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

Photo: Alamy
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Chain of command: how the office lanyard took over corporate culture

“I realised that I had to sort myself out with a new lanyard or I was going to struggle with my tribe.”

Compulsory lanyards arrived at BBC Broadcasting House in January 1991. Until then, a cursory flash of your staff card to the uniformed commissionaire would do. The Gulf War changed all that.

News trainees like me were pulled back from our regional radio attachments across the nation to serve the so-called Scud FM. In 12-hour shifts, we recorded CNN output on giant reel-to-reel tape machines, cutting packages to feed the rolling news. There were so many new faces, and the bead-chain lanyards gave a semblance of organisation.

Barely out of university, some of us were thinking: emergency civic responsibility. We had only seen lanyards worn in those 1970s and 1980s panic films such as WarGames. We were young outsiders getting access to the establishment.

Two 1990s television shows gave us our figureheads: Agent Dana Scully in The X-Files, flashing her FBI ID at every opportunity, and later Allison Janney’s C J Cregg in The West Wing, who embodied the idea of the female who had broken through, thoroughly qualified to run the operation. The lanyard was their symbol of arrival and as much of a challenge to the old order as their brightly coloured pantsuits were.

In a recent reassessment of the liberal love affair with The West Wing, Current Affairs magazine mocked fans who “think a lanyard is a talisman that grants wishes and wards off evil”. But it’s a good summary of how it felt then.

The novelist Bill Beverly, who grew up in the US Midwest, confirms my suspicion that the lanyard’s 1990s appeal lay in its historic gendered status: “They were for gym teachers and coaches. A lanyard for one’s whistle, for one’s stopwatch, for other elements of communication and control.”

Unlike military dog tags, which remained hidden, the lanyard was about publicly declaring that you belonged. Corporations, introducing them long before electronic scanner-gate entry became the norm, benefited from their identity as a symbol of cool access. Think of the Wayne’s World films, in which the backstage VIP lanyard is a celebratory badge of entry.

Over the years, lanyards have come to reveal so much about status. One charity worker, who asked to remain anonymous, has noticed who does and doesn’t wear them outside NHS hospitals: “I used to get the Tube into London Bridge and you’d see all the young doctors from Guy’s wearing their lanyards, quite proud. You never saw nurses or porters wearing theirs.”

At a big charity with compulsory lanyards for security cards, she saw tribal divisions: “The fundraising and facilities people all wore the work lanyard they gave you. But in public affairs and marketing and design, we all wore our own lanyards and turned our photo ID around. The electronic thing still worked, but no one could see your face. I realised within weeks that I had to sort myself out with a new lanyard or I was going to struggle with my tribe.”

When she moved to a small women’s charity, a more conventional rebellion emerged over corporate conformity: “I noticed they still needed an electronic card to get into the building. I was used to wearing a lanyard with one on, so I took a handful of nice ones in with me and gave them each one, and every one of the women just looked at me and went, ‘We’re not wearing that.’ It was the absolute opposite of command and control.”

At the Labour party conference last September, she saw how lanyards affected the mood. She observes that, as well as the standard union-sponsored lanyard, many members of Momentum were wearing a special lanyard with the Palestinian flag colours. “They really stuck out because they were like a party within a party,” she recalls. “Inside, they moved in packs. It was like the savannah – much more divided, even among the MPs.”

Journalists in the US have a tradition of bonding through novelty press cards on lanyards. One enterprising hack made them during the 1996 O J Simpson civil trial, with mugshots for each significant calendar date: Hallowe’en horror, Christmas, a Thanksgiving one featuring Simpson in a pilgrim hat with a turkey and the slogan “I’ll carve”.

Such small-scale rebellions over how we wear our lanyards are a distraction. Wearing our data around our necks, even displaying it boastfully, seems, in hindsight, a preparation for the normalisation of giving out our personal data online to corporations that can predict where we’ll go and how we’ll consume. If you have nothing to hide, what does it matter?

Twenty-six years on from my first encounter with it, in the new open-plan BBC Broadcasting House, lanyard-based security is much tighter for many reasons (including a break-in by a bunch of teens who found an unmanned door to the newsroom and wandered around posting rather giggly videos online).

There are still gestures of defiance. One colleague used to wear 20 or more lanyards collected from dozens of BBC buildings, twisted into a kind of giant wreath, like a Grand Prix winner.

My defeat lies in the way that I wear a second special labelled lanyard around my neck for the one day in the year that I might need access to a tiny, cordoned-off BBC area outside the Royal Albert Hall to record a line of voice track in an outside broadcast van.

Lanyards may have given us access but in accepting the myth of entry to august institutions, we are tagged and controlled for ever. 

This article first appeared in the 20 July 2017 issue of the New Statesman, The new world disorder