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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Only Drake could wow the O2 by pointing out random audience members' clothing

It takes charisma to pull off abandoning hits halfway through.

On the last London night of his Boy Meets World tour (20 March), Drake doesn’t come on stage until 10pm, which is enough to kill off most gigs at the O2 Arena (hello, Bieber), as people are worried about getting the Tube home. The amount of rum and Coke in the room – a steaming, unrecognisable space with a false ceiling of globular lights and a stampeding crowd split in half by a fence – certainly helps keep the buzz. But who’d have thought that a man standing onstage diligently pointing at audience members and saying what they’re wearing (“You in the blue dress shirt with the ­lager!”) would constitute one of the most exciting nights the O2 has seen in a while?

“Tonight is not a show, not a concert, not about me,” says Drake, who runs an annual “Drake Night” in Toronto and once visited Drake University in Iowa.

So far, the world’s favourite rapper – his latest album, More Life, recently got 90 million streams on its first day of release on Apple Music alone – has had a shifting identity. His songs capture a new strain of emotionally literate but solipsistic hip-hop, which can feel intense or whiny depending on how you look at it. His offstage behaviour is Type-A rapper – he has been accused of throwing beer bottles at Chris Brown, he has been punched by Diddy and he has had altercations with Jay Z, Kendrick Lamar, Pusha T and Ludacris.

But Aubrey Drake Graham, the son of a white, Jewish mother and an African-American father who once played drums alongside Jerry Lee Lewis, does skits about his petulance on Saturday Night Live (see “Drake’s Beef”). Emotionally demonstrative, openly dysfunctional, a bit of a bruiser, with an ability to flit between a dozen styles of music while expressing a desire for crowd participation that borders on the needy . . . Could this man be the ­Michael Bublé of hip-hop?

Drake’s sprawling two-hour roadshow is held back from chaos by the force of his physical presence. Blunt-headed with muscular, sloping shoulders and mesmerising, nimble feet, he prowls the edge of the stage. He has had so many hits (and has so many guest stars tonight) that he is not interested in playing them all the way through. Instead, recalling Prince in the same venue ten years ago, the show becomes a series of medleys. With just a drummer and a synth player at the back of the stage, he demonstrates an invisible, physical control over the music, operating it like a string puppet, stopping or starting songs with the drop of a foot or the shrug of a shoulder, so they collapse in the middle and are gone.

It takes charisma to pull off abandoning hits halfway through. Pointing at people in the audience, real or imaginary, is a music hall thing. Bruce Dickinson and Metallica’s James Hetfield do it too. Amid a hokey message to follow your dreams, he recalls his time spent singing for $200 a night as a John Legend tribute act. Cue a perfect demonstration of Legend-style singing – before he suddenly sloughs off “all this bathrobe-and-candle-sexy acoustic Ed Sheeran shit”, while huge columns of flame engulf the stage.

Drake is still at his best with blue, slinky songs of alienation – “9”, “Over”, “Feel No Ways” and “Hotline Bling”, which doubles up as make-out music for the couples in the crowd. One pair of lovers, Drake establishes during one of his crowd surveys, have been together for ten years. “I can’t even make a relationship last ten days,” he laments. In 2012, he told the Guardian, “I’ve had too many girls to ever feel uncomfortable about the man that I am.” An old-school boast from a modern man.

The guest stars serve to highlight Drake’s variety, rather than shine on their own. Their songs, too, are started, suspended, chopped and screwed. Drake is more macho when there’s another guy onstage with him – doing “Successful”, with the literally named Trey Songz, or dueling with thefrenetic Skepta, who sounds so much tougher (maybe because he’s a Londoner). The two whirl around the stage like helicopter seeds.

Nicki Minaj, apparently Drake’s one-time lover, rises fembotishly from a hole in the stage and says in a London accent, “I want some fucking crumpets and tea.”

She adds, of her host, “This nigga single-handedly changed the game.” Minaj sings her song “Moment 4 Life”: “I call the shots, I am the umpire . . .” But she doesn’t really. Even her presence flares up quickly and is gone.

Kate Mossman is the New Statesman's arts editor and pop critic.

This article first appeared in the 23 March 2017 issue of the New Statesman, Trump's permanent revolution