Healing as Metaphor
“Imagination atrophies.”
Horkheimer and Adorno,
The Dialectic of Enlightenment

Ed Cohen, Ph.D.
Associate Professor
Women’s and Gender Studies, English and Comparative Literature
Rutgers University
New Brunswick, NJ 08901

Throughout most of human history, healing was understood to be a "natural" quality intrinsic to the organism; however, by the end of the 19th century Vis Medicatrix Naturae had fallen out of favor among Western bio-scientists. Instead, Western medical rationality embraced a new image, "immunity," to describe how organisms survive illness and fundamentally reconceived the prevention and amelioration of illness. Yet immunity does not exhaust the ameliorative resources available to the human organism. Drawing on my 30 year experience of living with Crohn’s disease, I suggest that the imaginative technology of metaphor itself helps us recall the importance of “healing” as both a concept and a value. In affirming “healing as metaphor,” I argue both that healing incorporates a powerful metaphoric potential, i.e., the capacity to reimagine our relations to ourselves and to the worlds in which we live, and that metaphor provides a powerful healing potential, i.e., the capacity to reconnect our imaginations and our organisms.

I Heal Therefore I Am: An Autobiographical Opening
Probably more than many people, I grew up in thrall to a metaphor--not that I knew this at the time. During the summer after eighth grade I began to experience uncontrollable diarrhea and wasting. Within the course of a few months, I went from being a husky, energetic, pubescent boy to a withered, incontinent, critically-ill teen. Rather than starting high school with the rest of my cohort, I spent the fall adjusting to a different kind of institution: the hospital. After what felt like an eternity of probing, prodding, palpating, and x-raying, it was determined that I was suffering from an acute inflammatory bowel syndrome called Crohn's disease. When the doctors who were treating me tried to explain what Crohn's was, I heard the word "autoimmunity" for the first time. Now for a thirteen year old I had a pretty big vocabulary but this wasn't part of it, so they tried to break the word down for me. First one doctor told me: "Your immune system is attacking the lining of your small intestine. It's as if your body is rejecting part of itself." My face must have shown that I didn't get the concept, so another added: "Well, autoimmunity is like being allergic to yourself." Despite this clarification I was still adrift, so they tossed one more metaphoric life preserver my way: "It's as if you're eating yourself alive," they said. With this analogy they finally hauled me up onto the dry terrain of knowledge; I lived on that cannibal island for almost twenty years. No doubt, the doctors who gave me these memorable images offered them as gifts of understanding. They really did want to help. It's just that their metaphors weren't particularly safe for a thirteen year old's imagination. Or anyone's imagination as far as I'm concerned.

From my current perspective, I can see that one of my main medical problems was that the professionals who undertook my treatment didn't believe that metaphor had much to do with their practices. For them, the problems with my immune system were of the order of bio-chemical fact, as was my immune system itself. How they talked about it, how they thought about it, how they explained it, did not for them change the "it" to which they referred. The immune system was real: it did important things in the body and in the world and it was something medicine needed to know more about so that sick people like me could be helped. Not until a decade or so of medicalization later, after I had passed through another life and death encounter with my immune system, did I begin to glimpse that there might be problems of meaning as well as biology involved in my experience of living with an autoimmune disorder.

In my second year of graduate school, I was an acutely ill, twenty-three year old gay man living in the San Francisco Bay area. My doctors seemed unable to comprehend the complexity of my symptoms (which turned out to have been the result of an undetected bowel perforation that wreaked havoc within my abdominal cavity); consequently they subjected me to a barrage of inconclusive tests that left no orifice unprobed. One day, after I'd already submitted to exhaustive examinations by gastroenterologists, hematologists, radiologists, nuclear medicine experts, and infectious disease specialists, a new round of doctors came to my room to tell me about a deadly syndrome that had recently appeared among gay men in San Franciso. It seemed to be sexually transmitted and to destroy the immune system so that people died of horrible opportunistic infections. Then they asked me if I thought I might have it. Now given how sick I'd been for the preceding ten years, it was probably no big surprise that sex had not been a major part of my life. Indeed, my response: "Not unless you believe in immaculate infection," provided the best laugh I've ever gotten from a medical audience. Yet the force of their questions lingered. For years I'd imagined that I suffered from an overzealous immune system that was attacking me from within and now I was told that I might be suffering from a deficient immune system that could let otherwise harmless microbes overwhelm me from without. I just didn't get it. If the immune system was so real then why could its effects be so contradictory?

During the months that I spent in the hospital, I had the leisure to consider the many things medical experts had been telling me about my illness. Slowly, it began to occur to me that there remained a bit of confusion both about what immunity was and about what bio-medicine knew about it. Though I didn't perceive it then, retrospectively I believe that I encountered a contradiction deeply embedded in this metaphor which limits the ways we imagine experiences inscribed under its name. At the time however I was much more focused on denying the gravity of what was happening to me and so I tried to continue reading for my courses. Ironically--or prophetically, depending on how you like to interpret such coincidences--I was engaged in an independent study on the texts of Michel Foucault. Reading Birth of the Clinic, Discipline and Punish, and The History of Sexuality in my hospital bed affected me like a revelation. They gave me tools to reframe the ways my docile body was, and had been, enmeshed in the institutional plays of power/knowledge. They helped me to entertain the possibility that the "truth" of my illness might not be exhausted by the accounts that medical experts were giving me, much as I might desire that to be the case. For the first time in my extensive history of submitting to medical authority, I began to wonder if there might be something that the organism-that-I-am “knew” about my experience which might be important for my recovery, something that my doctors not only did not know but that they could not know within their version of "the true." For the first time, I began to wonder how to make such a "knowledge" known to myself.

As a counterpoint to this intellectual awakening, my body was undergoing its own radical transformations. Descending into acute illness is an awesome process, materializing the organism's struggle to maintain its vitality even in the face of overwhelming challenges. Yet perhaps even more awesome than such physiological disintegration is the organismic capacity to return to health following such a metamorphic episode. After an artery in my small bowel ruptured, causing blood to start gushing out of my rectum and precipitating what I remember as a somewhat cliché but nonetheless incredibly powerful, out of body, near-death experience, I was rushed into emergency surgery where several feet of festering intestine were removed and abscesses in my liver were drained. While recovering from surgery and receiving massive doses of I.V. antibiotics to help control the major infection that was ravaging my organs, I spontaneously began to put myself into trances--no doubt facilitated by all the drugs I was receiving. I would lie on my hospital bed, listening to tapes on my walkman and visualize wrapping a band of warm light around the surgical incisions. This was strictly pain management as far as I was concerned; no metaphysics was involved, since everything in my personal history mitigated against such a possibility. As I liked to say: my father was a physical chemist and my mother a communist, so materiality was all that mattered.

A few months later, when I was being discharged from the hospital, my surgeon told me that I had been one of the sickest people he'd operated on in five years who was still alive and that he had no idea how I'd gotten well so quickly. His words stunned me--and not just because they broke through the denial that had sustained me during my hospitalization and made me consider how sick I'd actually been. They also disoriented me because this was the first time I'd ever heard one of my physicians admit that there were elements to healing that exceeded his understanding. Reflecting on his comment years later in therapy, it struck me that what bio-science did not know about my experience might have been precisely what had enabled me to heal so rapidly.

Today I believe that what science does not and cannot know probably has as much to do with healing as what it does know. Now don't get me wrong: I am incredibly grateful for the capabilities of Western medical practice and especially its most high-tech manifestations without which I would have died on several occasions. Moreover, I think that these practices excel the closer and closer we come to death (which is probably not unrelated to how the opening up of corpses functions both in bio-medical history and in bio-medical training). However, I'm not so sure that they are as adept at addressing the ongoing experiences of illness that many of us diagnosed with chronic diseases endure, let alone at helping us imagine what healing from them might entail. And this assumes of course that we have access to such medical resources in the first place--which is not something that many people in the world today can presume.

Over the last twenty years, I have focused considerable attention on healing. Indeed, given how sick I'd been throughout adolescence and early adulthood, my radical recovery and ongoing remission from the symptoms of Crohn's (with a few lapses here and there during periods of high anxiety and stress) has been quite miraculous--albeit a miracle that requires lots and lots of upkeep. By and large, these healing efforts have taken place outside the ambit of medical rationality. Among numerous non-medical modalities, I have tried and deeply benefited from: psychotherapy, guided imagery, massage, bodywork, somatics, meditation, acupuncture, herbs, homeopathy, rolfing, tai chi, yoga, movement workshops, auric cleansing, and psychic counseling, to name a few. Beyond their specific benefits, which were quite significant, these practices have collectively taught me to appreciate and to value the organismic capacity for healing. Moreover, they have helped me to recognize what I would now call "corporeal intelligence," an intelligence which obtains both beneath and beyond the order of the individual, that went unrecognized and unappreciated throughout my extensive and intensive encounters with bio-medicine. In fact, so long as my attention was exclusively focused on the insistent problems with my immune system, healing seemed to be a non-sequiteur.

Of course, there is nothing inevitable about this exclusionary attention; however, I do believe there is something systematic about it. Having had my imagination not only shaped by, but thoroughly invested in, the bio-scientific understanding of Crohn's disease, it never occurred to me to consider that healing had been rendered anachronistic within the increasingly high-tech discourse of immunology. Only years later, when I had the good fortune to visit one of the twentieth-century experts on Crohn's, a very eminent and very elderly gastroenterologist who also happened to be the father of a good friend of mine, did I entertain this possibility. Chatting with Dr. J. about the changing protocols for Crohn's during his long career and the continuing uncertainties about what causes the condition or how to treat it--other than symptomatically--I was brought up short by his question: "You've done better than 99% of the patients I've seen over the years, so what do you think has enabled you to do so well?" Like my surgeon's comment a decade earlier, Dr. J's question catalyzed my thinking about how my experiences of illness had been limited by the medical frame through which I'd learned to make sense of them. Indeed, though I wasn't able to respond adequately to his question at the time, it sparked me to consider why healing had remained occluded so long as I remained attached to my immune system as the source--if not the cause--of all my physical problems. If Dr. J were to ask me this question today, I think I might reply: "I not only learned to value healing, but I learned that healing is itself a value."

Immunity Uber Alles; or, The Demise of Healing
Throughout most of recorded history healing was understood to be a "natural" quality of the organism, albeit one needing human support and encouragement. From antiquity until the middle of nineteenth century, the Western imagination recognized that nature exercised a curative power on the organism, a power which medicine sought at best to emulate or to enhance. Within the prevailing Hippocratic tradition, this force was known as Vis Medicatrix Naturae, the healing power of nature. According to this worldview, healing was imagined as a natural manifestation of the organism's latent elasticity; it was thus understood to embody the organism's more expansive relations to the world, embracing the forces that animated the cosmos as a whole. Those seeking to facilitate the healing process attempted to encourage the course of nature by addressing themselves to the micro/macrocosmic imbalances that impeded the favorable resolution of a symptomatic crisis. Thus, natural healing traditionally expressed the enmeshment of living beings in the universe and affirmed their fundamental connection to the matrix from which they arose and to which they would one day return.

By end of nineteenth century, however, the Vis Medicatrix Naturae had fallen out of favor among Western bio-scientists. Deemed unduly vitalistic for the emerging reductionist paradigms proposed by "scientific" medicine (which sought exclusively bio-chemical explanations for biological processes) healing became an increasingly anachronistic notion. Instead, Western medical rationality embraced a new image, adopted from a very old legal doctrine, to describe how organisms survive illness: "immunity." This metaphoric innovation fundamentally reconceived the prevention and amelioration of illness. Bracketing healing as an improperly fuzzy premise, scientific medicine incorporated what it now saw as more properly "natural" function of the organism: self defense. This metaphoric substitution proved a highly productive one for the science of medicine since it legitimated the reduction of the complex, contradictory, and yet entirely necessary intimacy of organism-environment to a single salient vector of engagement: aggression/response. Furthermore, it localized the individual organism as the site within which a cellular struggle for survival (a.k.a. disease) took place, while simultaneously defining a hostile microbial agent as the singular "cause" against which the organism must wage its war against death. No longer represented as evidence of the organism's essential connection to the world in which it lived, immunity refigured healing as an effect of singular organism's necessary struggle to defend itself against the world.

Certainly, we now take this reinterpretation to be definitive. Most of us who rely on bio-medical treatments accept the idea that our "immune systems" ought to "defend" us against disease (even as we are also increasingly aware that they do not always live up to this promise). Nevertheless, it is not entirely self evident why a term that had served almost exclusively as a political and legal concept for more than two millennia could have been so rapidly assimilated into modern biological thinking as one of its central metaphors. Indeed, given the seeming impropriety of using an explicitly juridico-political term to elucidate a biological phenomenon, we might want to know how this metaphoric translation came to make sense. We might also want to ask what the consequences of this translation were both for the practice of medicine and for the experience of healing.

The word immunity was transplanted into bio-science a little more than a hundred years ago in order to describe the ways in which multicellular organisms systematically mediate relations with the environments in which they exist--environments replete with other living beings. Needless to say, there is no natural or necessary connection that grounds the analogy between the legal and biological uses of the word. Moreover, as with all transformative metaphors, its rhetorical success depends upon the way it both retains and resolves the tensions that exist between the categories which it brings into relation. When immunity first began to appear in medical discourse during the middle of the nineteenth century, its metaphorical efficacy was constrained by the unresolved incongruity of the terms it puts into play. At that time, immunity did not significantly increase medical understanding because the force of the legal concept, which underscores exemption and distinction, overtly clashed with prevailing humoral and environmental explanations, which stressed continuity and connection among organisms and their contexts. Hence immunity appeared in these early biological uses as a paradoxical metaphor at best and not a particularly helpful paradox at that. By the end of the century, however, political, philosophical, and scientific developments had significantly changed the context for biological understanding. So much so that when the concept was reinvoked in the early 1880s and used to explain the miraculous results of Pasteur's vaccination experiments, it rapidly transformed the basic understanding of how organisms--and especially human organisms--endure.

During the last one hundred years, then, a term which first appeared in Roman Law has come to serve as the metaphoric crux of numerous technoscientific endeavors in human biology. Its naturalization has provided, and continues to provide, a conceptual frame for the practice of scientific medicine on and within the bodies of the citizen-subjects of the industrialized West. By facilitating the application of bio-chemical theory to organismic function, immunology has successfully modeled the "objects" of twentieth-century bio-medicine (in the double sense of its epistemological domains and its therapeutic aims). Today immunity literally underwrites the project of scientific medicine as it has been incorporated in our culture since the end of the nineteenth century. It is a trope which seems to make bio-chemical reductionism seem to make sense as the best--if not the only--way of understanding the complex, and at times contradictory, engagements of organism and environment. Immunity as metaphor underlies the truth of immunity as bio-scientific concept precisely in so far as we forget the metaphoricity which makes this "truth" seem true.

Both the conceptual limitations and the geo-political limits of Western bio-medical practice may stem in part from the ways a defensive sense of immunity has superceded healing as the privileged metaphor for the vital interplay of organism and environment. During most of Western--and non-Western--history, healing defined a quality that was manifest in a multiplicity of practices, only some of which were recognizable as "medical" in the sense that we now understand it. Indeed, it seems that scientific medicine was institutionalized in the West as a simultaneously technological and economic enterprise precisely by abjuring healing as an explicit value. Instead, in the wake of the turn towards interventionist bio-technologies and their theorization through the tropes of attack and defense, Western medical practice appears to have taken as its raison d’être the fortification of the isolated and vulnerable body--not surprisingly, the same locus which metonymically defines the "individual" as the Western political atom. With the advent of the modern bio-medical era, healing became largely reduced to events that were believed to represent the body's "self defense" which were themselves then analyzed primarily in terms of the bio-chemical reactions that crystallized within them. Concomitantly, health care became the (commercial) activity of supporting the individual's battle against disease precisely in so far as it enabled the victor to return to the more "productive" engagements of normal social life.

Unfortunately, while this model led to the development of numerous effective treatment protocols, treatments that became the major selling points for scientific medicine specifically and bio-science generally, it also took infectious disease as the paradigmatic example of the pathogenic encounter itself. Not surprisingly, then, bio-science has had more limited success in either understanding or treating numerous serious and chronic illnesses that are not readily assimilable to this model (e.g., cancers and autoimmune illnesses), while it has had its most triumphal achievements in both preventing and circumventing the deleterious effects of pathogenic contagions. Yet, as the recent appearance of anti-biotic resistant strains of formerly treatable illnesses (such as TB) or the pandemics of infectious illnesses for which no vaccines are available (such as AIDS) portend, even this "triumph" may not be as clear-cut as once was hoped. Moreover, the serious neglect of numerous debilitating and deadly "tropical" illnesses that affect parts of the world not amenable to huge profit-making by the bio-tech industries also threatens to undermine the credibility of Western medicine's triumphal claims. However, I am not really interested in disputing the "successes" of Western medical practice, without which I reiterate, I and many, many others around the world would not be alive. Instead what I would like to foreground are some consequences of taking the metaphors that underwrite immune discourse as immutable truths rather than as metaphors--albeit generative ones.

When bio-scientists at the end of the nineteenth century banished healing both as a natural capacity of the organism and as a productive metaphor for medicine, they substitute the idea of immunity as an organismic activity responsible for protecting the individual body against the threatening world in which it necessarily lives. As a result the embodied subject comes to be figured more in terms of the strategic vulnerabilities that expose it to illness and death and less in terms of its capacity for vitality and aliveness. Instead physicians themselves--and by extension bio-scientists and the health care corporations for which they increasingly work--come to serve as agents of the healing principle, which is reconstituted as an epistemological effect rather than a biological possibility. The theoretical premise which drives the transformative labors of a Pasteur, or a Watson and Crick, or a Salk, or the ongoing efforts of the normal laboratory bio-scientist, or even the daily struggles of the practicing physician, presupposes that these bio-medical practices incorporate the power of healing as manifest through knowledge. Better cures through better knowledge, could be the logo of the bio-tech enterprise that underwrites our contemporary "healthcare industry." (Indeed the pharmaceutical giant Pfizer has recently made this quite clear with its ad campaign: "Making life better through technology.") As a result, healing becomes understood as something that is actively instigated by bio-medical treatment, but only passively aroused in the treated individual.

The Value of Healing
Yet what if we were to reclaim the metaphor "healing" for ourselves? Or what if we were to consider the imaginary effects that metaphor evokes as part of the healing process? Or even more powerfully, what if we were to affirm healing as metaphor? --and I don't mean this entirely metaphorically. In the history of Western medicine, the imagination has proved a powerful counterpoint to the desire for biological determinism. As the historian and philosopher of science Isabelle Stengers has demonstrated, at the end of the eighteenth century bio-science propelled itself across the threshold of scientificity by devising an epistemological technology that allows it to distinguish between "real cures" and the practices of charlatans. The legacy of this technique is widely evident today in what is called "double blind testing" which provides the industry standard for determining acceptable therapeutics. Unfortunately what goes largely unappreciated by this paradigm is that which it explicitly excludes: the dismissively named "placebo effect." The irony here resides in the fact that the reason bio-medicine excludes the placebo is not because it is not therapeutically effective, but precisely because it is. However, since the effects a placebo produces are not determinant, they are hard to reproduce reliably and hence to appropriate profitably. Thus, instead of providing the basis for properly medical technologies, these imaginary effects are metaphorically bracketed as "placebos" and thereby declared to be uninteresting since they are deemed merely "imaginary." Yet if, as Donna Haraway reminds us, ". . . a research program is virtually always also a very mobile metaphor," then we can also welcome the significance of her insight that, "[m]etaphors are tools and tropes. The point is to learn to remember that we might have been otherwise, and might yet be, as a matter of embodied fact."

In order to entertain one such "otherwise," we might consider both what metaphor itself offers as a mode of healing and what the metaphor "healing" has to offer as a particular trope. By reanimating healing as an explicitly metaphorical technology, I want to suggest that there may be material payoff to the imaginary effects that bio-medicine has excluded under the name of the placebo. That is, healing may provide a metaphor that articulates human corporeality and imagination by traversing the unknown--and perhaps unknowable--dimensions that lie in between. Of course, metaphor is hardly unknown to bio-science; however, its role is understood to be primarily instrumental, not transformational. Before a metaphor becomes epistemologically "robust"--to invoke the quality that science attributes to its most successful poetic borrowings--its imaginary purchase is relatively patent. The meanings held in tension by the trope are largely available because they are provisional and hence still vibrant. At this early stage of a metaphor's circulation, people must actively engage the troubling uncertainties evoked between the disparate terms that metaphor brings into relation in order to realize its potential to augment their understanding. This imaginary engagement actually gives rise to metaphor's material effects by transforming the resources available for literally “making sense” of the world. Evoking the most concrete form of poesis, we might say that metaphor operates as a transformational technology by producing and reproducing similarities among differences. Hence metaphor's success depends upon the density and elasticity of the connections established among terms that simultaneously must be defined and maintained as distinct. In other words, metaphor thrives on tension. If there is no distance, no separation, no incommensurability among the elements that are rhetorically linked, there is no metaphor, just tautology.

Metaphor emerges then within the spaces of not-knowing opened up between related differences. Erupting from the abyss of the unknown, metaphor surges towards knowledge. The unknown is essential here since it is the precondition for the emergence of the known. Yet, in metaphor, the known does not replace the unknown but grows from it and is nourished by it. If the animating unknown is exhausted or denied, metaphor dies and its corpse petrifies, turning either into cliché or truth. None of this is especially problematic either for bio-science or for rationality more generally. Metaphor's transitivity feeds upon its transience: new metaphors yield new ways of knowing. The problem arises only when the generative unknown--or indeed unknowable--aspect of metaphor is "forgotten," thereby effacing metaphor's troubling powers and reducing it to a transparent instrument for knowledge.

In advocating healing as metaphor, I want to call attention to the generative potential that the unknown and the unknowable may harbor for our experiences of illness and disease. When I was lying in my hospital bed imagining bands of warm light wrapped around my surgical incisions, I was entering into an experience that was entirely unknown to me. Yet the power of that imagining remains palpable decades later. This metaphorical practice articulated possibilities that exceeded what I “knew” of my illness, especially as that knowledge had been inscribed within me by the skillful hands of the doctors who saved my life. The knowledge that dripped into my veins along with the antibiotics that bio-chemically addressed the bacteria making themselves at home in my abdomen did not convey much to me about the process that I inhabited and that inhabited me. Rather, only as I began to consider healing as a creative possibility that exceeded the domain of medical intervention, as a metaphor that might suture the gaping wound between the unknown dynamics of the human organism and the reflexive activities of human understanding, could I begin to appreciate and value it.

In the hospital, you learn that your “job” is to get well. How you do that however is not entirely clear. Certainly, being a “good” patient--taking all your meds, eating your meals, voiding on demand, offering up your veins, minding the doctors’ instructions, being polite to the nurses--is deemed a necessary condition. But is it a sufficient one? And what if your illness remains intractable? What resources are available to us if we cede to our physicians all knowledge about our experience? In recent years we have become increasingly aware of the limits of bio-medicine to address the organismic suffering we encounter as living beings. The explosion of what are called “alternative,” or “complimentary,” or “non-traditional,” or “adjunctive” therapies bears witness to needs that remain un(der)addressed by bio-medical protocols. While the efficacy of any of these non-scientific possibilities is certainly open to question—as are the effects of bio-medicine themselves—what seems less questionable is that collectively these supplemental practices recall the healing capacities that bio-medicine has increasingly bracketed over the last two centuries. By engaging the non-determinant (or not yet determined) aspects of our organismic capacities, these healing modalities ask us to reanimate our relation to metaphor as an imaginary technology precisely in so far as they confound the conceptual transparency that makes bio-medicine seem so true. When we go to the acupuncturist, herbalist, masseuse, bio-energy specialist, or shaman, for example, we not only avail ourselves of the particular skills that these practitioners possess, we also engage the possibility that bio-medical knowledge does not exhaust the promise of healing transformation. In addition to any specific therapeutic results, then, the resurgence of non-medical healing traditions may help us begin to appreciate the unknown, if not unknowable, dimensions of our biological existence as having valuable potential for our well being.

As a properly “enlightened” practice, medical knowledge seeks to circumscribe the frightening unknowns that diseases embody. In this sense, bio-medicine manifests one of the central paradoxes that cut across what Horkheimer and Adorno labeled “the dialectic of enlightenment”: “Man imagines himself free from fear when there is no longer anything unknown. . . . Nothing at all may remain outside, because the mere idea of outsideness is the very source of fear.” While I am most certainly in support of the knowledge effects that bio-medicine offers us, and I am most happy to be a poster-child for its successes, what I would like to reclaim is the affirmative potential that the unknown, that the outside, has for helping us reimagine what we believe we already know. In affirming “healing as metaphor,” I hope to suggest both that healing incorporates a powerful metaphoric potential to reimagine our relations to ourselves and to the worlds in which we live, and that metaphor provides a powerful healing potential to reconnect our imaginations and our organisms. But what do I really mean by this? I must confess that I really don’t know. However, it seems to me that it is a potentially productive kind of not-knowing, a kind of not-knowing that asks us to engage imaginatively with the organisms-that-we-are in the service of our vitality and aliveness. By valuing our capacity for both material and imaginative engagements with ourselves and our worlds, we body forth the transformational possibilities that we metaphorize as metaphor. By appreciating the healing capabilities of metaphor, we affirm our productive relations to the unknown that enables metaphor to mean. “Healing as metaphor” is only a metaphor, then, but perhaps it can become a metaphor that heals.