Basically, a therapist tries to get at the patient’s viewpoint. The professional listener says: “I am totally listening to everything that you say. You are not totally committed, nor do you need to be, to listen to everything that I say. You might hear many things that I say, that you say, or you might hear little of both. But we are each engaged in arranging different things. You are in a process of rearranging and integrating your new perceptions and calling attention to new ones for you to arrange and integrate.

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.

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.

Is anyone listening, out there? Are people simply rushing by? And how much of a difference can it make really, just one story, even all these stories taken together and funneled into the ear of the busy world—a world moving so quickly that voices and sounds Doppler into a rising whine, so distracted that even when your attention snags on the burr of something unusual, you are dragged away before you can see it, uprooting it like a bee’s spent stinger. It is hard for anything to be heard and even if anyone hears it, how much of a difference could it really make, what change could it possibly bring, just these words, just this thing that happened once to one person that the listener does not and will never know. It is just a story. It is only words.

From the first moment, I’m aware that therapy is a space separate from ordinary conversation. I listen more acutely than usual. I’m tuned in to levels of communication. I listen for the appearance and sound of the soul rather than the intended communication of my client. I hear overtones and reverberations. It’s not like listening at ordinary times in life. It’s not just focused listening, it’s listening for past voices and spirits and angels, to speak metaphorically.