Images of Care: 'To the thongs themselves!'

In this chapter we distinguish between causation, explanation, meaning, and understanding in mental health care. Greater understanding, and thus healing, is achieved when conditions of transparency make it possible for patients’ experiences of their world, that is ‘the things themselves’, to present in their true luminescence. We argue that, as concepts and theories stifle their presence, good mental health care requires images. We introduce Walter Benjamin’s concept of ‘dialectical images’. These are the products of ‘ideas’ not ‘pictures’, ‘reproductions’ or ‘symbols’. ‘Ideas are to objects like constellations to the stars’. They require a rich descriptive vocabulary and the engagement of the beholder with what he sees. We refer to Benjamin’s seminal essays on the poetry of Charles Baudelaire as illustration of the dialectical process that, in clinical practice, may help both give and find voice for the patient at the points of maximum tension in their lived experience and relationship with the clinician. ‘Where thinking comes to a standstill in a constellation saturated with tensions, there the dialectical image appears’. The aim is to reduce to the point of elimination the perceptual habit in which the patient’s everyday experiences and history may remain enveloped, and to allow their previously unimagined and even unheard-of profiles to emerge. This practice in clinical care requires courage, a sense of vocation, and materialist devotion to the patient. The result may be secular revelation.