Cultural perspectives on positive responses to extreme adversity: A playing field for metaphors

Abstract

In Euro-American societies, “resilience” and “post-traumatic growth” are commonly used metaphorical terms for positive responses to extreme adversity. However, research on illness narratives has demonstrated that other cultures may have different metaphorical concepts that act as vehicles for shared beliefs about how to overcome extreme adversity or traumatic experiences. The purpose of this article is to identify metaphors used in various cultures to describe positive responses to extreme adversity and to discuss the cultural ontologies and other socio-cultural factors that shape them. Metaphors of this nature were extracted from psychological, anthropological and ethnographic studies and were organized into categories: battle, path, container, balance, weight, object and network metaphors. Findings support the notion that metaphorical expressions related to positive responses to extreme adversity vary widely across cultures. We argue that an understanding of cultural differences in metaphors for mental health-related concepts is crucial to assisting trauma survivors from different cultural backgrounds.

Keywords

extreme adversity idioms of distress metaphor post-traumatic growth resilience socio-cultural factors

Introduction

Multiple concepts for adaptive and positive responses to extreme adversity exist in Western or Euro-American cultural contexts. “Resilience” is the most frequently studied protective and adaptive factor with respect to extreme adversity and represents the personal characteristic of being able to withstand adversity and recover despite hardship (Bonanno, 2004). The term resilience was originally applied to materials that deform under stress but are able to bounce back. Another adaptive response to adversity is referred to as “post-traumatic growth”; this term describes the benefits that arise from struggling with highly challenging life circumstances (Tedeschi & Calhoun, 2004). The term “growth” denotes the positive ability to develop new capacities and go beyond one's previous level of psychological functioning or life awareness. Parallels can be drawn with other familiar expressions such as to gain wisdom, to mature, to develop and to transform.

Many researchers have emphasized that there are cultural differences in how people deal with distress, trauma and recovery (e.g. Hinton & Kirmayer, 2013; Hinton & Lewis-Fernández, 2011; Kirmayer & Pedersen, 2014; Marsella, 2010; Splevins, Cohen, Bowley, & Joseph, 2010). A substantial body of literature challenges the implicit assumption that categories of psychological distress constructed by Western psychiatrists (e.g., trauma) are universally valid and applicable across cultural contexts (Kirmayer & Pedersen, 2014). Various studies have shown that people from different cultures have their own ways of conceiving of traumatic experiences and expressing associated distress (e.g. de Jong & Reis, 2013; den Hertog, de Jong, van der Ham, Hinton, & Reis, 2016; Hinton, Pich, Marques, Nickerson, & Pollack, 2010; Pedersen, Kienzler, & Gamarra, 2010). Idioms of distress—culturally specific modes of expressing distress which are often indirect and metaphorical—encompass very distinctive cultural norms, values and health concerns. In this article, to avoid the epistemological fallacy of assuming that “trauma” is a universal concept we use the term “extreme adversity.”

People's ability to respond to adversity in a psychologically adaptive way is also influenced by culture (McMillen, 2004; Ungar, 2011). What constitutes a positive response to extreme adversity depends on the culture in which an individual is embedded, and differences have been observed between modern, individualistic cultures and more traditional, collectivistic cultures (Weiss & Berger, 2010). Ways of expressing or describing positive responses to extreme adversity or distress can be considered “idioms of overcoming distress”; these are also very likely to depend in various ways on cultural context (Calhoun, Cann, & Tedeschi, 2010; Vázquez & Paez, 2010).

To date, efforts to look at positive responses to extreme adversity through a culturally sensitive lens have been limited (Berger, 2015). In particular, there is a need for greater understanding of positive psychological adaptations in cultures outside of Europe and North America. Constructing a balanced cross-cultural account of positive responses to extreme adversity requires analyzing the concepts and terms used in different societies from an emic, that is, culturally immanent perspective (Bernal, Bonilla, & Bellido, 1995; Vázquez, Perez-Sales, & Ochoa, 2014).

The question of whether mental health concepts are universal or culturally specific can be explored in relation to the analytical psychologist Carl Gustav Jung's work on symbolic representations and communications and non-Western psychological phenomena (Maercker & Heim, 2016). Jung postulated that “the fundamental ‘language’ of the psyche is not words, but images” (Abramovitch & Kirmayer, 2003, p. 159). One implication of Jung's postulated core principles for cultural psychology is the importance of metaphors. Metaphors can be viewed as expressions of shared cultural understanding that are fundamental to conceptual thinking, or as Lakoff and Johnson (1980) put it, “the most fundamental values in a culture will be coherent with the metaphorical structure of the most fundamental concepts in the culture” (p. 22). Metaphors may be understood as vehicles for personal and collective truths, rather than reduced to mere linguistic frames. Focusing on metaphorical expressions may enable one to capture fine-grained cultural variations in understandings of mental health-related concepts. In clinical contexts, exploring metaphors may enhance the therapist's understanding of culturally divergent conceptions of the process of recovery from, or positive adaptation to traumatic experience. Looking closely at metaphors may be even more effective than using illness narratives to illuminate explanatory models. Other than illness narratives and explanatory models, metaphors may enable an understanding of implicit cognitions that refer explicitly to local ontologies (Kirmayer & Ramstead, 2017). We follow the definition of shared ontologies as having been acquired through “the installation of specific sets of cultural expectations, embodied in cultural symbols and places, and enacted through everyday habits and rituals” (Kirmayer & Ramstead, 2017, p. 25). We recognize cultural ontologies as “a shared style or mode of expecting the world to be a certain way, [that] afford[s] certain possibilities for action while foreclosing others” (p. 26).

In this paper we argue that a more in-depth analysis of the metaphorical content of expressions for positive responses to extreme adversity across cultures is needed. Exploring culturally shared metaphors that give rise to local ontologies enables us to gain a better understanding of the cultural beliefs about health concerns reflected in different medical and religious approaches to recovery. For example, personal growth is a prominent metaphor in Euro-American cultures and is used to highlight the effort that people make to improve themselves after an aversive event as well as the way in which experiences of adversity can be perceived as opportunities for personal gain. People in other cultures may use different metaphors implying an aspiration to gain from the experience or may not recognize the notion of aspiring to personal gain in the aftermath of adversity at all. Thus, there is a need for a broader perspective on expressions related to positive responses to extreme adversity—one that is more inclusive of other cultures' alternative or related conceptions of recovery processes.¹

In this article, we present metaphors relating to positive responses to extreme adversity that are used in different contexts all over the world and propose a taxonomy of conceptual metaphors based on figurative origins that can be used to describe differences among cultures and concepts. We then discuss how socio-cultural factors shape the use of three types of metaphors. We hope that in deepening understanding of cross-cultural variations in metaphors for positive responses to adversity, this article can inform clinical practice.

Methods

A wide range of psychological, anthropological and ethnographic publications focused on emic perspectives on adversity and recovery was surveyed to identify verbal metaphors used in various cultures. To ensure that we captured a wide variety of metaphorical concepts, we did not restrict the reports by cultural origin. The keywords used were: overcoming adversity, growth, recovery, healing, well-being, psychological adaptation, adjustment, and resilience. These were combined with keywords such as metaphor, phenomenology, hermeneutics, narrative, qualitative or case study, and cultural or cross-cultural. Only English language search terms were used. We deliberately refrained from limiting our search to concepts emerging from Western studies (such as resilience or growth), in order to ensure we captured the broadest possible range of metaphorical concepts in use. The searches were carried out on PsycARTICLES, Pubmed and ISI Web of Knowledge from June 2015 until December 2015. We did not restrict our search by publication date, nor did we aim for a systematic review. From the 69 publications initially identified by the first author, both authors jointly selected 22 studies published between 1995 and 2015 based on metaphorical variation. The first author then grouped these publications thematically and after discussion with the second author, the first author interpreted the metaphors they contained according to cultural context. The 47 publications not used were excluded for reasons of redundancy and lack of metaphorical content.

Results

Our tentative taxonomy of metaphorical concepts is adapted from Levold's (2012) German-language-based categorization of resilience metaphors. Levold (2012) categorized various metaphors in terms of eight different figurative sources: organic (growth), battle/fight, path/motion, container, balance, object, weight and network metaphors. Table 1 briefly describes these categories.

Table 1.

Taxonomy for metaphors and their description*

Category	Description
Organic	Humans, like plants have the capacity to regrow after damage. They adapt through structural change and can prosper, thrive, flourish, survive and transform.
Battle/fight	Individuals show courage, bravery and invulnerability. Fighting adversity implies a fight in which the individual is a warrior and the adversity is personified as the enemy.
Path/motion	The movement in space and time allows for a new start, a turnabout, moving in circles (accepting the circularity of life and recognizing ups and downs and new starts instead of moving towards a dead end) and to ‘see an ending’ to the adversity. Individuals can overcome an obstacle, leave a problem behind, formulate new goals, pave new roads, make progress and be on a path or on a new journey.
Container	The container indicates an inside-outside relationship and antagonism between fullness and emptiness. It refers to the need to protect oneself from the outer world, set boundaries, build up one's inner strength and have control over the barrier between inside (self) and outside. The container metaphor may be extended to include purification processes, whereby the inside is cleansed of negative outside influences.
Balance	Adversity is likened to being thrown off balance, left in an unbalanced state of mind. Balance involves adjusting to an unusual or unequal (i.e. disturbed) state of mind, establishing equilibrium, counterbalancing adversity, seeking duality and/or circularity in a dynamic activity.
Weight	Adversities are heavy loads or burdens. One must resist/endure the burden with ease and facility, withstand or seek relief from the emotional pressure, and keep (maintain) one's psychological health.
Object	Just like certain objects, human beings can be indestructible and flexible. Individuals have the capacity to withstand adversity and thus be resilient.
Network	Individuals seek support from social relations whereby the connectivity gives stability in life. Social support allows a reaffirmation of culturally shared positive values.

*Modified from Levold, 2012

Our search identified various metaphors used to describe positive responses to extreme adversity. In what follows, we group these metaphors into Levold's (2012) categories and describe their applications in greater detail.

Battle and fight metaphors

Williamson (2014) reported that for some Rwandans one adaptive response to extreme adversity is to remember to be umuntu w'umugabo – literally “to be a man.” This is a common Rwandan phrase that reminds individuals to be strong and not to show emotions. In this context, being strong like a man, strong enough to confront adversity, means overcoming it by pushing it aside. The author of a study of Sudanese refugees concluded that suppression – in terms of applying strength to diminish negative emotions – was seen as an effective and often necessary means of coping with adversity (Goodman, 2004). In contrast, some Native Americans employ the metaphor of “shooting a bow” to describe the active overcoming of hardship (Denham, 2008). The expression literally means to “push one's arm out and away from one's body” and indicates in the metaphorical context that someone is pushing away adversity. One participant in Denham's study remarked that “Native people must remember the strength of their blood, the same blood that ran through your ancestor's veins […] The blood of Chiefs and warriors” (Denham, 2008, p. 406). In saying this, this person highlighted the importance of being strong and of “shooting the bow” in honor of the ancestors. The battle metaphor was also found in a South African study of adults who had witnessed or suffered human rights abuses (Magwaza, 1999). After their experience of extreme adversity these adults identified with martyrs or heroes and conceived their experience as transformative and enriching. In Euro-American cultures the battle metaphor is also a common way of responding to adversity in an adaptive way (e.g. Weiss, 2005). Examples include references to fighting against an illness and descriptions of the healing process as the conquering or defeat of a bodily intruder.

Finally, for some cultural groups extreme adversity is associated with spirit possession (Boddy, 1994). In this state, the perception may be that the evil entities – which might be construed as a personification of the adversity someone is facing – are trying to harm the affected individual and has to be fought in a battle in order to overcome the adversity (Lambek, 2002). From a metaphorical perspective, spirits or spirit possession can be seen as an embodied symbolic expression of distress and as a legitimate idiom of distress that is used to express and transform psychological suffering (de Jong & Reis, 2010; Neuner et al., 2012). This metaphor has been reported in studies in Mayotte island in the Mozambique Channel, the Mapuche community in Chile and Argentina (Lambek, 2002; Vázquez et al., 2014), in Southeastern China (Chan, 2014) and in traditional Somali culture (Whittaker, Hardy, Lewis & Buchan, 2005).

Path and motion metaphors

The life is a path metaphor occurs in various contexts including Asian spiritual and religious teachings (Chen, 2006). In Tibetan populations there is a saying that suffering and happiness can be used as a path to enlightenment (Dodrupchen, 2015). The idea that one may “see a new direction” after a traumatic experience also has been in a phenomenological study of Chinese patients with severe burn injuries (Zhai et al., 2010).Various studies in different parts of Africa have noted that being on a path is used as a metaphor for the continuation of life despite hardship. Narratives about positive responses to extreme adversity revolve around moving forward or going back to the previous state by avoiding thinking too much about the hardship and thus getting over it quickly (Goodman, 2004; Kryger & Lindgren, 2011; Whittaker et al., 2005; Zraly & Nyirazinyoye, 2010). A study conducted in Rwanda discussed the phenomenon of adaptive psychological response to the genocide and introduced the idea of gukomeza ubuzima (continuing life/health): “Gukomeza ubuzima is to accept your everyday problems and not to despair as if you were no longer alive; you rather believe that you are still on your way forward like others” (Zraly & Nyirazinyoye, 2010, p. 1660). As the authors explain, this Rwandan expression refers to a way of moving forward in life and living on, despite one's ongoing struggles, through accepting the existence of numerous problems.

Container metaphors

Container metaphors related to stress and major life adversities have been reported in various studies across the world and the inside-outside relationship is an important aspect of such metaphors. In a study of US residents many participants reported that having the sense that doors were opening was an important indication of a positive response to adversity (Roepke & Seligman, 2015). In another US study of narratives of crisis-related life phases metaphors such as liberation were used and there were references to being released from the mental space where one had been trapped and to opening and exploring in the context of experimenting with new activities and sides of oneself (Robinson & Smith, 2009). In the last phase of recovery the individual may move from darkness to light and finding a new and authentic way of being may play a crucial role in enabling one to achieve an integrated identity (Robinson & Smith, 2009). The darkness into light metaphor also appears in Canadian Inuit narratives (Waldram, 2008). References to regaining the ability to see as one emerges from emotional darkness into a bright life reflect a transformation of perception and a new appreciation for the present. The distinction between the inside and the outside and the role of the outside world are amongst the most important features of Inuit cultural models of healing (Waldram, 2008).

The container metaphor is characterized not just by the inside-outside relationship but also by the contrast between fullness and emptiness. Research in the US has identified metaphors related to being fuller after experiences of adversity; for example, one US patient who experienced a traumatic life event reported that after overcoming the crisis he was “the same person, just an expanded version with a different dimension to me. I think people would say the same thing of me, I'm the same Neil at my core, just reaching now into other parts of me, a fuller Neil perhaps” (Robinson & Smith, 2009, p. 91).

Identifying positive responses to adversity may also raise the question of how the optimal state of well-being can be reached. Buddhism teaches that instead of trying to attain a metaphorical state of inner fullness one should seek the opposite; in Buddhism pure emptiness or being void (sunyata) is regarded as the highest possible stage in the evolution of human consciousness. In that supreme state of enlightened consciousness, the mind is pure and empty of all mental constructs and impairments and transcends the dualistic consciousness of mind and body (Chen, 2006). In the Tibetan context, the concept of being empty or pure is positive and refers to being free and open for new experiences. This is illustrated by expressions such as “suffering can have a purifying quality” (Hussain & Bhushan, 2013, p. 214) or, as a Tibetan refugee said, “It is good to have all this suffering now in this life because then it is purified and we won't experience much later” (Lewis, 2013, p. 324).

Balance metaphors

Balance metaphors for adaptive and positive responses to extreme adversity were identified mainly in Asian cultures, but did occur in other regions of the world. Taoism, for example, holds that all things in the universe exist in polarity and that the existence of an object or state is dependent on its counterpart (Chen, 2006); hence happiness and adversity will always coexist and understanding the interdependence of polar opposites enables one to lead a peaceful and integrated life (Ajaya, 1997). Similarly, the proverb “sukha-dukha” used in Nepal by Hindus and Buddhists alike captures the ups and downs of life. The proverb suggests that to achieve a state of happiness or sukha, one must attain mental balance and insight into the nature of reality. The counterpart of happiness, dukha, which is often translated as “suffering,” is not simply an unpleasant feeling but a “basic vulnerability to suffering and pain due to misapprehending the nature of reality” (Ekman, Davidson, Ricard, & Wallace, 2005, p. 60). To emphasize the importance of this duality a Tibetan master pointed out: “[For t]he ultimate benefit – the nectar of realization – one must have mastered one taste of happiness and suffering” (Dodrupchen, 2015). He suggested that this is the only way one can ensure a balanced state of mind and wellbeing, even after experiencing hardship.

Metaphors from Asian cultures that express this mental balance often refer to nature. Religious practice, for instance, is said to help one to avoid a “life-wind imbalance” (Lewis, 2013, p. 321). Tibetan myths proclaim that if the mind is not to be disturbed by adversity one must not let the subtle wind energy be disturbed (Dodrupchen, 2015). According to their mythology this means that “…the other elements of the body will not be disturbed either. As a result, your mind will not be disturbed, and so it goes on, as the wheel of constant happiness turns” (p. 7). Similarly, Tibetan Buddhists may advise that, “During hard times one must remain without the slightest fluctuation in the mind, like Mount Meru, unshaken by the wind” (Dodrupchen, 2015).

Balance metaphors with natural elements are also used by Canadian Inuit cultures (Denham, 2008). Narratives about positive responses to adversity collected in one field study included the advice: “Keep your balance, the center of your world inside of you, gotta stay in balance. You let it go out of balance, and your life will start getting wrecked” (Denham, 2008, p. 401). The author explains that “this strategy keeps their [the Canadian Inuit] lives in balance and prevents the whirlwinds from wrecking the center” (Denham, 2008, p. 409).

Achieving balance may be both a means of recovering from adversity and a form of preparation for hardship and hence it may be closely related to the concept of resilience. Today, many of these balance metaphors, which mainly originate from Asian contexts, are prominent in the Euro-American “mindfulness” movement and in the third wave of cognitive-behavioral therapy, both of which are inspired by Buddhist concepts of positive responses to extreme adversity and have incorporated them into Euro-American clinical work (e.g. Kabat-Zinn, 2013).

Weight metaphors

Extreme adversities can metaphorically be understood as heavy loads or burdens in someone's life, which cause the feeling of an emotional pressure on one's shoulders. In Canadian Inuit culture, for example, the sensation of lightness is an important feature of mental health. As an individual said: “A person must confront and unload the layers of their burden in order to experience a sense of release, freedom, or lightness” (Fletcher & Denham, 2008, p. 125). On a different note, individuals who experienced extreme adversity at times feel as they were the burden themselves, causing others to feel heavy. A Rwandan study reported that survivors of the genocide strived not to be a burden on society and therefore tried to move on (Williamson, 2014). A Ugandan study of the post-traumatic growth phenomenon emphasized the importance of accepting community support (Kryger & Lindgren, 2011).

Object metaphors

When it comes to object metaphors, Nietzsche's words – “what does not kill me makes me stronger” – instantly come to mind. The concept of resilience, which is derived from the ability of a physical material to bounce back after being bent, is a good example of this type of metaphor (Bonanno, 2004). The notion of resilience is used to communicate static and material-bound properties of human beings and their interactions with the environment (Levold, 2012). The object metaphor may also include the closely related metaphorical concept of flexibility, which in the broad sense means to adapt to difficult situations when needed. In the mental health literature, it reflects the capacity to shift one's attention from negative emotions and cognitions to a more positive focus (Hinton & Kirmayer, 2016).

In some cultures, resilience is portrayed as the most important trait needed to overcome adversities and there is a growing interest in carrying out research on resilience, particularly in African cultures (Goodman, 2004; Whittaker et al., 2005; Williamson, 2014). In an ethnographic study of resilience among survivors of rape and genocide in Rwanda, the term kwihangana (withstanding) stood out. A quotation from one individual exemplifies how it is used: “To strengthen yourself, you feel that you don't let the suffering make you fade away; otherwise, you could die. You hurry up and go through it. You do not linger in that pain. But, as it goes, kwihangana causes you to feel that you brought force inside yourself” (Zraly & Nyirazinyoye, 2010, p. 1660).

Network metaphors

Many studies have described the phenomenon of positive psychological adaptation through connections with others and social cohesion (Goodman, 2004; Miller, Kulkarni, & Kushner, 2006; Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008; Schweitzer, Greenslade, & Kagee, 2007). Participants in a number of included publications emphasized the importance of social support in contexts of extreme adversity. For example, a Sudanese refugee told Goodman (2004), “if it was me by myself I could not have made it” (p. 1183). Although dependence on social networks appears to be ubiquitous in the face of adversity (Maercker & Horn, 2013), we identified only a limited range of verbal metaphors for the phenomenon.

Discussion

In this article, we have argued that there is a broad range of metaphors for positive responses to extreme adversity and that these vary across cultures. Having discussed various metaphorical concepts for positive responses to extreme adversity documented in the literature, we now turn to the question of how these metaphors reflect different cultural beliefs and values that correspond to local ontologies. Below, we scrutinize the socio-cultural factors relevant to three metaphorical conceptions of positive responses to extreme adversity: the widespread notion of a “need for growth” in Western cultures; metaphors of battle and community resilience; and metaphors of paths and journeys in time and space. What we refer to in this paper as “socio-cultural factors” includes a consideration of cultural value orientations (Schwartz, 1992). For example, whereas, some cultures value change, others value constancy. Some cultures pursue social harmony and continuity and tend to be accepting, whereas others encourage self-criticism and self-actualization and applaud active attempts to cope in the aftermath of difficulties (Vázquez et al., 2014).

Metaphors of growth and transformation

The (post-traumatic) growth metaphor evokes the notion of reliance on one's own inner strength, agency and confidence. Studies of post-traumatic growth in Western contexts suggest that the metaphor reflects an assumption that human beings have an obligation to manage their own well-being. This notion of personal responsibility for one's life is evident in the use of phrases such as, “It's an awesome life if you choose it to be” (Shakespeare-Finch & Copping, 2006, p. 365) and “I know that I am the author of my own story” (Weiss, 2005, p. 216) by participants in Western contexts. Some authors also ascribe the longing for growth to Western or specifically American culture (Held, 2002; McMillen, 2004; Tennen & Affleck, 2009; Watters, 2010). North Americans have been found to place more emphasis on looking on the bright side of life than people in other cultures (McMillen, 2004) and to overestimate the positive change that occurs after negative events (Tennen & Affleck, 2009); these traits have been referred to as the “tyranny of the positive attitude” (Held, 2002). The ambition to modify an attitude in the aftermath of trauma, though widely portrayed as a Zeitgeist phenomenon, may have historical roots. It has been argued that contemporary psychology has been influenced by the 16^th century Reformation movement and Martin Luther (1483–1556) and Johannes Calvin's (1509–1564) emphasis on self-enhancement (e.g. Weber, 2010). The ideas and values of the Christian Reformation were later reflected internationally in political writings, such as the United States Declaration of Independence of 1776. Others claim that it was the postmodern movement of the early 20^th century – with its emphasis on an accentuated form of individualism – that shaped Western cultural values and beliefs about illness and well-being (Gergen, 2001). The longing for self-determination and agency has become an individualist imperative: rather than merely having the freedom to do so, individuals now have an obligation or duty to transform and adjust to the most difficult life circumstances and to become a better person than ever before (Bracken, 2001; Gergen, 2001). Recent work in cultural psychology has highlighted the importance of considering how historic trends, such as the emergence of individualization or the shift into modernity, give rise to changes in cultural values (Inglehart & Welzel, 2005; Kasser, 2011; Maercker et al., 2009, 2015).

The pervasiveness of the concept of post-traumatic growth in Euro-American contexts is consistent with the proposition that an emphasis on growth in the face of adversity is particularly associated with modern individualistic values such as self-actualization and self-expression. Given the lack of comparable metaphors in societies that espouse traditional values such as stability and collectivity, we suggest that that less individualist cultures tend to value goals other than striving for explicit improvement of the self more highly.

Metaphors of battle and community resilience

Metaphors related to positive responses to adversity involving battle and fight are closely related to the notions of empowerment and self-empowerment and are used to emphasize the conviction that an individual or a community can achieve identity integration after surviving a traumatic experience. Williamson (2014) found in her study conducted in Rwanda that community empowerment can be achieved through agency and communion, thus highlighting changes in socially shared values. Thereby, the balance between autonomy and relatedness are claimed to be essential assets to increase group cohesion and collective identity to foster community resilience. The notion of community resilience is a widely recognized metaphorical concept (Kirmayer, Sehdev, Whitley, Dandeneau, & Isaac, 2009; Norris et al. 2008) and has been discussed in numerous studies of communities across the globe including Sri Lankans (Somasundaram & Sivayokan, 2013), indigenous people in Alaska (Allen et al., 2014) and Norway (Nystad, Spein, & Ingstad, 2014), although not termed but enacted as such.

Feelings of collectivity and community can metaphorically be understood as being strong weapons to feeling resilient to adversity. Studies based on the experiences of refugees from around the world – although, of course, they cannot be considered a homogeneous cultural group – suggest that, at the collective level, positive changes in response to a traumatic event can be promoted by enabling victims to “go public” by talking about their distress with other victims and to pursue communion and agency; positive changes are also promoted symbolically by collective ritual confrontation (Williamson, 2014; Zraly & Nyirazinyoye, 2010). This goes in line with the suggestion by Tedeschi, Shakespeare-Finch, Taku and Calhoun (2018), that self-disclosure at the community-level is vital to both acquiring community resilience and enhancing PTG. Self-disclosure is said to go beyond the broadly known concept of social support, as it allows for active participation in the community, including the participation in political debates in the fight for human rights (Magwaza, 1999).

Collective approaches to overcoming adversity call into question the modern, individualist idea that adversity and well-being are mainly functions of the individual and an emphasis on individual autonomy, self-efficacy and self-improvement. At the collective level, the main route to recovery appears to be through agency and communion with individuals with similar collective beliefs and values (Maercker & Hecker, 2015; Maercker & Horn, 2013). Collective traditions, beliefs and value systems can give meaning to an aversive event, and thus provide ways of expressing what has happened and defining its significance for the members of a particular community (Moscardino, Axia, Scrimin & Capello, 2007).

Metaphors of paths and journeys in time and space

Common uses of the path metaphor imply the necessity of behavioral choice. Following or rediscovering the “right” path often involves refraining from negative behaviors, harmful associations and unhealthy practices. Recovery and “going the right way” may thus be a way of behaving appropriately or correctly by following a life pattern according socio-cultural norms (Fiske, 2008).

Metaphors involving paths can be split into two categories: those involving linear paths and those involving cyclical paths. People in Western cultures may be more likely to perceive that there is only one “correct” path; thus, if one fails to follow this path, one may feel as if one's life has been a failure. Uses of the linear path metaphor in Western contexts, exemplified by expressions such as “getting back on the right track” (Tedeschi & Calhoun, 1995; Weiss, 2005), suggest a mental model of reality in which one's fate is influenced by one's efforts and actions (Tweed & Conway, 2006). However, the linear path metaphor of moving forward in order to get back to the previous state quickly, which appears in some African cultures, implies very different understandings about agency in the face of adversity. These metaphors suggest that the sensible option is to look forward and forget about the past, suggesting an understanding of the world and fate as unchangeable; in these cultures, efforts to change the self and the external world might be regarded as futile (Tweed & Conway, 2006).

In contrast, many Asian cultures propose that life is cyclical and that if an individual fails in this lifetime he or she may nevertheless be able to do better in his or her next life. According to publications focused on Asian contexts (Chen, 2006; Dodrupchen, 2015; Zhai et al., 2010), the expression path of life not only represents the possibility of change, but also communicates the benevolent purpose of life. The notion of a path of life implies that life will lead one where one needs to be taken, and that for this to happen both the good and the bad must be accepted (Tweed & Conway, 2006).

These different interpretations of continuity may be rooted in historical religious beliefs. Christianity holds that there is a clear beginning and a clear end to life. After being born, individuals find themselves on a linear path, where they remain until, finally, they enter the afterworld. Hence, uses of the linear path metaphor in historically Christian cultures may reflect the idea that life is a transient journey in which moving forward means leaving behind parts of one's adverse experiences, either by accepting them as part of one's life history or by forgetting them. In contrast, the concept of samsara is central to Buddhist and Hindu beliefs. Samsara means “suffering-laden cycle of life, death, and rebirth, without beginning or end” (Wilson, 2010). Buddhists and Hindus may thus approach the world and life by trying to achieve a mindset that acknowledges and accepts disturbances and suffering, sometimes treating them as preparation for even greater adversity (Tweed & Conway, 2006).

Although the path metaphor is compatible with various ways of interpreting the world, a common feature seems to be the implied temporal and spatial perspective and the notion of movement along the lifespan. Whilst the application of this metaphorical concept varies across cultures, its ubiquity suggests a cross-cultural understanding of recovery from adversity as a process that involves motion through space and time.

Limitations

This study has important limitations. We conducted a non-systematic review of the literature using English language search terms; the results of this study may thus not accurately reflect the full scope of available research on this topic. As we are not experts in many of the cultural areas we have described, we relied for our examples on previously published ethnographic studies or related work undertaken for other purposes. Future research on metaphorical expressions should be based on systematic collection of original material in languages with which the researchers are familiar. We recommend that ethnographic field studies are carried out using an inductive approach that integrates the researchers’ experiences with extensive knowledge of the culture under investigation, rather than relying on a metaphor classification scheme devised solely by Western researchers. Further, we were not able to differentiate clearly between the terms ‘extreme adversity’ and ‘traumatic event’. We encourage future researchers to take into consideration the severity of aversive events under investigation in order to improve our understanding of fine-grained differences in responses. Finally, defining what constitutes a metaphor for adaptive or positive responses to adversity has proven to be a challenge in two ways. First, closely related concepts like healing, well-being or coping-strategies to adversity were difficult to precisely differentiate from our concept under study. Researchers are encouraged to elaborate on this difference when working with metaphor analysis in the future. Second, in defining what constitutes a metaphor per se, one may undermine the emic perspective on this expression and impose one's own ontological assumptions. Intensive ethnographic fieldwork and close collaboration with local communities may counteract this problem, as observations and discussions can facilitate better understanding of cultural narratives and enactments.

Conclusion

In this article, we aimed to present a broad range of metaphorical concepts representing implicit ideas about positive responses to extreme adversity that are reflected in particular medical and religious traditions. We found that no single conceptual metaphor can represent the full breadth of subjective experiences of people living in different cultures and at different points in time. While metaphors used in Euro-American cultures seem to suggest that psychological improvement of the self is the responsibility of individuals confronting extreme adversity, other cultures have a repertoire of shared representations, myths, symbols, and rituals that reflect different beliefs and values about the self, the world, and the nature of suffering (Kirmayer et al., 2009; Somasundaram & Sivayokan, 2013). Individuals from more collectivist cultures may strive for social integration when faced with adversity, rather than seeking to directly improve their own state of mind (Lambek, 2002; Rimé, Kanyangara, Yzerbyt, & Paez, 2011). That said, it was difficult to precisely distinguish among the myriad religious and social influences on metaphorical concepts relating to adaptive or positive responses to adversity and to assign these concepts to specific cultures. The present era of globalization is characterized by continuous, dynamic exchanges between cultures, which may result in even greater within-culture variability of concepts—including among individuals in Euro-American societies.

These findings have important clinical psychological and psychiatric implications. The plurality of metaphorical expressions for recovery processes highlights the importance of respecting individuals' perspectives on and interpretation of health issues and recognizing that they are influenced by socio-cultural factors. The proposed taxonomy is not intended to guide clinical practice. However, this compilation of metaphorical concepts rooted in diverse cultural ontologies suggests that it is essential to consider the nuances of a patient's illness narratives and to try to interpret them according to the patient's worldview. Adopting the patient's language and acquiring a shared understanding of metaphorical meanings may prove an important step towards successful clinical practice in an increasingly globalized world.

Footnotes

Acknowledgments

A thank you goes to Moritz Mähr and Nicole Hauser for their critical thoughts and inputs. We also thank the anonymous reviewers and the editors for their valuable inputs.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a PhD grant from various foundations: We give thanks to the Psychology Fund at ETH Zurich, the Baumann Family Foundation, and the Foundation of the works of C. G. Jung.

Note

Iara Meili, PhD, completed her doctoral studies at the Division of Psychopathology and Clinical Intervention at the University of Zurich, Switzerland. Her research focuses on different approaches to understanding mental health issues in the field of cultural-clinical psychology.

Andreas Maercker, PhD, MD, is chair of the Division of Psychopathology and Clinical Intervention and a Professor of Psychology at the University of Zurich, School of Humanities and Social Sciences. Dr. Maercker researches trauma- and stress-related disorders, lifespan trajectories, and cultural dimensions of psychopathology. Since 2011, he has been chair of the WHO work group on ‘Disorders specifically associated with stress’ for ICD-11. He has been Principal Investigator of several national and international projects in these areas. He has published more than 250 papers and edited 12 German and two English volumes.

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