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

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How will future videogame makers design a grand strategy game about the 21st century?

With the diminishing power of nation states, and the lack of conventional warfare, what would a 21st-century grand strategy game look like?

In the world of historical strategy games, it always seems clear how to win. Paint the map your colour. Raise your flag over the capitals of your rivals. Pave the streets of your cities with gold. Games based around statecraft in olden times will tend to have diverse objectives, they usually focus on the greatness of a nation in the traditional senses of the word: military might, technological advancement, religious and cultural hegemony. These same priorities hold up from the times of the Roman Republic to the Cold War.

Yet if games designers in the future were to look at the world of today, how would they interpret the actions of modern governments? Do the same goals as before apply or have we moved on? Are the objectives of contemporary societies different, and if so, just what would a player in a game of 21st-century grand strategy be trying to achieve?

One thing is for sure, the conventional measures of success in historical grand strategy games don’t stack up so easily in a modern setting.

War, for instance, has always been a staple part of historical games and it remains a preoccupation of contemporary society too. In the 15 years of the 21st century, Britain has invaded two countries, conducted armed interventions in three more and is even now lining up the procurement of new fighter jets, new aircraft carriers and new nuclear weapons at incredible expense. So we can safely say we do not live in a peaceful age.

But despite having all this firepower and the political will to bring it to bear at the drop of a dossier, war doesn’t seem to serve Her Majesty’s Government in the way it does in either the history books or the strategy games. There is no territory to be won and no rival great powers being thwarted – only air strikes, occupations and teetering puppet governments.

Indeed the only country whose military adventures bear any resemblance to the old-timey way of doing things is Russia, with Putin perhaps the last of the breed of world leaders who still thinks swapping out the flags on municipal buildings constitutes a legitimate redrawing of national boundaries. Given his famous distrust for technology it seems quite likely he didn’t get the tersely worded Tweet from Obama about how that kind of thing isn’t supposed to work anymore.

On the economic side of things the approaches opted for by governments today don’t fit with the historical mind set either. Nations are no longer trying to get rich for their own sake. Privatisation relinquishes the assets of the state in return for a temporary financial gain and long term loss of revenue. Deregulation and poor tax enforcement bleeds capital overseas. It is here we see perhaps the key difference between games where you play as The State itself and real countries, countries run by people who have bank balances of their own and competing party financiers to appease.

The idea of running a country for the purpose of making that country wealthier and then reinvesting that wealth back into the country by developing assets and infrastructure has gone out of the window. Simultaneously both the leftwing model of a state run for the benefit of its citizens and the rightwing ideal of a country mastering its economy to become a more powerful force on the world stage have been quietly phased out. Outsourcing and tax havens suggest that there is no longer room for patriotism in economic policy – unless you’re China, of course, but it wouldn’t be much of a game with only one nation playing it.

On a technological front there was the space race, and there have even been games built around it. But in the 21st century, the urgency and the sense of competition has been lost. Rovers on Mars, probes on comets and space stations tend to be viewed in a spirit of collective human achievement, partly because of the collaborative nature of modern space exploration, and also, I suspect, because lots of people in those fields are Star Trek fans.

The idea of going to Mars so you can stand on the surface of another planet and tell the Communists to stuff it no longer appeals as much as that whole "pushing back the scientific boundaries for the benefit of all life of Earth" deal. It is laudable, but not ideal for games built around competing with other countries.

In the 21st century grand strategy game, we wouldn’t be looking to conquer the world, we wouldn’t be looking to buy it and we wouldn’t be looking to leave it in our technological wake either. So what does that leave? What would 21st-century grand strategy look like?

It could be argued that we’ve moved beyond the era of nation states as the bodies driving world affairs, and such a game might reflect that. Maybe something more akin to a Crusader Kings game would be the way to go, with the player taking the role of an individual – a connected political blueblood, perhaps, like an oligarch, a CEO, an activist turned politician, a drugs baron or a terrorist leader. Or maybe we would play not as an individual, but as an organisation, for example the CIA, ExxonMobil, Isis, Amnesty International or the Solntsevskaya Bratva.

It may be that we never see the present day immortalised in a strategy game, at least outside of that passing phase in Civilization where everything is either settled down or exploding in nuclear fire. Perhaps we’re destined to nestle into a historically obscure crack between the tumult of the 20th century and something spectacular or horrible yet to come. It is nice to think, however, that the times we live in are at least interesting and that maybe we’ll get to see it all laid out in a game one day, if only to find out what winning the 21st century would look like.

Phil Hartup is a freelance journalist with an interest in video gaming and culture