Metaphors for patient education. A pragmatic-argumentative approach applying to the case of diabetes care

  • Maria Grazia Rossi
Keywords: metaphor, argumentation, patient education, diabetes, perspective change


The purpose of this article is to investigate metaphors as argumentative devices in the context of communication in chronic care and, more specifically, in diabetes care. While scholars have compellingly insisted on the strong cognitive power of metaphors in communication and education (BLACK 1962, BURGERS, KONIJN and STEEN 2016, GIORA 2003, HESSE 1963, LOW 2008, ORTONY 1975, STEEN 2008, 2011), these insights have barely received attention in the field of health communication (CASARETT et al. 2010, DEMJEN, SEMINO & KOLLER 2016; DEMMEN et al. 2015, NAIK et al. 2011). This article introduces the main theoretical and practical problems with respect to the relationship between metaphors and argumentation, in both fields of health communication and philosophy of language. We will adopt a pragmatic-argumentative model of verbal communication with the final aim to propose a theoretical framework useful to evaluate metaphors in clinical contexts. The theoretical step discussed in this article constitutes the preliminary phase of a larger research program – Metaphors for diabetes – devoted to test the educational aptness of diabetes metaphors, in order to propose them as evidence-based instruments to health providers for patient education.


ARISTOTELE (1966), Ars Rhetorica, in ROSS David (ed.), Clarendon Press, Oxford.

BALINT, Michael (1957), The Doctor, His Patient and the Illness, International Universities Press, Oxford.

BIGI, Sarah (2014a), «Key Components of Effective Collaborative Goal Setting in the Chronic Care Encounter», in Communication & Medicine, n. 11(2), pp. 103-115.

BIGI, Sarah (2014b), «Healthy Reasoning: The Role of Effective Argumentation for Enhancing Elderly Patients’ Self-Management Abilities in Chronic Care», in Studies in Health Technology and Informatics, n. 203, pp. 193-203.

BIGI, Sarah (2016), Communicating (with) care. A linguistic approach to the study of interactions in chronic care settings, IOS Press, Amsterdam.

BLACK, Max (1962), Models and metaphors, Cornell University Press, New York.

BURGERS, Christian, KONIJN, Elly A., STEEN, Gerard J. (2016), «Figurative Framing: Shaping Public Discourse Through Metaphor, Hyperbole, and Irony», in Communication Theory, vol. 26 (4), pp. 1-21.

CASARETT, David, PICKARD, Amy, FISHMAN, Jessica M., ALEXANDER, Stewart C., ARNOLD, Robert M., POLLAK, Kathryn I., TULSKY, James A. (2010), «Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?», in Journal of Palliative Medicine, n. 13 (3), pp. 255-260.

CHIAPPE, Dan L., KENNEDY, John M., CHIAPPE, Penny (2003), «Aptness is more important than comprehensibility in preference for metaphors and similes», in Poetics, n. 31 (1), pp. 51-68.

CUCCIO, Valentina (2016), «Embodiment and Persuasion. The communicative power of metaphors», in Rivista Italiana di Filosofia del linguaggio, F. PIAZZA & S. DI PIAZZA (eds.), Building consensus, pp. 53-65.

DAMERALL, Alison Whiteford, KELLOGG, Ronald T. (2016), «Familiarity and Aptness in Metaphor Comprehension», in The American journal of psychology, n. 129 (1), pp. 49-64.

DARWIN, Charles (1859), On the origin of the species by natural selection, Murray, London.

DEMJÉN, Zsófia, SEMINO, Elena, KOLLER, Veronika (2016), «Metaphors for ‘good’ and ‘bad’ deaths: A health professional view», in Metaphor and the Social World, n. 6 (1), pp. 1-19.

DEMMEN, Jane, SEMINO, Elena, DEMJÉN, Zsófia, KOLLER, Veronika, HARDIE, Andrew, RAYSON, Paul, PAYNE, Sheila (2015), «A computer-assisted study of the use of Violence metaphors for cancer and end of life by patients, family cares and health professionals», in International Journal of Corpus Linguistics, n. 20 (2), pp. 205-231.

ENGEL, George L. (1980), «The Clinical Application of the Biopsychosocial Model», in The American Journal of Psychiatry, n. 137 (5), pp. 535-544.

ENTMAN, Robert M. (1993), «Framing: Toward clarification of a fractured paradigm», in Journal of Communication, n. 43 (4), pp. 51-58.

ERVAS, Francesca, GOLA, Elisabetta, ROSSI, Maria Grazia (2014), «Ragionare con il corpo. Il ruolo delle metafore e delle emozioni nel ragionamento» in NeaScience, M. CRUCIANI and A. REGA (eds.), Proceedings of Annual meeting of Aisc-Codisco “Corpi, strumenti e cognizione” [Bodies, Tools and Cognition], pp. 141-143,

ERVAS, Francesca, GOLA, Elisabetta, ROSSI, Maria Grazia (2015), «Metaphors and Emotions as Framing Strategies in Argumentation», in CEUR-WS, vol. 1419, pp. 645-650.

ERVAS, Francesca, GOLA, Elisabetta, LEDDA, Antonio, SERGIOLI, Giuseppe (2015), «Lexical Ambiguity in Elementary Inferences: an Experimental Study», in Discipline Filosofiche, n. 35 (1), pp. 149-172.

ERVAS, Francesca, GOLA, Elisabetta, ROSSI, Maria Grazia (2016a), «Come affinare le armi della seduzione: emozioni e vigilanza epistemica» in Rivista Italiana di Filosofia del linguaggio, RIFL/SFL(2015), pp. 38-52.

ERVAS, Francesca, GOLA, Elisabetta, ROSSI, Maria Grazia (2016b), «Argomenti metaforici: come integrare persuasione e argomentazione», in Rivista Italiana di Filosofia del linguaggio, F. PIAZZA & S. DI PIAZZA (eds.), Building Consensus, pp. 116-128.

ERVAS, Francesca, MONTIBELLER, Marcello, ROSSI, Maria Grazia, SALIS, Salis (forthcoming), «Expertise and metaphors in health communication», in Medicina & Storia.

GENTNER, Dedre (1982), Are scientific analogies metaphors?, in MIALL David S. (ed.), Metaphor: Problems and perspectives, Harvester Press, Brighton, pp. 106-132.

GENTNER, Dedre (1989), The mechanisms of analogical learning, in VOSNIADOU Stella, ORTONY Andrew (eds.), Similarity and analogical reasoning, Cambridge University Press, Cambridge, pp. 199-241.

GIBBS, Raymond W. (2008), The Cambridge handbook of metaphor and thought, Cambridge University Press, Cambridge.

GIORA, Rachel (2003), On our mind: Salience, context, and figurative language, Oxford University Press, Oxford.

GREGORY, Monica E., MERGLER, Nancy L. (1990), «Metaphor comprehension: In search of literal truth, possible sense, and metaphoricity», in Metaphor and Symbolic Activity, n. 5, pp. 151-173.

HAUSER, David J., SCHWARZ Norbert (2015), «The War on Prevention: Bellicose Cancer Metaphors Hurt (Some) Prevention Intentions», in Personality and Social Psychology Bulletin, n. 41 (1), pp.66-77.

HESSE, Mary B. (1963), Models and analogies in science, Sheed and Ward, London.

KATZ, Albert N. (1989), «On choosing the vehicles of metaphors: Referential concreteness, semantic distances, and individual differences», in Journal of Memory and language, n. 28 (4), pp. 486-499.

KECSKES, Istvan, ZHANG, Fenghui (2009), «Activating, seeking, and creating common ground: A socio-cognitive approach», in Pragmatics & Cognition, n. 17 (2), pp. 331-355.

KEEFER, Lucas A., LANDAU, Mark J., SULLIVAN, Daniel, ROTHSCHILD, Zachary K. (2014), «Embodied Metaphor and Abstract Problem Solving: Testing a Metaphoric Fi T Hypothesis in the Health Domain», in Journal of Experimental Social Psychology, n. 55, pp. 12-20.

LAKOFF, George (1992), The contemporary theory of metaphor, in ORTONY Andrew (ed.), Metaphor and Thought, Cambridge University Press, Cambridge.

LAKOFF, George (2008), The political mind: A cognitive scientist’s guide to your brain and its politics, Penguin.

LAKOFF, George (2014), The All New Don’t Think of an Elephant!: Know Your Values and Frame the Debate, Chelsea Green Publishing.

LAKOFF, George, JOHNSON, Mark (1989), Metaphors we live by, University of Chicago Press, Chicago.

LEVIN, Samuel R. (1982), «Aristotle’s theory of metaphor», in Philosophy & Rhetoric, n. 15 (1), pp. 24-46.

MACAGNO, Fabrizio (2016), Presupposition as Argumentative Reasoning in CAPONE Alessandro, MEY Jacob L. (eds.), Interdisciplinary Studies in Pragmatics, Culture and Society, Springer, New York, pp. 465-487.

MACAGNO, Fabrizio, ZAVATTA, Benedetta (2014), «Reconstructing Metaphorical Meaning», in Argumentation, n. 28 (4), pp. 453-488.

MOULD, Tracy J., OADES, Lindsay G., CROWE, Trevor P. (2010), «The Use of Metaphor for Understanding and Managing Psychotic Experiences: A Systematic Review», in Journal of Mental Health, n. 19 (3), pp. 282-293.

NAIK, Aanand D., TEAL, Cayla R., RODRIGUEZ, Elisa, HAIDET, Paul (2011), «Knowing the ABCs: A comparative effectiveness study of two methods of diabetes education», in Patient education and counseling, n. 85 (3), pp. 383-389.

ORTONY, Andrew (1975), «Why Metaphors Are Necessary and Not Just Nice», in Educational theory, n. 25 (1), pp. 45-53.

OSWALD, Steve, RIHS, Alain (2014), «Metaphor as argument: Rhetorical and epistemic advantages of extended metaphors», in Argumentation, n. 28 (2), pp. 133-159.

PEXMAN, Penny M., FERRETTI, Todd R., KATZ, Albert N. (2000), «Discourse factors that influence irony detection during on-line reading», in Discourse Processes, n 29, pp. 201-222.

PATERSON, Barbara, SALLY, Thorne, DEWIS, Marilyn (1998), «Adapting to and Managing Diabetes», in Journal of Nursing Scholarship, n. 30 (1), pp. 57-62.

PILGRAM, Roosmaryn (2015), A doctor’s argument by authority: An analytical and empirical study of strategic maneuvering in medical consultation, PhD Dissertation, University of Amsterdam.

ROSSI, Maria Grazia (2014), «Emozioni e deliberazione razionale», in Sistemi Intelligenti, n. 1, pp. 161-170.

ROSSI, Maria Grazia, MACAGNO, Fabrizio, BIGI Sarah (2016a), Metaphors for diabetes: A method of analysis and classification. Abstract accepted at 11th International Conference of the Association for Researching and Applying Metaphor “Metaphor in the Arts, in Media and Communication”, Freie Universität Berlin, Germany, 1-4/07/2016.

ROSSI, Maria Grazia, MACAGNO, Fabrizio, BIGI Sarah (2016b), The Role of Metaphors in Understanding and Reasoning in Medical Encounters. Abstract accepted at the 14th International Conference on Communication in Healthcare, The University Conference Centre, Heidelberg, 7-10/09/2016.

SCHERER, Aaron M., SCHERER, Laura D., FAGERLIN, Angela (2015), «Getting Ahead of Illness: Using Metaphors to Influence Medical Decision Making», in Sage Journals, n. 35, pp. 37-45.

SCHEUFELE, Dietram (1999), «Framing as a theory of media effects», in Journal of Communication, n. 49 (1), 103-122.

SCHWARZ Baruch B., ASTERHAN Christa S. (2010), Argumentation and reasoning in LITTLETON Karen, WOOD Clare, STAARMAN Judith K. (eds.) International handbook of psychology in education, Emerald, England, pp. 137-176.

SOPORY, Pradeep, DILLARD, James Price (2002), «The persuasive effects of metaphor: A meta-analysis», in Human Communication Research, n. 28 (3), pp. 382-419.

SPERBER, Dan, MERCIER, Hugo (2011), «Why do humans reason? Arguments for an argumentative theory», in Behavioral and brain sciences, n. 34 (02), pp. 57-74.

SPERBER, Dan, WILSON, Deirdre (1986), Relevance: Communication and cognition, Harvard University Press, Cambridge (MA).

SPERBER, Dan, WILSON, Deirdre (2008), A deflationary account of metaphors» in The Cambridge handbook of metaphor and thought, Cambridge University Press, Cambridge, pp. 84-105.

STEEN, Gerard (2011), «From three dimensions to five steps: The value of deliberate metaphor», in, n. 21, pp. 83-110.

STEEN, Gerard (2008), «The paradox of metaphor: Why we need a three-dimensional model of metaphor», in Metaphor and Symbol, n. 23 (4), pp. 213-241.

STREET, Richard L., MAKOUL, Gregory, ARORA, Neeraj K., EPSTEIN, Ronald M. (2009), «How Does Communication Heal? Pathways Linking Clinician-Patient Communication to Health Outcomes», in Patient Education and Counseling, n. 74 (3), pp. 295-301.

THIBODEAU, Paul H., BORODITSKY, Lera (2011), «Metaphors we think with: The role of metaphor in reasoning», in PloS one, n. 6 (2).

THIBODEAU, Paul H., BORODITSKY, Lera (2013), «Natural language metaphors covertly influence reasoning», in PloS one, n. 8 (1).

TOURANGEAU, Roger, RIPS, Lance (1991), «Interpreting and evaluating metaphors», in Journal of Memory and Language, n. 30 (4), pp. 452-472.

WALTON, Douglas (1996), Argumentation Schemes for Presumptive Reasoning, Routledge, New York.

WALTON, Douglas, REED, Christopher, MACAGNO, Fabrizio (2008), Argumentation schemes, Cambridge University Press, Cambridge.

WORLD HEALTH ORGANIZATION (2007), The world health report 2007: a safer future: global public health security in the 21st century,

r/2007/whr07_en.pdf?ua=1 [Accessed 20 December 2016].

YOUNGSON, Annabel, COLE, Fiona, WILBY, Helen, COX, Diane (2015), «The Lived Experience of Diabetes : Conceptualisation Using a Metaphor», in The British Journal of Occupational Therapy, n. 78 (1), pp. 24-32.

How to Cite
Rossi, M. G. (1) “Metaphors for patient education. A pragmatic-argumentative approach applying to the case of diabetes care”, Rivista Italiana di Filosofia del Linguaggio, 10(2). Available at: (Accessed: 14June2024).