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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We knew we’d become proper pop stars when we got a car like George Michael’s

“That was George Michael!” we both shouted. “And he was driving the car we want!”

One of the clichés about celebrity life is that all celebrities know each other. Back in the Eighties, when we were moderately famous, Ben and I did often bump into other famous people, and because of mutual recognition, there was a sort of acquaintance, if not friendship.

There was a random element to it, as well. Some celebrities you might never catch a glimpse of, while others seemed to pop up with an unexpected regularity.

In 1987, the car we drove was a 1970s Austin Princess, all leather seats and walnut dashboard. In many ways, it symbolised what people thought of as the basic qualities of our band: unassuming, a little bit quirky, a little bit vintage. We’d had it for a year or so, but Ben was running out of patience. It had a habit of letting us down at inconvenient moments – for instance, at the top of the long, steep climbs that you encounter when driving through Italy, which we had just recklessly done for a holiday. The car was such a novelty out there that it attracted crowds whenever we parked. They would gather round, nodding appreciatively, stroking the bonnet and murmuring, “Bella macchina . . .”

Having recently banked a couple of royalty cheques, Ben was thinking of a complete change of style – a rock’n’roll, grand-gesture kind of car.

“I wanna get an old Mercedes 300 SL,” he said to me.

“What’s one of those?”

“I’ll let you know next time we pass one,” he said.

We were driving through London in the Princess, and as we swung round into Sloane Square, Ben called out, “There’s one, look, coming up on the inside now!” I looked round at this vision of gleaming steel and chrome, gliding along effortlessly beside us, and at the same moment the driver glanced over towards our funny little car. We made eye contact, then the Merc roared away. It was George Michael.

“That was George Michael!” we both shouted. “And he was driving the car we want!”

We’d always had a soft spot for George, even though we seemed to inhabit opposite ends of the pop spectrum. He’d once been on a TV review show and said nice things about our first album, and I knew he had liked my solo single “Plain Sailing”. We’d done a miners’ benefit gig where Wham! had appeared, slightly out of place in their vests, tans and blond bouffants. There had been a bit of sneering because they’d mimed. But I remember thinking, “Good on you for even being here.” Their presence showed that being politically active, or even just caring, wasn’t the sole preserve of righteous indie groups.

A couple of weeks later, we were driving along again in the Princess, when who should pull up beside us in traffic? George again. He wound down his window, and so did we. He was charming and called across to say that, yes, he had recognised us the other day in Sloane Square. He went on to complain that BBC Radio 1 wouldn’t play his new single “because it was too crude”. “What’s it called?” asked Ben. “ ‘I Want Your Sex’!” he shouted, and roared away again, leaving us laughing.

We’d made up our minds by now, and so we went down to the showroom, flashed the cash, bought the pop-star car and spent the next few weeks driving our parents up and down the motorway with the roof off. It was amazing: even I had to admit that it was a thrill to be speeding along in such a machine.

A little time passed. We were happy with our glamorous new purchase, when one day we were driving down the M1 and, yes, you’ve guessed it, in the rear-view mirror Ben saw the familiar shape coming up behind. “Bloody hell, it’s George Michael again. I think he must be stalking us.”

George pulled out into the lane alongside and slowed down as he drew level with us. We wound down the windows. He gave the car a long look, up and down, smiled that smile and said, “That’s a bit more like it.” Then he sped away from us for the last time.

Cheers, George. You were friendly, and generous, and kind, and you were good at being a pop star.

Tracey Thorn is a musician and writer, best known as one half of Everything but the Girl. She writes the fortnightly “Off the Record” column for the New Statesman. Her latest book is Naked at the Albert Hall.

This article first appeared in the 12 January 2017 issue of the New Statesman, Putin's revenge