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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The non-fiction novel that takes readers inside the head of Raoul Moat

Andrew Hankinson’s depiction of Moat’s unravelling is being marketed as biography/true crime, but its semi-fictional world is something more complex.

In July 2010, just weeks after becoming Prime Minister, David Cameron expanded upon his vision for the “Big Society” that he had first unveiled at the 2009 party conference. It promised a “big advance for people power”, in which individuals would be responsible for their actions. “To be British is to be sceptical of authority and the powers that be,” he told conference. “There is a ‘we’ in politics, and not just a ‘me’.”

That same month, just two days after being released from HMP Durham for the assault of a child, the self-employed gardener and former doorman Raoul Moat shot and injured his ex-girlfriend Samantha Stobbart and killed her boyfriend Chris Brown, who he wrongly believed to be a policeman. Moat went on the run, shooting a policeman at point-blank range, then fleeing to the rural Northumberland town of Rothbury. For a week, the story of this exotically named, delusional man who left behind a wealth of material, including letters and four-hour-long Dictaphone recordings, was given joint top billing with Cameron’s “Big Society” – soon to be as dead and buried as Moat, who, cornered by police after a seven-day hunt, killed himself.

The journalist Andrew Hankinson’s depiction of Moat’s unravelling is being marketed as biography/true crime, yet really is a non-fiction novel, in which writer and reader squat inside a mind that moves from irrational anger and self-pity to despondency. Moat’s is a solipsistic narration, in which he is the perennial victim – of circumstance, enemies, authoritarian bureaucracy, police harassment and past lovers. There is little room here for the outside world. Like most outlaws, Moat believed that everyone had failed him. “All my life I wanted death,” he laments.

The real-life Moat story, however, was more than that of a lone fugitive. It was also about rolling news coverage and Facebook groups, some of which celebrated Moat as a Ned Kelly-type folk hero – a “#ledge”. When Cameron denounced him in parliament he inadvertently elevated Moat to a clearer anti-authoritarian position: the antithesis of a “Big Society” citizen, in fact. It is also the story of the Northumbria Police force, which did its very best to show that it had everything under control when it really didn’t.

And, bringing an element of farce to a tragedy, it featured the subplot of a thoroughly leathered Paul Gascoigne – the most exciting and idiosyncratic footballer of his generation – tearing through the countryside in a taxi with a fishing rod, a dressing gown and a rotisserie chicken in an attempt to bring a sense of calm to the situation. “All I want to do is shout, ‘Moaty, it’s  Gazza! Where are you?’” he explained en route during a live radio phone-in. “And I guarantee he will shout his name out: ‘I’m here.’” Gascoigne’s pantomime intervention added to the chaos: now another disenfranchised northern male was running amok. The parallels were evident: Gazza’s career had been beset by injury and alcoholism, Moat’s bodybuilder’s physique was no longer in prime condition after weight loss in prison. Both were separated from their families and prone to self-examination. Onlookers knew it could quite easily have been Gazza holed up in those woods.

Other exponents of the non-fiction novel such as Norman Mailer and Gordon Burn would surely have put all this in, yet Hankinson chooses not to cover any of the peripheral subplots, instead using a second-person narrative to burrow deep into Moat’s paranoia, sourcing all his text from real material. This narrative sacrifice in favour of a singular voice gives the book thrust and authenticity of voice, and manages to show the nuances of a man who was articulate and often capable, and had reached out to social services on many occasions for help. None of which excuses Moat’s action – but it does explain his choices. Where the tabloids favoured the simplicity of the textbook “cold-blooded killer”, Hankinson’s portrait lets the reader make his or her own judgement. Clearly Moat was a bully, and yet he was not born that way. Few are. “There’ll be books written about all this, and you’ll be made out to be some crazed fucking maniac,” he says to himself, with both foresight and grim resignation.

Elsewhere the semi-fictional Moat brushes over past transgressions and labours over the tiniest slights in such repetitive, droning detail that the reader’s sympathy soon wanes. The book’s strength lies in the real-life Moat’s keenness to confess – to be heard, finally, beyond death – through these nocturnal monologues, recorded in his tent after yet another meal of charred burgers. From these remnants, Hankinson deftly assembles the man’s inner workings, lending credibility to his portrait while, beyond the myopic commentary, we know, although we don’t see it, that the outside world is closing in. Critics might ask: why give voice to a loser? Perhaps because in the right hands any real-life story is worth telling, and history should never just record the heroes and victors. The losers play their part, too.

Ben Myers’s novel “Beastings” recently won the Portico Prize for Literature

You Could Do Something Amazing With Your Life [You Are Raoul Moat] by Andrew Hankinson is published by Scribe (211pp, £12.99)

Ben Myers’ novels include Pig Iron and Richard, a Sunday Times book of the year. His writing has appeared in The Guardian, NME, Mojo, Time Out, 3:AM Magazine, Caught By The River and many others. www.benmyersmanofletters.blogspot.com

This article first appeared in the 05 February 2015 issue of the New Statesman, Putin's war