The phenomenon, the explanations and the responses: metaphors surrounding diabetes in urban Canadian Indians.

Type II Diabetes is a growing problem among Indian people in Canada. Ojibway and Cree leaders in Toronto collaborated with the University of Toronto, Faculty of Nursing, to develop the Native Diabetes Program. A key to the success of the program was seen by Natives to be the story 'Nanabush and the Pale Stranger', which seemed to put into perspective the nature of diabetes as a phenomenon. It provided explanations for it and answered numerous questions (non-biological) associated with the disease and indicated appropriate coping strategies. Yet formal methods of analyzing the story would not reveal its benefit as there is no explicit reference to many of the questions it implicitly answers. Metaphoric relationships are illuminated which may provide an underlying rationality to the narrative. Cultural expression is advocated as a source of making meaningful and tolerable that which is feared and avoided; of generating metaphors which make health information understandable and useful, by providing resolution to conflicting systems of belief. Information does not come in discreet ingestible particles of fact. All information is a sort of propaganda in that it is tied to deeper meaning structures. Clinicians are architects of meaning construction. Clinical research and practice requires a knowledge of the folk and professional construction of meaning around so-called factual information.