Metaphors are commonly considered as cognitive and linguistic tools making the acquisition of new knowledge possible (Ortony 1975; Cameron 2002; Hesse 1966). Recently, metaphors have been investigated as tools to improve patient understanding and foster their self-management skills (Semino et al. 2018; Naik et al. 2011; Bleakley 2017). However, the conditions under which such communicative effects of metaphors are carried out are still controversial.

A study conducted in the context of diabetes care has shown a correlation between metaphors and misunderstandings. It has been argued that the prior contexts of experience encapsulated in the meaning of metaphorical expressions could be unshared between patients and providers, and this could explain the cases of problematic understandings (AUTHORS). Configuring medical interactions as strongly asymmetrical in nature (Bigi 2016; Macagno & Bigi 2017), AUTHORS have hypothesized that the lack of a pre-existing common ground shared by the interlocutors could make the reconstruction of metaphorical meanings more difficult. Patients and providers may have interpreted metaphorical expressions according to different background knowledge and different previous contexts of usage, which would explain the mismatch of understanding leading to misunderstandings.

The goal of this paper is to check the robustness of this hypothesis by adopting the dynamic and stratified view of common ground used within the Socio-Cognitive Approach (SCA) (Kecskes & Zhang 2013; Kecskes 2008; Kecskes 2010). The SCA is used to analyze 46 medical interviews (Bigi 2014) in which metaphors have been detected as triggers of problematic understanding. Results are expected to provide dialogical patterns indicating that patients and providers are assuming too much unshared knowledge, because of the effect of attention driven by salience (Kecskes 2013). It is argued that these asymmetrical interactions are characterized by an impoverished core common ground, which reduces amount of information that providers can take for granted.

In similar ways as in intercultural interactions (Kecskes 2015), the analysis of such a corpus shows that metaphorical conventionalized language – interpreted as frozen repository of knowledge – becomes problematic, although interlocutors share the same L1. Practical implications are discussed, especially in relation to the implementation of communicative instruments helping providers to (1) adopt a more conscious approach to what is said and (2) promote the co-construction of the emergent common ground with patients.

 

References

Bigi, Sarah. 2014. Healthy Reasoning: The Role of Effective Argumentation for Enhancing Elderly Patients’ Self-management Abilities in Chronic Care. Studies in health technology and informatics 203. Netherlands. 193–203.

Bigi, Sarah. 2016. Communicating (with) care: a linguistic approach to doctor-patient interactions. Amsterdam: IOS Press.

Bleakley, Alan. 2017. Thinking with Metaphors in Medicine: The State of the Art. New York: Routledge.

Cameron, Lynne. 2002. Metaphors in the learning of science: A discourse focus. British Educational Research Journal 28(5). Taylor & Francis. 673–688.

Casarett, David, Amy Pickard, Jessica M Fishman, Stewart C Alexander, Robert M Arnold, Kathryn I Pollak & James A Tulsky. 2010. Can metaphors and analogies improve communication with seriously ill patients? Journal of palliative medicine 13(3). United States. 255–260. doi:10.1089/jpm.2009.0221.

Hesse, Mary. 1966. Models and analogies in science. Notre Dame: University of Notre Dame Press.

Kecskes, Istvan. 2006. Formulaic language in English Lingua Franca Istvan Kecskes. (1). 1–28.

Kecskes, Istvan. 2008. Dueling contexts: A dynamic model of meaning. Journal of Pragmatics 40(3). 385–406. doi:10.1016/j.pragma.2007.12.004.

Kecskes, Istvan. 2010. The paradox of communication: Socio-cognitive approach to pragmatics. Pragmatics and Society 1(1). 50–73. doi:10.1075/ps.1.1.04kec. http://www.jbe-platform.com/content/journals/10.1075/ps.1.1.04kec.

Kecskes, Istvan. 2013. Intercultural pragmatics. Oxford: Oxford University Press.

Kecskes, Istvan. 2015. Intracultural communication and intercultural communication: Are they different? International Review of Pragmatics 7. 171–194. doi:10.1163/18773109-00702002.

Kecskes, Istvan. 2016. Can Intercultural Pragmatics Bring Some New Insight into Pragmatic Theories? In Jacob Mey & Alessandro Capone (eds.), Interdisciplinary Studies in Pragmatics, Culture and Society, 43–69. Cham: Springer.

Kecskes, Istvan & Fenghui Zhang. 2013. On the Dynamic Relations Between Common Ground and Presupposition. In Alessandro Capone, Franco Lo Piparo & Marco Carapezza (eds.), Perspectives on Linguistic Pragmatics, Perspectives in Pragmatics, Philosophy & Psychology 2, 375–395. Cham: Springer. doi:10.1007/978-3-319-01014-4_15.

Macagno, Fabrizio & Sarah Bigi. 2017. Understanding misunderstandings. Presuppositions and presumptions in doctor-patient chronic care consultations. Intercultural Pragmatics 14(1). 49–75. doi:10.1515/ip-2017-0003. http://www.degruyter.com/view/j/iprg.2017.14.issue-1/ip-2017-0003/ip-2017-0003.xml.

Naik, Aanand D, Cayla R Teal, Elisa Rodriguez & Paul Haidet. 2011. Knowing the ABCs: a comparative effectiveness study of two methods of diabetes education. Patient education and counseling 85(3). Ireland. 383–389. doi:10.1016/j.pec.2011.01.010.

Ortony, Andrew. 1975. Why Metaphors Are Necessary and Not Just Nice. Educational Theory 25(1). 45–53. doi:10.1111/j.1741-5446.1975.tb00666.x. http://doi.wiley.com/10.1111/j.1741-5446.1975.tb00666.x.

Semino, Elena, Zsofia Demjen, Andrew Hardie, Sheila Alison Payne & Paul Edward Rayson. 2018. Metaphor, Cancer and the End of Life: A Corpus-based Study. Routledge.