Transforming Mental Health Care with Cultural Narratives and Metaphors

In an influential paper, Laurence Kirmayer explores how cultural narratives and metaphors shape our experience of mental health and recovery.


In a groundbreaking academic article, Laurence J. Kirmayer, a leader in the field of cultural psychiatry from McGill University’s Division of Social & Transcultural Psychiatry, calls for a fundamental shift in how we understand mental health.

His paper, “Cultural Poetics of Illness and Healing,” advocates for an approach deeply rooted in the psychological humanities, exploring the complex interplay between language, metaphor, and the healing process.

“Our own self-understanding through metaphors and narrative constructions plays a key role both in internal regulation and in engagement with our social environments, which are largely constituted by ongoing interactions with others. The language we have available to articulate and express our experience changes the very nature of that experience. This is the case even for seemingly obdurate experiences of pain and suffering, no less than for the stories we borrow or invent to carry on our lives and project ourselves into new and better circumstances,” Kirmayer writes.
“The implication is that an adequate picture of the emergence of illness experience and its transformation through healing practices must lay bare the embodied processes of imagination as well as the social processes of self-construal and positioning through pragmatic, material, and discursive engagements with the cultural affordances that constitute our local worlds and niches. While much of this process of meaning-making is organized by and communicated through narratives, metaphors play a central role in efforts to make sense of symptoms and suffering for both patients and healers.”

At the heart of Kirmayer’s research is the idea that our understanding and experience of mental health are significantly shaped by the cognitive science of language and metaphor, combined with cultural influences. This approach highlights the crucial role of metaphors in both expressing and comprehending mental health issues. By delving into the concept of ‘poiesis’ — the act of creation through language — Kirmayer illustrates how our worldviews and methods of coping with suffering are intricately crafted through this process.

Kirmayer’s work reveals how individual and collective narratives, deeply ingrained in cultural history and community, crucially influence our experiences, expressions, and healing from mental and emotional distress. He argues that metaphors, deeply embedded in our cultural and personal backgrounds, shape how we perceive and articulate mental health challenges. These metaphors act as cognitive tools, providing new perspectives on familiar situations and influencing our thoughts and actions.

The article by Kirmayer presents a unique perspective on how language, particularly metaphor, plays a critical role in our comprehension and experience of mental health. According to Kirmayer, language is not just a means of communication but a tool through which we shape our understanding of illness and healing. The article discusses the concept of ‘poiesis’ – the act of creation through language, which he believes is instrumental in shaping our lifeworlds, allowing us to express our suffering and seek recovery.

It emphasizes that each culture has a unique language of suffering with its own metaphors rooted in specific histories, geographies, and communities. The article’s core argument is that metaphors play a central role in understanding and responding to mental health challenges. Metaphors are bridges that connect our physical experiences and emotions with more complex concepts. It is not just semantic but a complex process where metaphors can evolve and generate new meanings, influencing our thoughts and actions.

For example, metaphors can transform how we view certain experiences or emotions, giving them new connotations and implications. They can serve as cognitive tools, providing new perspectives on familiar situations and thus shaping our understanding and actions. Kirmayer believes that this process of metaphorical thinking is crucial in psychiatry and psychology as it affects both the patient’s and therapist’s understanding of the illness and recovery.

In exploring the ‘cultural poetics’ of illness, Kirmayer emphasizes the importance of metaphoric embodiment, demonstrating the interconnectedness of physical and discursive processes in our health experiences. Drawing from 4E cognitive science, he shows a reciprocal relationship between our bodily states, cognition, and the social discourse we partake in.

Kirmayer argues that active inference plays a crucial role in our linguistic processes by helping us predict future scenarios and imagine possible situations, which in turn helps us navigate the social world. However, he notes that computational models of metaphor in active inference do not fully capture the richness of meanings that are derived from cultural histories and contexts.

Kirmayer also addresses the shift in the DSM-5 from the notion of culture-bound syndromes to cultural concepts of distress, highlighting the complexity of symptom experience. He explores how cultural explanations of illness often rely on metaphors rather than fully elaborated models. This focus brings to light the significance of metaphors in embodied experience, symptom production, and coping mechanisms.

In addition, Kirmayer delves into the transformative power of metaphors in psychotherapy, illustrating how therapists use them to reshape patients’ understanding and responses to emotional and behavioral problems. He discusses the impact of colonialism on language and metaphors and emphasizes the importance of culturally informed therapies, like Psychohistoriographic Cultural Therapy in Jamaica.

His article also underscores the critical role of metaphor in medical education and practice. He advocates for a deeper understanding of the metaphors used in medicine to enhance the connection between practitioners’ and patients’ experiences. This concept extends to social poetics in medical education, focusing on understanding patients’ stories and lifeworlds beyond clinical diagnoses.

Kirmayer’s work offers a profound insight into the complex relationship between language, culture, and mental health, underscoring the need for a more nuanced understanding of mental health care that transcends traditional biomedical approaches.



Kirmayer, L. J. (2023). Cultural poetics of illness and healing. Transcultural Psychiatry, 60(5), 753-769.


  1. Interesting concept of the use of metaphor and language. This has been an issue at least in the past with the deaf where a clinician unfamiliar with ALS or slang ALS could create a tragedy because of the communication barrier. It is one side of a multifractal framework with multiple levels. Translators and it use in social services and the psych social medical and academic professions is worth a deep look see. Communication barriers all around. Just reading another language’s literature is as William Carlos Williams wrote so much depends on. Vast amounts of literature translations created barriers and so to can meeting with others who speak or come from a different culture. And many of the post WWI clinicians especially working with children and young folks cane as refugees/ immigrants and were actual survivors of an era in havoc and turmoil and abuse. However what could Fritz Reidl understand about the history of Americans and the isms and that the Nazis had used American history and laws with eugenics and oppression based on the color of one’s skin. He and others tried but the most important voices left out.
    The other issue is the vast spiky between biopsychiatry and all other medicine. The issue of TBI and CTE and abuse and environmental harm habe never ever been adequately addressed in any of the professions trying to help.
    So a thorough psychosocial history whichbI never had as a client/ consumer/ patient/ person in crisis would have included car accidents, sports playing , family culture, family substance abuse history, domestic violence history, and whether a family member has been in the military or any entanglements with the law enforcement system. And the assessment would take hours I think and why at this time period no one is allowed to do that. Back in the day at least three visits allowed for dx and most folks used the NOS. Adult adjustment disorder as if thinking of lexicon here having life management issues is a disorder.
    So it is basically ping pong and unless and until all these modalities are addressed and the intertwining of mind body heart and soul is attempted then the stone rolling gathering moss will continue until itt shatters. There never will be a perfect solution but there have always been people in every age of human civilization who at least had some sort of ability to help and not harm anor hinder. The old guard of baby boomers had some but many left in droves and the ones that remind became surviviors of other forms of trauma like paperwork and billing and some just became ghosts in the sysytemic. There but not there as workers. And I have no idea about those in administration who mostly had no frontline experience and were in a machine where they to were cigs are cigs in this multifractal machine that is old antiquated and lost the ability to help humans.

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  2. Why can’t Kirmayer simply fess up and say, “Psychiatry’s biological narrative hasn’t panned out, so now we’ve got to cover our asses by hiding out in the Humanities Department. Hope no one catches on…”

    And here’s some metaphors he might find useful: web of lies, house of cards, wolves in sheep’s clothing, trojan horse, mirage, mask, etc. Or just remember this little gem: psychiatry is ALREADY nothing but very bad poetry.

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  3. Birdsong for some reason literature and psychiatry got entangled and then academia became involved. And strange twists such as Bessell van Dee Klerk work on trauma in a lit analysis a theory textbook and also Tillie Olsens’s Silences and other female authors and academics. Some it it very anti psychiatry but with Solomon’s The Noonday Demon biopsychiatry became the thing. And lots of dialogue on that book could be had
    Shakespeare references Bedlam in his Tom O Bedlam character in King Lear.
    Robert Lowell the poet was in and out of St Elizabeth’s and many poets like Theodore Roekthke in the mh sysyem and who knows just that they were in it for better or for worse.
    So it’s there and has been there and I hear your anger mine waxes and wanes depending on many things.
    A book club or something where discussions can take place and perhaps action. The medical school in our area along with NAMI had a pipeline to tree medical school for consumers. But in the first few seconds it was so clear who they were looking for the 100% on my knees in prostration client to parrot the biopsychiatry beliefs. A living metaphor.
    Many academics have been in the system so I think people are just afraid and loss of job is always significant and the games the academic worlds play complex and deep.
    I really appreciate your voice and hope that it can be useful just beyond here. It is so important.

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  4. Making sense of this article’s bewildering excerpts was to no avail until these two words popped (out of the blue!) into my befuddled head: ‘flowery language’, which led (fortuitously!) to my finding the following:

    “Flowery language occurs when elaborate words are substituted for simple ones and longer sentences are used to try to convey multiple ideas. It is an attempt to make themselves sound like they know more about a subject by using jargon terms and connecting different concepts together.”

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  5. Narrative Therapy has been exploring and using these issues for over twenty years now. There’s a large body of writing, many well-developed practices, and a largish community of practitioners who have developed sophisticated critiques of the cultural narratives that rob people of personal agency and medicalize suffering. I’m often puzzled by the absence of any reference to this modality in the pages of MIA.

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