■ Cindy Dell Clark

PENNSYLVANIA STATE UNIVERSITY (DELAWARE COUNTY)

Visual Metaphor as Method in

Interviews with Children
A challenge to child-centered anthropology is to develop methods of exploring children’s
worlds that accommodate children’s own ways of communicating meaning, including
nonverbal, visual means. The article proposes an approach, the Metaphor Sort Technique,
and illustrates this method based on an ethnographic study of childhood diabetes and
asthma. The Metaphor Sort Technique employs pictures selected by children as metaphors
for their impressions of illness and its treatment. The Metaphor Sort Technique, as a feature
of discourse, stimulated, complemented, and supported children’s verbal utterances. The
study demonstrates that when modes of discourse include visual, nonliteral tasks, this can
activate a child’s discursive power, reducing deference and enhancing the child’s authority
in an adult–child encounter. [metaphor, interview, child, diabetes, asthma]

Children in Anthropological Research

E
ight decades after Edward Sapir’s 1934 lament that the active acquisition of
culture by the child was a topic too neglected in anthropology (Sapir 1951), an-
thropologists have come to better understand how children avail themselves
of cultural resources as they orient themselves to cultural worlds. Contemporary
scholars have documented that children make an active contribution to their own
enculturation and figure prominently in processes of cultural discourse.1 In consid-
ering the state of anthropological research on children at the turn of the millennium,
Helen Schwartzman (2001) notes a lessened inclination by scholars to regard children
strictly as adults-to-be, along with a greater regard for children’s perspectives and
actions in constituting culture. Contemporary sociologists of childhood have joined
anthropologists in drawing attention to children’s voices and perspectives through
an expansion of research revealing children to be centrally important, contributing
sociocultural actors.2 At the same time, scholars pursuing studies of children’s educa-
tion and literacy have espoused the use of methods borrowed from anthropologists,
in part for the capacity of such methods to reframe and refocus problems in terms
of children’s ongoing activity and views (Hatch 1995; Lancy 2001). For anthropolo-
gists, studying children in ways that focus on children’s vantage points can make
a consequential theoretical contribution to the discipline by casting light on genera-
tive processes of social relations, symbolic engagement, and identity (Goldman 1998;
Lancy 2003; Toren 1999).
Despite the accumulating awareness that children are underserved by their soci-
eties (Hecht 1998; Mickelson 2000; Scheper-Hughes and Sargent 1998; Stephens 1995),
youth are still not studied by anthropologists in proportion to their numbers in the

Journal of Linguistic Anthropology, Vol. 14, Issue 2, pp. 171–185, ISSN 1055-1360, electronic ISSN 1548-1395.


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171
172 Journal of Linguistic Anthropology

world populace (Friedl 2002; Hirschfeld 2002; Schwartzman 2001). Although it has
been suggested that sociopolitical biases inhibit scholarship on children (Chin 2001),
another crucial factor is the difficulty of developing culturally valid child-centered re-
search methods. Understanding discursive processes, specifically discourse involving
children, is a critical step in devising child-centered research methods.
Theoretically framing and conducting an investigation that is child centered rather
than adult centered is a challenge. Many theories of enculturation have a top-down
bias, favoring the roles of adults over children (Fine and Sandstrom 1988; Friedl 2002;
James et al. 1998; Waksler 1991). Children traditionally have been viewed by theo-
rists as incomplete, in the process of being socialized toward their future roles and
privileges (Ruark 2000). The movement toward child-centered research asks us to
rethink these conventional notions in order to study children in their present cul-
tural worlds from their own vantage points. A challenge within the child-centered
approach is finding ways to learn from children in a manner appropriate to their age
and culture-embedded ways of being. The younger the child, the less likely it is that
established research tools—such as straightforward verbal interrogation—can serve
to give access to the full range of youths’ understandings. Charles Briggs (1986) and
Elliot Mishler (1986) have considered the interview process among adults, arguing
that the medium of gaining information should reflect how meaning is communi-
cated in ordinary social life by the group under study. Interviewing minors calls for
employing communicative strategies that draw from children’s own native practices,
respecting children’s ways of extracting and expressing meaning. Visual, metaphor-
derived modes of interaction, I argue, can be instrumental to accomplishing this goal.
As linguistic anthropologists have shown, graphic and poetic modes of communi-
cation can serve to differentially activate power in discourse; this has already been
demonstrated in adult healing encounters (Kuipers 1989), in which asymmetrical rank
(patient versus healer) poses issues of power relations not unlike the rank differences
between child and adult (Perrino 2002; Wilce 1995, 2000).
Western play therapy is one cultural milieu in which American adults interact with
children in order to understand and aid the child (O’Connor and Schaeffer 1994;
Schaeffer and O’Connor 1983; Singer 1993). Nonverbal techniques to learn about chil-
dren have been part of play therapy since its historical inception. In 1919, Hertha von
Hug-Hellmuth, a pioneer clinician, chose to observe children in their homes under
the presumption that such observation enabled clinicians to be familiar with a child’s
environment. Growing out of Hug-Hellmuth’s work were efforts by early psychoana-
lysts, including Melanie Klein and Anna Freud, to substitute play for verbal methods
of child clinical treatment (Schaefer and Cangelosi 1993). In contemporary times, the
use of nonverbal methods of play in child psychotherapy has become pervasive as
a European and American treatment modality. Children engage in tactile play, role
playing, drawing and painting, games, clay manipulation, and play with any number
of cultural artifacts, including toy telephones, dolls, dollhouses, puppets, sand, wa-
ter, blocks, costumes, songs, food, and whatever prompt or stimulus the clinician or
child makes available (Schaefer and Cangelosi 1993). A child’s interaction with these
materials sets up a communicative system in which visual information is crucially
significant. The therapist watches what the child wants to communicate as the child
draws or makes believe or builds. Talk may well be part of this communication, but
visual material is substantially meaning-laden as the child “shows” as well as “tells”
her concerns and understandings. Play therapy thus employs a discourse that is richly
visual.
Another perhaps more subtle feature endemic to the practices of play therapy has to
do with a referential device common in children’s play, in which the meaning employs
visualized metaphor. For instance, a child may take a toy top and turn it around and
around as the child himself falls to the ground as if dizzy. The top is symbolically
mapped onto the child (or vice versa) in a trope of vertigo. In a documented case,
a child who had difficulty maintaining change in her personal behavior sang and
gestured to her therapist about the “Itsy Bitsy Spider,” a song that tells how a spider
Visual Metaphor as Method in Interviews with Children 173

repeatedly failed to maintain its progress in ascending a rain-soaked water spout

(Frey 1993:227). The spider is interpreted by the therapist as representing more than
itself, serving to poetically concretize an inchoate sense of the child’s own struggle.
Children communicating through concrete manipulations and images are engaged in
symbolic expressiveness through a visual form that assists the child’s communication
by making the inchoate more concrete (Schaefer and Cangelosi 1993).3 Play therapy
might be thought of as an embodied practice (Goodwin 1994) that uses graphic as
well as analogic forms to highlight, or set into relief, salient material for the child and
therapist.
The use of visual metaphor by U.S. children certainly is not limited to play ther-
apy, but rather is a characteristic feature of children’s cultural worlds (Fraser 2000;
Gibbs 1994; Winner 1988). Among adults as well, metaphor is so common as to be
readily overlooked in ordinary life (Lakoff and Turner 1989). Metaphors in visual
form receive especially wide use, since vision constitutes a shared basis for deriving
meaning—among the young and old alike (Johnson 1987:109). Metaphors are known
to be effective when used in the didactic education of children (Tobin and Tibbins
1996). In an effort to educate youngsters with diabetes about the need to balance
insulin with proper diet and exercise, for example, a previous study found that the
visual image of a teeter-totter (representing balance) served as an effective teaching
metaphor for young children (Clark 2003). Similarly, in ordinary play (not for clin-
ical purposes), children act to subordinate real objects and actions to the analogical
field of play, through which figurative meaning takes precedence over literal actions
(Vygotsky 1978). Metaphorical or analogical thought is cognitively accessible to chil-
dren in the five-to-eight-year age range and beyond, operating conceptually both
linguistically (Gibbs 1994; Verbrugge 1979) and visually. This does not imply that
children recognize the concept of a metaphor as a linguistic structure, but rather that
they tacitly communicate through metaphors; a lack of metalinguistic understanding
does not preclude youths’ facility with metaphor as an un-self-conscious medium of
expression.
Metaphor privileges the child’s meaning making, since metaphor’s nonliteralness
gives the child wide latitude over how to express meaning. That is, metaphor is
enabling rather than constraining, in that the allusive ties or common attributes
implied by a metaphor are creatively derived and discoverable by the individual
person, rather than determined or explicit. The child draws from a reservoir of
communally available cultural meanings in constructing metaphors, but she has
scope to make creative linkages. Metaphors, both visual and other kinds, are pivotal
structures in which meaning is discoverable but not imposed (Lakoff and Johnson
1980).
While metaphor gives the child latitude of expression, it also engenders social
connection, thereby serving to unite interlocutors. Metaphor potentially brings about
a shared-meaning process, a mutual engagement in signification. As the parties to
a metaphor “get” the entailed connection of meaning, there is a sense that (as in
sharing a joke) a community between teller and hearer comes into being along with
the metaphoric insight (Cohen 1979). In an interview situation, the interviewer is thus
intimated through metaphor into the child’s meaning making, a desirable turn of
events for child-centered inquiry.

The Metaphor Sort Technique

In what follows, I describe a method in which visual metaphors were employed to
aid a child-centered investigation within an extensive ethnographic project conducted
from 1992 to 1996 among 46 U.S. children suffering from diabetes or severe asthma.4
The study was intended to explore the experience of five- to eight-year-old children
who had chronic illness, with a central goal of foregrounding children’s own con-
cerns and understandings. Following Arthur Kleinman’s theory (1988) that illness is
not restricted to physical symptoms but extends to a polysemic set of cultural, social,
174 Journal of Linguistic Anthropology

and personal implications in the sufferer’s life trajectory, the goal was to prompt chil-
dren to express the significance of illness in their lives. The Metaphor Sort Technique
(MST), one method developed to facilitate children’s communication, directly made
use of visual metaphor as a means of engaging the child through a hands-on, inter-
active activity. The MST used the device of a picture sort, by which children looked
through visual stimuli and sorted the pictures into two open boxes, based on whether
the picture was similar in feeling to the topic in question. Pictures to be sorted by the
children were selected, based on pilot interviews, to cover a range of differing child-
comprehensible depictions that included both positive and negative associations. The
pictures were reproduced on white cards that could be readily manipulated. This sort-
ing task allowed the children to communicate nonverbally and to concretize inchoate
feelings through engagement with the visual stimulus. During the sorting process,
children often treated the pictures as full-fledged props to be meaningfully manipu-
lated (moving the picture of an airplane to make the plane fly, making a threatening
gesture with the picture of a spider, pretending to blow out birthday candles on a
cake, etc.).5
In one variation of the MST, children were asked to sort through 25 pictures of
places (ranging from a dark cave to a sunny playground to a burned-down forest)
and place them into one of two boxes. The children could choose pictures of places that
conveyed the same mood or feeling as their illness and place these pictures together
in a box, known as the “asthma box” or the “diabetes box” (depending on the child’s
illness). Conversely, pictures with a mood or feeling differing from the illness were to
be placed together in a separate box. The same depicted places were sorted regardless
of whether a child had diabetes or asthma, although of course the illness asked about
was the child’s own condition. The pictures, described here in words, included (1) a
girl gleefully descending a curving water slide; (2) a vaguely seen city skyline, with a
bridge in the foreground covered in fog; (3) an empty hallway with a series of closed
doors and a pair of empty boots; (4) a porch with unoccupied rocking chairs, looking
out on a sunny, green wooded scene; (5) a flooded plain, in which the top of a building
can be seen above the floodwater; (6) a snow-covered home, lit by outdoor and indoor
lights, with a vehicle’s snow tracks in the driveway: (7) a vivid island sunset over a
tranquil sea; (8) a large, dense crowd of people assembled in a city park; (9) a dark
and dingy gothic mansion set atop a hill amid dark, colorless clouds; (10) two human
figures, one with a fishing pole, sitting on a floating raft surrounded by water, with
rich green vegetation reflected in the water; (11) a girl swinging on a rope-and-board
swing hung from a tree, against a background of a blue sky, rolling green hills, and,
in the foreground, a rabbit hopping along a wall; (12) sparkling blue water, with the
dark tails of sharks visible above the surface; (13) an interior scene, with a neatly made
bed and an empty chair, looking out a window toward a day-lit swimming pool and
the surrounding lush, wooded landscape; (14) two adult swans, swimming in water
next to emerald-green trees, with green matter floating on the water; (15) a colorless
scene of trees, without much light, and evidence that some trees have been destroyed
by fire; (16) six people in a room full of artifacts, including books, games, and sports
equipment, with some items scattered about the room; (17) a flooded area lit up by
the hot colors of a fire burning in the background; (18) a cabin set in a rocky mountain
location, with colorful blooming flowers in the foreground; (19) a dark cave, in which
one person can be seen deep in its dark recesses; (20) trees that have been completely
devastated by fire, with one stump of a trunk and some branches visible but lacking
any remaining color of life; (21) an unpaved road leading deep into woods that become
darker and less green as the road progresses; (22) a lush green landscape, complete
with a waterfall and healthy greenery, and water in the foreground; (23) a densely
wooded scene, with two fishermen in a boat on a body of water; (24) a playground
with children at play, lit up bright yellow by the sun; (25) a child with an elderly man
in a boat with fishing equipment, both smiling as the child proudly holds up a fish on
a line, before a background of blue sky, a green-covered landscape, and a calm, blue
body of water.
Visual Metaphor as Method in Interviews with Children 175

In another MST variation, children were asked to sort through 30 depictions of

objects, shown in picture cutouts that were shaped to conform to the outline of the
object. The items to be sorted were chosen through pilot interviewing to include
familiar (though not necessarily literally real) objects that were hoped to encourage
a range of responses. The cutout pictures included an open jack-in-the-box, a closed
jack-in-the-box, a witch, a handheld remote control, boxing gloves, a spider, a treasure
chest, bubbles, a lightning bolt, a magic wand, a blanket, an ice skate, an airplane, a
school bus, birthday candles, a bumblebee, a train, a baseball helmet, a rainbow,
a life jacket, red shoes (like those worn by Dorothy in the film The Wizard of Oz),
a toothbrush, a car, a magic carpet, a teddy bear, an umbrella, a kite, a butterfly, a
Christmas stocking, and a bomb. The instruction with these pictures was for the child
to place in one box the pictures of objects exhibiting the same mood or feeling as a
particular medical treatment (such as injections or a metered-dose inhaler), and in
another box the pictures of objects exhibiting a mood different from their treatment.
If children had more than one salient treatment in their illness regimen (as most did),
they were prompted to sort the set of objects repeatedly for each salient treatment.
Children referred to this visual sorting of pictures as a “game” and became playfully
involved in expressing how they felt about their treatments through their chosen
visual metaphors. The use of the plain white boxes as containers for the sorted pictures
was a way of vividly showing that the pictures in the box were all of one category
along with the treatment, distinct and separate from the pictures in the other box.
In explaining the MST task to children, I used large, obvious gestures as I explained
how the cards would be put in the appropriate box. Children caught on to the task
readily, as was clear from the interview transcripts. Generally, children took well to
explaining verbally their choice of visual metaphors. For example, the following child
treated the picture sorting as a form of play and became involved in expressing how
she felt through the visual metaphor:
[Girl, age six, with asthma, holding a picture of a baseball helmet above her head.]
Cindy Dell Clark: The helmet’s on your head, and it feels like your nebulizer [a machine
for asthma treatment]; how come?
Girl: The nebulizer is so boring, and a helmet is not very exciting.
CDC: Okay, [points to helmet] boring, boring, boring.
Girl: [showing next picture] An umbrella.
CDC: What does an umbrella do?
Girl: So you won’t get wet.
CDC: Does a nebulizer do anything like that?
Girl: Yeah. It gives you air so you won’t die.
Through the use of the MST, children were able to explain their concerns to me,
many of which had been unknown and unmentioned by their parents. Some children
displayed anger at particular treatments or anxiety over death (particularly in cases
of asthma). Children maintained control of whether and when to mention a prob-
lem. I did not need to ask directly about vulnerable issues because children raised
them themselves; I thereby avoided the interviewer’s ethical quandary of implicitly
“teaching” the child about a hazard or problem of which he was not aware. Through
the sorting task and talk about it, children raised and framed issues in their own
terms, while I played the role of an interviewer who sought to understand. The MST
proved to be a genuinely child-centered method, which enabled young children to
express abstract or inchoate ideas through concrete, familiar objects and scenes. Even
children with limited vocabularies and incomplete language development used the
visual metaphors as a way to articulate feelings nonverbally through linkages of im-
ages, without relying solely on language-based communication.
Children often interpreted the pictures in unanticipated ways. (When this hap-
pened, I of course went along with their interpretations.) Some ignored (perhaps
defensively) the sharks swimming in Scene 12, presupposing the represented scene
to be a cheerful ocean, devoid of creatures, or perhaps with friendly whales present.
176 Journal of Linguistic Anthropology

The boxing gloves included in the cutout pictures were discussed by some children
as if they were warm mittens. Children with asthma repeatedly imputed danger to
pictures that seemed harmless to diabetic children; many of the scenes of flowers and
trees (4, 10, 14, 18, 21, 23, 25) triggered concerns by asthmatic children that these were
dangerous places, due to allergic reactions to the flora and fauna.
In addition to the flexible manner in which children interpreted the pictures, the
visual stimuli also were subject to meanings that fluctuated as a result of the shift-
ing sociocultural context. A cartoon-style bomb (a sphere with a fuse) was originally
included in the cutout objects but was removed when the 1997 Oklahoma City bomb-
ing occurred, in order not to frighten children. The meanings imputed to the pictures
reflected the fluid meanings in the social world, as well as those of individual children.
The visual nature of the MST was helpful in guiding interaction with each child. The
picture under discussion, a visual stimulus shared by the interviewer and interviewee,
became a focal point for discourse. Among physical perceptual phenomena, vision has
been theorized to have a privileged role in metaphor because it provides a common
outlook for co-looking persons (Johnson 1987:109). Vision provides a basis for shared
public knowledge. Moreover, it involves the ability to focus at will, such as picking out
one object from a background or differentiating fine details as a way of highlighting
what is salient (Goodwin 1994). In interviews, as children referred to a picture, I could
share their expressed view of it, even as they could fine-tune the way they perceptually
composed their gaze. The MST made space for the child’s chosen way of seeing, while
also laying out a frame for us to jointly “see” and consider together the implicated
view of illness.

Meanings of Illness and Treatment

In contemporary American society, children with chronic illness are largely treated
through biomedicine, with which the nuclear family is expected to conform (or, in
medical parlance, to be “compliant”). For a diabetic child, conformity with the biomed-
ical regimen invokes the recurring, ubiquitous interruption of the child’s activities for
treatment: monitoring glucose levels several times a day with a drop of blood taken
from the child’s finger, receiving insulin injections twice each day or more often, eating
rigidly scheduled meals and snacks, and not eating what is not permitted or when a
meal is not scheduled. These treatment activities are unrelenting and must be heeded
even if the child is on vacation, at an enjoyable outing, or playing with a friend. Being
diabetic entails acts leading to social exclusion, including a proscribed diet, which
blocks and stigmatizes a child from eating what is culturally normative for youth-
ful celebrations such as those at Halloween, Easter, Christmas, birthdays, sleepover
parties, circus trips, Scout outings, and Little League games. The child with diabetes
is nonnormative, not only because of the disease and its symptoms (such as insulin
reactions that cause a child to feel dizzy and irrational) but because of the vicissitudes
of treatment, which violate a child’s cultural appropriateness.
During the MST, one girl, age six, illustrated through a vivid metaphor how diabetes
entails restrictions on normal life. Discussing her choice of Scene 24, a playground, she
indicated that the feeling or mood of this picture was diabetes-like. In her explanation,
she described an element in the picture that was not literally shown: a fence around
the play area which, she said, “keeps you in,” that is, within the confines of the
playground. Through this imagined visual perimeter, the child discussed boundaries
that restrict the free range of playful experience. She explained that the fence made
diabetes seem “happy” and “sad” at the same time. The playground fence was a trope
for the way in which diabetes was a part of her everyday life, proximate to pleasure but
nevertheless restrictive. Not all children imagined fences around the playground, but
most described a blend of positive and negative ways of understanding diabetes when
choosing analogous scenes. On the one hand, diabetes invokes pleasant memories of
an attentive mother being with the child and helping him with treatments. On the
Visual Metaphor as Method in Interviews with Children 177

other hand, the need to endure the restrictions and hardships of treatment mediates
the pleasant image, introducing a negative counterpoint.
Strikingly, the same child who imagined a fence around the playground in Scene 24
also made it clear that diabetes was not a thoroughly abhorrent experience. In the MST,
this girl discussed her choices of Scene 12 (sharks in the ocean) and Scene 9 (a hilltop
mansion that she envisioned to be in a rainy, muddy storm), indicating that repulsive
entities (sharks or mud) would not be consonant with the feelings of diabetes.
[Girl, age six, with diabetes]

Girl: Oooh. [Throws aside Picture 12, making a sound to indicate disgust]
CDC: Oooh, you want to get rid of that one? What is that?
Girl: Is it sharks?
CDC: Did you think it was sharks?
Girl: [Nods affirmatively, and places Picture 12 in the nondiabetes box]
...
Girl: [Viewing Scene 9, stares at it for a moment]
CDC: You’re really thinking this over.
Girl: [Places Scene 9 in the nondiabetes box]
CDC: Definitely not. [Scene] 9 is not. How come?
Girl: ’Cause there’s a lot of mud there.
CDC: And when you’re in mud how does that feel?
Girl: Yucky.
CDC: Yucky, and diabetes isn’t yucky, is that right? Am I getting the right idea?
Girl: [Nods.]

In the MST task of sorting cutout objects, children did use the pictures to poetically
express how painful some treatments for diabetes were. Insulin shots were repeatedly
compared to disliked entities, including the “sting” of a bee, the “bite” of a spider,
the “scary” feeling of lightning, the “boom” of a bomb, or a “mean,” “bad” witch
who does harm. An injection of insulin was widely interpreted as a painful, invasive
violation. One child threw the picture of a spider across the room to explain its shared
meaning with injections. Despite parents’ expectations that children had become ha-
bituated to shots, children used the MST objects to show that, whether or not they
complained during injections, they nevertheless demonized and loathed this part of
their treatment. By comparison to shots, a blood glucose check (taking a small drop
of blood from the finger with a lancet) was described as less anxiety-provoking than
when first encountered, when children had feared the unknown implications of blood
loss. Children were more tolerant about blood tests, for which the “prick” did not sting
and pierce in the painful way of injected insulin. Many children had learned to do
their own blood tests, controlling this act at an earlier age than the self-injection of
insulin and thereby adding a sense of personal control. The blood test brought greater
reassurance that the child would stay in safe balance, since it monitored her status.
Blood testing was repeatedly compared in the MST task to protective, safe objects,
such as a “snuggly” teddy bear or the “safe” protection of an umbrella, bicycle hel-
met, or life jacket—in sharp contrast to the dangerous items selected as metaphors for
injection. To show how a blood test gave a “safe” feeling like an umbrella, one boy
gestured to show me the double-pronged meaning of the trope: holding the pictured
umbrella over his head, he first explained that the blood test kept him protected like
the umbrella—but in addition, he explained that a blood test made it easier to balance,
much as an umbrella aids a circus performer walking a tightrope.
Children with asthma, like children with diabetes, described experiences of limita-
tions and stigma. As was true of treatment for diabetes, treatment for asthma threaded
through and restrained the worlds of the children in the study. Asthmatic children
often were prescribed several forms of treatment, among them (1) handheld inhalers
(extended with attached “spacers”) through which to take in medication; (2) “nebuliz-
ers,” machines attached by a plug to a wall outlet and that, in turn, attach to the child
through a tube and mouthpiece; and (3) peak flow meters, devices into which the child
178 Journal of Linguistic Anthropology

exhales with purposeful force and that measure the quality of the child’s breath upon
exhalation. Asthma involved considerable stress due to both the treatment and the
terrifying symptoms. A recurring feature of children’s explanations of asthma, in ad-
dition to treatments, was the child’s pronounced anxiety about death—an association
frequently voiced with respect to asthma’s unpredictable attacks of breathlessness. Re-
gardless of messages from teachers, neighbors, and others that asthma was a minor
disorder, children were profoundly troubled by it.
The MST task was an effective way for children to express these feelings about
asthma. Presented with pictures of places, more than one child identified elements in
every picture that he or she thought could cause asthmatic symptoms. The dangers
ranged from bushes (which caused asthma just by the child’s touching them) to trees,
to any kind of green vegetation: “If I went to the woods over there, I would get asthma.”
One boy also singled out Scene 8, a depiction of a crowd in a park, saying that the
closed-in or “crowded” feeling reminded him of when his breathing gets “clogged
up.” The negative descriptions of scene after scene revealed that asthma was a realm
of recurring peril in which breathing difficulty could be set off at every turn.
In sorting pictures to find places that “have the same feeling as asthma,” children
most commonly chose pictures of natural disaster and lifelessness, such as Scenes 5,
9, 15, 17, 19, and 20. These depictions of fire, flood, and other devastation were not the
scenes of choice for diabetic children (who seldom mentioned issues of life and death).
The following are examples of verbatim comments by asthmatic children in response
to these pictures, unpacking their negative and fearful associations with asthma and
breathlessness

Of a tranquil pond scene: “It looks like it has mold in the pond. I’d be sick.” [Girl, eight]
Of a fire-filled scene: “It’s a fire and if I breathe in smoke, it’ll make me sick, that’s
all.” [Girl, eight]
Of a demolished house: “When I feel the house is blowing up, is when I’m coughing.
And when I feel like the house is blowing up, I feel really bad.
[It’s like] sometimes at the coal mine exhibit at the Museum of
Science and Industry, I might cough at the explosion. I thought
the explosion would kill everyone.” [Girl, six]
Of a dark cave: “You’re all alone, like it gives you the feeling of being kinda
scared. Because when you have asthma, you don’t like to be
alone and being scared you can’t breathe. Right. And it’s dark,
and there’s nothing living there, and it’s not a fun place to be.”
[Boy, eight]
Of a house: “It seems like it’s kind of a closed-in space that not much air
can get into. And it’s not that many cracks in the walls and
windows. I think you would have a hard time breathing. You’d
be wheezing a little bit. There’s a little bit of life, and there’s air
outside, but it might have a hard time coming in. ’Cause it’s kind
of like closed doors.” [Boy, seven]

Children’s fright at experiencing impaired breathing led to a clear need for reas-
surance. Medications often instantiated reassurance for asthmatic children, especially
inhalers containing medication for immediate relief of symptoms. Inhalers, regarded
with special trust, seemed to take on fetishlike connotations. When asked to choose
objects similar to an inhaler in the MST task, children chose protective items such as
the life jacket—thought by one child to be a “bulletproof vest” that “saves you,” or
by another child to be a device that prevents drowning and so “helps you breathe.”
Other objects comparable to an inhaler were warming mittens, a blanket, a baseball
helmet, a car’s seatbelt, an umbrella, or an emotionally comforting teddy bear. These
objects elicited verbal descriptions of care and security.
Other medical devices to treat asthma were less wholly praiseworthy than the
inhaler. The peak flow meter, as might be expected, was compared to other objects
involving blowing: blowing bubbles or blowing out the candles on a birthday cake. In
contrast to the metered dose inhaler, however, the exhalation into a peak flow meter
Visual Metaphor as Method in Interviews with Children 179

did not evoke associations of reassurance, as did the inhaler. No matter how hard
they blew, children with asthma found it difficult to produce a high reading on the
peak flow meter, which in turn implied failure or frustration. The nebulizer also was
not associated with wholly positive interpretations. On the one hand, a nebulizer was
compared to protective, salvific, or reassuring objects, such as a rainbow (“happy”
after rain), a bicycle helmet (“It protects you”), and an umbrella (“You won’t get
wet, just like it gives you air so you won’t die”). At times, the nebulizer was poetically
equated with objects or occasions of trustworthy companionship, such as a teddy bear,
or a birthday cake in the friendly circumstance of being surrounded by friends. Yet
the nebulizer had negative associations, as well, because of the pronounced boredom
during treatment. A nebulizer, one boy said, was like a school bus that passed the same
scenes every day and took so long that “I may be late for school.” Time dragged when
a child was attached to a nebulizer. Children felt detained by nebulizer treatments.
Theories of the symbolic meaning of medication have had proponents among ethno-
graphers. Alan Prout (1996) has proposed that the technologies used to treat illness
become intertwined in the social processes by which people influence one another.
Among the moderately ill asthmatic children Prout studied, for example, inhalers
were valued for minimizing the intrusion of asthma into ordinary family interaction.
Sjaak Van der Geest and Susan Whyte (1989) have similarly argued that medica-
tions can be formative of social relations, in light of the particular social context in
which a medicine is dispensed. Medical treatment carries social significance, a notion
confirmed by children’s responses in the MST task. In their visual choices and verbal
explanations, children endowed medication with substantial symbolic and expressive
meaning, situated within a sociocultural milieu.
Children, like the mature professionals studied by Charles Goodwin (1994), made
ready use of graphic representations to encode and communicate meanings to an adult
interviewer. Through visual manipulations, the expressive significance of medications
and illness was readily given structure, salience, and tractability by young sufferers.
Extending beyond literal talk, in other words, activated juvenile powers of both verbal
and nonverbal expression; in an adult–child exchange, this countered the normative
tendency toward youthful deference and amplified the child’s authority to portray
child-relevant issues of illness.

Conclusion
Neither asthma nor diabetes is an experience that is reducible to simplistic structures
of meaning. Subtle nuances characterize children’s understandings of their illnesses.
Treatments meant to relieve suffering, for example, ironically bring distress as well as
relief—as in the cases of painful injections or boring nebulizer treatments. In diabetes,
treatments involve connection to parental care but also annoyance. For asthma, the
impediment to breathing can simultaneously engender embarrassment, frustration,
and terror. The meanings enfolded into illness can be intricately multiple, calling for
a thick and finely tuned means of inquiry. It is relevant that children’s interpretations
of illness often involve highly potent, emotionally charged meanings. As they wrestle
with their fears and suffering, it may be taxing to marshal the right words or to frame
a strictly verbal explanation.
A demonstrated advantage of the MST is that the visual medium stimulates, com-
plements, and supports children’s verbal utterances. Just as play therapy or drawing
provides a visible context for expression, child participants in this study made articu-
late use of the visual metaphor in the sense of both speech and gesture. Corroborating
the successful use of metaphor in this study is past success with structured instru-
ments used by other scholars, such as having children assess pain through a depicted
thermometer or by using colors as analogs of pain (Dalquist 1990). Children use
metaphor in many contexts of everyday experience (Gibbs 1994). Mythic and media
characters are treated as metaphorical symbols, such as Santa (symbolic of winter and
Christmas) and the Easter Bunny (which stands for spring and Easter) (Clark 1995).
180 Journal of Linguistic Anthropology

Likewise, the attachment to stories that hold emotional meanings for particular chil-
dren shows that metaphor is an asset of their daily socioemotional life (Alexander
et al. 2001; Bettelheim 1977; Miller et al. 1993). Used in interviews, metaphor taps into
children’s ready aptitude for and cultural experience with discerning significance by
linking domains.
Of course, play and the use of visual material are practices subject to local cultural
rules. Both pretend play and the role of emotions in play can take variant, culturally
divergent paths (Gaskins and Miller 2002). Within American minority groups, notably
Old Order Mennonites, children might not use play (or metaphor) as a mode of ex-
pression in the same manner as the children studied here (Carlson et al. 1998). On the
other hand, cultural differences often call for the availability of diverse methods; for
healing treatment in societies that focus primarily on oral discourse rather than hav-
ing a print orientation, visual metaphors may be particularly well suited (Doumont
2002). It remains to be seen if the MST can travel across cultures, and if so, along
what paths. Intimate cultural acquaintance would certainly be a prior condition for
designing or carrying out a study with the MST and for assessing its sociolinguistic
relevance.
Handing a child a stack of pictures to use for purposes of expression builds on a prior
expectation that an interview is, in part, about looking. The term interview encodes
the idea that vision is involved in the inter-view process generally, amid the give-
and-take of conversation. Language also reveals how inquiry involves looking. In the
expression focused interview (the origin of the contemporary expression focus group)
the word focus betokens an implicit connection to vision—as if the inchoate comes
into better view through the interview process. Metaphors of vision are common as
well within the language of surveys: queries are described in terms of “looking at” an
issue or asking how the respondent “sees” things. Elicited opinions are “views.”
Visual materials, rather than reducing a complex phenomenon to its simplest form,
in this study empowered each child to communicate with emotional depth and nu-
ance. A picture invites consideration in fluid, layered ways, as aptly implied by the
adage that a picture is worth a thousand words. Putting pictures into children’s hands
gave them appropriate tools for framing intricate ideas. The MST provided a means
for children to express multiple meanings and the tensions between these meanings,
through the choice and explanation of metaphoric linkages. With the help of an inter-
viewer who reflected back what was said, these children used visual modes to convey
dense and highly emotional interpretations.
In extracting metaphors for the socioemotional significance of illness, children
proved able to do what theorist Gay Becker (1997) has termed “naming the nameless.”
This phrase describes the way metaphor can mediate the unfathomable dissonances of
illness. Illness, with its disruption of the usual cultural parameters, can plunge the ill
person into a dismantled, seemingly chaotic world. Becker has argued that metaphor
is a mediator that facilitates finding an orderly way out of this abyss. For instance,
a man might use metaphor to make a linkage between his present distress and the
healthier past, so as to explain his current misfortune.
The facility with which children used visual metaphors during interviews as a
medium of communication and understanding about illness suggests that this kind
of mental adeptness with making connections may be entailed in young persons’
navigation of cultural meanings as they find their way in a dissonant world. When
all is said and done, restricting our communication with children to words or ig-
noring metaphorical processes unwittingly limits researchers to modalities that ex-
clude the full range of sense making. Verbal questioning, as a restrictive menu of
inquiry, favors adults’ superior language skills and in the process dilutes what chil-
dren can express. Although it is certainly true that visual methods have disadvan-
tages, visual approaches are less prone to silence children than are strictly verbal
methods.6
Allison James has asserted that childhood ethnography is a worthy example of to-
day’s “experimental and poetic moment in ethnography’s own history” (2001:256), in
Visual Metaphor as Method in Interviews with Children 181

that childhood researchers adopt dialogical or perspectival approaches that seek to

be reflective of children rather than to exclusively assume taken-for-granted, con-
trolling, adult perspectives. Forms of study that activate children’s participation
push further in the direction of expanding children’s dominion within scholarly in-
quiry. Visual metaphor demonstrably animates young people’s stake and involvement
in interviews. A visual metaphor draws the interviewer into the child’s way of
seeing.
Children’s cultural experiences stand to be appreciated best if scholars seek to
see children’s views as fully as possible. This effort appears to be aided under two
conditions: first, when children are met eye-to-eye, through empowering, visual ap-
proaches; and second, when the interpretive lens is open to both literal and figurative
significance.

Notes
Acknowledgments. I wish to thank the Kellstadt Center at DePaul University and the Rain-
bow Foundation for Children’s Research for providing generous support for this investigation.
I also am grateful to Holly Blackford and Jonathan Monroe-Cook for their assistance and input
in preparing the study stimuli.
1. Recently, there has been a child-centered turn in the study of culture, as exemplified by
Briggs (1998), Clark (1995), Goldman (1998), Goodnow et al. (1995), Goodwin (1990), Panter-
Brick (2001), and Weisner (1998). Scholars interested in language socialization, such as Ochs
(1988), Schieffelin (1990), and others, have also contributed to this movement (see Kulick and
Schiefflin 2004).
2. Recent sociological inquiry into children as social actors is reflected in the work of Butler
and Shaw (1996); Corsaro (1997); James (2001); James, Jenks, and Prout (1998); James and Prout
(1997); Mayall (2002); Thorne (1994); and Waksler (1991), to name some examples.
3. Fernandez (1986) has shown how metaphor allows adults, as well, to concretize the
inchoate, suggesting that this is a general human process rather than one that is age-related.
4. The study included repeated, multimethod interviews with 46 children living in urban
and suburban Chicago, conducted in the children’s homes over a three-month period. Mothers
and sometimes fathers were also separately interviewed. Children came from diverse social
strata and ethnic groups. The investigation additionally used observational methods, including
photos taken by the child and family during the period of study (Clark 1999) and field notes
recorded by the parent about the child. The interviewed children suffered from either insulin-
dependent diabetes or severe asthma (Clark 2003).
5. Although a five- to eight-year age span was included, the study was not intended to
trace a developmental trajectory of children’s metaphor processes. To be sure, the younger
children sometimes required extra instruction and encouragement to coax them to explain their
metaphor choices—rather than to default to an “I don’t know” response. But with scaffolding
by the interviewer, children spanning the age range of the study were able to use metaphors as
tools to explicate the illness experience.
6. By some accounts, spoken language holds advantages for expressing abstract ideas
(Doumont 2002).

References Cited
Alexander, Kristin J., Peggy J. Miller, and Julie Hengst
2001 Young Children’s Emotional Attachments to Stories. Social Development 10(3):375–
398.
Becker, Gay
1997 Disrupted Lives: How People Create Meaning in a Chaotic World. Berkeley: University
of California Press.
Bettelheim, Bruno
1977 The Uses of Enchantment: The Meaning and Importance of Fairy Tales. New York:
Vintage.
Briggs, Charles L.
1986 Learning How to Ask: A Sociolinguistic Appraisal of the Role of the Interview in Social
Science Research. Cambridge: Cambridge University Press.
182 Journal of Linguistic Anthropology

Briggs, Jean L.
1998 Inuit Morality Play: The Emotional Education of a Three-Year-Old. New Haven, CT:
Yale University Press.
Butler, Ian, and Ian Shaw
1996 A Case of Neglect?: Children’s Experiences and the Sociology of Childhood. Aldershot:
Avebury Press.
Carlson, Stephanie M., Marjorie Taylor, and Gerald R. Levin
1998 The Influence of Culture on Pretend Play: The Case of Mennonite Children. Merrill-
Palmer Quarterly 44(4):538–565.
Chin, Elizabeth
2001 Purchasing Power: Black Kids and American Consumer Culture. Minneapolis: Uni-
versity of Minnesota Press.
Clark, Cindy Dell
1995 Flights of Fancy, Leaps of Faith: Children’s Myths in Contemporary America. Chicago:
University of Chicago Press.
1999 The Autodriven Interview: A Photographic Viewfinder into Children’s Experience.
Visual Sociology 14:39–50.
2003 In Sickness and in Play: Children Coping with Chronic Illness. New Brunswick, NJ:
Rutgers University Press.
Cohen, Ted
1979 Metaphor and the Cultivation of Intimacy. In On Metaphor. Sheldon Sacks, ed. Pp. 1–10.
Chicago: University of Chicago Press.
Corsaro, William
1997 The Sociology of Childhood. Thousand Oaks, CA: Pine Forge Press.
Dalquist, Lynnda
1990 Obtaining Child Reports in Health Care Settings. In Through the Eyes of the Child:
Obtaining Self-Reports from Children. Annette M. La Greca, ed. Pp. 395–439. Boston: Allyn
and Bacon.
Doumont, Jean-Luc
2002 Verbal versus Visual: A Word Is Worth a Thousand Pictures, Too. Technical Commu-
nication 49(2):219–224.
Fernandez, James W.
1986 Persuasions and Performances: The Play of Tropes in Culture. Bloomington: Indiana
University Press.
Fine, Gary Alan, and Kent Sandstrom
1988 Knowing Children: Participant Observation with Minors. Newbury Park, CA: Sage
Publications.
Fraser, Deborah
2000 Sin, Hope and Optimism in Children’s Metaphors. Paper presented at the Annual
Meeting of the Australian Association for Research in Education, Sydney, December 4–7.
Frey, Diane
1993 Learning by Metaphor. In The Therapeutic Powers of Play. Charles E. Schaefer, ed.
Pp. 223–240. Northvale, NJ: Jason Aronson.
Friedl, Erika
2002 Why Are Children Missing from Anthropology Textbooks? Anthropology News,
May:19.
Gaskins, Suzanne, and Peggy J. Miller
2002 The Cultural Roles of Emotions in Pretend Play. Paper presented at the Annual Meeting
of the Association for the Study of Play, Santa Fe, NM, February 20–24.
Gibbs, Raymond W.
1994 The Poetics of Mind: Figurative Thought, Language, and Understanding. Cambridge:
Cambridge University Press.
Goldman, Laurence R.
1998 Child’s Play: Myth, Mimesis and Make-Believe. Oxford: Berg.
Goodnow, Jacqueline, Peggy J. Miller, and Frank Kessel
1995 Cultural Practices as Contexts for Development. San Francisco: Jossey-Bass.
Goodwin, Charles
1994 Professional Vision. American Anthropologist 96(3):606–633.
Goodwin, Marjorie Harness
1990 He-Said-She-Said: Talk as Social Organization among Black Children. Bloomington:
Indiana University Press.
Visual Metaphor as Method in Interviews with Children 183

Hatch, J. Amos, ed.

1995 Qualitative Research in Early Childhood Settings. Westport, CT: Praeger.
Hecht, Tobias
1998 At Home in the Street: Street Children of Northeast Brazil. Cambridge: Cambridge
University Press.
Hirschfeld, Lawrence
2002 Why Don’t Anthropologists Like Children? American Anthropologist 104(2):611–627.
James, Allison
2001 Ethnography in the Study of Childhood. In Handbook of Ethnography. Paul Atkinson,
Amanda Coffey, Sara Delamont, John Lofland, and Lyn H. Lofland, eds. Pp. 246–257.
Thousand Oaks, CA: Sage.
James, Allison, Chris Jenks, and Alan Prout
1998 Theorizing Childhood. New York: Teachers College Press.
James, Allison, and Alan Prout
1997 Constructing and Reconstructing Childhood: Contemporary Issues in the Sociological
Study of Childhood. London: Falmer Press.
Johnson, Mark
1987 The Body in the Mind: The Bodily Basis of Meaning, Imagination, and Reason. Chicago:
University of Chicago Press.
Kleinman, Arthur
1988 The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic
Books.
Kuipers, Joel
1989 “Medical Discourse” in Anthropological Context: Views of Language and Power. Med-
ical Anthropological Quarterly 3(2):99–123.
Kulick, Don, and Bambi Schieffelin
2004 Language Socialization. In Companion to Linguistic Anthropology. Alessandro Du-
ranti, ed. Pp. 349–368. Oxford: Blackwell.
Lakoff, George, and Mark Johnson
1980 Metaphors We Live By. Chicago: University of Chicago Press.
Lakoff, George, and Mark Turner
1989 More than Cool Reason: A Field Guide to Poetic Metaphor. Chicago: University of
Chicago Press.
Lancy, David
2003 Anthropology and Children: Critical Appraisal of Hirschfeld’s Claims. Paper presented
at the Annual Meeting of the Association for the Study of Play, Charleston, February 19–22.
2001 Studying Children and Schools: Qualitative Research Traditions. Prospect Heights, IL:
Waveland Press.
Mayall, Berry
2002 Towards a Sociology for Childhood: Thinking from Children’s Lives. Buckingham, UK:
Open University Press.
Mickelson, Roslyn Arlin
2000 Children on the Streets of the Americas: Homelessness, Education, and Globalization
in the United States, Brazil, and Cuba. London: Routledge.
Miller, Peggy J., Lisa Hoogstra, Judy Mintz, Heidi Fung, and Kim Williams
1993 Troubles in the Garden and How They Got Resolved: A Young Child’s Transformation
of His Favorite Story. In Memory and Affect in Development: The Minnesota Symposia
on Child Psychology. Charles A. Nelson, ed. Pp. 87–114. Hillsdale, NJ: Lawrence Erlbaum
Associates.
Mishler, Elliot G.
1986 Research Interviewing: Context and Narrative. Cambridge, MA: Harvard University
Press.
Ochs, Elinor
1988 Culture and Language Development: Language Acquisition and Language Socializa-
tion in a Samoan Village. Cambridge: Cambridge University Press.
O’Connor, Kevin, and Charles Schaefer, eds.
1994 Handbook of Play Therapy, vol. 2. New York: John Wiley.
Panter-Brick, Catherine
2001 Street Children and Their Peers: Perspectives on Homelessness, Poverty and Health.
In Children and Anthropology: Perspectives for the 21st Century. Helen B. Schwartzman,
ed. Pp. 83–97. Westport, CT: Bergin and Garvey.
184 Journal of Linguistic Anthropology

Perrino, Sabina
2002 Intimate Hierarchies and Qur’anic Saliva: Textuality in a Senegalese Ethnomedical
Encounter. Journal of Linguistic Anthropology 12(2):225–259.
Prout, Alan
1996 Actor-Network Theory, Technology and Medical Sociology: An Illustrative Analysis
of the Metered Dose Inhaler. Sociology of Health and Illness 18(2):198–219.
Ruark, Jennifer
2000 Seeing Children and Hearing Them, Too. Chronicle of Higher Education, November
17:A22.
Sapir, Edward
1951[1934] The Emergence of the Concept of Personality in the Context of Culture. In
Selected Writings of Edward Sapir in Language, Culture and Personality. David G.
Mandelbaum, ed. Pp. 590–597. Berkeley: University of California Press.
Schaefer, Charles, and Donna Cangelosi, eds.
1993 Play Therapy Techniques. Northvale, NJ: Jason Aronson.
Schaefer, Charles, and Kevin O’Connor, eds.
1983 Handbook of Play Therapy. New York: John Wiley.
Scheper-Hughes, Nancy, and Carolyn Sargent, eds.
1998 Small Wars: The Cultural Politics of Childhood. Berkeley: University of California
Press.
Schieffelin, Bambi
1990 The Give and Take of Everyday Life: Language Socialization of Kaluli Children.
Cambridge: Cambridge University Press.
Schwartzman, Helen, ed.
2001 Children and Anthropology: Perspectives for the 21st Century. Westport, CT: Bergin
and Garvey.
Singer, Dorothy
1993 Playing for their Lives: Helping Troubled Children through Play Therapy. New York:
Free Press.
Stephens, Sharon, ed.
1995 Children and the Politics of Culture. Princeton: Princeton University Press.
Thorne, Barrie
1994 Gender Play: Girls and Boys in School. New Brunswick, NJ: Rutgers University Press.
Tobin, Kenneth, and Deborah J. Tibbins
1996 Metaphors as Seeds for Conceptual Change and the Improvement of Science Teaching.
Science Education 80(6):711–730.
Toren, Christina
1999 Mind, Materiality and History: Explorations in Fijian Ethnography. London:
Routledge.
Van der Geest, Sjaak, and Susan Reynolds Whyte
1989 The Charm of Medicines: Metaphors and Metonyms. Medical Anthropology Quarterly
3(4):345–367.
Verbrugge, Robert
1979 The Primacy of Metaphor in Development. In Fact, Fiction and Fantasy in Childhood.
Ellen Winner and Howard Gardner, eds. Pp. 77–84. San Francisco: Jossey-Bass.
Vygotsky, Lev
1978 Mind in Society: The Development of Higher Psychological Processes. Cambridge:
Harvard University Press.
Waksler, Frances Chaput, ed.
1991 Studying the Social Worlds of Children: Sociological Readings. London: Falmer Press.
Weisner, Thomas
1998 Human Development, Child Well-Being, and the Cultural Project of Development. In
Socioemotional Development across Cultures. Dinesh Sharma and Kurt W. Fischer, eds.
Pp. 69–85. San Francisco: Jossey-Bass.
Wilce, James
1995 “I Can’t Tell You All My Troubles”: Conflict, Resistance, and Metacommunication in
Bangladeshi Illness Interactions. American Ethnologist 22(4):927–952.
2000 Healing. Journal of Linguistic Anthropology 9(1–2):96–99.
Winner, Ellen
1988 The Point of Words: Children’s Understanding of Metaphor and Irony. Cambridge:
Harvard University Press.
Visual Metaphor as Method in Interviews with Children 185

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