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 conflict in Yemen is a Civil War by numbers

Amid the battles, a generation starves.

Ten thousand dead – a conservative estimate at best. Three million internally displaced. Twenty million in need of aid. Two hundred thousand besieged for over a year. Thirty-four ballistic missiles fired into Saudi Arabia. More than 140 mourners killed in a double-tap strike on a funeral. These are just some of the numerical subscripts of the war in Yemen.

The British government would probably prefer to draw attention to the money being spent on aid in Yemen – £37m extra, according to figures released by the Department for International Development in September – rather than the £3.3bn worth of arms that the UK licensed for sale to Saudi Arabia in the first year of the kingdom’s bombing campaign against one of the poorest nations in the Middle East.

Yet, on the ground, the numbers are meaningless. What they do not show is how the conflict is tearing Yemeni society apart. Nor do they account for the deaths from disease and starvation caused by the hindering of food imports and medical supplies – siege tactics used by both sides – and for the appropriation of aid for financial gain.

Since the war began in March 2015 I have travelled more than 2,500 miles across Yemen, criss-crossing the front lines in and out of territories controlled by Houthi rebels, or by their opponents, the Saudi-backed resistance forces, or through vast stretches of land held by al-Qaeda. On those journeys, what struck me most was the deepening resentment expressed by so many people towards their fellow Yemenis.

The object of that loathing can change in the space of a few hundred metres. The soundtrack to this hatred emanates from smartphones resting on rusting oil drums, protruding from the breast pockets of military fatigues, or lying on chairs under makeshift awnings where flags denote the beginning of the dead ground of no-man’s-land. The rabble-rousing propaganda songs preach to the watchful gunmen about a feeble and irreligious enemy backed by foreign powers. Down the road, an almost identical scene awaits, only the flag is different and the song, though echoing the same sentiment, chants of an opponent altogether different from the one decried barely out of earshot in the dust behind you.

“We hate them. They hate us. We kill each other. Who wins?” mused a fellow passenger on one of my trips as he pressed green leaves of the mildly narcotic khat plant into his mouth.

Mohammed was a friend of a friend who helped to smuggle me – dressed in the all-black, face-covering garb of a Yemeni woman – across front lines into the besieged enclave of Taiz. “We lose everything,” he said. “They win. They always win.” He gesticulated as he spoke of these invisible yet omnipresent powers: Yemen’s political elite and the foreign states entangled in his country’s conflict.

This promotion of hatred, creating what are likely to be irreversible divisions, is necessary for the war’s belligerents in order to incite tens of thousands to fight. It is essential to perpetuate the cycle of revenge unleashed by the territorial advances in 2014 and 2015 by Houthi rebels and the forces of their patron, the former president Ali Abdullah Saleh. This demand for retribution is matched by those who are now seeking vengeance for the lives lost in a UK-supported, Saudi-led aerial bombing campaign.

More than 25 years after the two states of North and South Yemen united, the gulf between them has never been wider. The political south, now controlled by forces aligned with the Saudi-led coalition, is logistically as well as politically severed from the north-western territories under the command of the Houthi rebels and Saleh loyalists. Caught in the middle is the city of Taiz, which is steadily being reduced to rubble after a year-long siege imposed by the Houthi-Saleh forces.

Revenge nourishes the violence, but it cannot feed those who are dying from malnutrition. Blowing in the sandy wind on roadsides up and down the country are tattered tents that hundreds of thousands of displaced families now call home. Others have fled from the cities and towns affected by the conflict to remote but safer village areas. There, food and medical care are scarce.

The acute child malnutrition reported in urban hospitals remains largely hidden in these isolated villages, far from tarmac roads, beyond the reach of international aid agencies. On my road trips across Yemen, a journey that would normally take 45 minutes on asphalt could take five hours on tracks across scrubland and rock, climbing mountainsides and descending into valleys where bridges stand useless, snapped in half by air strikes.

Among the other statistics are the missing millions needed by the state – the country’s largest employer. Workers haven’t been paid in months, amid fears of an economic collapse. This is apparently a deliberate tactic of fiscal strangulation by the Saudi-backed Yemeni government-in-exile. The recent relocation of the central bank from the Houthi-controlled capital, Sana’a, to the southern city of Aden is so far proving symbolic, given that the institution remains devoid of funds. The workforce on both sides of the conflict has taken to the streets to protest against salaries being overdue.

Following the deaths of more than 140 people in Saudi-led air strikes on a funeral hall on 8 October, Saleh and the Houthi leader, Abdulmalik al-Houthi, called for yet more revenge. Within hours, ballistic missiles were fired from within Houthi territory, reaching up to 350 miles into Saudi Arabia.

Meanwhile, in the Red Sea, Houthi missile attacks on US warships resulted in retaliation, sucking the US further into the mire. Hours later, Iran announced its intention to deploy naval vessels in the area.

Vengeance continues to drive the violence in Yemen, which is being drawn ever closer to proxy conflicts being fought elsewhere in the Middle East. Yet the impact on Yemeni society and the consequences for the population’s health for generations to come are unlikely to appear to the outside world, not even as annotated numbers in the brief glimpses we get of this war. 

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood