The Importance of Metaphors In Medicine

I’ve always been fascinated by how patients of all ages, backgrounds, and health statuses can report symptoms of chest pain, pressure, tightness, shortness of breath, palpitations, rapid or skipping heartbeat, and countless other varied symptoms – and immediately, intuitively attribute the cause to their hearts. More interesting still is that often, their hearts are working just fine.

Even a coronary arteriogram, (or cardiac catheterization) will not convince a surprising number of patients that the physical heart is not the root of the trouble. And no wonder: The heart is the rhythm keeper we’re born with, tirelessly beating all day, every day, sustaining us without fail upon going to sleep and continuing its work as we rise and start again each morning.

In this way, the heart becomes a marker of time and symbol of our aliveness – our essence. And this is an association that’s spread to our vernacular. In conversation we get “to the heart of the matter.” When something is troubling our spirit we have a “heart-to-heart.” It is no wonder the heart is always on our mind.

When patients report the kinds of problems I earlier described, stress is frequently the culprit. And often, upon hearing this, they can feel a little embarrassed or confused – as though their concerns were fabricated or all in their heads. Of course, given everything we know about the link between stress, inflammation, and chronic illnesses such as heart disease, that couldn’t be farther from the truth.

As physicians, it’s critical for us not to belittle a stress diagnosis, but instead discuss this important link. Because a healthy lifestyle impacts stress, that actually does take us back to many of the same changes we would recommend had an actual real-time heart problem been identified.

To my own patients, I use the example of thinking of their hearts as machines that must be cared for to sustain optimal performance. They cannot, for instance, just park these machines on the sofa, and they must feed them “premium gas,” not the cheap fast food or quick boxed or bagged foods that do not nourish our bodies. And they must identify practices – from spirituality to meditation to a hobby – that make them calm and happy each day, so the heart has the opportunity to beat at its steadiest, most optimal pace.

For many, stress can feel like a very vague, hard-to-act-upon diagnosis. But by tying it to the symptoms they perceive and prescribing actions around that, the solution becomes real and surmountable. It’s a reminder of the power symbols have in healing, and of how important metaphors are in medicine.