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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Would the BBC's Nazi drama SS-GB have felt half so resonant a year ago?

This alternate history is freighted with meaning now we're facing the wurst-case scenario. 

Would SS-GB have felt half so resonant a year ago? Though the clever-after-the-fact Nostradamus types out there might disagree, I can’t believe that it would. When it comes to the Second World War, after all, the present has helpfully stepped in where memory is just beginning to leave off. The EU, in the process of fragmenting, is now more than ever powerless to act in the matter of rogue states, even among its own membership. In case you hadn’t noticed, Hungary, for instance, is already operating as a kind of proto-fascist state, led by Viktor Orbán, a man whom Jean-Claude Juncker, the president of the European Commission, jokingly likes to call “the dictator” – and where it goes, doubtless others will soon follow.

The series (Sundays, 9pm), adapted from Len Deighton’s novel, is set in 1941 in a Britain under Nazi occupation; Winston Churchill has been executed and the resistance is struggling to hold on to its last strongholds in the countryside. Sam Riley plays Douglas Archer, a detective at Scotland Yard, now under the control of the SS, and a character who appears in almost every scene. Riley has, for an actor, a somewhat unexpressive face, beautiful but unreadable. Here, however, his downturned mouth and impassive cheekbones are perfect: Archer, after all, operates (by which I mean, barely operates) in a world in which no one wants to give their true feelings away, whether to their landlady, their lover, or their boss, newly arrived from Himmler’s office and as Protestant as all hell (he hasn’t used the word “degenerate” yet, but he will, he will).

Archer is, of course, an ambiguous figure, neither (at present) a member of the resistance nor (we gather) a fully committed collaborator. He is – or so he tells himself – merely doing his job, biding his time until those braver or more foolhardy do something to restore the old order. Widowed, he has a small boy to bring up. Yet how long he can inhabit this dubious middle ground remains to be seen. Oskar Huth (Lars Eidinger), the new boss, is keen to finish off the resistance; the resistance, in turn, is determined to persuade Archer to join its cause.

It’s hard to find fault with the series; for the next month, I am going to look forward to Sunday nights mightily. I would, I suppose, have hoped for a slightly more charismatic actress than Kate Bosworth to play Barbara Barga, the American journalist who may or may not be involved with the British resistance. But everything else seems pretty perfect to me. London looks suitably dirty and its inhabitants’ meals suitably exiguous. Happiness is an extra egg for tea, smoking is practically a profession, and
the likes of Archer wear thick, white vests.

Swastikas adorn everything from the Palace of Westminster to Trafalgar Square, Buckingham Palace is half ruined, a memorial to what the Germans regard as Churchill’s folly, and the CGI is good enough for the sight of all these things to induce your heart to ache briefly. Nazi brutality is depicted here as almost quotidian – and doubtless it once was to some. Huth’s determination to have four new telephone lines installed in his office within the hour is at one end of this horrible ordinariness. At the other is the box in which Archer’s mutinous secretary Sylvia (Maeve Dermody) furiously stubs out her fag, full to the brim with yellow stars.

When I first heard about The Kettering Incident (Tuesdays, 12.20am; repeated Wednesdays, 10pm) I thought someone must have found out about that thing that happened one time I was driving north on the M1 with a more-than-usually terrible hangover. Turns out it’s a new Australian drama, which comes to us on Sky Atlantic. Anna (Elizabeth Debicki), a doctor working in London, pitches up back in Tasmania many years after her teenage friend Gillian disappeared into its Kettering forest, having seen a load of mysterious bright lights. Was Gillian abducted by aliens or was she, as some local people believe, murdered by Anna? To be honest, she could be working as a roadie for Kylie, for all I care. This ponderous, derivative show is what happens when a writer sacrifices character on the altar of plot. The more the plot thickens, the more jaw-achingly tedious it becomes.

Rachel Cooke trained as a reporter on The Sunday Times. She is now a writer at The Observer. In the 2006 British Press Awards, she was named Interviewer of the Year.

This article first appeared in the 24 February 2017 issue of the New Statesman, The world after Brexit