The Paper Version of Me
Why I’m writing: What the Notes Don’t Say
There is a paper version of who I am.
Diagnoses. Interventions tried. Medications started and discontinued. Treatment plans. Hospitalisations. Assessments. Progress notes.
Fragments of a life, documented at particular moments in time.
And then there is me.
The person who lived between and through those moments.
The conversations that happened before and after the notes were written. The thoughts I didn’t articulate. The things I understood only much later. The coping strategies that made sense in one period of my life but not in another. The progress — and the suffering — that weren’t necessarily visible from the outside – even to the professionals.
The person I was then.
And the person I am now.
Neither version is static.
We are all changing.
Even our past self changes through the lens of our present.
That’s where What the Notes Don’t Say begins.
Fragments in time
Clinical records are documented snapshots. Fragments in time.
They are often written in the language of clinical care — a language designed to record and communicate information between professionals, some of whom may never meet the person behind the file.
They capture what was observed, reported, and understood at a particular point in time, inevitably shaped to some degree by the subjective perspective and clinical interpretation of the person documenting them.
But people keep moving.
We all change. Our habits change. Our behaviours change. The way we think changes. The strategies we use to cope change too.
Some fall away as we learn healthier ones. Others may once have helped us survive something difficult but become less useful as our circumstances change.
Sometimes we progress. Sometimes we relapse. Sometimes we become stuck.
And sometimes we look back and understand ourselves differently simply because we know something now that we didn’t know then.
The clinical picture isn’t static either.
The professionals we meet may see different things in us. Their training, specialisms, therapeutic approaches, and the information available to them all contribute to the clinical picture that emerges.
One professional may notice something another doesn’t.
A diagnosis that seems to explain one period of someone’s life may later change, or sit alongside a different diagnosis or understanding of who we are now.
Our understanding of mental health changes too.
Trauma itself is not new. Human beings have been observing its effects for generations. But our understanding of what constitutes trauma, how traumatic experiences can shape us, and what it means to provide trauma-informed care continues to develop.
Different disciplines, clinicians, and therapeutic traditions don’t necessarily understand the same experiences in exactly the same way.
And both things can be true. Dialectically.
The person can evolve.
The clinical understanding of that person can evolve too.
Yet the record remains.
People keep moving. The notes don’t.
Perhaps that doesn’t make the notes inherently right or wrong.
Perhaps that’s what makes them fragments.
Fragments of who we were.
Fragments of what somebody else saw.
Fragments of what we were able to communicate.
Fragments of what was understood at the time.
And, occasionally, fragments we may no longer recognise ourselves in at all.
That relationship fascinates me.
It also frightens me.
Because somewhere between the person documented on paper and the person who actually lived the experience is another version of the story.
Not necessarily a competing version.
A human one.
That’s the version I want to write about.
Why Elizabeth Bell?
Elizabeth Bell isn’t my real name.
A pseudonym gives me the opportunity to write candidly while protecting some of the privacy that mental-health treatment has already required me to surrender. I also do not want my identity to detract from what I am saying, without losing my authentic voice. I will respect the privacy of others in my writing too.
The name Elizabeth Bell also pays homage to women who wrote under other pen names.
Nellie Bly — born Elizabeth Jane Cochran — used investigative journalism to expose conditions inside a nineteenth-century asylum. Charlotte, Emily, and Anne Brontë published under the names Currer, Ellis, and Acton Bell.
Elizabeth and Bell, therefore, felt rather fitting.
The Bell has another meaning for me.
During Dialectical Behaviour Therapy (DBT), a bell sounds like an invitation to stop and return to the present moment.
This image stayed with me.
My own relationship with that sound became more complicated, intertwined with my experience of trauma.
Something intended to signal mindfulness evoked something very different in a stressful environment. A startle response. The nervous system is shifting into ‘fight or flight ‘ – a sound associated with calm becomes associated with threat.
Perhaps that is another example of two things being true at the same time.
And yet the bell still feels appropriate for what I’m trying to do here.
To stop.
To notice.
To make space for what else might be true.
Also, to understand that what is intended might not be our experience.
And who then deals with the in-between?
From the other chair
I’m not a clinician, therapist, or medical professional.
I’m writing from the other chair.
This is a patient-led perspective, without this being a patient-led narrative.
Where I bring psychological theory into my writing — and I will — I want to remain curious about the human experience behind it.
Many of the books I’ve read about trauma are written by psychiatrists, psychologists, and clinicians who have spent years working with people and trying to understand what happens to us when we experience trauma. Their theories haven’t emerged in a vacuum. They have been shaped by clinical practice, observation, research, and, importantly, by listening to people’s stories.
As a patient, I come to some of those same ideas from another direction: from living them.
Perhaps that is where things become most interesting.
When clinical knowledge and lived experience meet.
Not as competing versions of the truth, but as different ways of understanding what it means to be human. Again, their notes are not always our reality.
Whilst a therapeutic approach can teach us skills we carry for life, individual experiences within that treatment can also be difficult and, sometimes, damaging.
We can value what something gave us and still question parts of what happened.
That’s a principle I learned through DBT: Dialectics.
It’s also one I want to bring to this writing.
What the Notes Don’t Say
What the Notes Don’t Say won’t appear as a chronological account of my treatment or medical history.
There will be discussions about trauma. Diagnosis. Psychiatric treatment. Therapy. Therapeutic relationships. Books. Research. Psychological theory.
There will hopefully be some humour too.
I’ll write about the progress nobody recorded, as well as experiences I found difficult.
I’ll explore the person who exists outside the clinical version of themselves in Beyond the Notes.
Between the Lines: I’ll look more closely at some of the research, theories, and ideas that shape our understanding of mental health — from the perspective of someone who has encountered some of them from the patient’s chair.
Most importantly, I want to curate a space to be curious.
I won’t always end my articles by giving you the ‘right’ answer.
Because perhaps the most interesting question isn’t simply:
What do the notes say?
It’s: What don’t they say?
There is already a paper version of my story.
This is the real-life version that appears in and out of the notes.
— Elizabeth Bell
People keep moving. The notes don’t.
What the Notes Don’t Say is a lived-experience publication written from the patient’s perspective. It is not a clinical account or medical advice.