The Heartland – finding and losing schizophrenia by Nathan Filer

Nathan Filer’s debut novel The Shock of the Fall was hugely successful so inevitably there is a weight of expectation around The Heartland. This is a nonfiction exploration of schizophrenia, but the similarities are clear as Filer employs the same knowledge, sensitivity and engaging language that was present in his novel to open up a conversation about so-called-schizophrenia and tell the stories of some people whose lives have been impacted by it.

It’s a fascinating book: Filer is our reporter from the frontline of medical practice as he was previously a psychiatric nurse but he is also an eloquent and careful reporter of personal stories. He tells us about a soldier who thought his stay in a psychiatric ward was a secret mission, a journalist who thought she was a criminal and drank a mug of bleach to kill herself, a daughter whose mother went undiagnosed for years, and a mother who spoke about her son, which moved me to tears possibly because hers was the story which felt most relatable to me.

From the very beginning it’s clear this is a subject with no concrete answers. Should people seeking help with mental health issues be called patients or service users? To call them patients suggests they have an illness, however, if you instead believe that the behaviours and feelings are not symptomatic of illness but are instead a natural response to trauma then it is problematic to be labelled as a patient. And if there is no consensus on this, what hope is there of reaching any definitive conclusions in mental health practices?

Mental health issues are spoken about far more widely these days and yet it seems to me that whilst the public are more tolerant, maybe even supportive, of someone who has anxiety or depression than used to be the case, there is a feeling that people with schizophrenia are scary and dangerously unpredictable. This book offers beautifully clear explanations such as “… it might be best understood as a kind of psychological adaptation, a coping strategy gone awry or a form of storytelling carried out within the mind as a response to unbearably painful life events.”

There’s a lot of food for thought. For instance, anosognosia means “…having as a symptom of a disorder the belief that you do not have the disorder.” I mean, crikey! Homosexuality was only removed from the official list of diagnosable mental disorders in 1974! There’s a lot of alarming information here. We like to think that people smarter than us with their knowledge beyond our understanding are capable of healing us. To learn that the Diagnostic and Statistical Manual of Mental Disorders is perhaps more woolly than we would want is not great.

I highlighted so many passages in this terrific book because it’s something I will refer back to. I think everyone should read it. Despite the subject matter, it’s not a heavy academic read, instead, it feels pretty essential and Filer’s great skill is giving information to us in an interesting and accessible way. My very favourite note is this:

“It’s not always possible to find the right words but we can still be part of the conversation. We can walk with people for a bit, sit with them, hear them.”

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