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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So much for "the table never lies" – data unravels football's biggest lie of all

London side Brentford FC are using data to rethink the usual football club model.

It’s a miserable day for practice, the rain spitting down on the manicured training pitches of Brentford Football Club. Inside a tiny office marked Director of Football, Rasmus Ankersen is waiting for his phone to ring. The winter transfer window closes in 11 hours and there are deals to finalise.

Ankersen, a 33-year-old Dane with a trim beard and hair pulled into a small ponytail, seems relaxed. Perhaps he knows that the £12m transfer of the striker Scott Hogan to Aston Villa is as good as done. Or maybe his comfort comes from Brentford’s performance this season. The small west London club sits safely in the top half of the second tier of English football – at least according to management’s own version of the league table, which is based on “deserved” rather than actual results. Officially, on 31 January, when we meet, the team is 15th of 24.

“There’s a concept in football that the table never lies,” says Ankersen, whose own playing career was ended by a knee injury in his teens. “Well, that’s the biggest lie in football. Your league position is not the best metric to evaluate success.”

Brentford are an outlier in English football. Since the professional gambler Matthew Benham bought a majority share in 2012, they have relied on the scientific application of statistics – the “moneyball” technique pioneered in baseball – when assessing performance.

The early results were positive. In 2014, Brentford were promoted from League One to the Championship and the next season finished fifth. That same year, Benham’s other team, FC Midtjylland, which is run on similar principles, won the Danish Superliga for the first time.

Yet in 2016 Brentford slipped to ninth. Despite the disappointing season so far, Ankersen insists the strategy is the right one for “a small club with a small budget”.

Underpinning Brentford’s approach is the understanding that luck often plays a big part in football. “It is a low-scoring sport, so random events can have a big impact,” Ankersen says. “The ball can take a deflection, the referee can make a mistake. The best team wins less often than in other sports.”

In a match, or even over a season, a team can score fewer or more than its performance merits. A famous example is Newcastle in 2012, says Ankersen, who besides his football job is an entrepreneur and author. In his recent book, Hunger in Paradise, he notes that after Newcastle finished fifth in the Premier League, their manager, Alan Pardew, was rewarded with an eight-year extension of his contract.

If the club’s owners had looked more closely at the data, they would have realised the team was not nearly as good as it seemed. Newcastle’s goal difference – goals scored minus goals conceded – was only +5, compared to +25 and +19 for the teams immediately above and below them. Statistically, a club with Newcastle’s goal difference should have earned ten points fewer than it did.

Moreover, its shot differential (how many shots on goal a team makes compared to its opponents) was negative and the sixth worst in the league. That its players converted such a high percentage of their shots into goals was remarkable – and unsustainable.

The next season, Newcastle finished 16th in the Premier League. The team was not worse: its performance had regressed to the mean. “Success can turn luck into genius,” Ankersen says. “You have to treat success with the same degree of scepticism as failure.”

Brentford’s key performance metric is “expected goals” for and against the team, based on the quality and quantity of chances created during a match. This may give a result that differs from the actual score, and is used to build the alternative league table that the management says is a more reliable predictor of results.

Besides data, Brentford are rethinking the usual football club model in other ways. Most league clubs run academies to identify local players aged nine to 16. But Ankersen says that this system favours the richer clubs, which can pick off the best players coached by smaller teams.

Last summer, Brentford shut their academy. Instead, they now operate a “B team” for players aged 17 to 20. They aim to recruit footballers “hungry for a second chance” after being rejected by other clubs, and EU players who see the Championship as a stepping stone to the Premier League.

It’s a fascinating experiment, and whether Brentford will achieve their goal of reaching the Premier League in the near future is uncertain. But on the day we met, Ankersen’s conviction that his team’s fortunes would turn was not misplaced. That evening, Brentford beat Aston Villa 3-0, and moved up to 13th place in the table. Closer to the mean.

Xan Rice is Features Editor at the New Statesman.

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times