About What The Notes Don’t Say

People keep moving. The notes don’t.

What the Notes Don’t Say is a personal account exploring mental health, therapy, trauma, and treatment from the patient’s side of the therapy room.

There is a paper version of me.

The one that exists in assessment letters, treatment plans, and clinical notes written at particular moments in my life. Those records matter. But they don’t tell the whole story.

Clinical notes are designed to capture important data. However, they are also just snapshots in time. I have accumulated a catalogue of diagnoses buried in my notes, depending on who assessed me and how I was understood in that moment. Whilst my notes would often include a summary of my personal history, I noticed that they did not always fully contextualise my symptoms. Some were very comprehensive, but I also found factual inaccuracies in parts of my records.

Our notes cannot capture everything that it means to live through them.

People change. Our thoughts change. Our behaviours change. The ways we cope change. The professionals we encounter may understand us through different therapeutic or clinical lenses, while the fields of psychology and psychiatry continue to evolve and change too.

Somewhere between what is recorded, what is understood, and what is actually lived — lies another story. The one that I am interested in writing about.

Why What the Notes Don’t Say?

So, why did I choose the name What the Notes Don’t Say?

I came up with the idea over a morning cup of tea, after another night of not sleeping well. I had wanted to write for so long, but I needed to prioritise my own healing first.

The name derives from my own experiences, some of which I will share through my writing. The more I thought about it, the more the name seemed to capture everything I wanted to explore — mental health, therapy, theory, lived experience, and most importantly, the stories behind the notes.

Healing isn’t linear

Some of the best advice I have received is from other ‘patients’. Someone who became one of my closest friends told me that ‘healing isn’t linear.’ I totally get that now.

I also finally met a psychiatrist in recent years who gave me a diagnosis, which I can identify with. I finally felt seen. If, like me, you have had to navigate multiple diagnoses, treatment pathways, and setbacks over the years, then hopefully I can offer some hope. One of my life mottos is better late than never!

During the past few years, I have been able to reflect back on my experiences. I have witnessed firsthand that whilst some treatment, medication, or therapeutic modality can help some people, they may also have an adverse effect on others. A therapeutic approach can give us skills we carry for life, while individual experiences within that treatment can be challenging and, sometimes, damaging.

Both things can be true.

That idea — the ability to hold seemingly opposing truths at the same time — is something I learned about in Dialectical Behaviour Therapy (DBT), and it has become part of the ethos of What the Notes Don’t Say. Dialectics means that two things that seem contradictory can both be true at the same time.

Progress over perfection

We often make progress that nobody else notices. We celebrate wins that never make it into our medical notes.

We may also look back at an earlier version of ourselves and understand our behaviour very differently. Sometimes I wish I had got the right help sooner.

I feel privileged to have worked with some incredible mental-health professionals. At the same time, I’ve had to accept that some people, treatments and environments that were supposed to help me caused harm of their own.

Both things can be true.

What the notes often don’t say

Much information is lost in therapeutic and consultant rooms. The self-discovery, shared insights, and constructed knowledge. The relationships and ruptures that never make it into our notes.

I am interested in the gap between the reality of what a clinician might see — and what it actually feels like to live with our thoughts and behaviours, and what is really driving them.

I want to explore what helps, what doesn’t, what changes, what gets misunderstood, and what we learn.

What happens when clinical theory meets the considerably messier reality of being human.

Whichever path you are on, and whatever stage you are at — whether you’re here because of your own lived experience, you’re a professional, or you’re simply interested in the conversation — you are all welcome here.

Just a reminder. Be kind to yourself and to others.

From the patient’s side of the therapy room

I’m Elizabeth Bell, a pseudonymous writer with mental health lived experience.

I use a pseudonym deliberately. Mental health asks us to reveal extraordinarily private parts of ourselves, in our most vulnerable states. I believe that it’s possible to write candidly about those experiences while maintaining boundaries around the parts of our lives we choose to keep private. Whilst I will be sharing personal stories, I decided that for now, I didn’t want my identity to detract from my writing.

I have wanted to write for some time now. For a number of years, I simply wasn’t well enough. Whilst I am still in therapy, I am finally able to write about my experiences in a way that feels safe for me, while being mindful of you reading them.

I also really wanted to share my lived experience if it could help someone else. I wanted to invite other people to be curious with me — and to start conversations.

Kind ones.

So, let’s discuss What the Notes Don’t Say?

I found myself trying to piece together notes from various GPs, consultants, hospitals and psychiatrists, trying to understand how the clinical picture of me had developed over the years.

When I began gathering my medical records from different sources, I was completely taken aback by some of what had been written about me over the years.

But what surprised me most was what wasn’t in my notes.

The reasons why I hadn’t been able to take medication. The diagnosis that ‘stuck’ even though the recorded symptoms were not what I was experiencing.

This title is personal for another reason too. It refers to a time when important clinical data and safeguarding information weren’t included in my medical notes. What was missing mattered, and this had a significant impact on me.

More recently, I started to think about the gap between the person documented in our notes and the person actually living the life. The more I thought about it, the more I realised that gap was where I wanted to write.

The name Elizabeth Bell is a small clue — and part of my story.

Drawing from Zen Buddhist traditions, DBT incorporates the sound of a bell as a sensory cue, signaling an invitation for participants to redirect their attention to the present moment.

That image and sound stayed with me. While the DBT bell is designed as a mindfulness tool, it became a conditioned trigger for me. The memory still evokes feelings of control and coercion rather than safety.

In some ways, that’s what I want this to do here: pause, pay attention, and bring ourselves back to this moment. Whilst looking again at experiences that can become compressed into diagnoses, clinical language, and treatment outcomes.

Not to prove that one version is right and another is wrong.

To be curious.

To ask what else there might be to understand:

Others’ perspectives.

The person behind the diagnosis.

What you’ll find here

I’ll write about therapy, trauma, psychiatric treatment, diagnoses, and the changing ways in which we, and professionals, understand mental health. Through the lens of someone with lived experience.

I may write about some challenging experiences.

I hope to also include some positive ones.

I want to write about the ways therapy has supported me, as well as what happens when ‘therapy goes wrong’. The treatments that offer a light bulb moment of understanding and self-discovery. The skills that unexpectedly stick. The absurdities of navigating GP surgeries, hospitals, recovery centres and therapy rooms. The humour to be found in waiting rooms and ward corridors.

And the small pieces of progress that might never warrant a line in anyone’s notes but can feel enormous when they’re yours.

I’ll also explore psychological theory and research, particularly around trauma, from the patient’s side of the therapy room.

This isn’t anti-therapy by any means, nor is it a plug for any therapy modality.

It’s somewhere in between.

Because that’s where the interesting stories are.

A lived-experience publication

It’s important to note. I am not a clinician, psychologist, therapist, or psychiatrist.

When I discuss therapeutic approaches, psychological theories, or research, I do so as a writer and someone with lived experience who is engaging with those ideas.

I don’t always have definitive answers about my own experiences, either. My own understanding may change as I learn, reflect, and continue to make sense of them — and that’s what What The Notes Don’t Say is all about.

Where I write about therapy, treatment, or mental health services, I write from my own perspective. I will try to distinguish between my personal experience, my interpretation of that experience, and established clinical or research evidence, where possible.

I am writing about what happens when you put the patient back into the clinical story.

About what theory, diagnosis and treatment can look and feel like when you’re the person living inside them.

And the stories that don’t always make it into the notes.

— Elizabeth Bell

A note before you go

Disclaimer: What the Notes Don’t Say shares personal lived experience and is for informational and reflective purposes only. It does not provide medical advice, diagnosis, or clinical guidance, and should not be used as a substitute for professional healthcare.

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