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.

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.

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.

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.