Medicine as Metaphor

Water, stories, the body,
All things we do,
Are mediums that hide
And show what's hidden.
Study them,
And enjoy this being washed
With a secret
We sometimes know
And then not.
- Rumi

The practice of medicine is both an art and a science. We study and learn the system so that when the time comes to apply it, there is a greater possibility of successfully helping others. Yet, no matter how much one studies, no matter how well one knows the science of any given medical system, there always remain aspects that are unknown and unknowable. The individuated human being that stands before us as a patient is a unique, dynamic, and multidimensional entity that is equal parts mystery and revelation. They are an impermanent, ever-changing field of paradox and complexity, influenced by their history and experience, yet always capable of experiencing freedom from the tyranny of the past.

In this milieu of complexities, we seek to understand and grasp the spirit of the medicine, of the individual, of the moment. We seek to come to an experiential awareness of unity and transcendence even as we exist as embodied beings faced with the human struggle of duality — self and other, body and spirit, life and death. And yet, even as the body separates us, it provides us with the means to experience the physical, sensual world. Embodiment gives us the means to experience both the physical and the non-physical realities.

Enlightenment, the natural state, being in tune with the dao, none of these are found "somewhere else." They are all accessible to us right here, right now. As it is said in Buddhist doctrine, it is only through samsara that we find nirvana. In other words, it is only in form that the spirit can become tangible, even as it slips away in the impermanence of each instant.

A critical understanding that is necessary to finding the balance between the art and the science of medicine is the understanding of medicine as metaphor. In a very real sense, all medical theories and perspectives are metaphors — they are metaphorical abstractions, assumptions and generalizations about people, our environment, and the needs of the individual human. It is through such abstractions and generalizations that we are able to create models of how and why disease occurs and progresses, as well as models of what it means to be healthy.

However, these models, precisely because they are based on abstractions and generalizations, are never exact replicas of the individual human experience. For this reason, we can say that every medical model is, in fact, a metaphor for the lived human experience of disease and health. They are necessarily limited by the fact that they are merely models, and by their very nature models will always and only be metaphors — they are "fingers pointing to the moon," or as Alfred Korzybski aptly stated, "The map is not the territory."

Perhaps it can be said that the closer the metaphor comes to approximating the individual's experience, the more useful it is.

It is because all medicine is metaphor that medicine is both an art and a science — we need the science of the organizing metaphorical medical model, the structure of the lens through which we view each individual and imbalance, but we also need the art of knowing each individual is unique and of choosing which metaphorical lens to use in each moment. Often, it is when the practitioner and patient do not consciously acknowledge the metaphorical nature of the medicine that this becomes more problematic. One of the most beautiful aspects of Oriental medicine is that it self-consciously recognizes that it is metaphorical, that it consciously draws parallels to nature, to aspects of nature that correspond to the human experience.

When we start to believe that any given medical metaphor is a form of absolute truth, when we lose sight that it is only a relative, metaphorical perspective, the metaphor itself inevitably becomes self-limiting and therefore self-defeating. It becomes a self-limiting perspective precisely because it reifies itself, and therefore loses connection to the art of practicing medicine. In order to avoid such reification of perspective, it is vital to recognize that the moment-to-moment reality of the individual human experience can never be fully and adequately captured by words and models; words and perspectives are can never be more than approximations of the experience itself. They are metaphors for the experiences of life, and a means for providing context and interpretations for those experiences. They are a means of organizing and orienting the lived experience in such a way so as to make meaning of the experience.

Medical models are metaphors and stories, and as such they can never embody an absolute truth; the truth of being can only be experientially realized, not told. Metaphors are approximations, and what matters is finding the perspective that is most useful for any given individual at a given point in time. The etymology of the word doctor is to teach; our job as practitioners of medicine is not only to help diminish their suffering by subjecting them to acupuncture, herbal medicine, pharmaceutical drugs, or surgery, but to help diminish their suffering through teaching them and helping them to know and understand themselves and their experience. Using the metaphorical lenses skillfully allows us not only to make a difference in our patients' experiences, but also allows us to fundamentally shift their perspectives and understanding of themselves, to help them to see themselves as already whole.