Describing these phenomena as auditory hallucinations seems inadequate. The aridly objective, notionally academic term gives no indication of the distress associated with the voices or the behavioural consequences. The associated phenomena are closer to the core of what a patient might be experiencing and closer to what might be considered to be the priorities in terms of a therapeutic intervention.

The voice I hear and that speaks to me in a coherent and meaningful way is not a vibration of air molecules or the agitation of hair cells in the inner ear. The voice and the meaning I attach to its utterances are internally represented or constructed. It seems that this inferential process is what goes awry in psychotic states.

In this state all is noise and chaos and devoid of meaning. It is difficult to imagine: our lives are so much more made up of light and sound and thoughts and feelings that form meaningful patterns and which help us to make sense of our lives and may grant us pleasure. The patient experiencing a psychotic episode is robbed of these harmonies. We cannot know the mind of another, and certainly not the mind of a psychotic other, but we can imagine that such noise, such a dissolution of meaning, would be intolerable. In this context it becomes understandable that a person in such a state should urgently seek to find or construct meanings and, in this process, to employ themes that are culturally or spiritually familiar - albeit often in deeply strange ways, given the disorder of mind.

Cognitive blindness: We simply do not see what we do not see. That is not to say that we don’t see shapes, colors, light and dark, etc. But we don’t see meaning and context unless living and learning has modified our structures. Maturana calls this structural coupling.

Early philosophers argued that we cannot perceive ourselves directly, rather ourselves must be “caught in the act” of perceiving something that exists in the real world. Self-knowledge, therefore, comes from our reactions to things that happen to us and around us. Just as we learn about other people by observing their behavior and making inferences from it, we learn about ourselves by examining what we do when events force our hand—yet another reason why solitary introspection is insufficient and why experimenting provides more useful information than reflecting on past experience.

One of the primary ways in which unfreezing events mark a cut with the past and herald the start of a transition period, according to psychoanalyst Manfred Kets de Vries, is by serving as an organizing scheme for everything that occurs afterwards: “From this point on, every new disturbance is recognized as part of the same pattern of dissatisfaction,” he writes.