Did your last grant proposal have hand and foot, or did it have the head of a goddess and the foot of a broom? When you wrote it, did you go with your gut, or did you go head first through the wall? Are your patients doing things in beard to you? Does someone in your office have it fist thick behind the ears? Is this paragraph making any sense? It would if you understood the German, Cantonese, American, and Italian versions of the human body.

Since the 1970s, the rapid growth of cognitive science has led to clashes about the relation between language and the physical reality it supposedly represents. Maintaining that the body and mind are inseparable, cognitive psychologists and linguists regard language as a product of the brain, a communications system reflecting bodily experiences. Because languages come from bodies, they rely on metaphors rooted in physiological perceptions. But if this is the case, ask first-year language learners, then why do different languages represent the body so differently?

Despite the successes of cognitive science, the opposite viewpoint has maintained its appeal: bodies don't create languages; languages create bodies. Whereas cognitive psychologists argue that languages reveal their bodily origins, linguistic relativists claim that languages and cultures teach people how to experience their bodies, and that there is no universally comprehensible human body unmediated by words. George Bernard Shaw's character Henry Higgins expresses one version of this idea when he reflects, “You have no idea how frightfully interesting it is to take a human being and change her into a quite different human being by creating a new speech for her”. By altering language, Higgins hopes that he can shape thoughts—not so much Eliza Doolittle's, as the thoughts of those hearing her speak.

For clinical medicine, the stakes of this debate could not be higher. If languages create bodies, and people from different cultures experience illnesses differently, then they may need different treatments. In weighing the arguments, it is helpful to consider some expressions involving body parts—expressions whose meaning is less than obvious to those who do not speak the languages. From country to country, medical language retains a comforting uniformity, but outside the clinic, the body seems to change.

Among the most influential thinkers arguing that bodily experience shapes language have been the linguist George Lakoff and the philosopher Mark Johnson. In Metaphors We Live By, they propose that expressions describing one concept in terms of another reveal essential aspects of the ways people think. In English, for example, many sayings associate life and health with “up” and death and sickness with “down”, probably because a healthy person stands upright whereas a sick one has to lie down. Lakoff and Johnson qualify, however, that, “it is hard to distinguish the physical from the cultural basis of a metaphor…We experience our ‘world’ in such a way that our culture is already present in the very experience itself”. In their more recent book, Philosophy in the Flesh, they assert that, “Our conceptual systems draw largely upon the commonalities of our bodies and of the environments we live in…One of the important discoveries of cognitive science is that the conceptual systems used in the world's languages make use of a relatively small number of basic image schemas”. Although Lakoff and Johnson acknowledge that culture influences people's understandings of their experiences, they believe that the common elements in linguistic expressions reveal their grounding in bodily perceptions.

The cognitive psychologist Steven Pinker is much harder on the hypothesis that words shape thought. In The Language Instinct, he asks why, until recently, physical development has been viewed as genetically determined but cognitive development as culturally determined, a fact that he believes has hindered investigations of thought. “Language is not a cultural artifact that we learn the way we learn to tell time”, he asserts. “Instead, it is a distinct piece of the biological makeup of our brains…Language is no more a cultural invention than is upright posture”. Citing recent studies of visual and spatial perception, he points out the common responses of people who speak different languages, proposing that people think in a “mentalese” that they have learned to translate into the languages with which they've been raised. “People do not think in English or Chinese or Apache”, he concludes. “They think in a language of thought. This language of thought probably looks a bit like all these languages.”

In support of Pinker's claim, some metaphors associating body parts with abstract concepts recur in vastly different languages. Even when bodily expressions are translated literally, their meaning can often be guessed. In English, German, and Cantonese, you can have “eyes bigger than your stomach”. No knowledge of the sympathetic nervous system is necessary to understand why a traumatic experience might be described as “gut-wrenching”, and no one would take a despairing mother's cry, “My children are eating the hair off my head!” as a hint that she wants to go to the beauty parlour. It is less obvious, though, why English-speakers should “hate someone's guts”. Why not his heart or—more in tune with the findings of cognitive science—his brain? One can feel sympathy for the parent with no hair left on her head, but what should one feel for a person with hair on her teeth?

The fact that so many expressions about the body are bizarre, even incomprehensible, to non-native speakers suggests that people from different cultures understand and perhaps even perceive their bodies differently. Pinker is right that differences in language do not prove that people experience their bodies in distinct ways. The astonishing variety of these expressions raises the question, though, of how well any language can convey sensations and perceptions, a question that scholars in medicine, science, and the humanities can best address together.

The idea that the languages we speak determine the ways that we see the world emerged during the 1930s in the studies of the linguists Benjamin Lee Whorf and Edward Sapir. Whorf, a fire inspection engineer who taught himself Native American languages, proposed that, “The forms of a person's thoughts are controlled by inexorable laws of pattern of which he is unconscious. These patterns are the unperceived intricate systematizations of his own language…We all, unknowingly, project the linguistic relationships of a particular language upon the universe, and see them there”. Whorf's idea provides one explanation of why an American who charges US$5 for a tiny bottle of mineral water has “nerve”; a German, “forehead”; and a Spaniard, “hard face”. In each case, the association of the attitude with the body part makes sense once one has heard the expression. Without some explanation, however, the meaning is unclear.

Sayings that tie feelings to body parts have cultural histories. Besides criticising your attitude, an Austrian who asks, “what louse crawled over your liver today?” is resurrecting Galenic medicine, in which an excess of bile is putting you in a lousy mood. Once one becomes familiar with a language and the culture that created it, its associations of body parts with concepts and feelings seem quite natural. Of course liver problems cause irritability—but what is the German trying to tell you who says that something is getting him in the kidneys? Or the woman from Hong Kong who says that in the corner of your mouth, you seem to be savouring a feeling of spring? Should you ask for herpes medication? Or is she trying to tell you you're in love?

The amazing and often hilarious expressions that human beings have created around their body parts suggest that language and culture influence, but do not determine, the ways that we live with our bodies. The fact that clinicians in Dallas can communicate and collaborate with those in Singapore indicates that we probably do have some common “mentalese” representation of the way a human body works. But this has not stopped cultural prejudices from shaping the ways that we perceive, experience, and maintain our bodies: for instance, the puzzling association of bravery with large male genitalia. Considering the relative roles of the male and female parts in human reproduction, why does no one in the western hemisphere say about a courageous man, “Boy, he's got big ovaries!”? By sharing their knowledge, clinicians who know bodies and scholars who know languages just as intimately can help to create a medicine that works with these strange associations. If we ignore them, we'll be practising medicine with tomatoes on our eyes.

I would like to thank my colleagues at the Max Planck Institute for the History of Science, Berlin, Germany, for providing the expressions discussed in this article. I am grateful to the Alexander von Humboldt Foundation for supporting my research in Berlin and to the Max Planck Institute for the History of Science for hosting me.

Further reading Lakoff and Johnson, 1980. Lakoff G

Johnson M Metaphors we live by. University of Chicago Press , Chicago Google Scholar Lakoff and Johnson, 1999. Lakoff G

Johnson M Philosophy in the flesh: the embodied mind and its challenge to western thought. Basic Books , New York Google Scholar Pinker, 1994. Pinker S The language instinct. William Morrow , New York Crossref

Google Scholar Shaw, 2000. Shaw GB Pygmalion. Penguin , London Google Scholar Carroll, 1956. Carroll JB Language, thought, and reality: selected writings of Benjamin Lee Whorf. MIT Press , Cambridge, MA Google Scholar