Storylines of family medicine VI: ways of being-in the office with patients.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VI: ways of being-in the office with patients', authors address the following themes: 'Patient-centred care-cultivating deep listening skills', 'Doctor as witness', 'Words matter', 'Understanding others-metaphor and its use in medicine', 'Communicating with patients-making good use of time', 'The patient-centred medical home-aspirations for the future', 'Routine, ceremony or drama?' and 'The life course'. May readers better appreciate the nuances of patient care through these essays.

Making the Unseen Seen: The Role of Signaling and Novelty in Rating Metaphors.

Comprehension of metaphorical expressions differs with their degree of novelty. Conventional metaphors are typically comprehended as easily as literal sentences, while novel metaphors are responded to less quickly than their conventional counterparts. However, the influence of metaphor signals on the interpretability and acceptability of sentences with metaphors, especially their potential interaction with novelty, remains an open question. We conducted six online experiments among 1,694 native speakers of American English to examine how interpretability and acceptability ratings of individually presented sentences were affected by metaphor novelty and different types of metaphor signals. Across all six experiments, we consistently found that novel metaphors decreased the interpretability and acceptability of sentences compared to both conventional metaphors and literal controls. Signals, on the contrary, did not impact the interpretability or acceptability of the sentences. Moreover, only in experiment 3b did we find an interaction between metaphor type and signals. Specifically, when a metaphor was marked by double signals (i.e., both lexical signals and a typographical signal were added around the metaphorical keywords) vs. no signals, acceptability of novel metaphors increased, but acceptability of conventional metaphors decreased. We hypothesize that the double signaling of novel metaphors marks their novelty, making them more acceptable. By contrast, the double signaling of conventional metaphors may have been perceived as redundant, leading to a lower acceptability.

The Role of Metaphor in Hermeneutic Research.

The identification and interpretation of metaphor is useful to hermeneutic research. Metaphor is a way of conceiving one concept in terms of another and serves as a function of understanding. The author explores the rise of hermeneutics research and its relevance to nurse artsciencing. Metaphors are a creative strategy hermeneutic researchers can use to analyze and interpret data, and serve as a powerful strategy to represent complex realities, illuminate unnoticed aspects of a phenomenon, and provide depth of meaning to the understanding of human experiences.

Brain responses to a lab-evolved artificial language with space-time metaphors.

What is the connection between the cultural evolution of a language and the rapid processing response to that language in the brains of individual learners? In an iterated communication study that was conducted previously, participants were asked to communicate temporal concepts such as "tomorrow," "day after," "year," and "past" using vertical movements recorded on a touch screen. Over time, participants developed simple artificial 'languages' that used space metaphorically to communicate in nuanced ways about time. Some conventions appeared rapidly and universally (e.g., using larger vertical movements to convey greater temporal durations). Other conventions required extensive social interaction and exhibited idiosyncratic variation (e.g., using vertical location to convey past or future). Here we investigate whether the brain's response during acquisition of such a language reflects the process by which the language's conventions originally evolved. We recorded participants' EEG as they learned one of these artificial space-time languages. Overall, the brain response to this artificial communication system was language-like, with, for instance, violations to the system's conventions eliciting an N400-like component. Over the course of learning, participants' brain responses developed in ways that paralleled the process by which the language had originally evolved, with early neural sensitivity to violations of a rapidly-evolving universal convention, and slowly developing neural sensitivity to an idiosyncratic convention that required slow social negotiation to emerge. This study opens up exciting avenues of future work to disentangle how neural biases influence learning and transmission in the emergence of structure in language.

Illustration of self-perceived knowledge, skills, and interests in undergraduate dental students using a visual metaphor- results of a monocentric cross-sectional study.

BACKGROUND: Self-assessment and self-reflection of competencies are crucial skills for undergraduate students. This monocentric cross-sectional study aims to assess the self-perceived knowledge, skills and interests in conservative dentistry and periodontology of third-, fourth-, and fifth-year dental students by the Pictorial Representation of Illness and Self-measure (PRISM). METHODS: Seventy-five undergraduate dental students (n = 25 of each year) who studied between 2021 and 2022 at the Department of Cariology, Endodontology and Periodontology at the University of Leipzig, Germany, were included. All of them underwent a PRISM-based interview regarding their perceived knowledge, practical skills, and interests in conservative dentistry as well as its sub-disciplines. The distances in the PRISM task (in millimeters) were measured and compared between the groups. Spearman's Rho was used to reveal correlations between knowledge, skills, and interests in the cohort. RESULTS: Perceived theoretical knowledge and practical skills differed significantly between groups for the sub-disciplines periodontology, cariology, restorative dentistry and preventive dentistry (p < 0.05). However, students' interests did not significantly vary between groups (p > 0.05). In the field of conservative dentistry and its sub-disciplines, significant moderate to high positive correlations were found between knowledge and skills (p < 0.01), and weak to moderate positive correlations were found between interests and knowledge (p < 0.05). Regarding the relationship between perceived interests and skills, only restorative dentistry, endodontology and periodontology were significant and only moderate to weak correlations were found (p < 0.05). CONCLUSION: PRISM revealed differences in perceived knowledge and skills between third-, fourth-, and fifth-year dental students. Correlations were found between perceived knowledge and skills, as well as between interests and knowledge. PRISM may be a promising tool to support students and teachers in dental education.

Intuition and we-ness in Bion and post-Bionian field theory.

"Intuition" is probably the most frequently used term in all Bion's writings. However, in order to understand its role in his thought it is essential to give it the clearest possible definition. The thesis of this article is that by intuition Bion means a "specific" psychoanalytic concept. It is thus possible to extract intuition from the vague and mystifying reading of it by some authors, whic runs the risk of falling into an empty "intuitionism". For Bion, intuition is a psychoanalytic function of the analyst, the principal factors of which are the various expressions of dream-thought and insight. Furthermore, within the frame of the post-Bionian theory of the analytic field, the author suggests adding to these factors the use of the "we" vertex (or we-ness), i.e. to regard virtually every fact of analysis as co-created. The aim is to make the very concept of "field" more accessible. Compared with the metaphor of the analytic field, the concept of we-ness has both greater clinical versatility and greater pregnancy on the metapsychological plane. Indeed, it more directly reflects a radically social conception of human subjectivity: what is known in contemporary speculative thought - in J-L. Nancy, for example - as the "ontology of we".

Spice up the moment: The influence of spicy taste on people's metaphorical perspectives on time.

Embodied cognition contends that sensorimotor experiences undergird cognitive processes. Three embodied cross-domain metaphorical mappings constitute quintessential illustrations: spatial navigation and orientation underpin the conceptualization of time and emotion and gustatory sensation underlies the formulation of emotion. Threading together these strands of insights, the present research consisted of three studies explored the potential influence of spicy taste on people's metaphorical perspectives on time. The results revealed a positive correlation between spicy taste and the ego-moving metaphor for time such that individuals who enjoyed spicy taste (Study 1) and who consumed spicy (vs. salty) snack (Study 2) exhibited a predilection for the ego-moving perspective when cognizing a temporally ambiguous event. Because both spicy taste and the ego-moving metaphor are associated with anger and approach motivation, the latter two were postulated to be related to the novel taste-time relationship. Corroborative evidence for the hypothesis was found, which indicated that spicy (vs. salty) intake elicited significantly stronger anger toward and significantly greater approach-motivated perception of a rescheduled temporal event (Study 3). Taken together, the current findings demonstrate that spicy taste may play a role in people's perspectives on the movement of events in time and highlight the involved embodied interrelation between language, emotion, and cognition.

Can metaphors help us better remember wines? The effect of wine evaluation style on short-term recognition of red wines.

People are generally poor at remembering complex food stimuli, such as wine. While writing a description has been shown to improve memory performance, talking about wine is generally a difficult task for novices. However, giving novices a framework in which to evaluate the wine may help with the memory process. Using a short-term recognition task, this experiment compared different forms of wine evaluation on the to-be-remembered wine sample, using either 1) a classic smell and taste evaluation, 2) a multisensory metaphor selection task with visual, auditory, and tactile metaphors, or 3) a control condition with no writing. Results from 153 participants revealed that recognition performance between the three groups was not significantly different. Secondary analysis revealed that recognition accuracy was correlated with wine liking for the control group, suggesting that in the absence of explicitly evaluating the wine, participants relied on wine liking as a cue for memory. Implications for theory development and applications in wine education are discussed.

What does metaphoric language say about aggression? The relationships between metaphoric language, impulsivity, and aggression.

Aggressive behavior among adolescents has been identified as a serious worldwide problem, especially when combined with trait impulsivity. This study investigates the impact of an overlooked aspect of language, namely, metaphor comprehension, on impulsivity and aggression in adolescents. A total of 204 adolescents completed self-reported questionnaires assessing impulsivity and aggression and underwent tests assessing familiar and less familiar metaphor comprehension. The findings reveal inverse relationships between metaphor comprehension and both impulsivity and aggression. Regarding aggression, notable distinctions were observed in the correlations between familiar and less familiar metaphors with specific aggression types. Additionally, impulsivity was found to mediate the relationship between the comprehension of familiar metaphors and aggression. These results are elucidated in the context of cognitive and executive functions, emphasizing the significance of considering metaphor comprehension as a cognitive process capable of modulating aggressive behavior.

Terminology for discussing chronic pain: Using metaphors to educate families on chronic pediatric pain.

To educate families about chronic pain requires a holistic discussion on the nature of pain, multidisciplinary treatment, and empowering families with tools to support their child's recovery.

Analyzing metaphor patterns in COVID-19 news pictures: A critical study in China.

Drawing on Critical Metaphor Analysis, this study investigates major metaphors of the COVID-19 pandemic used by the Chinese government in the specific genre of news picture. It examines patterns of metaphor use in the first year of the pandemic in China and explains how and why the government employs the identified metaphors in the Chinese political context. Results reveal that pandemic metaphors (45%) are not as widely used in news pictures as presumed, the vast majority (95%) are rendered in verbal mode, and the most salient metaphors used in news pictures are the UP/DOWN (spatial), WAR, FAMILY, and COMPETITION metaphors. This study then addresses how COVID-19 metaphors are used in the Chinese political context and claims that the Chinese government uses specific metaphors with persuasive and ideological functions. The WAR metaphor aids comprehension of abstract concepts of the pandemic treatment, the FAMILY metaphor fosters empathy among Chinese individuals to counter blame and discrimination in society, UP/DOWN (spatial) and COMPETITION metaphors stimulate action to overcome the common "enemy." WAR and FAMILY metaphors also contribute to the construction of a greater sense of collectivism and play a crucial role in fostering a positive national identity. Implications, limitations and some directions for future research are suggested.

The journey within: mental navigation as a novel framework for understanding psychotherapeutic transformation.

BACKGROUND: Despite the demonstrated efficacy of psychotherapy, the precise mechanisms that drive therapeutic transformations have posed a challenge and still remain unresolved. Here, we suggest a potential solution to this problem by introducing a framework based on the concept of mental navigation. It refers to our ability to navigate our cognitive space of thoughts, ideas, concepts, and memories, similar to how we navigate physical space. We start by analyzing the neural, cognitive, and experiential constituents intrinsic to mental navigation. Subsequently, we posit that the metaphoric spatial language we employ to articulate introspective experiences (e.g., "unexplored territory" or "going in circles") serves as a robust marker of mental navigation. METHODS: Using large text corpora, we compared the utilization of spatial language between transcripts of psychotherapy sessions (≈ 12 M. words), casual everyday conversations (≈ 12 M. words), and fictional dialogues in movies (≈ 14 M. words). We also examined 110 psychotherapy transcripts qualitatively to discern patterns and dynamics associated with mental navigation. RESULTS: We found a notable increase in the utilization of spatial metaphors during psychotherapy compared to casual everyday dialogues (U = 192.0, p = .001, d = 0.549) and fictional conversations (U = 211, p < .001, d = 0.792). In turn, analyzing the usage of non-spatial metaphors, we did not find significant differences between the three datasets (H = 0.682, p = 0.710). The qualitative analysis highlighted specific examples of mental navigation at play. CONCLUSION: Mental navigation might underlie the psychotherapy process and serve as a robust framework for understanding the transformative changes it brings about.

Metaphorical language and psychopathological symptoms: a case study of trauma victims' metaphor use.

BACKGROUND: While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019-2020 Hong Kong social unrest, this study explored the correlations between trauma victims' quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms. METHODS: Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20- to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants' SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective. RESULTS: The study reveals how metaphor usage patterns can reflect the speakers' differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns. CONCLUSION: This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.

I'm still me, I'm still a person: war metaphor use and meaning making in women with metastatic breast cancer.

PURPOSE: The war metaphor is one strategy used frequently in breast cancer to inspire individuals in a "fight" against cancer and assist patients in navigating their illness experience. Despite prominent use, the emotional impact of this language has not been examined in the context of meaning making among women with metastatic breast cancer (MBC). METHODS: This study involved a semi-structured interview considering the war metaphor's impact on women's illness experience with MBC. Participants (n = 22) had been diagnosed with MBC for at least 6 months or following 1 disease progression and were undergoing treatment at an NCI-designated cancer center in Western Pennsylvania at the time of interview. Each participant underwent an individual interview exploring the war metaphor's impact on illness experience. Qualitative thematic analysis was performed to assess feelings about the war metaphor and emotional response to the lived experience of cancer. RESULTS: Two themes were identified surrounding metaphor use and participants' experiences with meaning making in cancer. First, women with MBC perceive the diagnosis as an "unfair fight" due to its incurable nature. Second, patients use alternative language of "living life" and communicate resistance to being defined by their cancer diagnosis. CONCLUSION: War metaphors are one collection of terminology people use to understand their diagnosis. However, their use may apply pressure to prioritize positivity in the face of diagnosis and treatment, in a unique clinical context where this may not be adaptive. These findings affirm a need to consider patients' lived experiences to best facilitate psychological adjustment to illness.

Seatbelts and raincoats, or banks and castles: Investigating the impact of vaccine metaphors.

While metaphors are frequently used to address misconceptions and hesitancy about vaccines, it is unclear how effective they are in health messaging. Using a between-subject, pretest/posttest design, we investigated the impact of explanatory metaphors on people's attitudes toward vaccines. We recruited participants online in the US (N = 301) and asked them to provide feedback on a (fictional) health messaging campaign, which we organized around responses to five common questions about vaccines. All participants completed a 24-item measure of their attitudes towards vaccines before and after evaluating the responses to the five questions. We created three possible response passages for each vaccine question: two included extended explanatory metaphors, and one contained a literal response (i.e., no explanatory metaphors). Participants were randomly assigned to receive either all metaphors or all 'literal' responses. They rated each response on several dimensions and then described how they would answer the target question about vaccines if it were posed by a friend. Results showed participants in both conditions rated most messages as being similarly understandable, informative, and persuasive, with a few notable exceptions. Participants in both conditions also exhibited a similar small-but significant-increase in favorable attitudes towards vaccines from pre- to posttest. Notably, participants in the metaphor condition provided longer free-response answers to the question posed by a hypothetical friend, with different metaphors being reused to different extents and in different ways in their responses. Taken together, our findings suggest that: (a) Brief health messaging passages may have the potential to improve attitudes towards vaccines, (b) Metaphors neither enhance nor reduce this attitude effect, (c) Metaphors may be more helpful than literal language in facilitating further social communication about vaccines.

More than just a child: dental students' perceptions of children using a mixed-method approach.

It is important to understand perceptions of dental students towards children to better design relationship. This study aimed to determine and conceptualize dental students'perceptions of children. The study group consisted of 514 dental students who were asked to complete the statement "A child is like…, because…". The metaphors were sorted into conceptual categories and examined for any significant differences between gender, education level and occupational preference. Quantitative (metaphor analysis) and qualitative (chi-square) analyses were used. Participants produced 421 metaphors under 33 general metaphors. The metaphors were collected under five conceptual categories: children as (1) requiring care, attention and sensitivity; (2) raw material; (3) developing and changing; (4) unpredictable and surprisingly; and (5) hazard. The metaphors were mostly under the "developing and changing" category. There were no significant differences between the groups in terms of gender, education level and occupational preference. Female and clinical dental students mostly produced metaphors in the "requiring care, attention and sensitivity" and "developing and changing" categories, respectively. Metaphor analysis is a useful tool in determining dental students' perceptions. Understanding dental students' perceptions of children can be an important part of fostering positive perceptions in their professional life.

Investigation of nursing students' emotional states toward challenging situations in clinical practice and metaphorical perceptions of the concept of a nurse.

AIM: This study aims to determine nursing students' emotions toward the challenging situations they encounter in clinical practice and their metaphorical perceptions of the concept of a nurse. BACKGROUND: Challenging situations in clinical practice negatively affect nursing students' perceptions of the nursing profession and their professional learning and development. DESIGN: The study is based on quantitative, metaphorical and picture-drawing analysis. METHODS: The quantitative and qualitative parts of it were conducted with 200 nursing students attending their first and second years in the 2021-2022 academic year. The Draw a Picture of a Cactus Test was carried out with 30 students in clinical practice. The data were collected using the "Sociodemographic Information Form" and the "Semi-structured Interview Form". Content analysis techniques, descriptive statistics, picture analysis and psychological tests were used to evaluate the data. The study was reported based on Standards for Reporting Qualitative Research (SRQR). RESULTS: Nursing students involved in the study produced 37 metaphors related to the "concept of a nurse" and three most expressed ones were "mother, lifeguard and helper." The metaphors produced by nursing students were categorized under six roles: "caregiver, educator, supporter, researcher, administrator and therapeutic/rehabilitator". The pictures drawn by the students about the challenging situations in clinical practice and the expressions they used were associated with self-centeredness (n=21), being attentive (n=19), aggression toward peers (n=13), low motivation (n=11) and need for protection (n=11). Nursing students experienced feelings of loneliness, passivity and anxiety when navigating difficult conditions in clinical practice. CONCLUSIONS: Metaphors and picture drawing allow a unique approach to the concept of nursing and nursing students' emotional states toward challenging situations in their clinical practice.

Embracing beauty through leftward movements: An ERP study on metaphorical association between hand actions and aesthetic judgments.

In this study, we examined the metaphorical association between aesthetic judgments of faces and horizontal hand movements as well as their cognitive neural mechanisms using a joint categorical response task. In the "aesthetic-action" metaphorical representation situation, participants were asked to classify beautiful/ugly faces by moving the mouse to the left or the right. The results showed that the joint categorization condition "judge beautiful-move mouse left, judge ugly-move mouse right" had a shorter reaction time than the "judge beautiful-move mouse right, judge ugly-move mouse left" condition, which was accompanied by larger amplitudes of the early component N170, EPN, and the late component P300. Combining the behavioral and event-related potentials (ERPs) results, the present study demonstrated a metaphorical association between horizontal hand actions and aesthetic judgments. It suggested that horizontal hand actions can affect the speed of aesthetic judgments by influencing processing fluency, emotional arousal level, categorization motivation, and attentional resources. These findings provide new perspectives to better understand the cognitive process of aesthetic judgments and provide a basis for applying embodied cognition and metaphor theory to the field of aesthetic psychology.

The role of spatial words in the spatialisation of time.

Language about time is an integral part of how we spatialise time. Factors like temporal focus can be related to time spatialisation as well. The current study investigates the role of language in how we spatialise time, using a temporal diagram task modified to include the lateral axis. We asked participants to place temporal events provided in non-metaphorical, sagittal metaphorical, and non-sagittal metaphorical scenarios on a temporal diagram. We found that sagittal metaphors elicited sagittal spatialisations of time, whereas the other two types elicited lateral spatialisations. Participants sometimes used the sagittal and lateral axes in combination to spatialise time. Exploratory analyses indicated that individuals' time management habits, temporal distance, and event order in written scenarios were related to time spatialisations. Their temporal focus scores, however, were not. Findings suggest that temporal language plays an important role in how we map space onto time.

Women's Metaphors About BRCA Gene Testing and How They Can Inform Health Communication Theory and Practice.

Genetic testing can detect whether an individual carries a harmful variant in the BRCA1 or BRCA2 (Breast Cancer 1 or 2) gene which, if present, drastically increases a woman's risk for breast and ovarian cancer. The experience of BRCA gene testing can be an emotionally laden process yielding significant uncertainty. In this study, we examined women's experiences of BRCA gene testing by exploring how participants communicatively framed and made sense of this process through the use of metaphors. Comparing uncertain and unfamiliar experiences to familiar references through metaphor can help people in challenging health-related situations with sense-making and communicating complex emotions. Furthermore, metaphors can be employed as a therapeutic tool by health care professionals, but their use has not often been studied regarding experiences of genetic testing, including BRCA gene testing. We conducted in-depth interviews with 42 women who have undergone BRCA gene testing (regardless of results), and analyzed data using constant comparative techniques. Eight categories of metaphors that women used surrounding BRCA gene testing were evident in the data, including those related to (a) knowledge is power; (b) gambling; (c) a journey; (d) a rollercoaster; (e) battle, disaster, or wreckage; (f) Pandora's box or a can of worms; (g) doom and gloom; and (h) the release or placing of a weight. Results enhance our understanding of women's experiences related to the uncertainty-inducing process of BRCA gene testing and lead to valuable theoretical implications and practical recommendations, including regarding the potential use of metaphors in patient-provider communication about BRCA genetic risk.