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

Marjane Satrapi
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SRSLY #8: Graphic Teens

We talk Diary of a Teenage Girl, Marvel's Agent Carter, and Marjane Satrapi's Persepolis.

This is SRSLY, the pop culture podcast from the New Statesman. Here, you can find links to all the things we talk about in the show as well as a bit more detail about who we are and where else you can find us online. Listen to our new episode now:

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The Links

Find out more about Let's Talk Intersectionality here.

 

On Diary of a Teenage Girl:

Here is Barbara Speed's piece about the film and its approach to sexuality.

She has also written in more detail about the controversy surrounding its 18 certificate.

We really liked June Eric-Udorie's piece about the film for the Independent.

 

On Agent Carter:

You can find all the episodes and more info here.

Caroline has written about Agent Carter and female invisiblity here.

This is also quite a perceptive review of the series.

Make sure you read this excellent piece about the real-life Peggy Carters.

 

On Persepolis:

Get the book!

You can see the trailer for the film adaptation here:

Three great interviews with Marjane Satrapi.

 

For next week:

Caroline is watching The Falling. The trailer:

 

Your questions:

If you have thoughts you want to share on anything we've discussed, or questions you want to ask us, please email us on srslypod[at]gmail.com, or @ us on Twitter @srslypod, or get in touch via tumblr here.

 

Our theme music is “Guatemala - Panama March” (by Heftone Banjo Orchestra), licensed under Creative Commons.

See you next week!

PS If you missed #7, check it out here.

Caroline Crampton is web editor of the New Statesman.

Anna Leszkiewicz is the New Statesman's editorial assistant. She tweets at @annaleszkie.