Strandlines and storytelling

When I was first sick and didn't get better, I lost faith in psychology. I became disillusioned by what I had believed the NHS and healthcare to be. It did not have the answers, and doctors did not know any more, or any better, than I did as a patient. It was a long time before I would realise this. I listened to the stories doctors told about me, none of which were meaningful or related to how I felt or what I experienced. I was at sea, cast adrift. There was no treatment and no great understanding. I needed to find my own anchor point, needing something other than medicine (or my previous job title) to identify with and hold on to. I needed to be able to create my own stories. 

My connection with the natural world has grown from this time. It has been a matter of survival for me to find a new pace of life, new elements to connect with, when the human world has eluded me. I distanced myself from seeking healthcare, exhausted and traumatised by the gaslighting dispensed, becoming mis-attuned from my body in having my own experiences dismissed and undermined. I risked further disability by continuing to seek help. Without a matching job title, I felt distanced from my identity as a psychologist. It no longer fitted. I no longer felt comfortable in it. 

Writing my own narrative

In the years since passed I have returned to the practice of letter writing in seeking understanding of my own for my illness. My own relational practice of Cognitive Analytic Therapy (CAT) has developed into a writing career, with work published for patient and professional communities, as well as broader audiences. My letters started as a way of making sense for myself and have grown into a way of making sense for others too, making sense of the systems that impacted me so profoundly, that impact also on others  – of grief and guilt, shame and blame. 

Over this time, I have seen many more people endure a similar process to the one I have undergone, of getting sick and not getting better. We are failed by medicine and also by stories. Over this time, I have been collecting diagnoses, identifying each group of symptoms and how they might best fit different conditions, all of which have daunting words reduced to acronyms. With each come new possibilities of treatment or management. In writing my own narrative I am making use of this new alphabet I have acquired. While medicine catches up with post-viral illness, and research finds treatment and more effective ways of managing the consequences, something that we can all do is to tell our own stories, to rewrite the unhelpful and harmful ones that are written for us – by society and by medicine and healthcare.

Inhabiting a small world, mostly just my bedroom and my flat for more than a year, unable to do more than rudimentary tasks of sustaining my sick body, I noticed the small things – how light moved across the room during the day and across the year. As I began to leave my flat, walking short distances, I noticed the weeds, self-seeded wildflowers and the domesticated ones that had escaped gardens. Living in a seaside town, reaching the sea was a wonderful and significant goal.

Beachcombing and psychotherapy

Now undertaking a practice-based PhD, beachcombing the strandline is not unlike my psychotherapy practice. I am storytelling, collecting stories from elsewhere and stitching them together to make new ones. In the NHS I wrote letters of reformulation to people in therapy, retelling the stories I had heard in sessions, finding themes from our conversations to name what had been, unpicking and restitching new understandings and perspectives together. I am now telling stories of objects: or rather, as in therapy, I am listening for the stories that the objects washed ashore might be able to tell me. I am drawing on this practice to tell wider stories, to find a way to represent the things I don't always have language for, hadn't previously noticed, find difficult to articulate, things that haven't been voiced. 

Living with chronic pain and fatigue, words escape me, brain fog muddles my speech and depletes my attention span. I am reliant on the things that wash in on the tide of my thoughts to organise my ideas. The things I find on the strandline speak to these experiences and to the vast themes that are difficult for so many of us to find words for – climate crisis, risks of flooding and temperature extremes, pandemics, austerity, ableism, ways we are all connected across the globe. It is the shoreline that offers up clues, that throws up our uncomfortable truths.

Walking the coastline, I start at Pett in East Sussex. I'm continuing a practice I have done for a long time. In recent years I have beachcombed at Bexhill, dragging home driftwood and hankering after lobster pots, collecting interesting pebbles, ones with holes in them. I've contributed to citizen science projects, recording egg cases of sharks and rays washed up on the beach for the Shark Trust. I've worked with quadrats for a Heritage Lottery project, recording the presence and abundance of indicator species along there too, flourishing mussel beds, and multitudes of anemones in the rock pools, indications of the water quality.

Finding a stranded jellyfish, I consider the role of agency (and its absence) in chronic illness and the rising temperatures of the sea. A cat shark egg case speaks to the species that live below the surface, the similarity of their make-up to ours. I dwell on the keratin tendrils that have anchored a mermaid purse to seagrass and my own poorly constructed collagen that scaffolds my connective tissue disorder (and likely my heightened risk for developing post-viral illness). Rope and string highlight the fishing industry and my own need for networks of structure and care, reminding me we are all interconnected. Plastics and other human made objects that have washed in and washed up show us the sea will always tell us our uncomfortable truths.

I am working with flotsam and jetsam. Elements of chance in the risk of disability and post-viral illness are reflected – the individual and the collective. Focusing on the global, the universal rather than the individual, I have moved to a greater understanding of the role of systems on the individual – of systemic injustice and how things that float to the surface, either in therapy or on the strandline, tell us important things about ourselves and the world around us.

Changing the environment

I would often take people out as part of therapy sessions, to sit outside, walk and talk, or get a coffee. Working with mental health community and in-patient rehabilitation services, it made for a less intimidating session with a psychologist. Being outside of a clinic space could be a way of engaging with people who may not find the magnolia eggshell hospital walls especially relaxing, where an hour to speak to a psychologist might feel threatening or challenging. There is little distraction from intrusive thoughts and distressing voices when sitting in a quiet room with a quiet person. To change the environment opened the possibility of a greater chance to connect, and in different ways. It was a more typical setting for a conversation and implicitly built in opportunities to use skills in community settings, skills so easily lost on admission to hospital. It may not have been a therapy session that many would recognise, but could nonetheless be as therapeutic as an hour surrounded by empty walls reflecting on early life experiences. 

Since leaving the NHS due to my own prolonged energy-limiting illness, I have a sense that working with people in outdoor spaces as a psychotherapeutic intervention, is more commonly used now in the wider field of adult mental health. In-patient gardening groups have grown along with green gyms and forest schools, services offering 'wellbeing' have expanded across woodlands and beaches. I have become more aware of practitioners identifying as 'outdoor psychologists' in private practice, working with or in the natural world too. While not for everyone, there can be a safety in having a boundaried clinic space, taking therapy out of the clinic and consulting room feels (for some) intuitively valuable. Something more akin to the experience of the everyday, something that can very literally give people breathing space. 

Yet the often proclaimed 'nature cure' of popular nature writing and widely advocated 'wellbeing' in 'nature' is not all it might seem. Cures of chronic illness are an unhelpful fallacy, green or otherwise. Suggestions that nature is there solely for our benefit similarly so. 

A relational practice with the natural world

Ruth Allen, author of 2024's Weathering: How the Earth's Deep Wisdom Can Help Us Endure Life's Storms, has written about her own psychotherapeutic practice in the outdoors. With a background as a geologist, Weathering follows a narrative of what Allen has learned from rocks, the ground beneath our feet, and from being outdoors. Having often used tools of grounding in my own work, picking up pebbles on the beach and inviting patients to find grounding objects of their own they can carry in a pocket, this again feels a useful way to learn and form new experiences in relation to yourself and another.

Allen writes about what being outdoors can teach the people she works with as she walks the moors of the southwest of England. It is an embodied practice of grounding, of earthing, connecting to all that the ground offers – a sense of time, a sense of place, a connection of body and land and everything that has been before. The role of rocks can teach us about erosion, for example, a reference I return to in my own body's erosion through illness – a process of revealing as well as destruction. I have learned new things as I have needed to adapt and create new ways of inhabiting my uncomfortable body and how it engages with the world. 

Similarly, Cognitive Analytic Therapy practitioners Amanda Copeland, Dr Abi Tarran-Jones and Dr Nick Barnes, run WildCATS, Restoring, Regenerating and Rewilding: A Collective Experience for Reconnecting with Land and Nature. They are combining the need to look after the spaces around us as well as ourselves, rather than drawing on nature as simply another resource to extract from – a risk I fear in the wider spread of 'green prescriptions' or 'nature on prescription' without more careful consideration. The risk is twofold: regarding the natural world as the source of a cure-all for our ills and not a place we are also responsible for; and reducing ill health to something that can be treated simply by being outside. 

Both Allen and WildCATS draw on relational practices of therapy, something I identify with in my own Cognitive Analytic Therapy practice. They also draw on the environment around us as something they are in relation with – something psychotherapy has historically been very poor at considering, principally concerned with the internal spaces we inhabit. Individual psychotherapy has rarely regarded the environment of an individual, our interconnectedness with others yes, but not necessarily the societal interconnections we live within. We exist as part of a wider ecosystem to our individual selves. Becoming and remaining ill has made me more acutely aware of this.