Anita Wohlmann and Birgit Bundesen introduce us to the ‘Metaphor Map’- a way to help those express, listen to, and create meaning out of psychic experience.
Metaphors are an important part of everyday speech. Consider the heart attack or the stabbing pain. Such metaphors often go unnoticed in clinical settings because they have become so normalised. When people with illness experiences cannot find the words to describe what they feel—because of shame, stigma, or experiences that are hard to explain—they use images and comparisons to communicate. A patient might say: “My thoughts are like a spiderweb” or “My mind is like a jigsaw puzzle.” Paying attention to these metaphors is practical clinical work. Metaphors offer clues for diagnosis, help build mutual understanding, and can even be useful as a therapeutic tool.
In times of crisis, metaphors can be unusually vivid, strange, or poetic. A mild depression, for example, has been likened to something that undermines a person “the way rust weakens iron,” and, by extension, a major depression is then something that makes the whole structure collapse (Conway 90-91, 2013). Rather than dismissing them as mere decoration or automatically labeling them as symptoms, health care professionals can treat these expressions as meaningful attempts to make sense of overwhelming, often painful experiences, and listen to them for the insights they offer.
Why a metaphor map?
The team behind the project we present below developed the Metaphor Map for Psychiatric Experiences to draw attention to such metaphors and make them accessible and usable for patients, health care professionals, educators, and families. The map is based on the REWRITALIZE project, a 15-week recovery-oriented creative writing intervention at the Center for Art and Mental Health in Copenhagen. REWRITALIZE consists of a series of participatory creative writing groups led by authors in collaboration with mental health care professionals. The writing groups are offered to all service users as an adjuvant to their psychiatric treatment (Bundesen et al 2024), and the interventions have demonstrated positive clinical results with improvement of alexithymia (difficulty identifying and describing emotions), mentalisation, and psychotic-like experiences for people suffering from schizophrenia (Henningsson et al 2024a, 2024b).
The metaphor map is based on over 3,000 pages of interviews with participants from the REWRITALIZE project. In these interviews, people with psychiatric experiences repeatedly used metaphors, which inspired the multidisciplinary team behind the metaphor map (with backgrounds in psychiatry, literary studies and poets with lived experience) to create a metaphor catalogue. Inspirations also came, among others, from Elena Semino’s 2019 “Metaphor Menu for People Living with Cancer,” which is a free brochure based on her research on the language people use for describing illness experiences.
The initial idea of a catalogue transformed during the process of re-reading and selecting the metaphors used. Many of the metaphors referenced natural spaces and animals. The idea of a landscape and a metaphor map thus emerged. Our Map organises a selection of striking metaphors into a visual, navigable resource (including a legend, coordinates, pathways) which can be explored intuitively, playfully, and creatively. Upon closer look, the map references a figurative landscape, a dreamscape.
Who is this map for?
In designing the map, we had a wide range of users in mind. Patients or people experiencing psychic distress can learn about other people’s experiences and feel a sense of recognition. They may also be inspired to develop new metaphors themselves. Perhaps they will feel seen in their struggle to express their experiences. Individuals can also see the variety of experiences, which may empower them to use their own metaphors or perhaps borrow from others.
Since we published the map in spring 2026, we have learned of one person who took a printed version of the map to a consultation with their psychiatrist. We do not know the motivations of this person, and we can only assume that, through its tangible form, the metaphor map functioned like a piece of evidence. We imagine the person thinking (or maybe saying): ‘What I’m experiencing is not only in my head; it’s real. Others experience it, too.’
Healthcare professionals can use the map tobe inspired and, maybe, adjust the language they use with patients. The map encourages them to be attentive to patients’ expressions, and recognise the struggle and sense of beauty the metaphors convey. They may feel inspired to juxtapose this insight with their diagnostic and therapeutic view. Research shows that doctors who use multiple metaphors in their conversations with patients are experienced as better communicators (Casarett et al, 2010). Other researchers have suggested that attention to the idiosyncratic metaphors expressed by patients can help develop a common language between them and their health care professional (Harrington 2012). In a literary context, this line of thinking has manifested in a Danish collection of poems Smerte-Hjerte (Rieder and Bundesen 2023), in which a poet suffering from schizophrenia develops a metaphoric language together with a psychiatrist, thereby transforming or poeticising so-called psychopathological symptoms into a common discourse (Ibid). Of course, family members and friends, too, can use the metaphor map.
When printed, the map can be shared as a brochure alongside other brochures used for patient information in the clinic. It can also be hung as a poster for practical use and for decoration.
How can the map be used in medical education?
The pedagogical usefulness of the map was tested in spring 2026 in a compulsory Narrative Medicine course in the first year of the medical programme at the University of Southern Denmark. In a 2-hour session, students were introduced to research on metaphors in health care contexts and they were invited to critically evaluate a metaphor used by healthcare professionals in a clinical ethics case. The aim was to raise awareness of the importance of language in clinical encounters and encourage nuanced dialogue. Caring for patients means also caring for language. The university’s current ‘Writer in Residence’, Anna Rieder, who is also a poet with lived illness experience, then introduced students to the metaphor map and facilitated a reflective writing exercise. The prompt was as follows:
| Choose 1 metaphor from the map that particularly speaks to you. Choose a role (e.g. patient, doctor, nurse, family member or friend) and write from this perspective. Tell a story about this metaphor and what it might mean. |
Some students found this exercise challenging, because they have had no experience with psychiatric conditions, whilst others started writing immediately. The open prompt was interpreted in a variety of way. Students wrote from the perspective of someone using the metaphor and expanded it with their own words and interpretations. Or they imagined a doctor-patient conversation in which the metaphor of their choice was used. Others took a more analytical approach and examined the possible meanings of their metaphor. Students also commented on limitations and problematic dimensions of a metaphor and its meanings, for example when a metaphor might put blame on a patient lock a dynamic experience into a single fixed image.
Some students prefaced their texts by sharing their own personal experiences with psychiatric illnesses and how these had influenced their writing. We share one of the responses in the textbox below. The student allowed us to include this and preferred to be named.
A response to the metaphor: “My mind is like a jigsaw puzzle that never fits together, and I’m always missing some pieces. It was difficult to reconcile oneself to that; I’m constantly searching for the missing pieces.”
I broke into pieces many years ago. As a little girl.
I have often felt like that shattered glass, where the splinters are so small that they no longer fit together.
Impossible to repair.
There’s a lot one can do to hold oneself together for a while.
Glue. Tape. Pure and simple manual labor.
Still, it always ended with me breaking again.
There just wasn’t anyone who could see it.
On the outside, the resourceful patient can fool everyone around them.
On the inside, I was crushed.
How does one go on living a life, when one keeps feeling deficient?
How does one exist in the world, when one will never be whole?
by Thea Juel Frederiksen, translated by Anita Wohlmann and Thea Juel Frederiksen.
Is the map free?
The digital version of the map is free for download from our website. It is available in English and in Danish. The map can be printed and folded as a brochure or hung as a poster.
The fact that the map is free and open access was made possible through the Discovery Grant, a funding instrument at the University of Southern Denmark that supports innovative ideas and the development of service-based products built on previous research.
If you would like to translate the metaphor map into a different language or use the idea of the metaphor map for other illness experiences, please get in touch with Anita or Birgit to explore the options.
The Metaphor Map was designed by Andreas Korsgaard Rasmussen (www.sandandclay.dk).
About the authors
Anita Wohlmann is associate professor in contemporary anglophone literature at the University of Southern Denmark, Odense, where she also teaches medical students in a compulsory Narrative Medicine course.
Birgit Bundesen is psychiatrist, senior consultant, researcher, poet and founder of the Danish Center for Arts and Mental Health.
References
Bleakley, Alan. 2017. Thinking with Metaphors in Medicine: The State of the Art. Routledge.
Bundesen, B et al. 2023: REWRITALIZE: Participatory creative writing groups led by authors in collaboration with mental health care professionals for people experiencing severe mental illness. Nordic Journal of Arts, Culture and Health, 2, 140–147.
Bundesen, B., Brestisson, J.T., & Rosenbaum, B. (Eds.). 2024. Kunsten at komme sig. REWRITALIZE – skrivegrupper i psykiatrien. Forlaget KLIM.
Casarett D, et al. 2010. Can metaphors and analogies improve communication with seriously ill patients? Journal of Palliative Medicine. 13: 255-60.
Conway, Kathleen.2013. Beyond Words: Illness and the Limits of Expression. University of New Mexico Press.
Harrington, Kristine. 2012. ‘The Use of Metaphor in Discourse About Cancer: A Review of the Literature.’ Clinical Journal of Oncology Nursing.
Henningsson, S., Brestisson, J.T., Printzlau, G.A., Rosenbaum, B., Bundesen, B. 2024. Arts and mental health: Assessment of changes in self-reported wellbeing, psychotic-like experiences, mentalisation, and self-efficacy for persons with schizophrenia spectrum disorders participating in the creative writing group intervention REWRITALIZE. Nordic Journal of Psychiatry. https://doi.org/10.1080/08039488.2024.2423761
Henningsson, S., Brestisson, J.T., Bjørkedal, S.-T.B., Bundesen, B., Nielsen, K.S., Ebersbach, B.E., Hjorthøj, C., Eplov, L.F. 2024b. REWRITALIZE your recovery: A study protocol for a randomized controlled clinical trial examining the effectiveness of the recovery-oriented creative writing group intervention REWRITALIZE for people suffering from severe mental illness. BMC Psychiatry, 24, 89.
Rieder, Anna and Birgit Bundesen. Smerte-Hjerte. Poems. Gyldendal 2022.
Scarry, Elaine. 1985. The Body in Pain: The Making and Unmaking of the World. Oxford University Press.
Semino, Elena. 2019. A ‘Metaphor Menu’ for People Living With Cancer. Lancaster
University. https://wp.lancs.ac.uk/melc/the-metaphor-menu/
Further Resources
Wohlmann, Anita. 2022. Metaphor in Illness Writing: Fight and Battle Reused. Edinburgh UP. Open access.
The description of the metaphor map seems to begin from a presupposition that psychiatric illness exists and developing language and metaphor bridges will help. For the other who has accepted the supremacy of psychiatric knowing, it offers steps for a bridge with those clinicians who participate. Embodying that bridge still puts more weight on the person who has been hard to “decipher” without diagnostic codes. Structures that shame “for the good of the othered,” often form hard to permeate walls. Hearing experience is a gift. When maps instruct how to open hearts and minds, it may be valuable, and when it’s constructed on basic blocks of assumption that the language of suffering that’s hard to see, hear, and measure must be attributed to an individual pathological difference. Risking connection when one has been harmed, wounded, othered, still places value on those authorized for “healing.” The psychiatric presupposition maintains the illness of the “other” instead of questioning the sources of suffering and learning with those harmed. The power to name is relational. Social conditions, cultures, beliefs, and values that separate to “help” by fixing labels on beings who use different metaphors constructs “others,” and then the authorized need maps to develop recognition that translation will help the authorized and may offer steps toward understanding the other. This is useful for those others who have internalized the psychiatric presupposition. Scar tissue may strengthen the individuals without addressing the baked in harm from the foundational lens that places soul, emotional, and ancestral wounding (effects )in the other without questioning their origins. Communal healing with equity is generated when we open to the metaphors and languages to locate paths that value, celebrate and grow metaphors of freedom and enoughness that includes all. Shaming doesn’t support communal wholeness. Moral injury from any role or social locations is an effect. Questioning presuppositions liberates and can co-created languages. Queering, opening, listening, loving…
xThis is a fascinating and conceptually rich article exploring the idea of “metaphor maps” and how visual and cognitive mapping techniques can help structure complex ideas in a more intuitive and accessible way. The discussion connects language, cognition, and visualization, showing how metaphors are not just linguistic tools but also frameworks for understanding relationships between abstract concepts.
At https://www.life1carehome.com/, we deeply appreciate how such interdisciplinary thinking can also be applied to healthcare and caregiving. In homecare and eldercare settings, clear communication and meaningful interpretation of patient experiences are essential. Using metaphorical and visual frameworks can sometimes help caregivers better understand complex emotional, psychological, and clinical conditions, ultimately improving empathy and care quality.
The article also highlights how mapping abstract relationships can enhance knowledge sharing, which is highly relevant in healthcare education, communication, and patient-centered care design.