Somatic metaphor: a clinical phenomenon pointing to a new model of disease, personhood, and physical reality.

The rarely discussed phenomenon of somatic metaphor is apparent when a physical disease--in its pathology, the organ(s) involved, and/or its body location--appears to be "saying" the same thing, expressing the same meaning, as the patient's subjective "story," conveyed in verbal language or in the pattern of important and meaningful events in the life of the patient. The author offers evidence that when patients presenting for diagnosis and treatment of physical disease are appraised from both normative physicalist and psychotherapy perspectives, somatic metaphors are frequently observed. Building on clinical examples, the crucial role of the clinician in observing (or failing to observe) this conjunction of physical disease and personal meaning is analyzed; a visual modeling of clinician patterns of observation is provided to facilitate clinicians in moving away from simplistic, reductionistic, observer patterns so that they may accommodate physical and "story" perspectives in the same clinical space; biomedical and biopsychosocial models are analyzed, demonstrating that neither can explain somatic metaphors and that an alternative theory is therefore needed; and a unitary model of personhood and disease is proposed that avoids mind-body dichotomies and dualistic assumptions and lays a groundwork for the exploration of physical and subjective aspects of patient reality as playing active roles in the development and perpetuation of, and recovery from, any physical disease.