Metaphorical constructions of hypertension among three ethnic groups in the Netherlands

Abstract

Background. This article examines the various metaphors used by hypertensive patients from different ethnic groups in multi-ethnic and multicultural Netherlands. The choice for the study of metaphors is based on the need of people to use metaphors, analogies and symbols to make sense of and express their illness experiences. Given the high prevalence of hypertension in Western countries, such as the Netherlands, and the fact that hypertension is also a major risk factor for cardiovascular disease among immigrants makes it necessary to study the various metaphors these groups use when speaking about the causes and consequences of their hypertension. This can contribute to a shared understanding and communication about this illness.

Methods. Discursive analysis of the metaphorical constructions of the causes and consequences of hypertension 55 participants of Creole, (White) Dutch and Hindustani descent employed in-depth interviews.

Results. The findings illustrate that the participants use several metaphors to ‘live’ their hypertension. The metaphors some of the participants employed to explain the origins of their hypertension construct the human body and its organs as machines or parts of machines. When speaking about the possible consequences the participants used metaphors that represented of hypertension as an unknown enemy, they feared because of its silent, invisible and uncontrollable character and the way it abruptly makes itself known.

Conclusion. Metaphors people employ to speak about their hypertension open up a space for patients to explain how they understand their hypertension and how they want to live with it even if it means resisting recommendations put forward by their doctors. It is therefore necessary to find metaphors that can work for health care providers and patients that work the best for communication about hypertension and its medical treatment.

Keywords:

• metaphors
• discursive constructions
• hypertension
• ethnic groups
• multicultural societies
• The Netherlands

Acknowledgements

We thank all the participants for taking the time to talk to us and the doctors and practice assistants for their willingness to mail the letters to their hypertensive patients. We would also like to thank the referees for their very helpful comments and suggestions.

Notes

1. The empirical data were generated in 2004 and 2005 when the first author was working at the Department of Social Medicine.

2. For convenience sake, the White Dutch, Creole and Hindustani Surinamese participants will be addressed as Dutch, Creoles and Hindustanis. Hindustanis are descendants of indentured labourers who were brought from India at the end of the nineteenth and the beginning of the twentieth centuries to work on the plantations in Suriname, a former Dutch colony in the Caribbean region. Creoles are descendants of Africans brought as slaves from the seventeenth to the nineteenth centuries and other ethnic groups such as Chinese, Europeans, Hindustanis, Javanese and native Surinamese. Most of the Creole participants identified themselves as such after revealing their mixed ethnic origins. For all kinds of reasons, health researchers in the Netherlands are quite eager to establish the African origins of the Creoles while simultaneously neglecting their more hybrid ethnic origins. Although it is a trend among the Creole Surinamese to identify themselves as African Surinamese, only one participant defined herself as such. The Surinamese migration to the Netherlands goes back to the seventeenth century (numbering a few hundred), with considerable increases after World War II. As Dutch nationals, the Surinamese could immigrate to the Netherlands without restrictions until 1975, when Suriname became independent.

3. The Dutch Eurasians are of mixed Dutch and Indonesian descent. Most Dutch Eurasians (being Dutch citizens) emigrated from Indonesia to the Netherlands after World War II.

4. These two participants were interviewed together because Mrs O., who, when interviewed, was still recovering from a stroke, was afraid that she would not be able to answer the questions properly. Mr P. was also treated for hypertension.

5. The same rule applies to researchers. The first author is thinking of a colleague who classified one participant's construction of his hypertension as a ‘time bomb’ as ‘bizarre’.