This paper investigates the epistemic, affective and ethical power of images in psychiatric care, building on Binswanger's existential morphologies. It argues that images occupy an intermediate space between sensation and concept, offering a path to reflection while preserving contact with lived experience. Unlike abstract conceptual thought, images are fluid, metamorphic forms of sensation that serve as co-produced figures of understanding in the therapeutic encounter, mediating between patient and clinician. Crucially, the paper advocates an 'and-both' framework: concepts are vital for communication between clinicians, but images are indispensable for engaging with the patient's lived world. However, images are vulnerable to degeneration - from imagination to persuasion, and from living symbol to rigid cliché or delusion. The vitality of care rests on keeping these images alive, dialogical and open to transformation. A psychiatry grounded in imaginal thinking evolves beyond mere classification into a poetics of recognition, where healing arises from the shared creation of meaning between two embodied presences.
Giovanni Stanghellini (Mon,) studied this question.