Acknowledging and affirming a person’s vivid experience and the struggle towards recovery - and simultaneously seeking to modulate or attenuate the intense distress and confusion that is part of the process - requires a difficult and time elusive balance.

It was not the voices in themselves that prompted such anguish with disastrous consequences, but the disruption of something beyond, and something that might be considered innate and particularly human: a sense of self, of the privacy of the self, and a precarious notion of free will.

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.

We see people who have come through the impossible and have resigned themselves to the necessity of being practical. Survival is living on, living above the wreckage: survivre, supervivencia. You think you know how hard life can get. Then something else happens, something of a kind different to what you ever allowed yourself to expect and you have to revise your whole picture. This doesn’t stop happening, there is no end of surprise. Strangeness arrives again and again, without end. We live on the accumulated ruins of experience. Überleben, sopravvivere.