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James Lawley

James LawleyJames Lawley offers psychotherapiy to individuals and couples, and coaching, research and consultancy to organisations. He is a co-developer of Symbolic Modelling and co-author (with Penny Tompkins) of Metaphors in Mind: Transformation through Symbolic Modelling, (with Marian Way) Insights in Space: How to use Clean Space to solve problems, generate ideas and spark creativity and an Online training in Clean Language and Symbolic Modelling. For a more detailed biography see about us and his blog.

Surgery and Metaphor
By James Lawley | Published  14 10 2012
Download a print-friendly version: 2012-10-14_Surgery_and_Metaphor.pdf

Tamsin Hartley, coach and Clean Language facilitator, has just had an excellent article, Cutting Edge Metaphors, published in the Journal of the Association of Surgeons of Great Britain and Ireland.[1]

That got me thinking about surgery and metaphor. The word ‘surgery’ itself has metaphorical roots being derived from the Greek for ‘hand’ and ‘work’ – handiwork you might say.

Surgery has often been used as a metaphor.

In Macbeth surgery has a clear political meaning. Interestingly, although Shakespeare’s characters readily refer to surgeons, no surgeon even gets a walk-on part in a Shakespeare play.[2]

Freud often used surgical metaphors where the psychoanalyst is the surgeon and psychoanalysis a carefully wielded scalpel.[3]

Lakoff has shown how military operations in the Gulf War were portrayed as hygienic, with bombing raids referred to as surgical strikes to take out the enemy.[4]

On a more mundane level, one struggling author said “Writing is like performing surgery on yourself without anesthesia”, while a teacher thought “teaching grammar is root canal surgery”.

Fabri at University of South Florida College of Medicine has proposed that ocean sailing could be used as a metaphor to enhance surgical training.[5]

At first sight there is nothing subtle about the metaphor ‘this surgeon is a butcher’. However it takes a detailed and complex analysis by Grady and his colleagues to explain what we intuitively grasp: the metaphor is a damning statement about an incompetent practitioner.[6]

Pascal Vouhé was more nuanced in his presidential address to the European Association for Cardio-Thoracic Surgery when he compared a surgeon to a musician since the goal of surgery is to restore the patient’s normal physiological harmony.[7]

Surgeons might also like to note that a group of their colleagues make much more use of metaphor than is common in the medical profession. Can you guess which?
When general medical dictionaries and encyclopedic texts from seven specialties – dermatology, internal medicine, general surgery, orthopedics, pathology, pediatrics and radiology – were examined, “A total of 375 metaphoric signs were collected, the overwhelming majority (66%) of which were radiologic in reference”.[8]

In discussions with radiologists, it might be worth remembering that they may well interpret images both concretely and metaphorically.


Hartley T, Cutting Edge Metaphors, Journal of the Association of Surgeons of Great Britain and Ireland, Number 37, September 2012 pp. 26-29.

Download the whole of Issue 37 from:

or read the article at:

2 Spicci M, The body as metaphor: digestive bodies and political surgery in Shakespeare’s Macbeth, Journal of Medical Ethics; Medical Humanities 2007; 33:67–69.

Howard T & Pettigrew J, Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage, University of Delaware Press, 2007.

3 Stepansky PE, Freud, Surgery, and the Surgeons, Hillsdale, New Jersey, Analytic Press, 1999.

4 Lakoff G. (1991) Metaphor and war: The metaphor system used to justify war in the Gulf.
Peace Research 23: 25-32.

5 Fabri PJ, Lessons learned at sea - ocean sailing as a metaphor for surgical training. American Journal of Surgery, 2003 Sep;186(3):249-52.

6 Grady JE, Oakley T,  Coulson T, Blending and Metaphor, in Metaphor in Cognitive Linguistics,  G. Steen, & R. Gibbs (eds.) Philadelphia: John Benjamins, 1999.

7 European Association for Cardio-Thoracic Surgery Daily News, Tuesday 14 September 2010.

8 Baker SR, Partyka L, Relative Importance of Metaphor in Radiology versus Other Medical Specialties. RadioGraphics, January 2012, 32, 235-240.


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