Perceptions and metaphors of patients about epileptic seizures and postictal state in Medellín-Colombia: A qualitative study

INTRODUCTION

PWE describe epileptic seizures and the postictal state with the description of experienced symptoms or through metaphorical language. For treating physicians, this metaphoric language may go unnoticed. The purpose of the study is to identify both the real and metaphorical descriptions of epileptic seizures and postictal state referred by PWE from Medellín Colombia.

METHODS

It is a qualitative study that uses grounded theory applied in ten semi-structured interviews of PWE from the Metropolitan Area of Medellín, Colombia. Descriptions of epileptic seizures and the postictal state were identified. For their classification into metaphorical and literal characteristics, the texts of "The Living Metaphor" by Paul Riccoeur, "The Illness and its Metaphors - AIDS and its Metaphors" by Susan Sontag, and "Metaphors of Everyday Life" by Lakoff and Johnson were used as references.

RESULTS

Ten clinical and fourteen metaphorical descriptions of epileptic seizures were identified. Regarding the postictal state, eight clinical and six metaphorical descriptions were identified. The metaphors were classified into three categories: a. external force b. depreciation and division and c. the absence of continuity (slowness, disconnection).

CONCLUSION

Metaphors are frequent in the description of epileptic seizures and can be useful in seizure classification, neuroanatomical localization, and therapeutic approach. Metaphors can be an initial stage in the construction of otherness as a form of identity.

Metaphoric language in the differential diagnosis of epilepsy and psychogenic non-epileptic seizures: Time to move forward

Conversation analysis (CA) to identify metaphoric language (ML) has been proposed as a tool for the differential diagnosis of epileptic (ES) and psychogenic nonepileptic seizures (PNES). However, the clinical relevance of metaphoric conceptualizations is not clearly defined. The current study aims to investigate the ML utilized by individuals with ES and PNES in a pulled multi-country sample. Two blinded researchers examined the transcripts and videos of 54 interviews of individuals (n = 29, Italy; n = 11, USA; n = 14, Russia) with ES and PNES, identifying the patient-seizure relationship representative of the patient's internal experience. The diagnoses were based on video-EEG. Metaphors were classified as "Space/place", "External force", "Voluntary action", and "Other". A total of 175 metaphors were identified. No differences between individuals with ES and PNES were found in metaphoric occurrence (χ2 (1, N = 54) = 0.07; p = 0.74). No differences were identified when comparing the types of metaphors utilized by participants with ES and those with PNES. Patients with PNES and ES did not demonstrate differences in terms of occurrence and categories in ML. Therefore, researchers and clinicians should carefully consider the use of metaphor conceptualizations for diagnostic purposes.

Improving the communication between farmers and veterinarians to enhance the acceptability of bovine tuberculosis eradication programmes

France and Spain have been fighting against bovine tuberculosis (bTB) for years, even though new outbreaks continue to appear on both sides of the border, generating misconceptions about the disease and social distrust in the eradication programme and competent authorities. The perceived disease risk and the commitment of all interested parties are key factors for the successful implementation of control programmes, as they might influence the acceptability of recommended measures. Effective communication can contribute to increasing knowledge, trust and stakeholders' engagement, thus ensuring the acceptability of the eradication programme. This study was conducted in Catalonia (Spain) and Pyrenees-Atlantiques (France) in the frame of the INNOTUB project (https://innotub.eu/) to characterise the communication on bTB in the trans-Pyrenees region and provide recommendations to improve it. The communication on bTB was characterised by analysing 153 (Spain) and 66 (France) online freely available texts, published between 2018 and 2020, through Content Analysis and Critical Metaphor Analysis. Moreover, six farmers and four veterinarians were in-depth interviewed in each area to gather information about the communication on bTB. Interviews were made in original languages and analysed using a qualitative thematic approach. A pilot participatory intervention inspired by the Systematic Tool for Behavioural Assumption Validation and Exploration (STAVE) method was used to develop a list of proposals to improve communication and to promote the creation of territorial networks/committees on bTB prevention and control. It included three focus groups with farmers and veterinarians, a meeting with representatives of the regional veterinary services, and a final deliberative workshop. Results highlight the existence of a controversial debate on bTB and a heterogeneous understanding between stakeholders. Institutional and scientific communication mainly focus on bTB detection and control while other aspects are left in the background. On the contrary, farmers extend their communication to a greater variety of topics. The metaphorical framing strongly differed among actors, while veterinary services and researchers "fight" against bTB and "progress" toward the eradication, farmers place themselves in a framework of "sacrifice" and, particularly in Spain, they play a passive role. The proposals developed by the participants to improve the current communication on bTB included: (i) create participatory meeting spaces to share opinions and information; (ii) improve data accessibility (on epidemiological situations); (iii) develop clearer and written protocols and informative visual material; (iv) redesign the training courses (v) increase the stakeholders' participation in the design of protocols.

Metaphors in blogs posted by Chinese lung cancer survivors

Metaphors play a crucial part in human cognition and significantly enhance doctor-patient communication. However, metaphor uses of Chinese lung cancer survivors are still understudied. The aim of the study was to examine how Chinese lung cancer survivors employed metaphors to describe their illness experiences using the method of inductive content analysis. The data analyzed in this study were derived from 15 blogs written by lung cancer survivors and posted on the social media site Xiaohongshu, totaling 204,395 characters. Through the analysis, 1762 metaphor phrases were identified. Five themes emerged: journey metaphor, violence metaphor, burden metaphor, building metaphor, and imprisonment metaphor. The identified metaphors enabled lung cancer survivors to emphasize different aspects of their illness experiences. Consequently, it is imperative for healthcare professionals to pay close attention to the metaphors employed by patients, as they have the potential to shape their understanding of the illness. By recognizing and engaging with these metaphors, healthcare professionals can gain deeper insights into the unique perspectives of Chinese lung cancer survivors, thus facilitating more effective communication and empathetic care.

On the use and abuse of metaphors in assessment

This paper is motivated by a desire to advance assessment in the health professions through encouraging the judicious and productive use of metaphors. Through five specific examples (pixels, driving lesson/test, jury deliberations, signal processing, and assessment as a toolbox), we interrogate how metaphors are being used in assessment to consider what value they add to understanding and implementation of assessment practices. By unpacking these metaphors in action, we probe each metaphor's rationale and function, the gains each metaphor makes, and explore the unintended meanings they may carry. In summarizing common uses of metaphors, we elucidate how there may be both advantages and/or disadvantages. Metaphors can play important roles in simplifying, complexifying, communicating, translating, encouraging reflection, and convincing. They may be powerfully rhetorical, leading to intended consequences, actions, and other pragmatic outcomes. Although metaphors can be extremely helpful, they do not constitute thorough critique, justified evidence or argumentation. We argue that although metaphors have utility, they must be carefully considered if they are to serve assessment needs in intended ways. We should pay attention to how metaphors may be misinterpreted, what they ignore or unintentionally signal, and perhaps mitigate against this with anticipated corrections or nuanced qualifications. Failure to do so may lead to implementing practices that miss underlying and relevant complexities for assessment science and practice. Using metaphors requires careful attention with respect to their role, contributions, benefits and limitations. We highlight the value that comes from critiquing metaphors, and demonstrate the care required to ensure their continued utility.

Right hemisphere and metaphor comprehension: A connectionist perspective

Metaphor comprehension is a cognitively complex task, with evidence pointing to the engagement of multiple cerebral areas. In addition, the involvement of the right hemisphere appears to vary with cognitive effort. Therefore, the interconnecting pathways of such distributed cortical centers should be taken into account when studying this topic. Despite this, the potential contribution of white matter fasciculi has received very little attention in the literature to date and is not mentioned in most metaphor comprehension studies. To highlight the probable implications of the right inferior fronto-occipital fasciculus, right superior longitudinal system, and callosal radiations, we bring together findings from different research fields. The aim is to describe important insights enabled by the cross-fertilization of functional neuroimaging, clinical findings, and structural connectivity.

A triangulation method on the effectiveness of digital game-based language learning for vocabulary acquisition

This research aimed to explore the views of 8th grade students on digital game-based English language learning as a foreign language (EFL). A total of 69 students between the ages of 12 and 14 participated in the study. Students' vocabulary acquisition skills were tested using a web 2.0 application called "Quizziz." The study utilized a triangulation method in which the results of a quasi-experiment and the metaphorical perceptions of the learners were obtained. The results of the tests were recorded at two-week intervals, and students' reactions to the results were collected using a data collection tool. The study used a pre-test, post-test, and control group design. The experimental and control groups took a pre-test before the study began. The experimental group then practiced vocabulary using Quizziz, while the control group practiced vocabulary by memorizing it in their mother tongue. The post-test results showed significant differences between the control and experimental groups. In addition, content analysis was used to analyse the data, with metaphors being grouped and frequencies calculated. The students generally expressed positive views on digital game-based EFL, stating that it was highly successful and that in-game power-ups, competing with other students, and receiving rapid feedback improved their motivation.

Use of metaphors when treating unexplained medical symptoms

The words one chooses to describe personal pain mirror current usage, but may also hold echoes of an individual’s lived experience. They may provide clues to the origin of physical symptoms that are medically hard to explain. The aim of this commentary is to propose, on the basis of the available literature, that verbal metaphors can prove effective in the psychotherapy of such conditions. I provide a case history of a 45 year old woman referred to psychiatry because of extreme ‘burning’ pain in her mouth and tongue. She had been to numerous doctors, had undergone a variety of tests, had tried many medical treatments, and had been prescribed a number of different pharmaceutical agents. She had changed her diet, done her daily dental mouth exercises, drunk a lot of water, but the burning continued and interfered, with her job (she was a teacher), her friendships, and her everyday life. This made her angry and recalcitrant to therapy, but the metaphor ‘burning with rage,’ as applicable to her pain, worked to establish a good alliance that led to a decrease of symptoms. Burning Mouth Syndrome is a medically unexplained condition of complex etiology that psychotherapy alone cannot reverse. The literature bears out, however, that the use of metaphors can help to open avenues of psychological exploration that accelerate adaptation to pain and improve quality life.

"What is this strange sensation?" A qualitative exploration of metaphors used to verbalise hard-to-describe experiences by people with epilepsy

Mental health comorbidities are frequent in epilepsy. Consequently, psychotherapy is becoming increasingly important. To address the psychological needs of people with epilepsy (PwE) it is essential to understand the subjective experiences of seizures better. There is little research on how people report seizures, and which psychological representations they have. We conducted a thematic analysis based on 42 (micro-phenomenological) interviews with 15 participants on their experiences of seizures. In these interviews, we identified three categories of seizure descriptions: (1) phenomena related to the body and emotions; (2) the moments that are difficult to describe; and (3) the use of figurative language and metaphors. Paroxysmal physical and psychological sensations were often reported spontaneously by the participants. The moments that were difficult to describe were expressed, among other things, through the use of paradoxes or the report of a 'strange' feeling and led participants to use figurative language. As these metaphors can reveal important information about people's subjective experiences, they were analyzed in detail. We identified the three main types of metaphors that the participants used most frequently: (1) perception, (2) nature, and (3) battle. The theme of battle was most frequently used in different forms and was closely related to the metaphors from the fields of perception and nature, thus representing a key point in the personal experience of seizures. These findings can contribute to developing psychotherapeutic approaches for the treatment of seizure disorders.

Pathologies and the Healing of the soul: medical terms as metaphors in philosophy

This paper critically examines the metaphorical use of medical terms in philosophy. Three examples selected from distinct philosophical contexts demonstrate that such terms have been employed as metaphors both to describe the practice of philosophising and historically to diagnose philosophical positions. The selected examples are (i) the title of Avicenna's main philosophical work, The Book of Healing, (ii) the criticism of medical metaphors in Enlightenment philosophy, and (iii) recent historical diagnoses in philosophy. The underlying epistemological assumptions of all three contexts are reconstructed to critically analyse the medical metaphors. Through this tripartite synopsis, I arrive at a normative conclusions medical metaphors, such as the "healing of the soul" or "pathology of reason", do not stand up to the critique of Enlightenment and are obsolete against the theoretical background of my reference texts.

Vitalism, Holism, and Metaphorical Dynamics of Hans Spemann's "Organizer" in the Interwar Period

This paper aims to provide a fresh historical perspective on the debates on vitalism and holism in Germany by analyzing the work of the zoologist Hans Spemann (1869-1941) in the interwar period. Following up previous historical studies, it takes the controversial question about Spemann's affinity to vitalistic approaches as a starting point. The focus is on Spemann's holistic research style, and on the shifting meanings of Spemann's concept of an organizer. It is argued that the organizer concept unfolded multiple layers of meanings (biological, philosophical, and popular) during the 1920s and early 1930s. A detailed analysis of the metaphorical dynamics in Spemann's writings sheds light on the subtle vitalistic connotations of his experimental work. How Spemann's work was received by contemporary scientists and philosophers is analyzed briefly, and Spemann's holism is explored in the broader historical context of the various issues about reductionism and holism and related methodological questions that were so prominently discussed not only in Germany in the 1920s.

University-level EFL students' views on learning English online: a qualitative study

The main aim of this article is to determine Turkish EFL (English as a foreign language) students' perceptions about learning English through distance education (henceforth DE) during the COVID-19 pandemic. To realize this aim, the study adopted a qualitative research design and used the metaphor elicitation technique, semi-structured telephone interviews, and an online focus group interview to collect data. The results of the analysis show that most of the students prefer face-to-face English education in a classroom setting rather than online education. Despite some positive comments about DE like it being more comfortable for shy students, students' attitudes toward DE were found to be mostly negative because of the challenges they faced like technical problems, health and focus issues, a lack of interaction and speaking practice in the target language, feelings of anxiety and isolation and low motivation, and DE not addressing all learning styles effectively. Using several qualitative data collection tools, this study provides valuable insights into the thoughts and experiences of students about online English language learning, which can be taken into account to enhance future online language teaching and learning efforts. This study also offers some suggestions to make online EFL education more productive and effective.

Attitudinal responses to current concepts and opinions from pain neuroscience education on social media

BACKGROUND

Pain neuroscience education (PNE) programs have become popular among clinicians and are widely promoted through social and mainstream media.

PURPOSE

To test the hypothesis that people with persistent pain are likely to express negative attitudes to PNE statements and compare their responses to other social media user groups.

METHODS

A total of 1319 respondents completed an online survey and were directed into four groups: persistent pain, healthcare professionals with persistent pain, pain-free healthcare professionals, and pain-free controls. The survey included ten statements of popular PNE concepts. Feedback was invited by offering seven attitudinal response categories (three positives, three negatives, and one neutral). A two-step hierarchical regression model was used to assess the likelihood of reporting negatively.

RESULTS

Compared to controls, respondents from the persistent pain group were more likely to report negatively towards all statements (OR 1.6-2.16), except for two statements (#3 and #5). Healthcare professionals were less likely to report negative attitudes for 4 out of 10 statement (OR 0.35-0.58). Health care professionals living with persistent responded to most statements like the pain-free controls (besides statement #2, OR 0.59).

CONCLUSION

People living with persistent pain are more likely to express negative attitudes to PNE statements on social media, unlike healthcare professionals who were less likely to express negativity. Healthcare professionals living with persistent pain responded to most PNE statements like the pain-free control group. The study's main weaknesses include the lack of psychometric information of the questionnaire used, selection bias, small samples of the healthcare professionals and the overrepresentation of young social media users.

Indirect work with hypnosis using metaphorical objects through unconscious intelligence in virtualspace

A narrative case study is used to illustrate a working model with metaphoric objects and movement within the context of Ericksonian hypnosis. The technique is meant to awaken an inner dialogue within unconscious intelligence. This case also illustrates how to modify the origin of an apparently difficult problem in a fast, efficient and loving way, without the need for information about the person or the situation. This therapy session was conducted using an online format. Work with metaphoric objects is an efficient technique that helps uncover the unconscious origin of the situations to be treated, as well as the solution. Due to the sensitive nature of these ideas, they must be handled with care and responsibility, as demonstrated in this case study.

Testing Emphasis Message Frames and Metaphors on Social Media to Engage Boaters to Learn about Preventing the Spread of Zebra Mussels

Message frames are often used to communicate about invasive species due to the additional meaning they provide. They appear in calls to action like "join the battle against invasive species," "unwelcome exotics," or "Stop Aquatic Hitchhikers." However, little is known about how stakeholders respond to these message frames. This research tested five common message emphasis frames used in invasive species communication. These message frames were placed in social media advertisements about zebra mussels to determine the impact each message frame had on user online behavior. For cost-per-click (CPC), ANOVA showed effects for framing and gender. Model coefficients revealed that Hitchhiker and Protective had significantly higher CPC than Science, and that women had a higher CPC. For comments, ANOVA showed effects for framing and gender. Model coefficients revealed that no frame had a significantly different effect on comments than Science, and that women commented on posts less. For shares, ANOVA showed effects for framing. Model coefficients revealed that Hitchhiker was shared more than Science. It is important to note that neither Militaristic nor Nativist outperformed Science on any measured outcome. Coupled with ethical considerations, our results suggest the use of Nativist and Militaristic frames are not necessary to influence online behavior. Message frames without ethical issues can be used to achieve the outcomes we tested without compromising message effectiveness. Within this article, we provide background on commonly used invasive species message frames, explain our methods for testing how they impact user behavior, and suggest limitations and applications of this work.

A metaphor for epidemiology: The sea of person time

Metaphors have had an important role to play in the theory and practice of epidemiology. Some well-known examples include "black boxes," the "web of causation," "shoe-leather epidemiology," the "ivory tower" and the ubiquitous "gold standard." Metaphors like these do not replace methods or principles but rather like memes can spark a creative response and thoughtful reflection. In this paper, I bring to the attention of epidemiologists a metaphor that originated forty years ago in a paper describing and explaining measures of disease incidence. The authors wrote about a "sea of population time" to represent how incident disease events-specifically, incidence density measures- occur in the two-dimensional space of person-time. A "sea of population time" or "sea of person time" seems ideally suited as a metaphor for creative and thoughtful development in epidemiology. The vast and varied characteristics of oceans provide a plethora of ideas that can potentially help us to think more deeply about the role and responsibilities of epidemiologists. As an example, consider the notion that epidemiologists' journey across this sea in their methodologically-laden and concept-heavy fishing boats searching for the causes of disease. At the same time, epidemiologists live in the sea itself subject to and thus at risk of all the same diseases that affect human populations. Storms on this imaginary sea could sink our boats causing us to rethink conceptual and methodological frameworks. Here I provide in lyric form examples that explore what might exist behind the sea of person time and on its shores.

Fighting COVID-19 with the team of 5 million: Aotearoa New Zealand government communication during the 2020 lockdown

Aotearoa New Zealand's response to the COVID-19 pandemic is considered one of the best in the world. A major component of the government response was the communication of public health measures. In this paper, we approach Prime Minister Jacinda Ardern's daily press briefings with the Director-General of Health, Ashley Bloomfield as a case study of government communication during a public health crisis. A reflexive thematic analysis leads us to identify three key themes: 1) open, honest and straightforward communication; 2) distinctive and motivational language; and 3) expressions of care. Situating our findings in the fields of crisis communication, science communication and psychology, we argue that the messages presented in the 2020 daily briefings supported the New Zealand Government's COVID-19 elimination strategy through building trust with the audience and framing the 'lockdown' as an urgent, collective and meaningful cause, mobilising New Zealanders to support public health measures.

Metaphors as models: Towards a typology of metaphor in ancient science

Metaphors play a crucial role in the understanding of science. Since antiquity, metaphors have been used in technical texts to describe structures unknown or unnamed; besides establishing a terminology of science, metaphors are also important for the expression of concepts. However, a concise terminology to classify metaphors in the language of science has not been established yet. But in the context of studying the history of a science and its concepts, a precise typology of metaphors can be helpful. Metaphors have a lot in common with models in science, as has been observed already. In this paper, therefore, I suggest a typology of metaphor in ancient science to fill this terminological gap by using concepts applied to the classification of models in science, as coined by Rom Harré. I propose to differentiate between homeoconceptual metaphors (with the same conceptual frame between source and target) and paraconceptual metaphors (mapped via a different conceptual frame). Furthermore, functional and structural aspects of metaphors in ancient science are taken into account. Case studies from ancient texts displaying metaphors in ancient science are presented and classified following the outlined typology of metaphors.

Cycles and circulation: a theme in the history of biology and medicine

We invite systematic consideration of the metaphors of cycles and circulation as a long-term theme in the history of the life and environmental sciences and medicine. Ubiquitous in ancient religious and philosophical traditions, especially in representing the seasons and the motions of celestial bodies, circles once symbolized perfection. Over the centuries cyclic images in western medicine, natural philosophy, natural history and eventually biology gained independence from cosmology and theology and came to depend less on strictly circular forms. As potent 'canonical icons', cycles also interacted with representations of linear and irreversible change, including arrows, arcs, scales, series and trees, as in theories of the Earth and of evolution. In modern times life cycles and reproductive cycles have often been held to characterize life, in some cases especially female life, while human efforts selectively to foster and disrupt these cycles have harnessed their productivity in medicine and agriculture. But strong cyclic metaphors have continued to link physiology and climatology, medicine and economics, and biology and manufacturing, notably through the relations between land, food and population. From the grand nineteenth-century transformations of matter to systems ecology, the circulation of molecules through organic and inorganic compartments has posed the problem of maintaining identity in the face of flux and highlights the seductive ability of cyclic schemes to imply closure where no original state was in fact restored. More concerted attention to cycles and circulation will enrich analyses of the power of metaphors to naturalize understandings of life and their shaping by practical interests and political imaginations.

Well-being in the time of COVID-19: Do metaphors and mindsets matter?

Communications about the Coronavirus Disease 2019 (COVID‐19) often employ metaphors, which can help people understand complex issues. For example, public health messages may focus on “fighting” the disease, attempting to rouse people to action by instilling a sense of urgency. In contrast, change‐focused metaphors may foster growth mindsets and self‐efficacy—cornerstones of well‐being and action. We randomly assigned participants to read one of two articles—either an article about coronavirus that focused on fighting the war or an article that highlighted the possibility of change. In Study 1 (N = 426), participants who read the war, relative to the change, message reported lower growth mindsets and self‐efficacy and these in turn, predicted lower well‐being and weaker intentions to engage in health behaviours. In Study 2, (N = 702), we sought to replicate findings and included a no treatment control. We failed to replicate the effects of message condition, although both messages predicted greater self‐efficacy compared to the control. Similar to Study 1, growth mindsets predicted intentions to engage in recommended health behaviours and self‐efficacy predicted both well‐being and action. We discuss theoretical reasons for discrepancies as well as practical applications for developing public health communications.

Metaphors of organizations in patient involvement programs: connections and contradictions

PURPOSE

In this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of "learning from patients" as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data (n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask "what is the organization that it might learn from patients?"

DESIGN/METHODOLOGY/APPROACH

Patient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must "learn from patients" in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involvement.

FINDINGS

Through our analysis, we interpret a range of metaphors of the organization, including organizations as (1) power and politics, (2) systems and (3) narratives. Through these metaphors, we display a range of possibilities for interpreting how organizations might learn from patients and associated implications for organizational change.

ORIGINALITY/VALUE

This analysis has implications for how the framing of the organization matters for concepts of learning in patient engagement activities and how misalignments might stymie engagement efforts. We argue that the concept and commitment to "learning from patients" would be enriched by further engagement with the sociology of knowledge and critical concepts from theories of organizational learning.

Musings about Metaphors and Models: the Need to Put Psychology Together Again

Zagaria, Andò & Zennaro (2020) raise several issues for the study of the human condition, highlighting the precarious status of psychology on account of a core weakness: The absence of consensus about fundamental concepts. Using the metaphor of a giant, albeit one with feet of clay, the authors develop an argument about how evolutionary psychology is the best possible candidate to advance a unified paradigm on account of theoretical consistency. In this commentary we examine the metaphors and models invoked in the article and suggest alternative perspectives on the grounds that a grand singular solution and consistency in definitions are not urgent requirements for understanding the complexity, diversity, and nuances of the human condition. We argue that plurality and low consensus can be taken as productive and functional; precisely because psychological and cultural phenomena are always characterized by uncertainty in irreversible time. Cultural psychology is a valuable paradigm, inclusive of universal and individual processes in ways that provide more appropriate resolution for cultural pluralism. Every definition of psychological phenomena, however obscure and contested, has arisen from theoretical speculation arising from a specific perspective.

Normative Data for Novel Nominal Metaphors, Novel Similes, Literal, and Anomalous Utterances in Polish and English

The two studies reported in the article provide normative measures for 120 novel nominal metaphors, 120 novel similes, 120 literal sentences, and 120 anomalous utterances in Polish (Study 1) and in English (Study 2). The presented set is ideally suited to addressing methodological requirements in research on metaphor processing. The critical (sentence-final) words of each utterance were controlled for in terms of their frequency per million, number of letters and syllables. For each condition in each language, the following variables are reported: cloze probability, meaningfulness, metaphoricity, and familiarity, whose results confirm that the sentences are well-matched. Consequently, the present paper provides materials that can be employed in order to test the new as well as existing theories of metaphor comprehension. The results obtained from the series of normative tests showed the same pattern in both studies, where the comparison structure present in similes (i.e., A is like B) facilitated novel metaphor comprehension, as compared to categorical statements (i.e., A is B). It therefore indicates that comparison mechanisms might be engaged in novel meaning construction irrespectively of language-specific syntactic rules.

Exploring the meaning of night shift placement in nursing education: A European multicentre qualitative study

BACKGROUND

An appropriate clinical learning environment has been identified as pivotal in nursing undergraduate education and should be planned responsibly. Specifically, night shifts placements have been documented as an important opportunity for developing a full understanding of the nursing profession and the whole process of nursing care. However, night shifts during placement have been reported to be stressful and anxiety-provoking, so their usefulness for nursing students is still debated.

OBJECTIVES

To elicit nursing students' perceptions of night shift placement through metaphors, with the aim of discussing the pedagogical and ethical implications.

DESIGN

A descriptive qualitative study was performed based on metaphors collected in an international cross-sectional study in 2016.

SETTINGS

A network comprising five Bachelor of Nursing Science degrees located in the Czech Republic, Italy, Poland, Portugal, and Slovakia was established.

METHODS

A total of 907 out of 1347 eligible nursing students from the five European countries described their learning experience on night shifts using a metaphor.

RESULTS

Overall, 288/907 (31.7%) metaphors emerged as being negative-oriented and 137/907 (15.1%) as positive, while the remaining students (482; 53.2%) did not report any metaphors. In all five countries, negative metaphors prevailed: 'Wasting time' (37/288), 'Useless' (32/288) and 'Handyman' (22/288) were the most negative reported metaphors on working a night shift. However, doing a night shift is also perceived as a 'Learning opportunity' (22/137), a 'New experience' (20/137) and an 'Opportunity to socialize with the profession' (14/137) as underlined by the positive metaphors.

CONCLUSIONS

Students perceive night shift placements mainly as a negative experience, which has little to do with education. While planning night shift placements, nursing educators should responsibly consider the whole process of education, analysing not only the learning outcomes that should be achieved but also the position of students and their experience as a person. Clinical mentoring can be a key resource in supporting students in transforming their night shift placements' experiences into a more meaningful or worthwhile experience. Moreover, night shifts should be offered to more experienced students, independent in their self-learning processes and capable of managing the limited possibility of interacting with other team members and patients.

Battle, Journey, Imprisonment and Burden: patterns of metaphor use in blogs about living with advanced cancer

BACKGROUND

The significance of metaphors for the experience of cancer has been the topic of extensive previous research, with "Battle" and "Journey" metaphors standing out as key. Adaptation to the patient's use of metaphor is generally believed to be an important aspect of person-centered care, especially in palliative care. The aim of this study was to investigate the use of metaphors in blogs written in Swedish by people living with advanced cancer and explore possible patterns associated with individuals, age and gender.

METHODS

The study is based on a dataset totaling 2,602,479 words produced some time during the period 2007-2016 by 27 individuals diagnosed with advanced cancer. Both qualitative and quantitative procedures were used, and the findings are represented as raw frequencies as well as normalized frequencies per 10,000 words. Our general approach was exploratory and descriptive. The Mann-Whitney U test was used to analyze statistical significance.

RESULTS

Our results confirm the strong foothold of "Journey" and "Battle" metaphors. "Imprisonment" and "Burden" metaphors were also used by the majority of the individuals. The propensity to use metaphors when describing the cancer experience was found to differ extensively across the individuals. However, individuals were not found to opt for one conceptualization over the other but tended to draw on several different metaphor domains when conceptualizing their experience. Socio-demographic factors such as age or gender were not found to be strong predictors of metaphor choice in this limited study.

CONCLUSIONS

Using a range of different metaphors allows individuals with advanced cancer to highlight different aspects of their experience. The presence of metaphors associated with "Journey", "Battle", "Imprisonment" and "Burden" across individuals could be explained by the fact that the bloggers are part of a culturally consistent cohort, despite variations in age, sex and cancer form. Awareness of metaphors commonly used by patients can enhance health professionals' capacity to identify metaphorical patterns and develop a common language grounded in the patients' own metaphor use, which is an important requisite for person-centered palliative care.

[Walking aids seen from a cultural historical perspective : Functional and semantic diversity of assistive systems facilitating locomotion in old age]

BACKGROUND

Assistance systems serving the locomotion of older people interact in many ways with the culture of a society. Since early modern times at the latest, walking aids were tantamount to human frailty; however, the cane also symbolized governmental power or reputation. Nowadays, the cane, the wheelchair, and the rollator have not only a functional significance in terms of a better mobility, they also enable people to take an active part in social life.

OBJECTIVE

This study aimes at tracing back these provisional insights into the history of civilization and thereby analyze the roots, new forms and pictures of the handling and metaphors of these assistance systems. The goal in the context of this special issue is to decipher a central textual and pictorial symbol of old age, comparing it with more recent symbols of assistance in old age.

MATERIAL AND METHODS

Methodologically, the text combines approaches of philology and history of medicine with those of the history of art. It analyzes (after a brief retrospection of ancient times and the Middle Ages) by means of textual and pictorial sources from the sixteenth to the twenty-first centuries the historical development of these aids of locomotion for older people. Additionally, it explores the cultural relevancy of these assistance systems.

RESULTS AND DISCUSSION

In history the medical profession paid relatively late and then only minor attention to the assistive systems analyzed here. Its semantic diversity is closely related to the age roles and stereotypes of age prevailing in certain epochs. The more the respective assistive tool is used by old people, the more suitable it is as a symbol of old age and the more biased and negative the semantic connotation seems to be. The development of a symbol of age connoting frailty, at present symbolized most clearly by the rollator, tends to refer to a pejorative image of age in a society. The cultural historical analysis suggests that a contrasting development will only be possible when the assistive systems will again fulfil a diversity of alternative functions and semantics.

Who are the users of synthetic DNA? Using metaphors to activate microorganisms at the center of synthetic biology

Synthetic biology, a multidisciplinary field involving designing and building with DNA, often designs and builds in microorganisms. The role of these microorganisms tends to be understood through metaphors making the microbial cell like a machine and emphasizing its passivity: cells are described as platforms, chassis, and computers. Here, I point to the efficacy of such metaphors in enacting the microorganism as a particular kind of (non-)participant in the research process, and I suggest the utility of employing metaphors that make microorganisms a different kind of thing-active participants, contributors, and even collaborators in scientific research. This suggestion is worth making, I argue, because enabling the activity of the microorganism generates opportunities for learning from microorganisms in ways that may help explain currently unexplained phenomena in synthetic biology and suggest new experimental directions. Moreover, "activating the microorganism" reorients relationships between human scientists and nonhuman experimental participants away from control over nonhuman creatures and toward respect for and listening to them, generating conditions of possibility for exploring what responsible research means when humans try to be responsible toward and even with creatures across species boundaries.

Using root metaphors to analyze communication between nurses and patients: a qualitative study

BACKGROUND

Metaphors in communication can serve to convey individuals' backgrounds, contexts, experiences, and worldviews. Metaphors used in a health care setting can help achieve consensual communication in professional-patient relationships. Patients use metaphors to describe symptoms, or how disease affects them. Health professionals draw on shared understanding of such metaphors to better comprehend and meet patient needs, and to communicate information that patients can more easily integrate into their lives. This study incorporated a theoretical framework based on four worldviews, each with an underlying foundational metaphor (root metaphor). The use of these root metaphors (formism, mechanism, contextualism, and organicism) can have an explanatory function and serve to impart new meanings, as each type of metaphor can lead to a particular interpretation. The study aimed to extract and discuss the root metaphors, with a view to analyzing the communication between health professionals and patients.

METHODS

In a case study in Spain over a six-month period, we analyzed the content of recorded, transcribed interviews conducted by one nurse with 32 patients who had chronic illnesses. We inductively extracted five categories that emerged from the interviews: blood sugar, cholesterol, exercise, blood pressure, and diet. We then examined these categories from the standpoint of each of the four root metaphors using two approaches: A series (deductive) and an emergent (inductive) approach.

RESULTS

The results show that the nurse tended to primarily use two worldviews: mechanism and formism. In contrast, patients tended to favor mechanism when discussing cholesterol, blood pressure, and blood sugar levels, whereas contextualism was predominant when the category was diet or exercise.

CONCLUSIONS

This study adds to the existing literature on health professionals and patients' communication. It shows how the use of Pepper's root metaphors help to analyze the communication between the nurse and patients. Furthermore, it shows they are both using different root metaphors when they are talking about illness and treatments especially regarding blood sugar, cholesterol, exercise, blood pressure, and diet. Further qualitative and quantitative studies are needed to solidly these findings.

Finding features, figuratively

Object concepts refer to unique clusters of properties that can be selectively activated or inhibited depending on what information is currently relevant. This conceptual "stretching" enables limitless new meanings to be generated, and figurative language provides a useful framework in which to study this conceptual flexibility. Here we probe the cognitive and neural mechanisms underlying the comprehension of novel metaphors as a means of understanding the conceptual flexibility inherent to language processing more generally. We show that novel metaphor comprehension involves the activation or inhibition of conceptual properties that are either relevant or irrelevant to the metaphor, and that left inferior frontal gyrus is recruited in this process, supporting a role for this region in the fine-tuning of conceptual meaning. Our results are consistent with a flexible, compositional account of conceptual structure in which semantic control mechanisms operate over conceptual properties during figurative language comprehension in order to create context-dependent meaning.

Downwards Vertical Attention Bias in Conversion Disorder vs Controls: A Pilot Study

BACKGROUND

Conversion disorder (CD) is a largely enigmatic disorder, one that requires a thorough ruling-out process. Prior research suggests that metaphors and conceptualization are rooted in physical experience, and that we interpret our affective world through metaphors. Spatial metaphors (interaction of affect and vertical space) are a prominent example of the grounding of metaphors. This is a relatively unpaved direction of research of CD.

OBJECTIVES

The present pilot study sought to explore this view by investigating the "healthy is up, sick is down" spatial metaphors (e.g., "fell ill" and "top shape") in patients with CD, examining the correlation between the processing of bodily-related words, CD, and vertical space. We hypothesized that patients with CD, who experience their bodies as ill, will demonstrate a downwards bias when processing bodily-related words; corresponding to the "healthy is up, sick is down" spatial metaphor.

METHODS

A total of 8 female patients (ages M-38.13 SD-10.44) and 42 female controls (ages M-36.4 SD-14.57) performed a visual attention task. Participants were asked to identify a spatial probe at the top or the bottom of a screen, following either a bodily related (e.g., arm) or non-bodily related (e.g., clock) prime word.

RESULTS

As predicted, when processing bodily-related words, patients with CD demonstrated a downwards attention bias. Moreover, the higher the patient's level of somatization, the faster the patient detected lower (vs upper) spatial targets.

CONCLUSIONS

This study suggests that the changed health paradigm of patients with CD is grounded in sensorimotor perception. Further research could propose new diagnostic and treatment options for CD.

Examining the use of metaphors to understand the experience of community treatment orders for patients and mental health workers

BACKGROUND

Community Treatment Orders (CTOs) are often complex because of the ethical tensions created by an intervention that aims at promoting the patient's good through an inherently coercive process. There is limited research that examines the complexity of CTOs and how patients on CTOs and workers administering CTOs make sense of their experiences.

METHODS

The study involved in-depth interviews with 8 patients on CTOs and 10 community mental health workers in South Australia, to explore how they constructed their experiences of CTOs. Critical discourse analysis (CDA) was used to analyse the data, supported by NVIVO software.

RESULTS

Analysis of the interviews revealed that patients and workers experienced the CTO process as multi-dimensional, including some positive as well as more negative constructions. The positive metaphor of CTOs as a safety net is described, followed by a more detailed description of the metaphors of power and control as the dominant themes, with five sub-themes of the CTO as control, wake-up, punishment, surveillance, and tranquiliser.

DISCUSSION

Metaphors are a way that mental health patients and mental health workers articulate the nature of CTOs. The language used to construct these metaphors was quite different, with patients overwhelmingly experiencing and perceiving CTOs as coercive (that is, punishing, controlling and scrutinizing), whereas workers tended to perceive them as necessary, beneficial and supportive, despite their coerciveness.

CONCLUSIONS

By acknowledging the role of metaphors in these patients' lives, workers could enhance opportunities to engage these patients in more meaningful dialogue about their personal experiences as an alternative to practice predominantly focused on risk. Such a dialogue could enhance workers' reflection on their work and promote recovery-based practice. More understanding of how to promote autonomy, capacity and supported decision-making, and how to address the impacts of coercion within care, is needed.

Musical metaphors: evidence for a spatial grounding of non-literal sentences describing auditory events

This study investigated whether the spatial terms high and low, when used in sentence contexts implying a non-literal interpretation, trigger similar spatial associations as would have been expected from the literal meaning of the words. In three experiments, participants read sentences describing either a high or a low auditory event (e.g., The soprano sings a high aria vs. The pianist plays a low note). In all Experiments, participants were asked to judge (yes/no) whether the sentences were meaningful by means of up/down (Experiments 1 and 2) or left/right (Experiment 3) key press responses. Contrary to previous studies reporting that metaphorical language understanding differs from literal language understanding with regard to simulation effects, the results show compatibility effects between sentence implied pitch height and response location. The results are in line with grounded models of language comprehension proposing that sensory motor experiences are being elicited when processing literal as well as non-literal sentences.

Eye movements during mental time travel follow a diagonal line

Recent research showed that past events are associated with the back and left side, whereas future events are associated with the front and right side of space. These spatial-temporal associations have an impact on our sensorimotor system: thinking about one's past and future leads to subtle body sways in the sagittal dimension of space (Miles, Nind, & Macrae, 2010). In this study we investigated whether mental time travel leads to sensorimotor correlates in the horizontal dimension of space. Participants were asked to mentally displace themselves into the past or future while measuring their spontaneous eye movements on a blank screen. Eye gaze was directed more rightward and upward when thinking about the future than when thinking about the past. Our results provide further insight into the spatial nature of temporal thoughts, and show that not only body, but also eye movements follow a (diagonal) "time line" during mental time travel.

A clinical treatment intervention for dysphoria: externalizing metaphors therapy

The purpose of this article is to explore a novel, short-term treatment intervention for internalizing behaviours. This intervention is primarily based upon an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas. This article addresses the clinical population of children and youth, specifically through outlining the protocol, externalizing metaphors therapy. A selective review of significant works regarding the efficacy of short-term therapy was conducted, including the process of change within narrative therapy. It is proposed that two specific processes account for the mental health change experienced by clients who receive this new treatment intervention: (1) externalization of problems and (2) purposeful client-generated metaphor manipulation, impacting upon underlying schemas. From these theoretical constructs, the present article outlines a three-session treatment protocol that manualizes these key clinical processes. A case study is presented to illustrate this intervention for anxiety and depression. Further clinical research is underway to address the testable hypotheses resulting from the current theoretical model. Clinical trials in brief psychotherapy are suggested to empirically evaluate the efficacy of this new treatment intervention for dysphoria.

KEY PRACTITIONER MESSAGE

This article outlines a short-term treatment intervention for anxiety and depression (dysphoira) through a novel 3-session model, where the clinician-practitioner can obtain competency through a one-day workshop.Its relevance for the clinical researcher and the mental health community is in its versatility in addressing internalizing behavior for four clinical populations: (1) children and adolescents; (2) children and adolescents on the autism spectrum; (3) adults in general; and, (4) adults with a dual-diagnosis. The treatment protocol described within is based upon the externalizing and deconstructive properties of Narrative Therapy, and the transformation of metaphoric imagery of Metaphor Therapy; both of which have little empirical support with narrative practices gaining international attention and widespread usage - through brief therapy, long-term therapy, and walk-in clinics in North America. For the first time, the theoretical constructs of the 3-session model are described and a case example illustrates the interlinking concepts.