Metaphors and representations of Systemic Lupus Erithematosus (SLE). A comment on the article by Sutanto et al

The article by Sutanto and colleagues presented a systematic review and thematic synthesis of qualitative studies that explored the experiences of adults living with SLE. In qualitative research and reviews, findings strictly depend on researchers perspectives and questions. From a social psychology perspective, we suggest that an interesting point of view for considering the growing corpus of qualitative studies, would be the social representation theory, with a specific focus on metaphors that patients adopt to describe their condition. In an extensive literature review, we identified three main metaphors used by professionals to describe lupus related diseases: ‘the wolf’, ‘the monster Hydra’ and the ‘butterfly’, each of them emphasizing specific disease aspects and manifestations. However, the professionals’ perspective represents just half of the picture. Which are the common representations of the disease shared by patients? Are they related with an wild beast they can fight (wolf), a unbeatable terrifying monster (like Hydra), or a peaceful animal to live with (like a butterfly)? We suggest that future review of qualitative studies with SLE patients, will be able to answer more specific questions, clarifying the use of representations in the light of illness severity, coping strategies and acceptance of the disease. This kind of research will help clinicians in providing useful information to patients, but avoiding distressing or frightening disease representations.