This essay offers a personal account of one physician's attempt to engage with psychotic patients in an inner-city hospital. It considers some of the obstacles to psychoanalytic work with psychotic patients, including anxiety in the psychotherapist, anxiety in the patient, institutional resistances, and paradigmatic errors. A discussion of paradigmatic errors in Western mental health care is expanded upon. Rorty's () critique of objectivity and Kuhn's () work on scientific paradigm shifts are discussed in an attempt to demonstrate how we might better understand psychosis as an illness and connect with patients across the entire diagnostic spectrum.

This essay outlines novel ways of communicating with patients by altering semantics, syntax, word use, or sounds. Language is viewed as a tool for coping with problems rather than a medium with which to mirror external reality or internal human nature. This view of language emerges from a pragmatic critique of truth. The broader goal of this essay is to weave together the philosophy of pragmatism, especially as it has been articulated by Richard Rorty, with the theory and practice of psychoanalysis. Clinical case examples are discussed.