It is a curious paradox that schizophrenia might be imagined as a condition of being both less or too much of whomever we might be. An intricate balance is lost.

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.

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.

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.

Sometimes this difference is not even substantive. Sometimes it is a shift internally that the listener cannot see, but the thinker can feel. Sometimes it is a new emotional relationship with the thought.

So I have become impressed by those thinker-‘repetition’ moments, now understanding that, yes, it matters what the thinker says, but it matters more what happens for them because they say it.