Book review: The Heartland: Finding And Losing Schizophrenia, by Nathan Filer

The philosopher Ludwig Wittgenstein toyed with a very interesting idea in his posthumously published Philosophical Investigations. He called it Familienähnlichkeit, usually translated as “family resemblance” but “sort of like, like” might be a better way of putting it.

Nathan Filer PIC: Ian Gavan/Getty
Nathan Filer PIC: Ian Gavan/Getty

Basically, it’s an easy idea. We would call Solitaire, rugby, Monopoly and polo all kinds of games, even though there are no rules that connect them except that we call them games. Nevertheless, there’s a consensus that they are all games in a manner in which cooking or public speaking or doing philosophy (maybe) are not games.

This might seem off-piste, but it is relevant to Nathan Filer’s book on schizophrenia. What is schizophrenia? In some ways, this book says it isn’t a condition at all. Where does anxiety or bipolar disorder or compulsive behaviour shade into schizophrenia? Or any mental illness? The short answer is that nobody knows.

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Filer won many awards for his first book, about trauma and denial, The Shock Of The Fall, and has worked as a mental health nurse, so is suitably placed to tack through the various problems of definition and categorisation when it comes to a non-fiction book on matters that are obviously important to him. It swings between case histories and cautious reviews of the academic material around the problems. As the reader goes through the book, they meet a journalist who thinks she is the Most Wanted Person in Britain, a soldier who was convinced that his sectioning was an undercover mission, a mother dealing with a son whose lifestyle is spiralling out of control, a student looking after her increasingly reclusive mother in rural Wales, and a man who hears voices he calls “The Whisperers”. What works best in the book is the way that, as a novelist, Filer lures the reader.

These case studies are done with admirable skill (Freud, after all, was a better novelist than a scientist). They are immersive in that they are written from within the psychosis, rather than coldly observing it from afar. The reader is wrong-footed in a very clever way – was this person actually a killer or did they just imagine being a killer? It is a harrowing read when there is no safe place to put your foot in the narrative. It is also humane, and does what psychiatry ought to do and does not do enough. These people are humans, just as I am. The novel has a capacity for true empathy and Filer deploys all its techniques to make his subjects not objects.

In terms of the more polemical parts of the book, again, there is much to admire. Filer makes the point early on that ideas of schizophrenia being a Jekyll and Hyde scenario are best left to Victorian gothic fiction. He is equally uneasy on the “definition” of schizophrenia in various iterations of the DSM – The Diagnostic And Statistical Manual Of Mental Disorders. Some of the gallows humour in the book comes from this, and his equal scepticism over the efficacy of medication. If you are told that a certain drug might have the side-effects of “increased saliva production” and “dry mouth”; or “sleepiness” and “trouble sleeping”, you might reconsider whether anyone knows anything about anything. As Alexander Pope wrote: “this long disease, my life”. We all suffer, but some of us cannot cope with suffering. That many patients get worse rather than better on medication is a genuine and pressing concern. That two psychiatrists can see the same patient and give differing diagnoses is more than worrisome.

There is a great deal to ponder here. Unfortunately, there are stylistic glitches that distract from the message. The most egregious is when Filer begs the indulgence of the reader to quote from his own novel (sorry: denied. You could have used Dostoyevsky or Kafka or Bernhard). There is an irksome jauntiness about the more serious passages. Sometimes this manifests itself as footnotes that seem like quips; sometimes it occurs as a rather jaunty tone: “It’s true, isn’t it?”, “we’ve heard” (no, we’ve read), a flaunty “Eh Voila”, the preponderance of “Let’s”. It reads like a bad transcription of unscripted radio. These quibbles should not take away from the book’s virtues: let us just say that its virtues are marred by its infelicities. It seems at times as if the matey tone is actually talking down to the reader. Sorry, but I have read Michel Foucault on mental health.

Three things emerge from this work. Poverty is a significant correlating factor in mental health issues, as is familial breakdown. Medication is often the pharmakon, the cure which is a poison. There is no recognisable definition of almost all terms that are used, and that includes stigma, treatment, cause and delusion (there is a neat Oulipo moment where Filer deliberately redoubles a word to see if you notice it: delusion is actually quite commonplace).

Everyone will experience sadness, and for some it will be unbearable. But everyone has the capacity to be kind, and that will not just help others, but themselves. Raggedy though it is, I would encourage everyone to read this, and think on it. - Stuart Kelly

The Heartland: Finding And Losing Schizophrenia, by Nathan Filer, Faber & Faber, £14.99