The Body's Insistence On Meaning

The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience Author(s): Laurence J.
Kirmayer Source: Medical Anthropology Quarterly, New Series, Vol. 6, No. 4 (Dec., 1992), pp. 323-346 Published by: Blackwell Publishing on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/649358 Accessed: 26/10/2008 09:08
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ARTICLES
LAURENCE J. KIRMAYER
Department of Psychiatry McGill University
The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience
Illness experience is articulated through metaphors that are grounded in-and constrained by-both bodily experience and social interaction. The bodily grounding of metaphor is based on the hierarchical elaboration of sensorimotor equivalences. The social grounding of metaphor resides in the pragmatics of language where context and intention are inseparable from meaning. Metaphors allow for inventive play, despite the dual constraints of body and society, by requiring only piecemeal correspondences to the world through ostension. The meaning of metaphors is then to be found not in representation but in presentation-modes of action or ways of life. Clinical examples illustrate how a semantics of metaphor can clarify the tensions between the essential irrationality of illness experience and the biomedical presumption of rationality. [illness behavior, semiotics, semantics]
Don't be the riderwho gallops all night and never sees the horse that is beneathhim. -Robert Bly, WhenGrapesTurnto Wine ith language we construct fictions, but not all experience is fictive, subject to the limitless power of imagination to transfigure and invent. Our aching bodies remind us there are at least two orders to experience: the order of the body and the order of the text (Berger 1987). Recently, scholars in many disciplines have begun to approach the body with renewed respect (Johnson 1987; Lakoff 1987; Levin 1985; O'Neill 1985; Rochberg-Halton 1986; Scarry 1985; Turner 1984). This concern for the body seems to be a response to obvious imbalances in contemporary Western thought: a pervasive dualism in which the activity of the mind is valued over and against the life of the body; a hyperrationalism that ignores the significance of bodily felt meaning and minimizes the
MedicalAnthropology Quarterly6(4):323-346. Copyright? 1992, AmericanAnthropologicalAssociation.
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way in which emotions compel thought, choice, and action;an emphasison disembodiedideas, divorcedfrom agents and situations,leading to a decontextualized view of knowledge and value; the postmodernloss (or abuse) of textualtradition, which divorces writing from its communalground;a radicalabstractionism andrelativismthatnegate the meaningof the individual,lending themselves to totalitarian modes of thinkingin which the suffering body is subordinated to or philosophical politicalideals. Againstall of these ways of unmakingthe world, the turntowardthe body representsa longing for community,for bodily connection andparticipation a habitableworld of substanceand feeling. in There is an inescapablecircularitybetween the order of the body and the orderof the text. Past infancy, bodily experience is most conspicuously elaborated and communicatedthroughlanguage. Language, in turn, is groundedin bodily experiencesthat provide common referentsfor a lexicon and in the organizationof bodily actionthatprovidesa prototypefor syntacticstructure (Johnson 1987; Vowles 1970). Any attemptto give autonomyto the study of either body or text, divorcedfrom the other orderof experience, is epistemologicallynaive. How can we say the body is "so and so," when that knowledge is worked out throughlanguagethat imposes its own structureon experience and thought?On the otherhand, how can we claim to encompass all possible worlds of meaning in the permutations languagewhen bodily painandsufferingup-endourorderly of lives and drive us to the most desperategesturesof faith? Medicalanthropologists, of along with reflectivepractitioners medicine, are uniquelypositionedto explore the significanceof embodiment. Sickness places the body in the foreground.As Kleinman(1988) movingly illustrates,the problem of sickness raises two fundamental questions for the sufferer:"Why me?" (the problemof bafflement)and "Whatcan be done?" (the problemof orderand control). Sickness challenges culturalcliches and facile explanations.It poses anew the problemof Job, latentin every life, made personaland immediateby the insistenceof bodily suffering. How can meaningand value be sustainedwhen consciousnessis constricted,degraded,and defiled by pain? Searchingfor a comprehensiveframeworkfor medical anthropology,Scheper-Hughesand Lock (1987) describe three realms of the body: the individual body-self of lived experience, approached phenomenology, but known most by directly in the wrenchingimmediacy of pain (Scarry 1985); the social body of symbolic representation (Douglas 1973); and the body-politic of power, domination, and control(Turner1984). These distinctionspoint not so much to three bodies as to threetypes of text producedby scholars.1In any real event, the three bodies form a single system, which may be simultaneouslyriven by conflict and unified by self-regulatoryprocesses. Translationbetween these texts then demandsan understanding the processes that mediate the relationshipsbetween of body, self, and society; between bodily feeling and social symbolism-psychophysiology;betweensocial symbolismandpolitics-rhetoric; andbetweenbodypolitic and body-self-the dynamicsof knowledge and power. Despite the rhetoricof holism, the epistemological circularityof body and text does not imply the two orderscan be readily dissolved into one. Body and text (like body and mind, from which this modem dualityis transposed,cf. Kirmayer1988) standin dialecticalrelationshipto each other. And if the text stands for a hard-wonrationalorder, imposed on thoughtthroughthe careful composi-
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tion of writing, the body provides a structureto thought that is, in part, extradimensionto thoughtcarriesimportant rationalanddisorderly.This extra-rational information aboutemotional, aesthetic, and moralvalue. The dominantrepresentationaltheories of meaning employed in medicine, psychiatry, anthropology, and cognitive science have tended to consider only those aspects of thoughtthat conformto the rationalityof an ideal, disembodiedmentality. The body and its passions are viewed as disruptionsto the flow of logical thought, as momentary aberrations troublesomeforms of deviance to be rationalized,contained, and or controlled. Yet, in everyday life, bodily experience preemptsour rationalconstructions.Throughthe pain and sufferingthatforeshadowits own mortality,the body drives us to seek meaning, to take our words as seriously as our deeds. Ultimately, the body insists that we finalize our temporarymental constructions, committingourselves to some view of reality. Any theory of meaningthat hopes to addressthe experience of illness must give due weight to the primacyof the body not only as an object of thoughtbut as itself a vehicle for thinking,feeling, and acting. The body cannotbe contained by a theory of representation-for the body is not the same as the body-image. The body's influenceon thoughtis more presentationthan representation, given in substanceandactionratherthanin imaginationandreflection.How to approach this privilegedposition of the body withoutdiscardingthe perspectivismof representational theory is a problemfor any serious medical anthropology. In this article, I examine some limits of the prevailingrationalisticsemantic theories. In their stead, I outline a semantics of metaphorthat offers a way to explore the presence and insistence of the body in the mental and social life of patientsand physicians. In the first section, I describe biomedical and psychoof dynamicinterpretations the experienceof a patienton hemodialysisto illustrate how the implicitassumptionsof each interpretive system ignore salientaspects of bodily experience and social context. Next, I briefly summarizesome of the rationalistic and "mentalistic" biases of semantic theories, including psychodynamics and structuralism, which downplaythe primacyof the body. In the third andfourthsections, I introducemetaphor theoryfromthe perspectiveof cognitive and developmentalpsychology and illustratethe bodily and social groundingof metaphor.The conclusionconsiderssome broadimplicationsof the embodiment of metaphorfor theoriesof meaningand clinical interpretive practices. Ridding the Body of Poison
Dr. A is bewilderedby the irrational behaviorof Mr. Y, a 35-year-oldbusinessmanreceivinghemodialysisfor chronicrenalfailure. AlthoughMr. Y has a dangerouslylow hemoglobin, he refuses a blood transfusion.Mr. Y explains thathe is terrifiedof receiving other people's blood because it may containgenetic materialthatcarriestheirpersonalitytraits. This could affect his mind and alterhis personality.Dr. A finds this explanationabsurdif not unintelligible.He reasons with Mr. Y, trying to impresson him the facts: "Red blood cells don't contain genetic material . . . and genes do not transmitpersonalityfrom one adult to another.Personalityis a functionof the brain,not the blood. You arein desperate need of a blood transfusionto avoid a heartattackor stroke." Mr. Y acknowledges this informationbut remainsunconvinced.
The doctor'srationalexplanationbegins with the "facts" of biomedicaltheory and proceeds, with the rhetoricalstyle of medical authority,to an imperative
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for action.The patient'srationality evidencedby his abilityto graspthe doctor's is argument,acceptingthe premises of biomedicine and following the logic to its necessaryconclusion. The physicianexpects thatby argumentand educationthe patientcan be made to acceptthe real stateof affairsand choose the only rational courseof action-unless, of course, his capacityfor reasonis somehowimpaired. The epistemology implicit in the doctor's approachstems from a naive realism: The patient's world is made up of tangible objects (blood,'hemoglobin, genes) which, if only he could see clearly, would provide accurateinformation abouthow and when and why to act. Althoughthe physician's perceptionis augmentedby technicalinstruments his personaluncertainty shoredup by coland is leagues and canonicaltexts, he acts as thoughthe worldhe perceives throughthe mediumof medicaltheoryis "out there" for all to see. The epistemologyof biomedicine is based on the metaphorof vision, in which the eye takes in a replica of an objective world which the brain then representsor mirrors(Rorty 1979). Technologyextendsthe rangeof the eye but does not alterits intrinsicobjectivity. Mind figures, in this picture, as the place where informationabout the world is are recorded,organized,and stored.Thus, mentalrepresentations presumedto be more or less isomorphicto reality, directlyencoding facts aboutthe world. This epistemologysupportsthe radicalseparationof fact and value where, by value, I meanthe felt importanceor significanceof means and ends.2 Mentalrepresentations areprimarily aboutfacts andonly secondarilyarethey deformedor disrupted by idiosyncratic personalor social values. The physicianignoresthe way in which medicaltrainingandthe adoptionof a theoryembeddedin technicallanguageandpracticesactuallycreatethe ordered realityin which he discovers and situatesthe patient's "real" problems. Within the narrowepistemologicalframeworkof biomedicine, the rationalityof Mr. Y's view of the world dependsentirelyon the empiricaltruthof his beliefs as judged againstthe standard providedby biomedical theory. Given this occlusion of the function of medical theory and practice, it is not surprisingthat reality-creating the physicianquickly grows impatientwith the patient's inability to see what is there. Disagreement with medicalopinionis primafacie evidence of irrationality. In his frustration, doctorquicklyresortsto scientificandprofessionalauthority the to resolve, deflect, or ignore the patient'sdoubt. The theoryof meaningthatcorresponds the physician'sepistemologysubto ordinatesmeaningto truthand holds that truthresides in the world. Facts, then, are represented the mind as explicit conscious propositionswhose main propin ertyis theirtruthvalue. As such, the doctorcan provideMr. Y with factualtruths, which have unambiguousmeaning and, if complete enough, lead inescapablyto certainconclusions. Mr. Y may hold certain false beliefs, which can be challenged and replacedon a piecemeal basis by more accurateinformation.When this sortof educationfails to change the patient'sbehavior-even thoughthe patient can recite the biomedicalfacts and seems to understand doctor's line of the reasoning-the physiciansuspectssome hiddenperversityof the patient'smind.3
Dr. A then asks for a psychiatricconsultation"to get Mr. Y to do the reasonable thing." In conversationwith the psychiatrist,Mr. Y recountshis frighteningexfor periencesduringrepeatedchildhoodhospitalizations kidneydisease. He says he mistrustsdoctorsbecause of these experiences. He makes many allusions to the fragility of his body boundariesand physicians' imperiousdisregardof his
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in He to self-care. This vulnerability. appears beveryfastidious hisownphysical to about whathe putsintohis the prompts psychiatrist askMr.Y if he is careful or and body-like water food.He smileswithsomeembarrassment says:"You I water eatonly and understand verywell, doctor. onlydrink me purified spring it or think is irrational, but meatwithnohormones additives. will probably You I believeit is better my health."Whenhis symptoms moresevere, for become he distressed Mr.Y eventually a although is obviously accepts bloodtransfusion by thesituation. The psychiatristlistens throughMr. Y's self-descriptionfor evidence of the unconscious.The patientcannotfully describehis predicament a conscious set as of beliefs. Instead, he reveals his conflicts indirectlythroughpatternsof associand ation, parapraxes, unintended gestures. The psychiatristlooks to the patient's historyof relationships,and to the twists and turnsof the clinical conversation, to reveal the core conflicts and basic irrationalities organizethe patient'sexthat to perience.A sense of physical vulnerability,of a fragile body-boundary be vigilantly guarded,of pollution by contact-all are prominentin Mr. Y's thinking. Fromthis the psychiatristextrapolatesforwardto otherrelatedsymptoms, which the patientconfirms.The psychiatristsearchesfor historicalevents thathave conditionedMr. Y's mistrustof doctors and fear of medical treatment.A childhood historyof kidney disease led to repeatedhospitalizationsfor investigativeprocedures. These childhood hospitalizationsinvolved separationsfrom his family, that have shaped his uncertaintrustin caretaking with feelings of abandonment relationships.These painful separationshave continued:Mr. Y's wife and child to have returned stay with his extended family in Europeand he now lives alone is in Canada.He denies any maritaldifficulty, claimingthatthis arrangement simply due to his efforts to continue to conduct business in Canada. He minimizes the impactthis separationhas had on his illness. The psychiatristinterpretsthis distressas evidence of conflict:Mr. Y has difficultyforming denialof predictable close relationships; probablyfeels abandoned his family once again but has he by with family, past and learnedto hide his feelings. His anger and disappointment present,are displacedand expressedas mistrustof the doctorsand nurses whose he treatment disparagesand comparesunfavorablywith the medical care he has received in Europe. This position allows him to maintainthe fiction of positive relationshipswith others back home while communicatinghis suffering to the medicalcaretakers with whom he has vital ongoing relationships. The epistemology implicit in the psychiatrist'sapproachis a version of psychological realism:Humanaction is distinguishedfrom nonhumanevents by intention. Behavioris guided by belief, and so, in the case of persons, reasons can be causes. Beliefs may not correspondclosely to a consensualrealityand may be hiddenfromconsciousness. However, the psychiatrist,as detachedobserver,can discern the underlyingbeliefs that govern the patient's behavior. The patient's If life-worldis madeup not of materialobjects but of mentalrepresentations. Mr. Y believes that foreign blood is polluted with microscopic fragmentsof the donor's personality,then this is true-at least within Psyche's realm. This respect for the autonomyof the psyche coexists uneasily with the materialismof biomedicine and probablyaccounts for some of the suspicion with which medical practitionerscontinue to view psychiatry(Kirmayer1988). The psychiatrist'sgoal, however, is not much differentfrom that of his medical col-
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leagues-to rationalizethe irrationaland so, induce the patientto accept the authorityof medicine in the form of a "necessary" blood transfusion.The psychiatricstrategyto accomplishthis goal may include teachingthe patientthe origins of his beliefs in details of personalhistory. Once these beliefs are situatedin an idiosyncratichistory, it is easier to discounttheir relevance for rationaldecision making. A second focus of psychiatrictherapyinvolves trainingthe patientto better express and manage his emotions. Emotion clouds perception. Implicit even in the encouragement freely express emotion is the notion that once emotion is to it will subside and allow the patientto make more rationaldecisions. expressed are Indeed,the epistemologyof psychiatrysometimesholds thatpsychiatrists able to see their patients' minds more clearly than the subjects themselves, not only becausepsychiatrists detachedbut preciselybecause they have become aware are of the distortingeffects of their own emotions and can somehow factorthem out of theirperceptions. The theory of meaningthat correspondsto this psychiatricepistemology is based on mentalrepresentation. The representations impartmeaningmay be that hiddenfromconsciousness-never articulated once expressed,but now pushed or back down by repression. The representations revealed by the patient's actions be distortedand partof the work of psychotherapy to expose them so that is may they may be rationallyconfrontedand broughtback into accordwith consensual reality. The biomedicalperspectiveemphasizesbiological disease to the exclusion of illness experience(Kleinman 1988). Psychodynamicpsychiatryplaces illness determinants leads to experienceat centerstage, but its emphasison intrapsychic a decontextualized view of the patient.Both perspectivesmiss crucialdimensions of embodiment: physical substanceand social context of the patient'spredicthe ament. Hemodialysiscontravenesthe healthy order of bodily experience. The patientwitnesseshis blood leaving his body andtravelingthroughplastictubinginto the hidden depths of the dialysis machine. The machine has nervous habits: it blinks and twitches-shifting registers, clicks, and beeps mark the progress of blood throughthe machine. Once processed-transformed by the machine-the bloodreturns the patientto be containedandhiddeninside the body once more. to the Ordinarily, presenceof blood is indicatedby a healthycolor and turgorto the skin, a steady heartrate and stable blood pressure, a clear-headedability to perceive and think, and a strongbody, able to stand, move, and exert itself without unduefatigue. Duringandimmediatelyafterdialysis, however, patientsoften feel drainedandexhausted,unsteadyon theirfeet; theirthinkingis clouded;when they standabruptlythey may feel faint. Such complicationsof dialysis make it seem as though the machine has altered the blood or incompletely returnedit to the body. These experiencesboth give rise to, and are amplifiedby, the equationof blood and "strength." Dialysis confrontspatientswith violationsof conventionalbody boundaries. This transgressionof boundariesis paralleledby recurrentdilemmas about the limits of controlby self and other(Alexander1981). Patientsareexpected to passively cooperate with treatmentand accept "machine-dependency"while acin tively participating managingtheir illness and maintainingtheir autonomyin
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every othersphereof life. The regions of the patient'slife given over to medical care and those areas that remain independentchange dramaticallywith the fortunesof treatment the progressof disease. Dependingon shiftingcircumstanand ces that are often obscure to the patient, medical staff may view either acquiescence or independenceas signs of maturerationality. For the patienton hemodialysis, the permeabilityand transgression body of boundaries ambiguitiesaboutthe limits of autonomyand necparallelsrecurrent essarydependence.These universalissues takeon heightenedmeaningin the context of each individual'shistory. Earlychildhoodexperiencesof unexplainedpain madeMr. Y's body a mysteryto himself. Contrary their social image as careto givers, the surgeonsand nurses who treatedhim as a child caused considerable pain andfear-sticking needles and knives into his body anddrawingblood from him. He has experiencedhis body as somethingappropriated others for study by and examination.At times it has seemed that they knew his insides more intimately than he did, with their ability to peer inside his bodily cavities and their arcanetechnical knowledge of how the body works. Encouragedto take charge of his own care, he has acquiredthe vocabularyof biomedicinebut puts it to his own use, emphasizingthose elements of health underhis direct control. So it is thathe becomes preoccupiedwith what he puts into his body. He posits a direct connectionbetween what goes in and what comes out of his body, and this is confirmedby the daily consequencesof even slight deviation in the dramatically strictdiet andfluidintakehe mustfollow on dialysis. He idealizes whatis natural, organic, and pure-food from the country, untaintedby the toxins and pollution of technologized urbanlife-a common theme among city dwellers (Herzlich 1973), but this has the force and certaintyof a belief that has become centralto his bodily experience. There is a furthersocial dimension to Mr. Y's preoccupationwith reestablishing the integrityof his body boundaryand maintainingthe purityof his "insides." Mr. Y is a foreigner, a businessmanwho has come from Europeto Canada. He views the locals as less culturedand sophisticatedthanhimself. He feels theircoarsenessis intrinsic, partof their bodily constitution,and fears receiving blood from them since this would tainthis body and with it his mind. This incipiently racisttheme of "blood purity," althoughit may receive impetusfrom Mr. Y's childhoodtraumas,finds supportin collective representations discrimiand natorypractices. Mr. Y is not alone in using birthplace,accent, education, and othersigns of ethnicity to markstatus. Mr. Y's assumed superiorityis endorsed by a segmentof his cultureof origin. It is matchedby local attitudesthatexpress feelings of inferiority.Mr. Y's prejudiceserves to draw a sharpboundarythat separateshim from others. It alienateshim from his medical caretakerswho not but, reactingwith moralrepugnance,cease only find him difficult to understand to wish to understand.
Islands of Reason, Oceans of Desire
In sickness we confrontthe inchoate. Bodily sufferingdistortsthe landscape of thought,renderingour previousconstructionsincoherentand incomplete. The study of the essential irrationalityof sickness is hamperedby the fact that the "objective" social sciences adopt many of the same rationalisticvalues as bio-
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medicine. For medicine the irrationalis pathological;for the social sciences the is irrational deviant or exotic. Those who sympathizewith the deviant offer rational explanationsas justification. The dominanttheories of the social sciences tendto treatthe nonrational aspects of existence as defective or in need of rationalization (Sperber 1985). This emphasis on rationalityand control is a central of preoccupation Westernculture, and it permeatesour models of the acquisition and use of knowledge, no less than our ethical and aestheticvision. It is no surprisethen thatscholarsstruggleto capturefeeling within the skein of rationaldiscourse. The rhetoricof rationalitypromotesa naive view of conceptualrepresentations as propositionsdirectly accessible to consciousness. This allows us the fictionthatpeople can, quitereasonably,tell us theirbeliefs. Rationalitytheninheres in the logical consistencyor coherenceof beliefs and in the consistententailment of our actionsby our beliefs. Westernacademicpsychology is foundedon a similar assumption rationality: of statesof mind can be correlatedwith behavioronly if we assumea coherentand stable set of productionrules by which intentionand belief are translated into action (Heil 1986). A similarview of belief obtains in anthropology.Young (1981, 1982) has characterized "rationalman position" in medical anthropology,which comthe prisesseveralunderlyingassumptionsabouthuman"nature" including:(1) Language andcognitionsharethe same underlyingstructure.Languageallows access to people's beliefs. Thus, there need be no significantgap between someone's volition and their verbalized intentions. (2) Knowledge is internallyconsistent accordingto some variety of propositionallogic. (3) Reasoning is a conscious mentalprocess by which people organizeknowledge to provide useful information andguide action. It loosely follows deductiveor inductivelogic. Otherforms of reasoning(e.g., symbolism)have only restrictedapplicationto dreams,rituals, magic, or expressive culture. (4) People behave pragmaticallyon the basis of causalmodels and attemptto predictandcontrolwhatis going to happento them. Into this neat scheme the irrational intrudes.Action does not springdirectly to frombelief. Belief often follows action, manufactured justify behaviorto one's self or to furthera strategicself-presentation.Beliefs themselves are situational, inconsistent,at times incoherent.Whatcoherencebelief attainsmay reside not in logical consistencybut in the wholeness of an image or metaphor,in the dynamics of emotion or the persistenceof a mood, or it may be imposed by the physical of constraints the body in the course of turninginconsistentbeliefs into action. The irrational then is not simply a defective category-the mere absence of rationality-but a category with its own distinct qualities. The irrationalstands for the role of the body in thought:sensuous and emotional. Emotions "are embodied thoughts, thoughtsseeped with the apprehensionthat 'I am involved' " (Rosaldo 1984:143). Emotionsdeterminenot what is logical to do to achieve certain ends but what ends are most pressing in a given situation.The affective significanceof words, concepts, and images is not simply derivedfrom theirformal with each otherbut is basedon theirlargerhumansignificance.Food relationships and sex, fear and desire, sickness and health, however much they are elaborated in abstract semanticmodels, take theirurgencyandpower frompeople's ways of life. The attemptto model these exigencies of human life as equivalent to any otherrationallyheld propositionignores their salience and subjectively compel-
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is ling quality.This failureto recognizethe primacyof the irrational partof a more basic defect of rationalisticsemantic models their lack of attentionto the embodimentof meaning.4 While the interpretivemethods of psychodynamicsand structuralism offer approachesto the irrational,both lack sufficientlyrich concepts of embodiment and so, inevitably,end in rationalreduction.Psychoanalysisseeks to containthe of between uniirrationality the body within a system of a few correspondences versal existential themes and supervenientbiological drives. The vast arrayof symbols and forms of expressionis reducedto a few core conflicts. Indeed, some have defined "symbol" as a sign signifyingone of a few universal psychoanalysts bodily acts:birth, death, hunger, sex, aggression, and a few others(Jones 1967). By virtueof its signifying one such knot of humanpassion, the symbol takes on a powerfulevocative functionthatcan speakto us acrosscultures.Psychoanalytic tends to view cultureas a layer of sharedbeliefs plasteredonto the anthropology basic biopsychodynamic structure the humanbeing (Gellner 1985). The diverof sity of culturesreflects variationin surface meaningwhile the depths of each individualinvolve the same processes of psychological conflict (Spiro 1982). The symbol can be decoded in termsof universalhumanthemes;even religious symbols serve primarilyto represent,deflect, and resolve inner conflicts. From the psychoanalytic viewpointthen, therecan be only a few possible meaningsfor any conceivable symbol. For this reason, Freudianand many contemporary psychoof dynamicinterpretations literatureand art often do violence to the power and life of the work. As Bersani (1986:108) notes, "the work of art is often 'treated'-interpreted and, one might almost say, cured-as if it were little more than a socialized symptom." In justly criticizing the reductive interpretation of art, however, this remarkdenigratesthe significanceof "socialized symptoms" whose meaningis also not exhaustedby a psychodynamictreatment.Psychoanalytic explanationreduces the variety, complexity, and multivocalityof the patient'sbodily experiencesandexpressions, with theirfrequentconscious lacunae, to the arbitrary completeness, rationality,and self-consciousnessof the analyst's theory(Sperber1974). Structuralism reducesthe body to idealizedpartsand functionsthatpopulate a symbolic order. Substitutingform for content, structuralist theory results in a "cognitive crystallography"in which the sense of what really mattersis lost in theories respect the enormousvariety of symelegant abstractions.Structuralist bolic representations meaningbut, owing to theirpurecognitivism, leave symof bolic systems unmotivatedand, in a sense, quite arbitrary. Yet,
Symbols are generatedout of a need, whether a life wish or a death wish, but thereis no real interpretation is not situationaland strategic.To supposethat that thereis a real or trueinterpretation surpassessituationandthe primalpreocthat cupationsof a given participantis the first strategyby which the inchoate has been approached. . . Judgementin symbolic analysis is much less empirical thanmoral. [Fernandez1982:19-20]
is Ultimately, structuralism limited in its explanatorypower because it promotes a separation abstractmeaningand embodieduse. of For structuralism,the body is a mannequin-a strippeddown, inanimate frameon which the vestments of theory can be draped. For psychoanalysis, the
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body is a primitive, ungovernedengine of desire. In practice, both approaches tend to deal not with the realities of the body itself but with limited images or of the representations the body. In substituting image of the body for the body, of text for performance, for action, both psychoanalysisand structurrepresentation alism are able to exaggeratethe coherenceof meaningsystems. the Sperber(1974) has called for a semantictheorythatincorporates insights of structuralism psychodynamicswhile avoidingtheirlimitations.Frompsyand chodynamicswould come attentionto the wellspringsof action, the motive force, the power of mattering.From structuralism would come attentionto the interrelatednessof symbols and of the formal structureand coherenceof symbolic systems that allows them to encode complex structuresof the social world. Only a perspectivethat encompassesboth can hope to provide an adequateapproachto the shifting meanings of illness experience. A semantics of metaphorcan meet this challengeand offers a way into the urgencyand inventivenessof language. Towarda Semanticsof Metaphor In seeking to give metaphora centralrole in semantictheory, we must consider it not simply as a literarytrope but in its more encompassingmeaning of metaphoric concept.5The metaphor"A is B" is an invitationto think of A (the topic) as if it were a sort of B (the vehicle). Metaphorconfers the propertiesof one concept on anotherand all of our cognitive, affective, and somatic ways of knowing may be broughtto bear to elaboratemetaphoriccorrespondences.As well, unlike explicit tropes, metaphoricconcepts may be implicit or unintendistinction. tional, used withoutawarenessor concernwith the metaphoric/literal are Metaphors asymmetricalanalogiesin which high salience featuresof the vehicle are appliedto the topic (Ortony 1979). "Surgeons are butchers" is quite distinctfrom "butchersare surgeons"-each metaphordrawson salient features of the vehicle to make latent featuresof the topic more salient. But the flow of information metaphoris not completely one-sided. Topic and vehicle must inin teractto determinewhich of many potentiallysalient featuresof each can be related and are relevantto context and intention(Steinberg and Nigro 1983). Attempts to reduce a specific metaphora priori to an isomorphicmappingof the structure one domainonto anotherfail because the homologous featuresof the of two domains are unknown until they are related metaphorically.Metaphorinvolves a process of discovery or invention. Hence, metaphoris essentially creative of meaning-even when this meaning is static and conventional, as is the case for the dead metaphorswe call literal speech. In the process of interaction,topic and vehicle color each other. Metaphors aboutsurgeonsand butchersinfluencethe way we thinkaboutboth occupations. Further,metaphorsnot only change the way we view a specific topic, they can restructure whole domain (Kelly and Keil 1984 cited in Winner 1988:122ff.). a Once a metaphoric comparisonis made with a specific event, relatedevents may be thoughtof in terms of parallelmetaphors.For example, comparingpop psychology to fast-foodencouragesus to thinkof classical psychoanalysisas an elaboraterepast.And theremay be otherschools of psychology we find hardto swallow. Even a momentof metaphoriccontactbetween two concepts encouragesus to play with structuring whole regions of experience in terms of metaphorsborrowed from relateddomains.
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The perceptualbasis of metaphoris similarityor equivalence. In its crudest form this perceptualequivalence involves synesthesia-equivalences across differentsensorymodalities. Infantsreadilyperceive cross-modalanalogies in what may be takenas the earliestform of metaphor(Wagneret al. 1981). Luria'smnemonist, S, who claimed to have eidetic recall for many of his childhoodexperiences, providesevidence for the role of synesthesiain spontaneouslyorganizing perceptual categories.In a streamof associationsandimageryto the Russianword zhuk(beetle), he createsa vivid portraitof the metaphoricworld of the infant: Andin theeveningwhenyouturn thelight,that'salsoa zhuk,fortheentire on roomisn'tlit up,justa smallarea,whileeverything remains else dark-a zhuk.
Wartsare also a zhuk. . . . Now I see them sitting me before a mirror.There's A zhuk-that's a dented piece in the potty .... It's a piece of rye bread...
There myeyes staring mefromthemirror-dark-they're at are noise,laughter. alsoa zhuk.Now I'm lyingin my crib... I heara shout,noise,threats. Then someone's in It's makteakettle. mygrandmother boilingsomething theenamel red ing coffee. Firstshe dropssomething intothe kettle,thentakesit out-a zhuk.A piece of coal-that's also a zhuk.I see themlightingcandleson the Sabbath. candle burning theholder, someof thetallowhasn't A is in but melted turns black.I'm scared, I and yet. Thewickflickers goes out. Theneverything
cry-this is also a zhuk. . . . And when people are sloppy pouringtea, and the dropsmiss the pot and land on the plates, that's also a zhuk. [Luria1968:84]
Spontaneous perceptual metaphors become more elaborate as the child grows. A 15-month-oldchild points to his toe sticking througha hole in his sock andlaughinglysays "Turtle"; a three-and-a-half-year-old child peers into mother's curly dark hair and proclaims: "Dark woods" (Winneret al. 1979). Such rest inventivemetaphors on salientperceptualsimilarities-elements of which are universal.In adulthood these similaritiesareoften overshadowedby conventional associationsbased on socialization (hair is viewed in terms of its grooming and of It conformityto standards attractiveness). remainsfor poets to remindus of our natallanguage. In the underlyingsimilaritiesthat arise from perceptualsalience we find one way the body makes its presenceknown throughmetaphor. Metaphorsare not only linguistic or perceptual,however; they can also be made with gestures or actions. Enactive metaphorstransforman object through its use. By 18 months, childrenare able to play with objects as if they were something else: a comb becomes a toothbrush,a truckbecomes a telephone (Winner et al. 1979). Even where there is little or no resemblancebetween objects, enactive metaphorscan transformthe meaning of one into the other. Such gestural featureof nonverbalcommunication. metaphors persistas an important Metaphorsare producedin the perceptionof resemblancesand in symbolic play before they are recognized as anomalous parts of speech (Vosniadou and Ortony1983) andlong beforethey can be verballyexplained(Winner1988). Both and perceptual enactivemetaphorsaregroundedin bodily experience. Withoutan initial set of perceptualequivalenceclasses, the infantwould have no way to recognize regularitiesand constructa coherentworld. Elementaryperceptualsimilaritiesarisingfromthe bodily experienceareextendedthroughmetaphorto yield morecomplex categorizations experience. Metaphors of basedon perceptualsimilarityand enactmentare closely related and we might call their function senso-
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rimotorequivalence:things that look the same and things that can be used the same way are made the same throughperceptionand action. roots. Zajonc(1980, 1984; have affective as well as sensorimotor Metaphors but see Russell and Woudzia 1989) provides evidence that affective evaluations or judgmentscan be made quickly and reliably in the total absence of stimulus recognition.His studies suggest thatthereare information processingsystems associatedwith emotion that allow rapidjudgmentsof certainqualities of stimuli. These affective qualities supply a metaphoricdimensionto words and concepts. Osgood's work with the semanticdifferentialhas establishedcross-culturaluniversals of affective meaning involving dimensions of evaluation, potency, and activity(E-P-A) (Osgood, May, and Miron 1975). These dimensionsparallelthe attention,and functioningof adaptivebiological systems for approach/avoidance, arousal. These fundamentalaspects of motivationand emotion can still be discernedin the more complex forms of sentimentthat arise from patternsof social of actioncan be explained interaction. Indeed, some of the structure interpersonal in termsof the social regulationof these dimensionsof affectiveexperience(Heise 1985). Developmentalstudies indicate that metaphorcomprehensionbegins at an of earlyage andis governednot so muchby the maturation generalcognitive skills (such as logical operationsor classification)as by the child's fund of knowledge aboutthe world and, hence, aboutthe objects referredto by the termsof the metcomaphor.Until the age of eight or nine, childrenmakemanyerrorsin metaphor of prehensionbecausethey lack knowledge of the world, particularly the abstract of propertiesand interrelationships things. Young childrentend to look for sensory similaritiesbetween topic and vehicle when a nonsensory, relationalsimilarityis intended(Winner1988:36). Olderchildrenare able to decode metaphors in termsof affective meaning:they are sensitive to the evaluative, potency, and activity dimensions of metaphoricmeaning explored by Osgood and his colleagues in their semanticdifferentialstudies. Finally, as a fund of abstractrelational knowledge develops, metaphorcomprehensionreaches an adult level of in metaphorsconsophistication selected domains. But the ability to understand tinuesto develop over the life spansince it dependson knowledge andexperience of specific domains, not simply on a general process of abstraction.The richer one one's fundof knowledge, the further can decode andextrapolatea metaphor. Whatsort of semanticscan be built on these considerationsof the developThe meaningof words and gesturesis grounded mentalpsychology of metaphor? in bodily experience. Meaning resides not exclusively in the relationshipsbewould have it) but in theirconnectionto the body tweenconcepts(as structuralism and its skills and practices. Meaningemerges from the capacityto use bodily experience(includingsocially embodiedexperience)to thinkwith metaphorically. WhenMr. Y expresseshis fear of taintedblood and personalityinvasion, he his thatstructure experiencein termsof contagion. The law of is using metaphors contagion, one of the laws of primitivemagic describedby Frazerand again by Mauss, statesthatthingsthathave once been in contactwith each othermay affect each other througha transferof some of their propertiesvia an invisible "essence." This is not simply a cognitive construction.Nor is it the resultof conflicts pushedout of consciousness. The contagionmetaphoris a consequenceof bodily learning,and it persists as a resultof the natureof bodily revulsion and disgust.
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Rozin, Millman, andNemeroff (1986) reportstudiesthatshow the operation of the laws of sympatheticmagic in everyday life. The law of contagion ("once in contact always in contact") reflects the psychological process of forging metonymic relationships.For example, drinks that have once had contact with a dead, sterilizedcockroachare viewed as contaminatedand are rejectedwith disgust. Clothing previously worn by a disliked person remains "soiled" and undesirableeven when freshly laundered.The law of similarity("the image equals the object") is illustratedby experimentsshowing that people are repelled by chocolate fudge shaped like dog feces and are less accuratethrowingdarts at a pictureof someonethey like thanat a villain. In Rozin's studies, the laws of sympatheticmagic operateeven though people "know better." The power of metonym and metaphortranscendsthe dictatesof logic and reason. The enactive natureof early symbolization suggests a metaphorfor metaphor:Metaphorsare tools for working with experience. A metaphorexpresses somethingthatthe body knows how to do, a way of workingwith or transforming a concept. Tools are pluripotential.Their shape suggests a use to the hand but they can be used in many ways not originally intended(althoughthis sometimes involves misuse, as when the handle of a screwdriveris used to hammernails). Metaphorprovides ways of acting on our representations,or of making presentations to others, that transformthe conventional representation,unpack new meanings,open up the situation.The logic of a metaphorcan only be appreciated when we see how it is applied, and there are always new uses to which a metaphorictool can be put. So metaphorscannot be reducedto any finite diagramor set of images. Metaphoric connotationis inexhaustible because, like a tool, a metaphorcan always be used to fashion something new. The more we know of the world, the furtherwe can extend our metaphorsand the more skillfully we can use them to reshapeexperience. In additionto providing an account of conceptual inventiveness, metaphor theoryoffers a remedy for the droughtof passion in semantics. Individualexperience is organizedby metaphorswhose meaning is not completely accessible to consciousness and is not circumscribedby a rationalaccountingof associations or beliefs. Metaphortheory shows how our purest, most abstractideas are products of bodily action and emotion. Unlike psychodynamictheories of meaning, metaphor theorydoes not assume thatconflict lies behindevery symbol. Conflict and ambivalencecan arise from the dynamics of bodily and affective processes (as in the laws of sympatheticmagic) or fromthe antinomiesof desire (e.g., Freud 1961[1930]). But the "depth" of metaphoricmeaning may subsist in bodily experiences that are themselves unconflicted. The bodily groundingof metaphor providesmodes of thinkingthatyield rich, yet often hidden, meanings.The social world provides furtherways of extending metaphorto generatehighly differentiated abstractsymbols. Thus, the multivocalityof symbols need not be reduced to a single personaltheme. The meaning of illness experience and behaviorcan be soughtnot only in personalhistorybut in the social contexts and ways of life thatalso serve to groundmetaphor.
The Embodiment of Metaphor
Talk of flesh and blood makes our words immediate. This immediacy is a consequenceof the developmentalhistoryof metaphor.As we have seen, the ear-
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liest vehicles for metaphor bodily sensationsandactions(Johnson1987). Over are time, bodily emotions and sequences of interactionwith othersgive rise to complex feelings or sentiments that provide more elaborate grounds for metaphor (Lakoff 1987). In this way, our complex conceptions are built from elemental bodily experience by extending a scaffolding of metaphor(Lakoff and Johnson 1980). It might seem that the elaboratestructurethat underliesmetaphorwould make for great distance between abstractionand physical experience. But, for than literal expresadults, metaphorstake no longer to process and understand sions (Winner 1988:125). The psychophysiology of metaphormediates the immediate-closing the gap between the body and society. Injuryor alterationof the body changes not only the contentof thought, but also its form. Sacks perceptivelydescribesthis link after an injurythat damaged nervesin his leg. Tryingto move his limb underthe guidanceof a physiotherapist, I felt the effortdiffuseuselessly,unfocussed, it were. I felt thatit had no as
properpoint of applicationor reference. I felt that it wasn't really "trying," wasn'treally "willing"-because all "willing" is willing something,andit was preciselythat somethingwhich was missing. Miss Prestonhad said, at the start of our session, "Tense the quad. I don't need to tell you how." But it was precisely this "how," the very idea, which was missing. I couldn't "think" how to contractthe quadricepsanymore.I couldn't "think" how to pull the patella, and I couldn't "think" how to flex the hip. I had the feeling that somethinghad happened,therefore,to the powerof my "thinking"-although only with regard to this one single muscle. [1984:64]
A partialloss of sensorimotor functionis experiencedas a loss of the ability to think certainthoughts. In place of the clarity of willing a movement, Sacks
experiences his intention as "diffuse . . . unfocussed," without "point of appli-
cation." As the denervationof his limb progresses, the alterationsin sensation contribute a profounddisorientation.Touchinghis own leg, Sacks is horrified to to find it losing its reality and substantiality.Ultimately, his sense of self is underminedby the alterationsin sensationand controlof his leg. Just as bodily changes are felt immediately in the metaphoricprocess of natureof metaphorensuresthatthoughtsmay be felt thought,so the interactional immediatelyin the body. For example, in clinical hypnosis, it is common to suggest that countingfrom 1 to 10 will take the subject one step deeper into trance with each count. The sequence of numbersis metaphoricallymapped onto the experienceof depth (itself a metaphorfor the degree of focusing of attentionor absorption).It follows from this correspondence,without furtherexplanationor instruction,thatcountingfrom 10 back to 1 will lead to coming graduallyup out of trance.Interestingly,the experienceof going down and coming up is often felt in the body as a kinestheticsensation. People will spontaneouslysupply images
that fit this experience: swimming downward toward darkness and floating up-
ward toward the light at the surface. If the hypnotic guide suddenly reverses countingwithout warning, the directionof felt movement abruptlychanges and this can cause a distinct sensationof turning, veering, even vertigo. This is inito tially surprising subjects-there is no indicationthey are consciously figuring out how to act. Rather,they experiencethis movementas happeningto them and it may convince them they are experiencing something extraordinary.But the
hypnotic situation is not extraordinary; it merely frames each metaphor-making
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it standout from the streamof communicationthat ordinarilycreates a seamless consensualreality. If the bodily groundingof metaphoris revealedin the images we supplyfor up and down, an elementaryform of the social groundingof bodily experienceis illustratedin the responseto a mere change in the sequenceof numbers spokento the hypnotic subject. The dual groundingof metaphorin bodily and social experience has farmeaning. Lakoff reachingimplicationsfor developmentalaccountsof metaphoric and Johnson(1987) suggest that a small numberof image-schemasbased (1987) on bodily experienceof the physical world providebasic metaphorsthat structure our more abstractmodels of experience. As Quinn (1991) points out, however, do manyof the experiencesthey offer as fundamental not seem to be trulysimple. For example, they proposethatour understanding containmentis based on exof of taking things out of and puttingthings into physical containers. As periences even casual observationof an infant shows, however, this is not simply a motor act but an event charged with the pleasurableanticipationof exploration, the vague fear of what is hiddenin the shadows, and the surpriseof unexpecteddiscovery. All of this is conditionedby the presenceof parents,siblings, and others, so that social context is woven into even the simplest actions from the start. The elementalis not given but must be extractedfrom shifting experienceby the conof struction invariants,and what is invariantmay not be a motoract or perception but an attitude,plan, disposition, or desire. Thus, metaphorsthat seem to arise fromsimple motoracts are themselves rootedin affectively chargedmotivational schemata. This affect is in turn shaped and interpretedthroughculturallygovernedinteractions with others. If this is true for the image-schemasof apparently simple motor acts, how much more so for such significantevents as "the experience of the body as a containerof blood and sensation" (Johnson 1987). For a dramaticillustrationof the role of culturein shaping such elemental body experiences, consider the permeable boundaries of the Hindu body-self (Bharati 1985), which make the worriesof Mr. Y seem eminently sane and sensible. The bodily experiencesthat Lakoff and Johnsonwould place at the base of metaphor,then, are themselves complex social and culturalconstructions.Some of this complexityis reintroduced Lakoff (1987) in consideringthatpartof the by of structure metaphoricmodels stems not directly from the body but from prototypicalsocial situationsor scenarios. For example, metaphoricthoughtaboutanin ger is structured termsof the bodily experience of autonomicarousaland cardiovascularresponse(e.g., angeris a hot liquid underpressure)but also in terms of social situationsin which there is an offending event and a failed attemptat controlthatleads to an act of retribution (Lakoff 1987:397ff.). Conventionalmetto aphorsare shapedby knowledgeof situations,which is culture-specific an even greaterdegree thanbodily experience. Because of their embodied nature, metaphors create meaning not only but throughrepresentation throughenactmentor presentation.The presentation of metaphor takes two forms:metaphorsas cognitive tools that work on our concepts to fashion new meaning (as discussed in the previous section); and metayet phorsas communicativeacts or gestures, constrainedby social structure giving rise to new patternsof social interactionand modes of discourse (Fernandez 1986).
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Wittgenstein'snotion of the languagegame is helpful to clarify the sense of as metaphoric presentation social enactment(Bloor 1983). "The term 'language-. game' is meantto bring into prominencethe fact thatthe speakingof language is partof an activity, or of a form of life" (Wittgenstein1958:I, para. 23). Wittgenstein sees the use of languageas akin to a game in which thereare tacit rules and take turnsto create a meaningfulactivity. Learningthe meaning of participants wordsis equivalentto learningthe properoccasions andtechniquesfor theiruse.6 Situationsevoke appropriate action; in turn, actions refigurethe meaning of situations. As social enactmentor presentation,metaphorcan thereforebe constitutiveof meaningwithoutrequiringany intermediary process of mentalrepresentation. In fact, languagegames can teach words for which there are no discreteobjects, actions, or events to be represented.As an illustration,consider Boyer's (1986) analysisof termslike "mana" or "manitou," which play a centralrole in the conceptual systems of many cultures, yet, on close examination, seem empty-that is, they have no apparentcontent, existing without clear referents, internalstructure,or representation. Boyer suggests that these sorts of terms are learnedby participationin a succession of situationswhere mana is (tacitly or explicitly) known to be present. Exemplary social events provide contexts in which it is appropriate use the "empty" term.7Social interaction(including, to for example, respondingto emotions in the faces and gestures of others at ritual occasions where mana is immanentor manifested)shapes the meaning of mana to give it instrumental significance. A varietyof discourses-from informalgossip to technical discussions and the expression of an expert opinion-supply meaningto the "empty" term not throughostension but throughits use. Clearly, mana is not a meaningless signifier, a null sign, or wild card, capable of standing in place of anything. It stands only for what is potent or poten-
out tiallypowerful.This level of meaningis abstracted not at the level of complex cognition but at an earlier affective level. As Boyer argues, for "empty" concepts, there is a necessary causal link between the entity referredto and the acquisitionof the concept:that is, one has to have been influencedby mana to understandwhat the concept means. Mana is not an abstractconcept but ratheran
experiential one. Its "emptiness" lies in the fact that experiential knowledge need
not be represented, can be presentedby the body. The experienceof potency in it ritualsettingsandhumanrelationshipsshapes a crudeconceptof mana which can thenbe elaborated in throughparticipation specific social contexts where rules of social interactionare acquired. The nature of power and potency is enlarged throughthe cognitive elaborationsof metaphorthatdrawon (and reshape)a way of life. In Wittgenstein'stermsthen, "empty" concepts derive meaningthrough in participation languagegames that teach the rules of usage. Indeed, the ability to use a conceptproperlyencouragesin us the illusion thatit pointsto some object in the world and has a corresponding mentalrepresentation.8 The idealizedlanguagegame is a metaphoremployedby Wittgensteinto explicatethe differentways in which knowledgeis acquiredandused. It roots meaning in social interactionand techniqueor praxis. The concept of languagegames invokes the rule-governedaspects of social life that can be described in formal models. But the rules of language games are not conscious directions-the very idea of following a rule is abstracted of the largerwhole thatconstitutesa way out
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of life. The rules of social interactionare not embodied in any one individual;a rule-governed patternemerges from the fact that each personknows how to play his part. Recognizingthe dual groundingof metaphorin bodily and social experience allows us to steer a course between relativismand universalism. be of For, how can knowledge the construct individual minds,yet publicand shared? There a vastamount understanding is relative givencultures is of that to andnotuniversal thatis still shared individual of but members a culture. If, by as Johnson our of in argues, universal experience ourselves theworldgivesrise to universally shared received models theworld of best understanding, culturally account this otherkind of understanding is shared for that acrossindividual so. minds,butnotuniversally [Quinn 1991:91] Metaphors embody the situationalknowledgethatconstitutesculture.While conventionalmetaphors reflectcommon sense, the idiosyncraticmetaphorsof individualsare local contributionsto the culturalsituation. So each individualretains the potentialto create new meaningfrom his or her uniqueperspective. The social groundingof metaphorin a way of life is crucialto the development of an aesthetics, ethics, and pragmaticsof knowledge. Left to tinkeron its own, metaphoris capable of wild and limitless invention. This inventiveness is constrainedby participation language games. While the bodily groundingof in ensurestheirqualityof immediacy,throughsocial interaction critical a metaphors or "objective" dimensionis introduced into the play of metaphor.Cultural meaning, then, cannotbe reducedto metaphors,any more than things can be reduced to words;cultureremainsa way of life, possible only by virtue of the existence of othersreadyto assume theirroles. Conclusion Partof whatmakesthe patient'sself-descriptionunintelligibleto the biomedical physicianis the practitioner'stendency to take the metaphoricconstructions of illness experiencefor literalstatementswithin the empiricalrealmof biomedicine. Languageis treatednot as a personal expression but as a transparent universal code. But "blood" for the patient is not "blood" for the physician. The inabilityto see the metaphoricand contextualbasis of discourse limits the physician's comprehension the patient'slife-world. of The psychodynamic clinician is attunedto metaphoric meaningbut interprets it reductivelyas simply indicatinguniversal mental mechanismsthat serve primarilyas defenses againstanxiety. The patient'smetaphorscan then be replaced by a more exact descriptionof emotionalconflict. This providesa rationalexplanation for the patient's idiosyncraticbehavior, but it forecloses the search for meaningintrinsicto the metaphoricgesture. Aftertelling the storyof a patientwith chroniclow backpain who has undergone repeatedsurgicalprocedures,Kleinmanconcludes: the of that Among aspects hispersonality havebeentransformed thepainare by histrust others hisconfidence himself hisbody.'It hasbeenterrible in and in and for me. I know,eventhough can'tchangeit, I havebecometense,self-conI don'trespect me." Howie scious,andhopeless.I'm easilyhurtandfeel others
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neverused the term, but several times I felt he could have addedthe termspineless-that this image was partof how he regardedhimself. [1988:71]
The crucialquestionis: Whose metaphoris this, the patient'sor the physician's? Do such metaphorsreflect the patient's underlying body image or conceptual model of his illness? Are they constructionsof the physician aimed to provide between coherencefor a world disordered pain?Are they tacit understandings by patientand physician, drawnfrom sharedexperiences of embodimentor a conventionalsocial code? Are they, finally, just literatedevices to simplify the paand tient's experience, create the illusion of understanding, limit our discomfort with the inchoate? The metaphoric processallows all of these formsof meaning.Whena patient with a life-long historyof migraineheadachesspontaneouslyremarks,"My head age, her model of migraine, and the way she wishes to be handledby the physifrom a common fundof physicalexperiencebut its cian. She drawsthis metaphor nuanceand full significancedependon the languagesof sufferingused within her family and salient in her currentsocial context (which includes the health care system). It is not necessarythata speakerrealize her statementis a formalmetarelationship,whetherin the speakphorfor it to be the expressionof a metaphoric er's own cognitive model or in the relationshipof body to society. Symbolizing
is the embodiment or enactment of metaphor. This is so whether the action is is made of glass," she is simultaneously revealing something about her body im-
intentionalor accidental. The politics of metaphorinheres in the processes that authorizeand control Medical authorityuses judgments based on metaphorsdrawn interpretations. frombiology to legitimateor disqualifythe patient'sillness behavior,often without awarenessof the patient'sown interpretation. Psychoanalysisaccepts the patient's metaphor raw materialbut places the analystin an unassailableposition as as the interpreter truthandmeaning(Gellner1985). The overzealousinterpreter of who ascribesmeaningto every action may actuallyobstructthe sufferer'ssearch for his own metaphor.The sufferingindividual-for whom the inchoateis less an obstaclethanthe prima materia for self-understanding-may experiencethe clinician's facile and all-encompassing interpretationsas oppression (Kirmayer 1988). Ultimately, all forms of political rhetoric use metaphors about what is "given," "natural,"or "good" to dominateour imaginationof what is possible (Perelman1982). The various constructivistperspectivesin psychology and the
social sciences undermine this tendentious appeal to common sense, technical certainty, or conventional morality by arguing that our experience and empirical
knowledgeare not directconsequencesof a naturalworld but are, in fact, human constructions. Constructivism emphasizesthatthe sense-dataof the world are not received raw. Facts are not in the world to be picked up by the senses; they are cognitive made to fit our preconceivednotions and implicittheories(Neisser constructions, 1976). This process of shapingreality in accordwith belief begins at the earliest stages of perception,which is itself guided by theories aboutthe world. The categories of experience, the limits of objects, and the causal orderof processes are all consequencesof active meaning-givingfunctionsof mind, both as it is repre-
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sentedby each individual'spsychology and, most importantly,as it is createdout of the rules and structures society (Barnesand Bloor 1984). of Thus, we never see reality directlybut only throughthe formativeinfluence of our social conceptions of reality. This is a liberatingvision that allows us to challengethe received wisdom of our time, to imagine new worldsor ways of life thatmight be more desirable. In this radicalrelativism, there is no way to decide betweenalternate visions on the basis of theircorrespondence some underlying to has the same potentialto generateself-confirmingperceptions. reality;any theory constructionsof realitymust appealto some Instead,the choice between alternate otherdomainof value such as overarchingprinciplesof ethics or aesthetics. But there are limits to this view, for whateverour mental map of a room, if we are wrong, we will barkour shins raw againstthe furniture.As Taylorinsists: "There is an inner connection between understanding world and achieving the technologicalcontrolwhich rightlycommandseveryone's attention,and doesn't justjustify ourpracticesin ourown eyes" (1984:101). Therearethingsourworldview does not create or eliminateby its ontological premises. They can be modthis ified, the blow can be lessened, we can look at our raw shins and interpret not as evidence of misplacedfurniture as indicatingsomethingentirelydifferent: but moralretribution wrong deeds, disfavorwith the gods, eating of taboo foods, for and so on. But the person who notices his surroundings marksa correspondand ing spot on the map has the potentialto avoid barkinghis shins a second time. The point of the social constructionof reality, then, is not that it eliminates this realist/idealistdimension to experience but that it insists that we accord the same importanceto socially constructedartifactsand to the rules of social interactionandexpressionthatwe accordto materialevents. Social constructivism can contribute a more detailedmap of reality-precisely the sort one needs to stay to socially alive. The cartographer's problemthenbecomes how to place the socially constructed the bodily given on the same map. This is where metaphor and theory can make a signal contribution. In ItaloCalvino's TheCastle of CrossedDestinies (1977), the narrator enters a forest wherehis voice is stilled. He comes upon a castle and entersa greathall. There, arounda table, sit a silent host of characters,playing a game of cards. On closer inspection, the narrator sees that they are dealing tarotcards. He soon realizes they aretelling each othertheirstories throughthe sequenceof images presentedby the cards. Details in the tarotimages open up narrative possibilities that the omniscientauthor-now in thin disguise as narrator-weaves into a coherent tale. As each charactertells his story, the tarotcards are fit together in a magic squareof intersectingstories. Reading in one direction, we find the story of the courtier,andfrom anotherdirection,cross-cuttingthe same cards, the storyof the knight. Every paththroughthe field of cardsyields a new strandof potentialnarratives. Calvino's castle of crossed destinies illustratesthe double constraintof embodimenton the constructionof meaning:each symbol is drawn from the conventionalimages inscribedon the face of the cards. Each narrator follows a path throughthe same orderly field of cards and so uses images available for other narratives. we take the images of the tarotcardsto be the sense-dataof percepIf tion or, better, our bodily experiences (built on a scaffolding of metaphorand, hence, alreadyat many removes from the raw qualia of experience) and the rec-
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tangular grid of the interlocking cards as the social matrix of communication that demands that each image take its place in context, we have an apt metaphor for the interplay of body and society in the generation of myth and meaning. As this extended metaphor makes clear, however, our destinies are crossed but not determined. The path through the field of cards offers a range of narrative possibilities: it leads the author and reader to come at the next card from a particular angle; but the metaphoric elaboration of the tarot images allows author and reader to strike out in new directions. The author's artistry creates a seamless fusion of image and intention. But the Castle is, after all, a world of literary invention, designed to draw attention to its imaginary status. Each time one of Calvino's constructions escapes the boundaries of its card, we are reminded that the literary world is not self-contained. The realm of symbols lives in and among the world of things. NOTES A Acknowledgments. version of this article was presented at the XII International Congressof Anthropologicaland EthnologicalSciences in a symposium, "Between Semantics and Rationality," organized by Gilles Bibeau and Ellen Corin, Zagreb, Yugoslavia, July 24-31, 1988. I would like to thankDavid Howes for many stimulatingdiscussions of this work. may be addressedto the authorat the Instituteof Communityand Correspondence Family Psychiatry,4333 chemin de la C6te Ste-Catherine,Montreal,Quebec, H3T 1E4, Canada. 'And a fourth,semiotically distinctbodily realmis side-stepped:the body of biology is not entirelysubsumedby the threecategories of Scheper-Hughesand Lock. Even if we to of deny the distinctiveepistemologicalcharactersitics science (which I am not prepared do) we are left with crucial semiotic distinctions. Compare:(1) feeling sick; (2) being treatedas sick by others;(3) being told you are sick by a doctor;(4) findingyour temperThe last event is neitherstrictlybodily felt, social-symatureelevated on a thermometer. bolic, nor political, but indexical-demonstrably linked to the body's physical condition (cf. Mounin 1985). This points towarda semiotic analysisof the uniquevalue of scientific
inquiry.
2Clearly,value resides not only in felt significance but in reasoned principles supportedby logical argumentor the weight of evidence, and also in conventionalpractices acceptedby a historicalcommunity. However, values that are initially experiencedas exin trinsicare internalizedas bodily felt convictions throughparticipation a way of life. 3Thedoctor'sjudgmentof irrationality,then, rests on the patient's failure to accept the tenets of biomedicine (beliefs); to articulatea sensible priorityamong his goals (personal survival versus avoiding genetic pollution); and, finally, to restrainhis emotional reactionto his predicament.These distinct aspects of irrationality may be given different weight by individualspracticingwithin the same culturalframework. 4A theoryof embodiedthoughtwould also addressthe formallimitationsof semantic networkmodels of cognition, which do not take sufficientnote of the role of referenceor and denotationin meaning(Johnson-Laird, Herrmann, Chaffin 1984). 5Thisliberal use of the term "metaphor" has a venerabletraditionfrom Aristotle's as treatment metaphor the "intuitiveperceptionof the similarityof dissimilars"(Wheelof wright 1962:74), throughVico's recognitionof the poetic basis of social-historicalunderstanding(Bergin and Fisch 1970), to contemporarycognitive science models of belief (Ballim, Wilks, and Barnden1992).
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The whole pointof this emphasison techniqueis to help us get rid of the common impressionthat language is like a mirror,and that whenever a sentence has meaningthereis something, a propositioncorresponding it. Using lanto guage is exercising a technique. . . . W. tried to explain by the analogy with a map. In a map, squaresmay represent houses andlines may representstreets, and this now may be explained to a child. This is a house and this is a street. "Now it's as thougheverythingon the map representssomething," W. said, but "representingis not represented the map." The map we may say repon resents. Thatit is a map involves thatthe map is used in a certainway. Its use is whatmakesit a map. In the same way it is the use of a sentencewhich makes it intelligible. [Bouwsma 1986:23-24] owes much to earlier Wittgenstein'snotion of techniqueor use in place of representation conceptsof "imageless thought" in Germanacademicpsychology (Bartley 1985:128 ff.; but see Bloor 1983:14ff.). 7ToBoyer's social accountwe might add thatif the preeminentfeatureof mana terms is their evocation of potency or efficacy then their meaning may reside in affective processes like those that give rise to E-P-A on the semantic differential(Osgood, May, and Miron 1975). Specifically, mana is potency in E-P-A-pure affective meaning that does not requirefurthercognizing as a propositionalnetworkor imagistic representation be to used to think with. The point remains that meaning can be presentedin the word mana withoutany representation the concept. of
6
8"'
who is underthe compulsionof a rule" (Wittgenstein1958:86e). This seems to me to lay the groundfor a more satisfying account than Sperber's(1985) somewhatopaque notion of "semi-propositionalrepresentations." By insisting on a representationalmodel of that knowledge, Sperberis forced to classify representations fail to identify a unique verifiablepropositionas "semi-propositional."The currentview of metaphoras presentation or enactmentsuggests that rules of usage, bodily and rhetoricalskills may be embodied dispositionsto respond or ways of acting that are neither propositionalnor imagistic in structure. Action systems based on procedural knowledge do not requirementalrepresentationsto generatecomplex sequences of behavior. REFERENCES CITED Alexander,Linda 1981 The Double-Bind between Dialysis Patients and Their Health Practitioners.In The Relevanceof Social Science for Medicine. Leon EisenbergandArthur Kleinman, eds. Pp. 307-329. Dordrecht: Kluwer. Ballim, A., Yorick Wilks, and John Barden 1991 Belief Ascription, Metaphor,and IntensionalIdentification.Cognitive Science 15:133-171. Barnes, Barry,and David Bloor 1984 Relativism, Rationalismand the Sociology of Knowledge. In Rationalityand Relativism. MartinHollis and Steven Lukes, eds. Pp. 21-47. Cambridge,MA: MIT Press. Bartley, W. W., III 1985 Wittgenstein.2nd edition. LaSalle, IL: Open Court. Bergin, ThomasG., and Max H. Fisch 1970 The New Science of Giambattista Vico. Ithaca, NY: CornellUniversityPress. Berger, H,. Jr. 1987 Bodies and Texts. Representations17:144-166.
'But surely you can see . . . ?' That is just the characteristic expression of someone
344
Bersani,Leo 1986 The FreudianBody: Psychoanalysisand Art. New York: ColumbiaUniversity Press. Bharati,Agehananda 1985 The Self in HinduThoughtand Action. In Cultureand Self: Asian and Western Perspectives.AnthonyJ. Marsella, George DeVos, and FrancisL. K. Hsu, eds. Pp. 185-230. New York:TavistockPublications. Bloor, David 1983 Wittgenstein: Social Theoryof Knowledge. London:MacMillan. A Bouwsma, O. K. 1986 Wittgenstein: Conversations1949-1951. J. L. Craftand R. E. Hustwit, eds. Indianapolis,IN: HackettPublishing. Boyer, Pascal 1986 The "Empty" Conceptsof Traditional DeThinking:A SemanticandPragmatic scription.Man (n.s.) 21:50-64. Calvino, Italo 1977 The Castle of CrossedDestinies. New York:Harcourt Brace Jovanovich. Douglas, Mary 1973 NaturalSymbols:Explorationsin Cosmology. London:Barrieand Jenkins. Fernandez,JamesW. 1982 The Darkat the Bottomof the Stairs:The Inchoatein SymbolicInquiryandSome Strategiesfor Coping with It. In On Symbols in Anthropology:Essays in Honor of HarryHoijer. J. Maquet,ed. Pp. 1343. Malibu, CA: UndenaPublications. 1986 Persuasionsand Performances: Play of Tropesin Culture.Bloomington:InThe dianaUniversityPress. Freud,Sigmund 1961[1930] Civilizationand Its Discontents. New York:W. W. Norton. Gellner, Ernest 1985 The PsychoanalyticMovement. London:PaladinBooks. Heil, John 1986 Does Psychology PresupposeRationality?Journalof the Theory of Social Behaviour6(1):77-87. Heise, David 1985 Affect Control Theory: Respecification, Estimation and Tests of the Formal Model. Journalof Mathematical Sociology 11:191-222. Herzlich,Christine 1973 Health and Illness: A Social-Psychological Analysis. New York: Academic Press. Johnson,Mark 1987 The Body in the Mind. Chicago:Universityof Chicago Press. and Johnson-Laird, Phillip N., D. J. Herrmann, R. Chaffin 1984 Only Connections:A Critiqueof Semantic Networks. Psychological Bulletin 96(2):292-315. Jones, Ernest 1967 The Theoryof Symbolism:Paperson Psycho-Analysis. Boston: Beacon Press. Kirmayer,LaurenceJ. 1988 Mind and Body as Metaphors:Hidden Values in Biomedicine. In Biomedicine D. Examined.Margaret Lock and DeborahGordon,eds. Pp. 57-93. Dordrecht: Reidel. Kleinman,Arthur 1988 The Illness Narratives: Suffering,Healingandthe HumanCondition.New York: Harper& Row.
345
Lakoff, George 1987 Women, Fire and DangerousThings. Chicago:Universityof Chicago Press. Lakoff, George, and MarkJohnson We 1980 Metaphors Live By. Chicago:Universityof Chicago Press. Levin, David Michael 1985 The Body's Recollection of Being: PhenomenologicalPsychology and the Deof construction Nihilism. London:Routledge& Kegan Paul. Luria,A. R. 1968 The Mind of a Mnemonist.New York:Basic Books. Mounin,Georges 1985 Semiotic Praxis. New York:PlenumPress. Neisser, Ulric 1976 Cognitionand Reality. San Francisco, CA: W. H. Freeman. O'Neill, John 1985 Five Bodies: The Human Shape of Modem Society. Ithaca, NY: Cornell UniversityPress. Ortony,Andrew 1979 Beyond LiteralSimilarity.Psychological Review 86:161-180. Osgood, CharlesE., W. H. May, and M. S. Miron Universalsof Affective Meaning. Urbana:University of Illinois 1975 Cross-Cultural Press. Perelman,Chaim 1982 The Realm of Rhetoric. Notre Dame, IN: Universityof Notre Dame Press. Quinn, Naomi The Theoryof Tropes in 1991 The CulturalBasis of Metaphor.In Beyond Metaphor: Anthropology.James Fernandez,ed. Pp. 56-93. Stanford,CA: StanfordUniversity Press. Eugene Rochberg-Halton, Attitude.Chicago:UniSocial Theoryin the Pragmatic 1986 MeaningandModernity: versityof Chicago Press. Rorty, Richard 1979 Philosophyand the Mirrorof Nature.Princeton,NJ: PrincetonUniversityPress. Rosaldo, Michelle Z. 1984 Toward an Anthropologyof Self and Feeling. In CultureTheory: Essays on Mind, Self andEmotion. RichardShwederandRobertA. LeVine, eds. Pp. 137-157. Cambridge: CambridgeUniversityPress. Rozin, Paul, LindaMillman, and CarolNemeroff 1986 Operationof the Laws of SympatheticMagic in Disgust and Other Domains. Journalof Personalityand Social Psychology 50(4):703-712. Russell, JohnA., and L. Woudzia 1986 Affective Judgments,Common Sense, and the ZajoncThesis of Independence. Motivationand Emotion 10(2):169. Sacks, Oliver 1984 A Leg to StandOn. New York:Harper& Row. Scarry,Elaine 1985 The Body in Pain:The Makingand Unmakingof the World. New York:Oxford UniversityPress. Lock Nancy, and Margaret Scheper-Hughes, 1987 The MindfulBody: A Prolegomenonto FutureWork in Medical Anthropology. Medical AnthropologyQuarterly(n.s.) 1:6-41. Sperber,Dan 1974 RethinkingSymbolism. Cambridge: CambridgeUniversityPress.
346
ANTHROPOLOGY MEDICAL QUARTERLY
1985 On AnthropologicalKnowledge. Cambridge: CambridgeUniversityPress. Spiro, MelfordE. 1982 Collective Representationsand Mental Representationsin Religious Symbol Systems. In On Symbols in Anthropology:Essays in Honor of HarryHoijer. J. Maquet, ed. Pp. 45-72. Malibu, CA: UndenaPublications. Sternberg,RobertJ., and G. Nigro Journal of and 1983 Interaction Analogy in the Comprehension Metaphors.Quarterly of Experimental Psychology 35A:17-38. Taylor,Charles 1984 Rationality.In RationalityandRelativism. M. Hollis and S. Lukes, eds. Pp. 88105. Cambridge,MA: MIT Press. Turner,BryanS. 1984 The Body and Society. New York:Basil Blackwell. Vosniadou,S., and AndrewOrtony Distinction in Young 1983 The Emergence of the Literal-Metaphorical-Anomalous Children.Child Development54:154-161. Vowles, David H. In 1970 Neuroethology,Evolutionand Grammar. Developmentand Evolutionof Behavior:Essays in Memory of T. C. Schneirla. L. R. Aronson et al., eds. Pp. 194215. San Francisco,CA: W. H. Freeman. Wagner,S., et al. 1981 "Metaphorical"Mappingin HumanInfants. Child Development52:728-731. Wheelwright,Philip 1962 Metaphorand Reality. Bloomington:IndianaUniversityPress. Winner,Ellen 1988 The Point of Words. Cambridge,MA: Harvard UniversityPress. Winner,Ellen, et al. 1979 First Metaphors.In Early Symbolization. Howard Gardnerand D. Wolf, eds. Pp. 29-41. San Francisco,CA: Jossey-Bass. Wittgenstein,Ludwig 1958 PhilosophicalInvestigations.London:Basil Blackwell. Young, Allan 1981 When Rational Men Fall Sick: An Inquiry into Some Assumptions Made by MedicalAnthropologists.Culture,Medicine and Psychiatry5:317-335. Model Approach.Culture,MedicineandPsy1982 RationalMen andthe Explanatory chiatry6:57-71. Zajonc, RobertB. 1980 Feeling and Thinking:PreferencesNeed no Inferences. AmericanPsychologist 35(2):151-175. 1984 On the Primacyof Affect. AmericanPsychologist 39(2):117-123.

The Body's Insistence On Meaning

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The Body's Insistence on Meaning: Metaphor as Presentation and Representation in Illness Experience Author(s): Laurence J.

Department of Psychiatry McGill University

THE BODY'S INSISTENCEON MEANING

THE BODY'S INSISTENCEON MEANING

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

MEDICAL ANTHROPOLOGY QUARTERLY

THE BODY'S INSISTENCEON MEANING

ANTHROPOLOGY MEDICAL QUARTERLY

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