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 Assistant Editor at the New Statesman.

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

All photos: BBC
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“You’re a big corporate man” The Apprentice 2015 blog: series 11, episode 8

The candidates upset some children.

WARNING: This blog is for people watching The Apprentice. Contains spoilers!

Read up on episode 7 here.

“I don’t have children and I don’t like them,” warns Selina.

An apt starting pistol for the candidates – usually so shielded from the spontaneity, joy and hope of youth by their childproof polyester uniforms – to organise children’s parties. Apparently that’s a thing now. Getting strangers in suits to organise your child’s birthday party. Outsourcing love. G4S Laser Quest. Abellio go-carting. Serco wendy houses.

Gary the supermarket stooge is project manager of team Versatile again, and Selina the child hater takes charge of team Connexus. They are each made to speak to an unhappy-looking child about the compromised fun they will be able to supply for an extortionate fee on their special days.

“So are you into like hair products and make-up?” Selina spouts at her client, who isn’t.

“Yeah, fantastic,” is Gary’s rather enthusiastic response to the mother of his client’s warning that she has a severe nut allergy.

Little Jamal is taken with his friends on an outdoor activity day by Gary’s team. This consists of wearing harnesses, standing in a line, and listening to a perpetual health and safety drill from fun young David. “Slow down, please, don’t move anywhere,” he cries, like a sad elf attempting to direct a fire drill. “Some people do call me Gary the Giraffe,” adds Gary, in a gloomy tone of voice that suggests the next half of his sentence will be, “because my tongue is black with decay”.

Selina’s team has more trouble organising Nicole’s party because they forgot to ask for her contact details. “Were we supposed to get her number or something?” asks Selina.

“Do you have the Yellow Pages?” replies Vana. Which is The Apprentice answer for everything. Smartphones are only to be used to put on loudspeaker and shout down in a frenzy.

Eventually, they get in touch, and take Nicole and pals to a sports centre in east London. I know! Sporty! And female! Bloody hell, someone organise a quaint afternoon tea for her and shower her with glitter to make her normal. Quick! Selina actually does this, cutting to a clip of Vana and Richard resentfully erecting macaroons. Selina also insists on glitter to decorate party bags full of the most gendered, pointless tat seed capital can buy.

“You’re breaking my heart,” whines Richard the Austerity Chancellor when he’s told each party bag will cost £10. “What are we putting in there – diamond rings?” Just a warning to all you ladies out there – if Richard proposes, don’t say yes.

They bundle Nicole and friends into a pink bus, for the section of her party themed around the Labour party’s failed general election campaign, and Brett valiantly screeches Hit Me Baby One More Time down the microphone to keep them entertained.

Meanwhile on the other team, Gary is quietly demonstrating glowsticks to some bored 11-year-old boys. “David, we need to get the atmosphere going,” he warns. “Ermmmmm,” says David, before misquoting the Hokey Cokey out of sheer stress.

Charleine is organising a birthday cake for Jamal. “May contain nuts,” she smiles, proudly. “Well done, Charleine, good job,” says Joseph. Not even sarcastically.

Jamal’s mother is isolated from the party and sits on a faraway bench, observing her beloved son’s birthday celebrations from a safe distance, while the team attempts to work out if there are nuts in the birthday cake.

Richard has his own culinary woes at Nicole’s party, managing both to burn and undercook burgers for the stingy barbecue he’s insisted on overriding the afternoon tea. Vana runs around helping him and picking up the pieces like a junior chef with an incompetent Gordon Ramsay. “Vana is his slave,” comments Claude, who clearly remains unsure of how to insult the candidates and must draw on his dangerously rose-tinted view of the history of oppression.

Versatile – the team that laid on some glowstick banter and a melted inky mess of iron-on photo transfers on t-shirts for Jamal and his bored friends – unsurprisingly loses. This leads to some vintage Apprentice-isms in The Bridge café, His Lordship's official caterer to losing candidates. “I don’t want to dance around a bush,” says one. “A lot of people are going to point the finger at myself,” says another’s self.

In an UNPRECEDENTED move, Lord Sugar decides to keep all four losing team members in the boardroom. He runs through how rubbish they all are. “Joseph, I do believe there has been some responsibility for you on this task.” And “David, I do believe that today you’ve got a lot to answer to.”

Lord Sugar, I do believe you’re dancing around a bush here. Who’s for the chop? It’s wee David, of course, the only nice one left.

But this doesn’t stop Sugar voicing his concern about the project manager. “I’m worried about you, Gary,” he says. “You’re a big corporate man.” Because if there’s any demographic in society for whom we should be worried, it’s them.

Candidates to watch:


Hanging on in there by his whiskers.


Far less verbose when he’s doing enforced karaoke.


She’ll ruin your party.

I'll be blogging The Apprentice each week. Click here for the previous episode blog. The Apprentice airs weekly at 9pm, Wednesday night on BBC One.

Anoosh Chakelian is deputy web editor at the New Statesman.