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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There are only two rules for an evening drink: it must be bitter, and it must be cold

A Negroni is the aperitif of choice in bars everywhere from London to Palermo - and no wonder.

The aperitif has the odd distinction of being the only alcohol that can always rely on a sober audience: it is the opener, the stimulant, a spur to the appetite for good food and good conversation. This preparatory beverage is considered the height of sophistication, and certainly nobody labouring in field or factory ever required a pep to their evening appetite. Still, to take a drink before one starts drinking is hardly clever behaviour. So why do it?

One reason is surely the wish to separate the working day from the evening’s leisure, an increasingly pressing matter as we lose the ability to switch off. This may change the nature of the aperitif, which was generally supposed to be light, in alcohol and character. Once, one was expected to quaff a pre-dinner drink and go in to dine with faculties and taste buds intact; now, it might be more important for those who want an uninterrupted meal to get preprandially plastered. That way, your colleagues may contact you but they won’t get much sense out of you, and pretty soon they’ll give up and bother someone else.

The nicest thing about the aperitif, and the most dangerous, is that it doesn’t follow rules. It’s meant to be low in alcohol, but nobody ever accused a gin and tonic or a Negroni (Campari, gin and vermouth in equal portions) of that failing; and sherry, which is a fabulous aperitif (not least because you can keep drinking it until the meal or the bottle ends), has more degrees of alcohol than most wines. An aperitif should not be heavily perfumed or flavoured, for fear of spoiling your palate, yet some people love pastis, the French aniseed drink that goes cloudy in water, and that you can practically smell across the Channel. They say the scent actually enhances appetite.

Really only two rules apply. An aperitif should be bitter – or, at any rate, it shouldn’t be sweet, whatever the fans of red vermouth may tell you. And it must be cold. Warm drinks such as Cognac and port are for after dinner. Not for nothing did Édith Piaf warble, in “Mon apéro”, about drowning her amorous disappointments in aperitifs: fail to cool your passions before sharing a table, and you belong with the barbarians.

On the other hand, conversing with your nearest over a small snack and an appropriate beverage, beyond the office and before the courtesies and complications of the dinner table, is the essence of cultured behaviour. If, as is sometimes thought, civilisation has a pinnacle, surely it has a chilled apéro carefully balanced on top.

The received wisdom is that the French and Italians, with their apéritifs and aperitivos, are the experts in these kinds of drinks. Certainly the latter are partial to their Aperol spritzes, and the former to such horrid, wine-based tipples as Lillet and Dubonnet. But the English are good at gin and the Americans invented the Martini. As for Spain, tapas were originally snacks atop a covering that kept the flies out of one’s pre-dinner drink: tapa means lid.

Everywhere, it seems, as evening approaches, people crave a drink that in turn will make them salivate: bitterness, the experts tell us, prepares the mouth to welcome food. The word “bitter” may come from “bite”, in which case the aperitif’s place before dinner is assured.

I like to think that a good one enables the drinker to drown all sour feelings, and go in to dinner cleansed and purified. Fanciful, perhaps. But what better lure to fancy than a beverage that exists only to bring on the evening’s pleasures?

Nina Caplan is the Louis Roederer Pio Cesare Food and Wine Writer of the Year

Nina Caplan is the 2014 Fortnum & Mason Drink Writer of the Year and 2014 Louis Roederer International Wine Columnist of the Year for her columns on drink in the New Statesman. She tweets as @NinaCaplan.

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times