“Going down” and “getting deeper”: Physical and metaphorical location and movement in relation to death and spiritual care in a Scottish hospice

This paper illustrates how attending to the metaphors people use for particular concepts, and to the context in which they use them, can increase our understanding of the meanings they attach to those concepts. It considers two linked emergent findings from an ethnographic exploration of spiritual care in a Scottish hospice: (1) the relationship between the perceived likelihood of palliative care patients' deaths and their physical location in and movement between various parts of the hospice, and (2) the use of physical metaphors to describe both the increased probability of particular patients' deaths (“going down” or “going downhill”), and spiritual care (“getting deeper”). The paper explores these findings and the relationships between them. It discusses how workers in this hospice located death somewhere other than “here”, both physically: in private spaces, and metaphorically: down, which has strong negative associations. Workers also metaphorically located spirituality elsewhere: deep, so that “getting deeper” with patients meant that workers metaphorically accompanied them somewhere else. Although deep does not have the negative connotations of down, “getting deeper” might mean encountering distressing, or down, emotions. Many workers sought to counter these negatively perceived emotions by “cheering up” patients, rather than “getting deeper” with them.