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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The West can never hope to understand Islamic State

Graeme Wood's The Way of the Strangers: Encounters with the Islamic State reminds us of something that ought to be obvious: Islamic State is very Islamic.

The venue for the declaration of the “Islamic State” had been carefully chosen. The Great Mosque of al-Nuri in Mosul was a fitting location for the restoration of a “caliphate” pledged to the destruction of its enemies. It was built in 1172 by Nur al-Din al-Zengi, a warrior famed for his victories over the Crusaders. When Abu Bakr al-Baghdadi ascended the pulpit in July 2014 and proclaimed his followers to be “the backbone of the camp of faith and the spearhead of its trench”, he was consciously following in Nur al-Din’s footsteps. The message could not have been clearer. The Crusaders were back and needed defeating.

Time present and time past are both perhaps present in time future. In Islamic State’s propaganda, they certainly are. Sayings attributed to Muhammad that foretold how the armies of Islam would defeat the armies of the Cross serve their ideologues as a hall of mirrors. What happened in the Crusades is happening now; and what happens now foreshadows what is to come.

The Parisian concert-goers murdered at the Bataclan theatre in 2015 were as much Crusaders as those defeated by Nur al-Din in the 12th century – and those slaughters prefigure a final slaughter at the end of days. When the propagandists of Islamic State named their English-language magazine Dabiq, they were alluding to a small town in Syria that – so they proclaim – will at last bring the Crusades to an end. Every issue is headed with the same exultant vaunt. “The spark has been lit here in Iraq, and its heat will continue to intensify – by Allah’s permission – until it burns the Crusader armies in Dabiq.”

How much does Islamic State actually believe this stuff? The assumption that it is a proxy for other concerns – born of US foreign policy, or social deprivation, or Islamophobia – comes naturally to commentators in the West. Partly this is because their instincts are often secular and liberal; partly it reflects a proper concern not to tar mainstream Islam with the brush of terrorism.

Unsurprisingly, the first detailed attempt to take Islamic State at its word ruffled a lot of feathers. Graeme Wood’s article “What Isis really wants” ran in the Atlantic two years ago and turned on its head the reassuring notion that the organisation’s motivation was anything that Western policy­makers could readily comprehend.

“The reality is,” Wood wrote, “that the Islamic State is Islamic. Very Islamic.” The strain of the religion that it was channelling derived “from coherent and even learned interpretations of Islam” and was fixated on two distinct moments of time: the age of Muhammad and the end of days long promised in Muslim apocalyptic writings. Members of Islamic State, citing the Quran and sayings attributed to the Prophet in their support, believe themselves charged by God with expediting the end of days. It is their mandate utterly to annihilate kufr: disbelief. The world must be washed in blood, so that the divine purpose may be fulfilled. The options for negotiating this around a table at Geneva are, to put it mildly, limited.

In The Way of the Strangers, Wood continues his journey into the mindset of Islamic State’s enthusiasts. As he did in the Atlantic, he scorns “the belief that when a jihadist tells you he wants to kill you and billions of others to bring about the end of the world, he is just speaking for effect”. Although not a report from the “caliphate”, it still comes from front lines: the restaurants of Melbourne, the suburbs of Dallas, the cafés of Ilford. Wood’s concern is less with the circumstances in Syria and Iraq that gave birth to Islamic State than with those cocooned inside stable and prosperous societies who have travelled to join it. What persuades them to abandon the relative comforts of the West for a war zone? How can they possibly justify acts of grotesque violence? Is killing, for them, something
incidental, or a source of deep fulfilment?

These are questions that sociologists, psychologists and security experts have all sought to answer. Wood, by asking Islamic State’s sympathisers to explain their motivation, demonstrates how Western society has become woefully unqualified to recognise the ecstatic highs that can derive from apocalyptic certitude. “The notion that religious belief is a minor factor in the rise of the Islamic State,” he observes, “is belied by a crushing weight of evidence that religion matters deeply to the vast majority of those who have travelled to fight.”

Anyone who has studied the literature of the First Crusade will recognise the sentiment. The conviction, popular since at least the Enlightenment, that crusading was to be explained in terms of almost anything except religion has increasingly been put
to bed. Crusaders may indeed have travelled to Syria out of a lust for adventure, or loot, or prospects denied to them at home; but that even such worldly motivations were saturated in apocalyptic expectations is a perspective now widely accepted. “Men went on the First Crusade,” as Marcus Bull put it, “for reasons that were overwhelmingly ideological.”

The irony is glaring. The young men who travel from western Europe to fight in Syria for Islamic State – and thereby to gain paradise for themselves – are following in the footsteps less of Nur al-Din than of the foes they are pledged to destroy: the Crusaders.

Jonathan Riley-Smith, who revolutionised the study of the Crusades as a penitential movement, once wrote an essay titled “Crusading as an Act of Love”. Wood, in his attempt to understand the sanguinary idealism of Islamic State sympathisers, frequently echoes its phrasing. In Alexandria, taken under the wing of Islamists and pressed to convert, he recognises in their importunities an urgent longing to spare him hellfire, to win him paradise. “Their conversion efforts could still be described, for all their intolerance and hate, as a mission of love.”

Later, in Norway, he meets with a white-haired Islamist to whom the signs of the impending Day of Judgement are so palpable that he almost sobs with frustration at Wood’s failure to open his eyes to them. “To Abu Aisha, my stubbornness would have been funny if it were not tragic. He looked ready to grab me with both hands to try to shake me awake. Were these signs – to say nothing of the perfection of the Quran, and the example of the Prophet – not enough to rouse me from the hypnosis of kufr?”

Wood does not, as Shiraz Maher did in his recent study Salafi-Jihadism, attempt to provide a scholarly survey of the intellectual underpinnings of Islamic State; but as an articulation of the visceral quality of the movement’s appeal and the sheer colour and excitement with which, for true believers, it succeeds in endowing the world, his book is unrivalled. When he compares its utopianism to that of the kibbutzim movement, the analogy is drawn not to cause offence but to shed light on why so many people from across the world might choose to embrace such an austere form of communal living. When he listens to British enthusiasts of Islamic State, he recognises in their descriptions of it a projection of “their idealised roseate vision of Britain”. Most suggestively, by immersing himself in the feverish but spectacular visions bred of his interviewees’ apocalypticism, he cannot help but occasionally feel “the rip tide of belief”.

The Way of the Strangers, though, is no apologetic. The time that Wood spends with Islamic State sympathisers, no matter how smart or well mannered he may find some of them, does not lead him to extenuate the menace of their beliefs. One chapter in particular – a profile of an American convert to Islam whose intelligence, learning and charisma enabled him to emerge as the principal ideologue behind Dabiq – is worthy of Joseph Conrad.

Elsewhere, however, Wood deploys a lighter touch. In a field where there has admittedly been little competition, his book ranks as the funniest yet written on Islamic State. As in many a British sitcom, the comedy mostly emerges from the disequilibrium between the scale of his characters’ pretensions and ambitions and the banality of their day-to-day lives. “He can be – to use a term he’d surely hate – a ham.” So the British Islamist Anjem Choudary is summarised and dismissed.

Most entertaining is Wood’s portrait of Musa Cerantonio, whose status as Australia’s highest-profile Islamic State sympathiser is balanced by his enthusiasm for Monty Python and Stephen Fry. His longing to leave for the “caliphate” and his repeated failure to progress beyond the Melbourne suburb where he lives with his mother create an air of dark comedy. Visiting Cerantonio, Wood finds their conversation about Islamic State ideology constantly being intruded on by domestic demands. “His mother was about ten feet away during the first part of the conversation, but once she lost interest in the magazines she walked off to another part of the house. Musa, meanwhile, was discussing theoretically the Islamic views on immolation as a method of execution.”

The scene is as terrifying as it is comic. Were Cerantonio merely a solitary eccentric, he would hardly merit the attention but, as The Way of the Strangers makes amply clear, his views are shared by large numbers of Muslims across the world. Just as Protestant radicals, during the 16th-century Reformation, scorned the traditions of the Catholic Church and sought a return to the age of the Apostles, so today do admirers of Islamic State dread that the wellsprings of God’s final revelation to mankind have been poisoned. What, then, are they to do?

That their enthusiasm for, say, slavery or the discriminatory taxation of religious minorities causes such offence to contemporary morality only confirms to them that there is a desperately pressing task of purification to perform. As Wood observes, “These practices may be rejected by mainstream Muslim scholars today, but for most of Islamic history, it barely occurred to Muslims to doubt that their religion permitted them.” Verses in the Quran, sayings of the Prophet, the example of the early caliphate: all can be used to justify them. Why, then, should Islamic State not reintroduce them, in the cause of making Islam great again?

Perhaps the most dispiriting section of Wood’s book describes his attempt to find an answer to this question by consulting eminent Muslim intellectuals in the US. Scholars whose understanding of Islam derives from a long chain of teachers (and who have framed documents on their walls to prove it) angrily condemn Islamic State for ignoring centuries’ worth of legal rulings. It is a valid point – but only if one accepts, as Islamic State does not, that scholarship can legitimately be used to supplement the Quran and the sayings of Muhammad.

When Wood asks Hamza Yusuf, an eminent Berkeley Sufi, to demonstrate the group’s errors by relying only on the texts revealed to the Prophet, he struggles to do so: “Yusuf could not point to an instance where the Islamic State was flat-out, verifiably wrong.” This does not mean that it is right but it does suggest – despite what most Muslims desperately and understandably want to believe – that it is no less authentically Islamic than any other manifestation of Islam. The achievement of Wood’s gripping, sobering and revelatory book is to open our eyes to what the implications of that for all of us may be.

Tom Holland’s books include “In the Shadow of the Sword: the Battle for Global Empire and the End of the Ancient World” (Abacus)

The Way of the Strangers: Encounters with the Islamic State by Graeme Wood is published by Allen Lane (317pp, £20​)

This article first appeared in the 19 January 2017 issue of the New Statesman, The Trump era