be attributed to higher familiarity levels.
Collapse
|
7
|
Zurlo MC, Ruggiero M. Assessing Pragmatic Language Skills in Adults with Major Depressive Disorder: An Exploratory Study. Psychopathology 2021; 54:78-91. [PMID: 33690229 DOI: 10.1159/000513270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is increasing evidence that major depressive disorder (MDD) is associated with significant pragmatic language impairments. However, there is a lack of studies that use standardized tools and simultaneously investigate all pragmatic language skills among MDD patients. The aim of this study was to propose a more thorough investigation of all pragmatic language skills in patients with MDD. METHODS Twenty adults (aged 22-65) with a DSM-5 diagnosis of MDD were assessed using BLED Santa Lucia (Batteria sul Linguaggio dell'Emisfero Destro Santa Lucia), a battery designed to evaluate pragmatic language skills (comprehension of inferences, of picture and written metaphors, of indirect requests, of humoristic expressions, and of prosody). The performance of the MDD participants on all BLED Santa Lucia subscales was compared to 20 healthy control subjects (aged 20-60) matched for gender, age, years of education, and employment status. RESULTS MDD patients performed poorer than controls in comprehension of inferences (p < 0.01), picture metaphors (p < 0.001), written metaphors (p < 0.001), indirect requests (p < 0.01), humoristic expression (p < 0.05), and prosody (p < 0.05). CONCLUSIONS All pragmatic language skills can be significantly impaired in MDD patients. A valid assessment of all pragmatic language skills can allow, for each patient, the definition of a specific profile of risk and protective factors before and during psychotherapy.
Collapse
Affiliation(s)
- Maria Clelia Zurlo
- Dynamic Psychology Laboratory, Department of Political Sciences, University of Naples Federico II, Naples, Italy,
| | - Maura Ruggiero
- Department of Humanities, University of Naples Federico II, Naples, Italy
| |
Collapse
|