Some of the biggest challenges in clinical practice revolve around patient education: ensuring medication adherence and explaining difficult medical concepts to patients. Analogies can be an effective tool in the therapeutic armamentarium. This paper elucidates steps in discussing analogies and contains several useful analogies for various problems encountered in psychiatric practice.
Patient and caregiver education for psychiatric illness is often referred to as psychoeducation. It may also be defined as the education of a person with a psychiatric disorder (and their caregivers) in subject areas that serve the goals of treatment and rehabilitation.1 Psychoeducation can be used for various psychiatric disorders, including schizophrenia and bipolar disorder.
Psychoeducation is both essential and especially challenging. It improves knowledge, thereby bringing change in attitudes, and (hopefully) behavioral changes that, in turn, affect treatment outcomes.1 Many factors complicate psychoeducation, including cognitive deficits that accompany psychiatric illness, 2 poor insight, stigma, lack of laboratory markers, inadequate knowledge of neurological sciences, and prevalence of magico-religious practices. Therefore, it is a challenge to explain difficult or complex concepts to patients so that they may understand treatment decisions or advice, stay engaged in treatment, and follow medical advice and instructions.
Psychoeducation can be improved by use of metaphors, similes, and analogies. Analogies are often preferred, as they are easier to understand and demand less knowledge of the literature. The rationale for the use of analogies can be explained by cognitive development work by Jean Piaget, PhD. His theory states that the ability to relate to tasks directly impacts the understanding of new and complex tasks. 3
Use of Analogies
An analogy allows for a comparison between two things; it is especially helpful in explaining or clarifying ideas. Various disorders have successfully utilized analogies as part of patient education—diabetes3, dermatological conditions4, neurological conditions,5 and general patient education.
An effective analogy should include a common principle that is appropriate to the patient’s background, knowledge, age, gender, and ethnicity. Multiple distinct analogies, including visual analogies and patient-generated analogies, are recommended.3 Presenting scenarios and asking questions allows greater patient involvement.
Patient psychoeducation module
Use of analogies in psychiatric clinical practice can be broadly categorized into five domains of psychoeducation, all of which are explored in this article [TABLE].
Assessment, diagnosis, causes, and symptoms
Issue: Most diseases are diagnosed with the help of medical tests. Patients may be dissatisfied or confused when their psychiatric diagnosis is based on a clinical interview.
Principle: Psychiatric disorders do not have straight-forward diagnostic tests.
Result: Patients gain a great understanding of the differences between diagnosing medical and psychiatric illnesses.
Coffee and sugar
Concern: Shouldn’t you order a cat scan or magnetic resonance imaging before starting my treatment?
Response: If we take a photograph of a cup of coffee, will it tell us if there was enough salt or sugar added to the coffee? We can only comment tasting it, right? Sometimes a scan may help us better understand the situation. However, a good patient interview—a taste of what’s going on—can truly help diagnosis a psychiatric illness.
Wires and electric current
Concern: How can I be suffering from a disorder when all my medical tests are normal?
Response: Suppose a light bulb is not working. It may be due to a wire or electricity problem. Similarly, in our bodies problems may be due to neurons (wires) or the chemicals they use to communicate (electricity). Current medical tests generally are designed to check for wire-related problems, such as photographing the wires (ie, neuroimaging). Since psychiatric problems are often related to electricity (eg, chemicals like neurotransmitters), they may not be seen in medical tests.
Issue: Psychiatric disorders may be viewed as the patient’s emotional failures by their caregivers.
Principle: Each patient’s experience with mental illness is different and unique.
Result: The caregiver reattributes the symptoms to the disorder and does not blame the patient. This helps the patient, the patient-caregiver relationship, and the caregiver (eg, reducing burnout).
Concern: Why doesn’t the patient see the world normally like we all do?
Response: If you wear black glasses, the world may appear black, even though it is not black. The disorder similarly distorts the world for the patient. To complicate things, the patient may not realize that they are wearing glasses that distort their world view.
The illness versus the person
Concern: We are finding it very hard to tolerate the patient’s behavior.
Response: Say you are sitting in a restaurant and healthy, alert, sober adult kicks you. You would be understandably upset, right? Now consider your reaction if you are accidently kicked by a child having seizures. Would your reaction be the same? Would you be upset with the child or would you recognize the kick was an unintentional result of the seizure? It helps to understand behavioral symptoms are part of the illness and not done purposely by the patient to upset you.
Flashlight in the dark
Concern: How will knowing the details of the disorder help me in dealing with the patient?
Response: Just as you will be able to differentiate a rope from a snake in the dark with the help of a flashlight, adequate knowledge of the illness can help in differentiating symptoms from normal experiences. We literally need to shine a light on things to better understand what is going on.
Treatment and compliance to medication
Concern: Patients achieve results from treatment and want to discontinue treatment.
Principle: Psychiatric disorders like other non-communicable diseases require long-term treatment strategies.
Result: These examples engage patients and promote long-term adherence.
Care for the sapling
Concern: Now that we know the diagnosis, what is the way to get well?
Response: A plant requires time and care before it yields fruit. The disorder requires similar care:
- Time and attention (ie, visiting the doctor)
- Fertilizer (ie, expenses)
- Regular care (ie, daily meds), and
- Fruit takes time to appear (ie, treatment response)
Concern: I have been taking my medication. Why have I yet to experience improvements?
Response: Medical treatment is similar to a farmer’s work. One has to dig the mud, remove the weeds, and then plant the seed. How long do you think it will be before the farmer see any growth? (Elicit the answer “Several days.”) How about before the farmer sees any fruit? (Elicit the answer “Several months.”) Exactly. Some medicines are like seeds; they take time to grow (ie, act) in the body.
Concern: I am doing well now. I feel that I have recovered, and I no longer need medication.
Response: Let’s think about a person wearing eyeglasses. When the patient wears glasses, they see clearly. If they throw away their glasses, will they continue to see as well?
Similarly, you are well because you are taking your medication regularly. If you stop the medication (ie, throw out the glasses), you will not be as well (ie, won’t see as clearly).
Locking the door
Concern: Why do you insist I continue to take my medication, even though I no longer have symptoms?
Response: Did you lock your home when you left for this appointment? Did you do so because you knew that thieves were waiting?
Just as locked you home to avoid the risk of getting robbed; regular use of the medication keeps you safe with a smaller risk of becoming ill again.
Watering the plant
Concern: I have not taken my medication for a few days, and I am still doing well. Does that mean that I do not need medication anymore?
Response: When you stop watering a plant (ie, nonadherence), the plant does not die immediately (ie, experience immediate relapse). But once the plant dies (ie, relapse occurs), you will have to start with a new sapling (ie, go back to the first step/restart treatment). You also will have lost a healthy, flourishing plant (ie, the progress you made).
For that reason, does it not make sense to continue the medication?
Crossing the road blindfolded >
1. Cechnicki A, Bielańska A. The influence of early psychosocial intervention on the long-term clinical outcomes of people suffering from schizophrenia. Psychiatr Pol. 2017;51:45–61.
2. Bisbee, C. Patient education in psychiatric illness. J Orthomolecular Psych. 1979;8:239-246.
3. Harmon CC, Hamby J. Utilizing analogies in diabetes education. Diabetes Educ. 1989;15(5):413.
4. Frieden IJ, Dolev JC. Medical analogies: Their role in teaching dermatology to medical professionals and patients. J Am Acad Dermatol. 2005;53:863-866.
5. Gregory RJ. Neuro-talk: an intervention to enhance communication. J Psychosoc Nurs Ment Health Serv. 1998;36:28–31.