Introduction

I love to write and have previously shared my lived experience of mental health challenges in articles, essays and talks. I’ve always focused on emotional hurt and healing with only passing reference to diagnosis. Contributing to this book allows me to examine the impact that diagnosis and subsequent treatment had on my recovery. I welcome this opportunity. As a personal essay, what follows is not an argument for or against diagnosis or treatment choices for other people. I simply relay my own experience and interpretation of it, as only I am qualified to do.

The Beginning – A very good place to start

To highlight the most glaring omission of psychiatric diagnosis, I will briefly share my backstory as a starting point. Surely, this is important to understand any story. Traits of my character relevant to mental health challenges were evident in early childhood. I was always highly intuitive, empathic and sensitive. As a perfectionist and high achiever, I was self-critical, readily accepting responsibility to make things better. I was also intelligent and creative. An active mind, unbound by the realms of possibility, meant my imagination provided escape from any hurt I felt. Possibly because of these traits, insomnia, vivid dreams and nightmares are some of my most abiding childhood memories.

My formative years were punctuated by changing environments, from conflict in Northern Ireland, to the outback of Australia, to boarding school and back to rural Ireland by age 14. Assimilation and making new friends were survival skills that I mastered with outgoing confidence and an affable personality. While my immediate family was fractured by alcohol and boarding school, emigration also meant the absence of a wider family circle. I always had a sense of aloneness and fitting in rather than belonging.

Many will recognise these as Adverse Childhood Experiences (ACEs), factors increasing the risk of mental illness. Despite this, or maybe because of it, I reflect on a child who was adept at coping with challenges and change. She was both sociable and comfortable in solitude. She felt deeply, expressed emotions freely, and instinctively sought comfort in nature and imagination when necessary.

Just Add Trauma

I was becoming a teenager when I returned to Ireland from Australia with my parents and only sister. My two older brothers remained in Australia and London. Within two years of being home, my big sister, who I adored, killed herself. She was 18, I was 16. I resuscitated her on the side of a road, but she still died. I was in shock and couldn’t grieve. Instead, I did what I knew best, I moved again. By the end of that summer I had relocated again, this time from rural Ireland to inner city London. I enrolled myself in secondary school and excelled academically and in sports. I disconnected from the trauma by creating a brand-new life, forming new relationships with people who knew nothing of my past. I chose not to tell them.

Mix in Life Stressors and Respond Naturally

While studying for A Levels and applying to universities, I became pregnant. I continued to study, while also working to support myself and my son as a 19-year-old single parent. Physically, I was fit and healthy. Mentally, I was resilient and resourceful. Understandably, I still felt the strain of sleep deprivation, isolation and financial pressure. I was coping but acknowledged that I was starting to struggle. So, wanting the best for my son, I did the responsible thing – I sought help. The messaging was clear, ‘seeking help’ meant seeing a GP. So, that’s what I did.

Voila! A Diagnosis

This is where my story will be familiar to many. In London in 1995, a 7-minute consultation with an NHS GP I was meeting for the first time, resulted in a diagnosis of depression and prescription for psychotropic medication. There was no context to why I was feeling the way I was, no mention of ACEs, trauma, grief, or stressful living conditions, no signposting practical support or talking therapy. A medical diagnosis with pharmaceutical treatment was my only option. That was that. I was 22 years old.

How Diagnosis Felt, What It Meant to Me

At this stage of my life, so much had happened so quickly that I was in a kind of survival mode just to get through each day. I had already escaped painful feelings by moving, overworking and overachieving. Now, I had a medical diagnosis and treatment to reinforce the notion that numbing emotional pain was the right thing to do. The diagnosis told me that feelings of sadness, anxiety and overwhelm weren’t a natural response to difficult life events, because these events hadn’t been mentioned. Instead, my emotional response was framed as malfunctioning. This was a physiological issue, a chemical imbalance in my brain that could only be rectified medically, with a chemical cure.

I was a fitness instructor who didn’t drink alcohol, smoke cigarettes or use any other substances, because health was important to me. I understood that using substances to cope could lead to dependency and more issues. But when a medical professional acknowledged my suffering with criteria of symptoms and a diagnosis, being prescribed drugs felt like validation. I had barely taken paracetamol before this point, so taking drugs daily felt like a big step, and one I’d rather not take. But I was assured this was a short-term, necessary treatment for my illness. There was no information on side effects, potential harm, or dependency, and certainly no alternative offered. The point was to stop me from feeling bad so I could keep going. So, that’s what I did. I took the tablets, and I just kept going, and going and going.

Yet, no matter how hard I tried to avoid them, painful emotions kept coming up. When they did, I now understood these emotions as ‘symptoms of my illness’. Not something to share with family and friends, the only person qualified to treat symptoms of an illness was a medical doctor. I was still uncomfortable taking drugs and felt that another way would be healthier. But without the financial means for private healthcare, I couldn’t explore other options. My sister had killed herself. I never wanted to get that hopeless, I had a young child depending on me. I had to do something. Without money, this was my only option, and at least it was something.

Uncomfortably Numb

You don’t have to be medically trained to know that drugs can’t numb selective emotions. In numbing painful feelings, prescription drugs also anaesthetized all feeling. My intuition was blunted and my creative energy sapped. Antidepressant medication was robbing me of these natural coping resources. I felt worse. Each visit to the psychiatrist resulted in medications being changed and/or increased. I began to think I’d never get better, and my latest diagnosis of a ‘severe, recurring, treatment resistant, depressive disorder’ reinforced my resignation. The treatment for this new diagnosis was to keep increasing the dosage until I could barely stay awake during the day and was utterly disconnected from myself, just as life kept piling on the stress.

During this time, I had moved back to Northern Ireland, moving house 5 times in as many years. I lost both parents suddenly and a disproportionate number of friends and family died by suicide. I was in an abusive relationship and had the relentless financial pressure of single parenthood. But I just kept going, taking the tablets ensured that I felt very little, and cried not at all.

Not so Pretty – Polypharmacy

Instead of being felt and expressed, profoundly important emotions were numbed and buried deeper, festering into psychosomatic illness. I now had irritable bowel syndrome and migraine, treated with more drugs. So-called ‘side effects’ weren’t initially connected to the psychotropic medication in my system and became ever-present. I gained a huge amount of weight despite a healthy diet and fitness regime, this affected my self- esteem. I had a tremor, itchy skin and constant thirst, this affected my social skills. When I tried to discuss these issues with medical prescribers, they were dismissed as ‘just side effects’ and I was offered ‘something to help with that’, meaning more drugs to stop my body from reacting to the drugs it was already struggling to process.

In reality, there’s no such thing as ‘side effects’, there are just effects. Some are desirable – I didn’t feel overwhelming sadness anymore. Some are undesirable – I had to avoid eating in company and ran to the toilet constantly. As a result, I became socially anxious, I withdrew, and my mental health worsened.

Hurray! Now I’m Bipolar

The more antidepressants silenced my sadness and stifled my creativity, the more creatively these vital parts of me sought expression. I had always felt deeply, with visceral bodily responses to my emotions and environment. When I was younger, and unmedicated, I accepted this as just how I experience the world. But after taking heavy doses of antidepressant medication for a long period of time, these experiences became extreme and frightening. Sadness became sinister, leading to suicidal ideation. I experienced psychosis with delusions and hallucinations. I was re-diagnosed with bipolar affective disorder and hospitalised twice for my own safety. Psychiatrists now explained my new diagnosis as a severe, lifelong and life limiting illness, that was probably hereditary. After many years of the drugs not working, re-diagnosis brought a sense of relief. It explained what was really ‘wrong’ with me. I wasn’t ‘depressed’ all along, I was bipolar! So now, with the right diagnosis, I would finally get the right medication, so I could finally be well.

I was awarded Disability Living Allowance, reinforcing that with such a serious diagnosis, employment was unrealistic. My prescription was now an antidepressant, anti-anxiety, mood stabiliser, antipsychotic and sleeping medication – daily. This was a maintenance dose. I wasn’t 40 yet.

Be a Good Girl, Take Your Medicine

I remained compliant because I equated compliance with being responsible. These were medical experts, and I had a diagnosable illness. They must know better than my own sense that I’d prefer not to be on a cocktail of drugs for the rest of my life. But remember, I was poor, so didn’t have the privilege of treatment choice or means to afford private therapy. I became resigned to a half-life, and for the first time started using alcohol and cannabis to sleep, socialise, feel and not feel. I was already disconnected, medicated and reduced to a passive existence, so why not?

At this time, powerful, anti-stigma campaigns were increasing in the media. To question or resist a bipolar diagnosis and lifetime of medication was portrayed as being embarrassed or ashamed of an illness. This illness was akin to any physical illness, not my fault and out of my control. Yet, I was painfully aware that I had never grieved the loss of those I loved most in the world, and my current circumstances were relentlessly tough. When I stripped it all back, the fact remained that I was medicating my emotions. As little as I felt, that still just didn’t feel quite right to me.

Working to Educate Young Minds

Having excelled academically through it all, I couldn’t accept a life not using my brain. So, starting voluntarily and progressing to a full-time coordinator position, I had a successful career in mental health education. I worked for charities delivering mental health awareness courses to a broad cross-section of society. These courses were devised in-house with clinical governance and approval of the board. The chair of the board was a psychiatrist. Most of my work was in schools.

I delivered PowerPoint presentations on mental health and illness, including information and a video aimed at teenagers on how SSRI’s (antidepressant medication) worked. The penultimate slide took 5 minutes of a 90-minute session and was dedicated to ‘self-help’ and ‘alternative’ or ‘complementary’ therapies. Language is important and the message was loud and clear; the medical model is the credible main event, everything else is secondary, an add on. ‘Reduce stigma!’ was the catchphrase. This effectively meant if you’re struggling, see your GP for a diagnosis and medical treatment.

Lived experience made my delivery very convincing. I was holding down a good job, despite serious mental illness. I spoke about how medication had saved me and was absolutely necessary for managing bipolar affective disorder. I was teaching young teenagers that feelings of depression and anxiety at this difficult stage of development weren’t normal, natural responses, but diagnosable medical illnesses, treated by doctors with medication. I had become part of the problem.

Listening More Than Talking

As well as working with teenagers, I facilitated countless groups of adults from vastly different backgrounds. I used this position to listen as much as I talked and learn as much as I taught. I always asked groups to consider for themselves ‘What helped?’ and a very definite pattern emerged from responses; ‘the garden… my pet…fishing ….a good walk’. I was teaching the importance of seeking professional, medical help and diagnosis. Yet, without direction and irrespective of background, hundreds of people repeatedly told me that at times of distress, they were drawn to nature.

Hold on a Minute!

This was my ‘Hold on a minute! Moment’. I reflected on my own relationship with nature. As a child in the Australian outback, I instinctively went to the bush, alone with my dog when I was upset. When struggling in London as a teenager and young adult, I took long walks on Hampstead Heath. Even as a suicidal inpatient of a Northern Ireland psychiatric hospital, I yearned to get out of the sterile building to the small wooded area beside the hospital. It was true! The more distressed I had felt, the stronger the pull to be with nature.

So, countless strangers were telling me nature helped them, my own experience told me that nature helped me. But I was personally and professionally enmeshed in a medical model of diagnosis and drugs, so I knew that the mental health system gave no credence to the importance of nature connection for good mental health. Why not?

Since that first GP appointment, I had been a model patient. I had accepted every diagnosis and taken every medication prescribed, as prescribed. Despite long waiting lists, I always attended appointments and engaged fully. The fact that my prescription had only ever increased was surely a clear indication that it wasn’t working. I had lost faith. I had to disengage from the mental health system for the good of my mental health. Isn’t that ironic?

It’s important to remember that I had 20 years professional experience in mental health education. I was well-informed and acutely aware of risks associated with what I was doing. As a bipolar patient with a history of psychosis and suicidal ideation, wanting to stop medication would be interpreted as ‘lacking insight’ and ‘non-compliance with treatment’. Understandably, no psychiatrist would agree to this in case I killed myself on their watch. I would have to do it alone, carefully and sensibly. I kept a diary of my mood and symptoms and told one close friend who I saw regularly and trusted completely. She had a key to my house, contact details for my GP and psychiatrist, and my written consent to intervene if mood changes or behaviour became alarming or dangerous.

While very gradually tapering medication, I increased self-awareness and nature connection. I slowed down; making life choices that prioritised well-being above all else. I moved to the countryside and immersed myself in nature, turning the soil, walking the hills, and swimming in the cold sea. Long before sea swimming was popularised by lockdown and the mental health benefits became common knowledge, I was drawn to the cold because it felt like a reset. In withdrawal from drugs, cold water was clean, fresh and pure. I was outdoors, usually barefoot, in all weather.

I didn’t know then that this was Ecotherapy, and I was in intensive care. I hadn’t done any research and had no professional input. I was guided entirely by my intuition and felt sense of what soothed and what agitated me, choosing behaviours and environments accordingly. In nature, I reconnected with the raw, hurting version of myself that had been silenced. In solitude, I sobbed and wailed, feeling held with acceptance, love and support by other-than-human life. I also experienced surges of ecstasy and high energy, which I allowed to flow through me without fear. I felt, processed and released a lifetime of grief and emotional pain, and I healed.

What Would the Doctor Say?

Can you imagine if I had told a psychiatrist that I was getting into the cold sea in winter and had stopped wearing shoes? I touched and talked to trees, listening to what they had to tell me. I wrote frenzied nonsensical streams of consciousness in the middle of the night. I danced freely whenever I felt the urge to move and shake my body. Without understanding why, I tapped my fingertips on my head and face to relieve tension. I tuned into the cycles of the moon and seasons, following their rhythm. Although these behaviours are strange in the 21st century mainstream western world, they made me feel better, lighter, more balanced and grounded. I had a sense of reconnection to myself as part of the natural world. I became more confident and capable in all aspects of my life. Yet, had I tried to explain this to a psychiatrist in a typical 10-minute consultation, s/he would have taken one look at my bulging file and concluded that I was hypo-manic, elated, delusional, hallucinating, psychotic. These unconventional but nourishing and healing behaviours would be classed as symptoms of an illness to be stopped, with medication.

Within 2 years I was entirely medication-free. I had no depression, elation, anxiety or psychosis. I was sleeping soundly, flourishing creatively and enjoying better mental and physical health than I had ever known, or dared believe possible.

With newfound clarity and a sense of epiphany, I requested my medical records to study them alongside my diaries. I objectively examined the timeline of how a healthy, hardworking 22-year-old, who experienced trauma and difficult life circumstances, became a heavily medicated, hospitalised bipolar patient before the age of 40. The answer is the treatment I received through psychiatric diagnosis. The correlation was clear. As bad as I had felt, I never had suicidal thoughts or psychosis before I took antidepressants. Once labelled in a system that reduces human experience and emotional suffering to a checklist of DSM (Diagnostic and Statistical Manual of Mental Disorders) symptoms, I may have survived and functioned, but only as a dumbed-down and subdued version of myself. I never would have thrived, reclaiming my passion, creativity and voice, with courage to share it with the world.

It’s an Ecotherapy Life for Me

I was motivated to return to work in mental health, but only with a holistic approach that values education, self-determination and connection. My experience had taught me the importance of authenticity. I need to believe 100% in what I’m doing, otherwise I just can’t do it, no matter how convenient or well-paid. Being out of alignment with my true self makes me sick, literally.

Now I work part-time for Solas Donegal in the Republic of Ireland. Solas is a mental health recovery programme based on a model of walking, talking and listening in green spaces. As a partnership between the HSE and Inishowen Development Partnership, referrals come from GPs, psychiatrists and psychologists. My colleague is a mental health nurse, liaising effectively with these professionals regarding diagnosis and medication. Referrals also come from social prescribers and self-referrals. As a Peer Support Worker, I promote ecotherapy, education, and community involvement.

We’re not based in a clinical setting, but in a community building, from where we are visible, outdoors and active. Participants with a broad range of mental health challenges engage for 1, 2 or 3 days a week over 2 years. All aspects of the programme are co-produced by participants and staff. Each participant is respected as a unique individual with valuable talents and skills, as well as psychiatric diagnoses and repeat prescriptions. We know each person’s story because we listen to them, building a relationship naturally over time. Solas participants are the agents of their own recovery and support each other. As staff, we walk alongside them, both literally and figuratively.

My role in Solas provides me with training in Ecotherapy and opportunities to network with other mental health professionals working outside the medical model. Instead of mental illness, diagnosis and medication, my understanding of mental health now focuses on being trauma informed and listening to emotional distress. This makes sense to me.

I’m also self-employed as an Ecotherapy Facilitator, because I’m not the therapist – nature is. I facilitate groups providing education and removing barriers to practical experiences in walking, hiking, sea swimming, forest bathing and bushcraft. I elevate the importance of nature for healing by creating time and space for this innate connection to be remembered and revalued.

My approach is intentionally and unapologetically simple. Layers of bureaucracy and professional hierarchy are stripped away to focus energy on inherent human need: connection to nature, others and self. People crave time to slow down and space to be heard, so that’s what I provide.

Personally, I continue to prioritise nature connection as a cornerstone of mental and physical health. My ‘hold on a minute moment’ was 9 years ago. Since then, my work in Ecotherapy has grown from strength to strength. I also write, study and travel. I swim in the sea and climb mountains. I enjoy healthy relationships with others and with myself. I’m 51 now and have never doubted for a second that heeding my intuition and disengaging from a medical model of mental health care was the best thing I could have done.

Ecotherapy is not some airy-fairy, hippy-dippy, new-age nonsense. It is a scientifically proven, evidence-based approach to mental health care that predates both psychotherapy and psychiatry. In recent years, Ecotherapy has gained recognition as a credible discipline due to an ever-increasing body of international research. Science and academia are catching up with what intuition and lived experience always knew and told us, but we were too busy to listen – that nature heals.

Back to Basics – Not for Profit

Evolutionary psychology posits that all human emotions serve a purpose. Maybe, reluctance to indefinitely anaesthetise emotions with drugs isn’t a result of mental health ‘stigma’. Maybe, it’s the result of something deeper; innate knowledge that feelings must be felt and expressed for human health. Intuition has been finely tuned over many millennia to keep us safe and well. It is not aligned with any interest other than ours.

My opinion is that the medicalisation of emotion can disempower individuals and disconnect communities. When emotional suffering is framed as an illness, it requires medical treatment by a qualified professional to ‘make better’. So, a person loses agency over their own wellbeing. The listening ear of friends, family and neighbours is devalued in the pursuit of symptoms, diagnosis, risk assessment and record-keeping. These are major concerns for the presured professional carrying a huge weight of responsibility. The result is that a vulnerable person, needing to be heard, talks to the top of a stranger’s bowed head, because they’re busy taking notes. The humanity of this human interaction is lost for both people.

It is transformational for a person to be fully present, listening to another person; not to intervene or fix, but to hold space for their pain with empathy and compassion. Yet the dominance of the medical model has de-skilled and discouraged people from doing this for each other. They feel ill-equipped because they’re not qualified professionals. With love and best intentions, family and friends are now more inclined to respond to a person in distress by encouraging them to ‘see someone about that’, i.e. get on a waiting list for diagnosis and treatment. The professionalisation of support also means the natural feel-good factor of having helped someone in need, just by listening to them is denied to the layperson.

Despite media campaigns to always seek professional help for emotional suffering, there is still reluctance to do so because people fear ‘just being put on tablets’. This fear is not unfounded. It has been the experience of many, because for decades disproportionate resources have been invested in a medical model of mental health care.

Professionally and personally, I observe most people experiencing mental health challenges as a response to trauma, grief, abuse, inequality, discrimination, poverty, stress and isolation. So surely a connective human response, feeling heard and part of a just society with practical support would ease their distress. Instead, people are often on medication indefinitely as their only option, enabling them to tolerate the intolerable.

To each their own, with respect

Polarisation of thought and opinion in any discourse is frustrating. I’m aware that my narrative may be manipulated and misrepresented as anti-medication and/or anti-psychiatry. The term ‘pill shaming’ is used to describe any viewpoint that questions the overuse of psychiatric drugs and irresponsible prescribing practices. This is inaccurate and unhelpful. For or against arguments disallow space for those in the middle, who are listening and weighing things up with open and critical minds. Frankly, it’s just not in my nature to shame anyone, least of all a person who is struggling and seeking support.

I fully understand and accept that for some, medication has been a useful short-term intervention to relieve the debilitating impact of mental health challenges. This has enabled lifestyle changes and engagement with support and talking therapies to address underlying issues. In turn, this has led to recovery. Great! Equally, I accept and respect that for some, the long-term use of psychiatric medication is a well-informed choice, underlined by their experience that it has improved their quality of life. Also, great!

I do not judge or criticise the person seeking help, or the professional trying to provide that help. On this journey through diagnosis and treatment, I encountered well meaning, capable, ethical, overworked professionals. They did their best and did not mean to harm me. But they were doing their best in a broken system. Once diagnosed and medicated, my appointments were short, infrequent and seldom with the same person. Twice in 20 years, I was offered talking therapy; first, 6 × 1-hour sessions with a counsellor. Then, when I researched CBT myself and requested it, I was on another waiting list for 18 months – taking an increased dose of medication all the while. I finally received an appointment, just as I was re-diagnosed with bipolar. A locum psychiatrist decreed that CBT was unsuitable for a bipolar patient.

My long-awaited therapy was cancelled with the stroke of a pen, and another prescription for heavier drugs was written instead.

Conclusion

I conclude that diagnosis of mental illness, resulting in continuous treatment with copious amounts of psychotropic drugs was harmful to my mental and physical health. Painful, necessary emotions were numbed, so couldn’t be processed and healed. I was disconnected from intuitive knowing that what I needed was time and safety to feel and express emotional pain. I found what I needed in the natural world.

The further I have distanced myself from a medical model of mental health care, the better my health has been. I’ve not only accepted, but grown to love my authentic self; that free-spirited, emotional, empathic, intuitive and nature-loving person I always was. I couldn’t love myself while heavily medicated because I couldn’t know myself.

As a personal essay, the relationship between government, psychiatry and the pharmaceutical industry is beyond the scope of this work. Suffice to say, I am convinced that this relationship had a direct bearing on how readily I was diagnosed with a ‘severe lifelong psychiatric illness’, treatable with a lifetime’s worth of pharmaceutical products. Without money, I was powerless to challenge this in a system built on power imbalance and profit, a system that has nothing to do with health and wellbeing.

I hope my story is heard amidst the multi-billion-pound campaigns to ‘reduce the stigma of mental illness’ by seeking and accepting diagnosis and medication in response to emotional pain. It is equally important that my story is heard alongside that of a person whose experience of diagnosis and medication was positive. Everyone’s experience is equally valid, but some are given more attention and credibility because they uphold the status quo.

What if struggling 22-year-old me had the financial means to seek private healthcare? Drugs would never have been my first choice. Even without knowing what I do now, I would have chosen social and green prescribing and practical support. I would have engaged fully with counselling and psychotherapy. Then, I would never have known how bad things could get, and never had reason to share my story with you.

still writing, and sharing my story with you

Different Diagnoses, Similar Experiences

Narratives of Mental Health, Addiction Recovery and Dual Diagnosis

Michael John Norton|Oliver John Cullen

Giving voice to those in recovery who have chosen to channel their real-life experiences for the sake of helping others, this timely work offers valuable insights for researchers, mental health professionals, family members and support networks, as well as anyone whose life has been touched by the shadows of mental illness, addiction or dual diagnosis.

https://books.emeraldinsight.com/page/detail/different-diagnoses-similar-experiences/?k=9781804558492

Diagnosed Disconnect – Prescribed Harm