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.

Accordingly, the chapter explains why the sick behaviour of individuals can be a reflection not of chemical imbalances or dysfunctional childhoods, but of the degree of sickness prevailing in any given society. It argues further that the negation of universal human needs such as creativity, sociality and autonomy generates alienation in its technical sense, giving rise in turn to all manner of relational disturbances. The chapter maintains that the cultivation of hope, which, like all other emotions can be approached intersubjectively, depends on our capacity for recognising and responding to the psychological and material needs of our fellow South Africans.

As Jungian analyst James Hillman remarked, “Psychotherapy is only working on that ‘inside’ soul. By removing the soul from the world and not recognising that the soul is also in the world, psychotherapy can’t do its job anymore. The buildings are sick, the institutions are sick, the banking system’s sick, the schools, the streets - the sickness is out there.

In the world beyond therapy, however, intersubjective hope demands nourishment at two levels - first, at a socio-psychological level defined by reciprocal recognition, and second, at a social-material level involving an equitable distribution of the resources required for dignified living. This is easier said than done: what I am describing, after all, is a virtual utopia in which each of us feels recognised in our humanity, and in which our basic needs are adequately satisfied. In fact, when placing this quandary in proper historical context, one realises that the history of our species - never mind South Africa - is a history of masters and slaves.

Jean is criticizing herself for doing something harmless while at the same time rebelling against doing the one thing she has to do to keep her medical license. She is proclaiming her innocence in regard to the opioid prescription but pleading guilty to watching too much TV. Things are all twisted, and I do my best to straighten them out. “There’s a big difference between turning off the TV because you are tired and turning it off because you are supposed to,” I say. Jean has every right to watch as much TV as she wants; it is her only pleasure these days, the only relief from the surveillance she is under. I continue to talk with her about changing the story she is telling herself, about treating this time as a retreat (with TV!) into which she can surrender. Surrender becomes a theme we can explore. Jean is a conscientious and experienced clinician. She is devoted to her patients, and she knows that clinical work is much more important, and meaningful, than the electronic medical records being demanded of her. But right now, for the next year and a half, the medical records have to have priority. Can she submit to that with patience? Can TV be her reward? Or will her sense of the injustice perpetrated upon her paralyze her even further?