Either we need to come to terms with a possibility that we are all in some ways a little bit mad, which is a cliche, or we need to consider a much more inclusive, less discriminating attitude towards experiences we do not share or understand.

Binary thinking might appear to make things simple, but in all likelihood the issues become more muddled and distorted.

This is contingent upon a particular set of cultural beliefs, of course, but the implication in general is that it might be more helpful and useful to our patients for us to listen to what they are telling us, rather than simply to suppress the symptoms of psychosis.

If any light or hope can be found in this profoundly sad expression of the human predicament, it might be in the way that, as these determined and desperate acts of self-harm arise in some, they as mysteriously pass. I remain nevertheless haunted by the events I have described.

One critical step in this process is to re-imagine the symptom not merely as a sign of a pathological process but as an endeavour to find meaning and regain control. This would entail acknowledging rather than dismissing these often bewildering symptoms.