Academic journal article American Journal of Pharmaceutical Education

Mixing Metaphors in Pharmacy Education Is a Bad Solution for Students

Academic journal article American Journal of Pharmaceutical Education

Mixing Metaphors in Pharmacy Education Is a Bad Solution for Students

Article excerpt

Three thought-provoking essays published in the American Journal of Pharmaceutical Education focused on the deleterious effects of consumerism on pharmacy education. Cain et al convincingly argued that a student sense of entitlement can undermine professional education: "Grade inflation, student incivility, altered classroom practices, and decreased faculty member morale are all potential after effects of teaching students who hold academic entitlement beliefs." (1) As a response, Karpen's letter offered a pharmacy student's refreshing perspective on what students legitimately expect from the educational establishment. (2) Finally, Holdford's clever and insightful essay, "Is a pharmacy student the customer or the product?" warned of the threats to education posed by a related emerging trend, the identification of students as "customers" of the educational system. (3) Although Holdford's diagnosis was insightful, his proposed cure was less so: he suggested the alternative to viewing students as customers was to view them as educational products we deliver to our real customers: the students' future employers and the public who would consume the students' services. While many of his observations were on target, this remedy would likely exacerbate rather than correct the problem, for it retained the consumer mentality that underlay the designation of student as customer in the first place. Nonetheless, this student-as-customer model is indeed a pressing issue because, in both education and medicine, a consumer mentality is increasingly threatening care. A more radical solution is needed--one requiring a better understanding of both the essence of professionalism and the uses and misuses of metaphor.

Some may argue that it does not make a difference what we call students, (4) but this is not a pedantic quibble over terminology. Nomenclature sets up paradigms that govern our thinking, actions, and structures. To think of students (or patients) as customers is to think metaphorically: that is, to attribute to one entity the characteristics of another in order to provide clarity or insight. (5)

Metaphors are not merely rhetorical or poetic devices that do nothing more than clothe our preexisting ideas in fancy dress. They are extremely important organizational tools in the formation of our ideas and structure of our daily practices. Lakoff and Johnson argued in Metaphors We Live By that metaphors are generative, theory-constitutive. In other words, we organize our work and our lives differently, for instance, depending upon whether we see the human mind as a wax tablet, a landscape, a web of relations, a spread sheet, or a neural network. (6) Metaphor is instrumental even in the development and dissemination of scientific theory; while the traditional metaphor for the Newtonian cause-and-effect universe is a billiard table, a warped Einsteinian universe of space-time is more easily conceived by the metaphor of the universe as a billiard table in which the slate surface has been replaced by a flexible net. (7)

Nonetheless, metaphor continues to evoke apprehension, and perhaps appropriately so. For instance, Susan Sontag acknowledged but declaimed the power of metaphor in Metaphor and Illness, which argues that metaphor should be banned from medical discourse. (8) Herself a "victim" of cancer (note the metaphor here), Sontag contended that military, magical, and romantic metaphors used in talk about diseases categorized, demoralized, shamed, isolated, and silenced patients. In her later work, AIDS and Its Metaphors, Sontag acknowledged that her earlier strident condemnation of metaphor was combative and unrealistic: "Of course, one cannot think without metaphors. But this does not mean there aren't some metaphors we might well abstain from or try to retire." (9)

This is more to the point. Metaphors open a window onto reality but thereby blind us to other perspectives: as the philosopher Martin Heidegger pointed out, "every revelation is a darkening," or as Ralph Waldo Emerson more succinctly observes, "every advantage has its tax. …

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