Physical illness: social construction or biological imperative?

All cultures have metaphors for mental illness that define how it is diagnosed, treated, and experienced by the patient. Cultural metaphors that define mental illness have been traced predominantly to biomedical and systems models. However, the research on factors such as progression of illness, survival rates, adherence to medical regimens, level of disability, and experience of pain in chronic and acute life-threatening illnesses suggests another metaphor. This article not only explores how a constructivist metaphor makes sense of this research, but also suggests an approach to consider in helping patients and their families deal with the difficult life circumstances that illness imposes. Implications for nurses are outlined.