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Metaphor and metonymy in psychiatry

Author: Helga Mannsåker


Psychiatry is a branch of medicine whose research «objects» are disorders of the mind. One of the challenges psychiatrists face is that the functions and dysfunctions of the mind are not directly observable or objectively measureable – there are no blood tests, x-rays or brain scans for diagnosing mental disorders. Furthermore, the line between normality and abnormality (and between different mental disorders) is not easy to draw. The diagnostic manuals DSM and ICD present classifications and guidelines, but these are constantly debated and changed. The cause and manner of development of most mental disorders are still more or less unknown.

How does one talk about such elusive topics? One uses metaphor and metonymy. Psychiatric expert terms are often metaphoric and/or metonymic in nature.

Let me give you some examples.

We often talk about SADNESS as feeling DOWN. This metaphor is present in the term depression, from Latin deprimere ‘press down’. The term is also metonymic, because it refers to the cause/disorder (the agent “pressing the person down”) by means of the effect/symptom (the person is “pressed down”).

Mania, from Greek mania ‘rage’, is another example of a metonymic term where the cause/disorder (the agent “enraging” the person) is referred to by means of the effect/symptom (the person is “enraged”).

Mania is characterized by increased activity, rapid speech, increased self-esteem etc. and thus considered the exact opposite of depression, hence the term bipolar disorder, which is the new name for manic depression. While depression is DOWN, mania is UP. It is not uncommon to see bipolar disorder illustrated by means of a graph with ‘mood’ on the vertical axis and ‘time’ on the horizontal axis, with “normal” mood placed around zero, i.e. in-between mania and depression. See for example this article: These illustrative graphs are consistent with the metaphors DEPRESSION IS DOWN and MANIA IS UP because the higher up on the vertical axis, the more severe is the mania, and the lower down, the more severe is the depression.

Schizophrenia, from Greek skhizein ‘to split’ and phren ‘mind’ is also a metaphoric and metonymic term. According to Berrios et al. (2003) the so-called “Splitting metaphor” was popular in the 19th century as an explanatory model for deviant behaviour. The term schizophrenia, Freud’s theory on splitting of the ego as a defence mechanism, and Robert Louis Stevenson’s book Strange Case of Dr Jekyll and Mr Hyde are some of the remnants of this model. Eugen Bleuler, the Swiss psychiatrist who coined the term schizophrenia, believed that the fundamental symptom of the disorder was what he called “Spaltung der psychischen Funktionen”. The term schizophrenia thus refers to the cause/disorder (the agent “splitting the person’s mind”) by means of the postulated effect (the person’s mind is “split”).

These were just some of the examples of metaphor and metonymy in psychiatric expert language that I have investigated in my research.

Now that I have overcome my anxiety (from Latin angere ‘to choke’) and phobia (from Greek phobos ‘flight’) related to writing a blog post in English, I pass the blog baton over to the co-chair of MetNet Scandinavia, Linda Greve.


Berrios, G. E., Luque, R., & Villagrán, J. M. (2003). Schizophrenia: A Conceptual History. International Journal of Psychology and Psychological Therapy, 3(2), 111-140.

Bleuler, E. (1908). Die Prognose der Dementia Praecox (Schizophreniegruppe). Allgemeine Zeitschrift für Psychiatrie und psychisch-gerichtliche Medizin, fünfundsechzigster Band, 436-464.

Grande, B., Birmaher & Vieta. (2015). Bipolar disorder. Lancet, 387(10027), 1561-1572.


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