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

HELEN SLOAN / THE FALL 3 LTD
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The Fall is back - and once again making me weary

Five more episodes to go, after which its “feminist” writer (his word, not mine), Allan Cubitt, should pull the plug on it at last. Plus: Damned.

It is with much weariness that I return to The Fall (Thursdays, 9pm), the creepy drama that still doesn’t know whether it wants to be a horror-fest or a love story. I’ve written in the past about what I regard as its basic misogyny – to sum up, it seems to me to make a fetish of the violence committed against women, a preoccupation it pathetically tries to disguise by dint of its main character being a female detective – and I don’t propose to return to that theme now. However, in its early days, it was at least moderately gripping. Now, though, it appears to be recovering from some kind of nervous breakdown. If in series two the plot was wobbling all over the place, series three has misplaced the idea of drama altogether. Nothing is happening. At all.

To recap: at the end of the last series, Paul Spector, aka the Belfast Strangler (Jamie Dornan), had been shot while in police custody, somewhat improbably by a man who blames him for the demise of his marriage (oh, that Spector were only responsible for breaking up a few relationships). On the plus side for his supposed nemesis, DSI Stella Gibson (Gillian Anderson), before he fell he led them to Rose Stagg, the ex-girlfriend he’d locked in the boot of a car some days previously, and she is going to live. On the minus side, Spector’s injuries are so bad, it’s touch and go whether he’ll survive, and so Gibson may never see him brought to justice. Of course, the word “justice” is something of a red herring here.

The real reason she wants Spector to live is more dubious. As she stared at his body in the ICU, all tubes and monitors, her expression was so obviously sexual – her mouth opened, and stayed that way, as her eyes ran over every part of his body – that I half expected her to reach out and stroke him. Just in time for this nocturnal visit, she’d slipped into another of her slinky silk blouses that look like poured cream. (Moments earlier – think Jackie Kennedy in 1963 – she’d still been covered in her love object’s blood.)

The entire episode took place at the hospital, police procedural having morphed suddenly into Bodies or Cardiac Arrest. Except, this was so much more boring and cliché-bound than those excellent series – and so badly in need of their verisimilitude. When I watch The Fall, I’m all questions. Why doesn’t Stella ever tie her hair back? And why does she always wear high heels, even when trying to apprehend criminals? For how much longer will the presumably cash-strapped Police Service of Northern Ireland allow her to live in a posh hotel? Above all, I find myself thinking: why has this series been so acclaimed? First it was nasty, and then it was only bad. Five more episodes to go, after which its “feminist” writer (his word, not mine), Allan Cubitt, should join Gibson in the ICU, where together they can ceremonially pull the plug on it at last.

Can Jo Brand do for social workers in her new comedy, Damned, what she did a few years ago for geriatric nurses in the brilliant Getting On? I expect she probably can, even though this Channel 4 series (Tuesdays, 10pm), co-written with Morwenna Banks and Will Smith, does have an awfully inky heart. Hungry children, drug-addict parents, a man who can go nowhere without his oxygen tank: all three were present and correct when Rose (Brand) went to visit a client who turned out to be a woman who, long ago, had nicked her (Rose’s) boyfriend. Ha ha? Boohoo, more like.

Damned is basically The Office with added family dysfunction. Al (Alan Davies) is a hen-pecked wimp, Nitin (Himesh Patel) is a snitch, and Nat (Isy Suttie) is the stupidest and most annoying temp in the Western world. This lot have two bosses: Martin (Kevin Eldon), a kindly widower, and Denise (Georgie Glen), the cost-cutting line manager from hell. And Rose has a plonker of an ex-husband, Lee (Nick Hancock). “I’ve been invited to the Cotswolds for the weekend,” he told her, trying to wriggle out of looking after the children. “Is that why you look like a knob?” she replied.

Jerky camerawork, naturalistic acting, a certain daring when it comes to jokes about, say, race: these things are pretty familiar by now, but I like it all the same.

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 29 September 2016 issue of the New Statesman, May’s new Tories