FROM 01 MARCH 2021 BIGISSUE.COM | 39
Open Dialogue brings therapist, doctor, su�ferer, peer-
supporter (someone who has been through it) and family
together to listen and talk about what has happened, and
why. � e results are stunning: two years a�ter breakdown,
75 per cent of those who have had the treatment are back at
work or studying, compared to nine per cent of those treated
conventionally in the UK. Most take no medication.
I was interviewed by a key UK practitioner but was unable
to access Open Dialogue. It is spreading but availability is
still tiny. Instead, I turned to psychotherapy, which made a
tremendous di�ference, addressing roots and traumas buried
within me, freeing me from much confusion and harmful
thought patterns.
From psychotherapists I learned about ways of seeing and
talking about wellbeing. You will have noticed that I have used
little of the vocabulary you might expect in this story. Although
words like bipolar and manic depression may be useful to
some, interviews with psychologists and psychiatrist showed
that many professionals see our current system of diagnosis,
labelling and medication as unhelpful, if not harmful.
� ere is an extraordinary split at the heart of the way we
regard the whole subject.
Many psychiatrists know that pills are a short-term solution
to long-term troubles (they treat symptoms, not causes) but feel
they have no alternative to prescription.
Many psychologists question the entire basis upon which
psychiatry proceeds. � ey believe we need a lot more talking
and many fewer pills.
“Bipolar is a very popular diagnosis,” one psychologist told
me, “and I wouldn’t take it away from anyone, but I don’t fi nd
it helpful. I want to know what has happened to you, and start
work from there.”
I am no expert on anyone else’s condition, and if medication
works, great. It certainly helped bring me out of the madness.
But I have resisted long-term drugs, being in the incredibly
fortunate position of being able to a�ford therapy when I
desperately needed it.
Should you hit trouble, my only advice would be to look
hard at what works for you, and to insist on being treated as an
individual rather than a case.
As is well known, reducing, changing or stopping
medication should only be done in careful consultation with a
doctor. But it is worth remembering that doctors have a duty to
help with that, should it be desirable.
Before the pandemic struck, de-prescribing was taking o�f.
I interviewed doctors and psychiatrists who now start their
conversations with your personal circumstances, questions
about why you feel the way you do and what you can do to
change it. Creativity, exercise, art, social prescribing (joining
groups, sports, clubs – anything is better than nothing),
exposure to nature, good diet, proper sleep and an avoidance
of stress – though easier said than done – can bring huge
progress. A good question to ask yourself is, “Is what I am going
through related to factors I can change, or that will change?”
I know the theory and still struggle with the practice. I have
yet to take up running, for example. But two years a�ter I broke
down, I remain sane, healing and hopeful. Researching and
writing about this vital area has made one thing clear. Talking
really works. Over half of those given therapy for anxiety or
depression make a complete recovery, accord to NHS statistics.
Everyone deserves quick access to clinical psychotherapy on the
NHS. Whether we demand it, vote for it or train to do it, this is
how we can change millions of lives.Heavy Light: A Journey � rough Madness, Mania and Healing by
Horatio Clare is out on March 4 (Vintage, £16.99). @HoratioClare