Nathan Filer: How novels can help us understand mental health

Costa award winning novelist Nathan Filer on his life as a mental health nurse, the location of illness and the power of fiction.

Which is the better way to understand mental illness: a medical textbook, or a novel? Is there any reason to bother raking through three hundred pages of prose, when irregular human behaviour can be reduced to a simple clinical term, such as “bipolar”, or “autism”, or “schizophrenia”?

Nathan Filer thought long and hard about whether to include any of these words in his debut book, The Shock of the Fall, which won the Costa First Novel Award on 6 January. It tells the story of Matthew Holmes, a headstrong, quick-witted teenager haunted by the death of his brother on a family holiday when he was nine years old.

“I don’t diagnose him with schizophrenia, in that I never have a character in a position of authority say he’s got it,” Filer told me shortly after the prize announcement, “but then, he does end up on a community treatment order being given a depot injection against his will, so I guess it’s pretty strongly implied.”

In many ways Filer, a registered mental health nurse who worked for four years on a 19-bed open acute ward for people with a range of mental illnesses, is writing against the trend. The American essayist Marco Roth has charted the rise of the “neuronovel”, in which bad behaviour becomes synonymous with bad brain chemistry: think of Jed Parry in Ian McEwan’s Enduring Love, or Christopher Boone in Mark Haddon’s Curious Incident of the Dog in the Night-Time. For Roth, this represents a loss of confidence in fiction: an allegory of the fear that science has become the best and only reliable measure of the human condition.

There is an increasing sense that inwardness, subjectivity and selfhood – the basic stuff of fiction – ought to be discarded as soon as possible. “I never quite understood why you would read fiction to understand the human condition,” Richard Dawkins told the New Republic last year. As cognitive therapies give way to cheap and readily available pharmaceuticals (the number of people in the UK taking antidepressants doubled between 2000 and 2011), the reduction of mind to brain in literature may well have been foreseen.

“It’s a temptation to write the illness and then bolt the character on to it,” Filer says, “but having worked in the field for so many years, it became a little bit more natural for me to see the person and see the illness as one facet of their character.”

We have been depicting mental illness in art far longer than we have been diagnosing it. Hamlet may have been bipolar, but that is not all that he was. It is not unreasonable to assume that observation and imagination may still paint a broader picture than textbooks, or even help them along.

Filer speaks fluent NHS: he still works occasional shifts as a nurse and uses expressions such as “service user” and “pathologise” without sounding cold or patronising. In his book, Matthew becomes a kind of challenge – to look beyond the disease and see what remains.

“The only way we’re ever able to diagnose people in mental health – we don’t put patients in an MRI scanner – is through the way they interact with people,” Filer says, explaining how he used his novel to ask questions, arising out of his work, on the location of mental illness.

“If we say that his schizophrenia is located in him,” he goes on, “and look at his mother (clearly there’s some anxiety and depression there), it seems that their respective problems are located in the space between them.

“The catalyst for breakdown is always stress: it’s life events. If you want to depict mental illness accurately, then the interplay needs to be shown. Fiction can do that.”

Brain tweezers: fiction can be a tool for analysing how we think. Image: Illustration Works/Alamy.

Philip Maughan is a freelance writer in Berlin and a former Assistant Editor at the New Statesman.

This article first appeared in the 15 January 2014 issue of the New Statesman, 1914 to 2014

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How Girls made an entire episode out of a single conversation about sexual assault

“American Bitch” is a claustrophobic and clammy exploration of horrible rape debates.

Recently, I was at a party in London that a friend had brought me to. I knew nobody else there, and was happily chatting complete nonsense with a total stranger. Somehow the conversation meandered to a problematic male celebrity accused of domestic violence.

I made an offhand comment about how I couldn’t support him any more. The man I was talking to objected. Should we believe everything we hear? In under five minutes, our conversation had reached a point where he said authoritatively, “Are you really going to confidently throw around statistics like ‘over one in 20 women are raped’? Listen, I know the legal definition of rape.”

The machinery in my brain gave a familiar, dull clunk. Oh, I’m in one of those conversations. One of those conversations where a man tells a woman about what counts as rape and what doesn’t.

It takes a few minutes to realise that the latest episode of Girls, “American Bitch”, is one of those conversations. It opens with Hannah approaching a lovely white pillared apartment block, politely telling the doorman “I’m here to see Chuck Palmer.” She reapplies her lipstick in the elevator. Is she interviewing someone for a magazine? Picking someone up for a date?

Chuck meets Hannah at the door, asks her to take her shoes off, line them up next to the others, without touching his suede boots, and mentions that the “special slippers” are “just for” him. In case we were in any doubt, he says “Yes, I’m that asshole.” We see endless copies of books with his name on the cover, and certificates branding them New York Times Best Sellers on the walls, a Pen Faulkner Award for Fiction, even a photo of him with Toni Morrison. This is a very famous writer.

When Chuck admits it was “good” that Hannah showed up, she replies, “I’m just surprised you found the article that I wrote. You must have an ass-deep Google alert on yourself, this was like a niche feminist website, it’s not the front page of the Times.”

“It’s just I’m hypervigilant these days,” he says. “Look, I’m not trying to get an apology out of you.”

“Ok, good.”

There’s a very specific edge to their conversation – we’re in familiar territory. “I’m obligated to use my voice to talk about things that are meaningful to me,” Hannah goes on. “And I read something about you that troubled me, that troubled me greatly – namely, that you’re using your power and your influence to involve yourself sexually with college students on your book tour, and whether all those sexual encounters were consensual or not –”

“Ok, hold up, because that’s where this line is pretty fucking messy, when words like consensual are thrown around.”

Oh, here we are. One of those conversations.

The scene carries on like this long enough for us to realise that this is probably a bottle episode - with limited characters and sets to keep costs down - like Season Two’s “One Man’s Trash”, featuring Patrick Wilson. That was another episode focusing solely on Hannah hanging out in the big luxurious apartment of a richer, older man. But this one is more of an ethical dialogue about the problems of accountability verses privacy. For the full half hour, Hannah and Chuck debate. Chuck claims his own kind of victimhood. His personal life has been invaded, a kind of groupthink has ended with the presumption of his guilt, and now, he can’t sleep, having nightmares about his daughter discovering the allegations online. “You remember what happened at Salem,” he says gravely. “I’m the witch!” (A few moments later, he compares himself to “some fire and brimstone preacher”, seemingly not noticing the irony.) Meanwhile, Hannah stands up for the girls who claim Chuck assaulted them, adding her own experience as a victim of sexual assault to the discussion to try and help him to understand.

Of course, this isn’t simply an ethical problem explored in dialogue. The texture of their debate is as telling as the basic argument itself. Chuck repeatedly interrupts Hannah, when she’s saying things like “women who have historically been pushed to the side and silenced an–”. He asks sarcastic, aggressive questions like, Did I put a gun to her head? Did I offer her a job?” and, even, “How does one give a non-consensual blowjob?”

At the same time, he also tries to charm Hannah, singling her out as special. “Listen, you’re clearly very bright, I could tell that from the first sentence you wrote,” he says casually, a minute or two into their first conversation. “Why would a smart woman like you write a very long and considered piece of writing on what is ultimately hearsay?” he says soon after. “Cause you’re smart, you write well, you write sharply,” he insists, when she asks why he invited her over instead of a different journalist.

And it works. Chuck is just self-deprecating enough that we see flashes of humanity in him. He asks Hannah questions about where she grew up, giggles with her, and talks about her dreams to be a writer. “Maybe one day you’ll be famous,” he says. “And a lot of people will know some stuff about you – some stuff. I mean, they’ll think they’ll know everything, but they won’t. Like what happened to me. You thought you knew everything, but you didn’t.”

Hannah shakes her head like a schoolgirl in trouble. “No, I didn’t,” she says.

At this point, I felt a squirming in my stomach. Viewers have always been quick to blur the line between fiction and reality when watching Girls, and we know that Lena Dunham has plenty in common with both Hannah and Chuck: yes, she’s a feminist writer who has spoken out about sexual violence, but she’s a famous writer who has faced a degree of public condemnation – and was even accused of sexually assaulting her sibling. “We just wanted to look at it from all sides,” Dunham told Vulture of the episode. Was Girls really telling the story of the poor, misunderstood, sexually aggressive male writer?

The next scene takes place in Chuck’s bedroom, where Hannah is awestruck over a signed copy of Philip Roth’s When She Was Good – Roth’s only novel with a female protagonist, Lucy, who repeatedly attempts to connect with and reform the disappointing men around her. “I know I’m not supposed to like him because he’s a misogynist and he demeans women,” Hannah says, in a comment that could easily refer to Chuck as much as Roth, “but I can’t help it.”

Chuck eventually asks Hannah to lie down on the bed with him – whilst encouraging her to “keep your clothes on to delineate any boundaries that feel right to you” – and when she does so, he unzips his fly, rolls towards Hannah, and flops his dick onto her thigh. Hannah surprises even herself when she touches it, panics, and tries to leave.

It’s a typical Girls moment - ridiculous, blunt, and sudden but still funny, and it reveals Chuck once and for all for the predator he is, whilst simultaneously portraying him as pathetic.

“People don’t talk about this shit for fun,” Hannah tells Chuck, and she’s right, these arguments are not fun. As Dunham told Vulture: “We’re having so many conversations about rape culture and assault and they’re really, really important conversations, but a lot of women walk around with a lot of shame about things that don’t look like rape in the traditional way.” Although there’s a grim humour in the familiarity of these scenes, this bottle episode feels claustrophobic and clammy, with shots of Hannah rubbing her neck or looking away awkwardly. It’s sweaty and stressful.

“Anyway, last year, I’m at this, whatever, warehouse party in Bushwick, and this dude comes up to me,” Hannah says earlier in the episode. The two are old schoolmates, and they talk about a former teacher, who Hannah calls out as a molester. “And you know what this kid said? He looks at me in the middle of this fucking party, like he’s a judge, and says, ‘That’s a very serious accusation, Hannah.’ And he walks away.” Yup. Sounds like one of those conversations.

Anna Leszkiewicz is a pop culture writer at the New Statesman.