Response

It is refreshing to read an academic paper about Barbie in the pages of the British Journal of Psychiatry (this issue).^{Reference Dosani1} Barbie is an important image from popular culture that has a significant place in the lives of children and adolescents and has now made its debut appearance in the Journal. I want to place my discussion of Dosani’s paper in the context of icons: what they are, how religious icons function and how they differ from cultural icons, which is what Barbie is, and the treatment of religious icons in Dostoyevsky’s The Idiot, as a prelude to marking out a territory for icons in psychiatric practice.

An icon is an image or symbol that is widely recognised and represents something larger than itself. One of the most widely recognised icons is that of the Madonna and Child. It is a religious icon that is especially important in Eastern Orthodox Christianity. It is more than a painting: it is considered a sacred portal, a window between the divine and the earthly, and is a focus for devotion, meditation, prayer and worship. It has been a continuously revered, copied and venerated image for nearly two millennia. It is itself a development from an earlier icon, that of Isis and Horus, which depicts a mother figure holding or nursing a divine child. The compositions of both the Madonna and Child and Isis and Horus highlight and symbolise notions of divine motherhood, the mother safeguarding and nurturing a vulnerable child and acting as an intermediary between humanity and the divine.

Another way to understand icons and iconography is to consider the role and function of masks in traditional masquerades, particularly African masquerades. The mask in this setting is not merely a representation of a god or spirit: when worn in the context of ritual, it becomes the entity that it represents. Such is the force and power of masks that it is understood that the deity is immanent, realised and manifest in the mask. In other words, religious icons are not mere images or symbols but sacred objects that channel power, transfigurations of physical objects into divine presence.

In Dostoyevsky’s The Idiot,^{Reference Dostoyevsky2} an icon, Holbein’s painting Christ in the Tomb, is described as depicting Christ, who has just been taken down from the Cross. The depiction departs from the established iconography of Christ in the moment of his death, of his extraordinary facial beauty, which Dostoyevsky says is an attempt to preserve in him his beauty even during his most terrible moments. Holbein, on the other hand, depicts the corpse of a man who has endured endless torments, torture and agony. The face is said to be horribly lacerated, swollen, with bloody bruises, and the eyes are open, the pupils narrow, and the large, open whites of the eyes gleam with a deathly, glassy sheen. And the question is whether this martyr could rise from the dead? The point I am making is that it is not only that a particular icon, Isis and Horus, can metamorphosise into the Madonna and Child, but that the parameters of an icon, the iconography, can alter from an idealised Christ in the Tomb to a realistic and grim Christ.

Barbie, unlike the Madonna and Child, is a cultural icon, a secular image. It is an embodiment of a particular ideal of beauty. It crystallises a standard, a figure that is tall, thin, blonde, with specific proportions – that is, shorthand for an idealised Western feminine aesthetic. It could be argued Barbie both helped to create and to perpetuate these aesthetics and as such is both an icon of aspiration and an icon for feminist critique. So, how do cultural icons differ from religious ones? Religious icons point towards transcendental or eternal realities whereas cultural icons merely reflect current values – that is, are representations without embodying what they represent. They are not so much silent as not having an accompanying sacred presence. Cultural icons are inherently temporal and emerge from specific historical moments and evolve with cultural shifts, as Dosani describes. There is no devotional practice associated with Barbie, and Barbie is not treated with reverence. Barbie’s power derives from collective recognition, from a social agreement that it is meaningful. And it is celebrated, criticised, commodified, parodied or ignored without compunction.

What Dosani’s article does is to remind us that cultural icons are available as means and modes of communication within the clinical encounter. Our patients are as likely to wear a cross, another icon, to signal their faith as they are to wear a T-shirt emblazoned with Elvis’ face, a cultural icon to reference their affinity to rock and roll. And children may clutch a Barbie, an object that is widely recognisable and that may create an opportunity to start a conversation about identity, about aspiration or about uncertainty and gender ambiguity. Our task as clinicians is to recognise that these are privileged moments that make possible deeper engagement with patients, that allow for a move from a transactional inquiry to meaningful communication of the kind that Dosani describes in her persuasive article.