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Exploring serious mental illness: an interview with nurse-turned-author Nathan Filer

In the run-up to World Mental Health Day 2019 on 10 October, nurse-turned-author Nathan Filer talks to Stephanie Jones-Berry about his latest book

In the run-up to World Mental Health Day 2019 on 10 October, nurse-turned-author Nathan Filer talks to Stephanie Jones-Berry about his latest book

  • New book tells stories of five people with serious mental illness and explores their meaning
  • Message for mental health nurses is to stay curious, interrogate ideas, continue to investigate
  • Author Nathan Filer wants readers to empathise better with people who have mental illnes

Nathan Filer. Picture: Emily Parker

Mental health nurses should ‘stay curious and interrogate ideas’ says nurse-turned-writer Nathan Filer as he prepares to present this year’s RCN Foundation annual lecture in London.

Mr Filer, who won the Costa Book of the Year Award for 2013 for his debut novel The Shock of the Fall, will use the lecture to explore his ideas about mental illness and the importance of empathy.

In conversation with nurse consultant Jonathon Slater, Mr Filer is expected to discuss his new non-fiction book The Heartland: Finding and Losing Schizophrenia.

In the book, published in June, Mr Filer endeavours to explore what he refers to as ‘so-called schizophrenia’.

His aim has been to untangle ‘the more pernicious myths and stereotypes that the word schizophrenia so stubbornly evokes and… arrive at some clarity about our own mental well-being and that of others.’

'There is no consensus over anything about schizophrenia'

Using a narrative that takes readers through the real stories of five people with serious mental illness, and weaving around them essays exploring their meaning, Mr Filer analyses common understandings of the condition.

Speaking to Mental Health Practice ahead of the RCN Foundation lecture, he explains: ‘As I say early in the book, there is no consensus over anything about schizophrenia.'

‘Mental health nursing is an extraordinarily important and entirely noble profession’

‘Right now there are debates in the fields of psychology, psychiatry and mental health nursing over everything from causes to risk factors, to treatment and beyond.

‘My aim is not to arrive with some definitive conceptualisation about what this thing is – I don’t think that is possible – but it is to pull together all these ways of thinking about it in an open and enquiring way.’

Opinion is split on the usefulness of psychiatric diagnosis

Mr Filer hopes readers will finish the book with a sense of greater emotional understanding so they can empathise better with people who have mental illness.

Writing the book also made him re-examine his practice as a nurse and see it through a different lens, he says.

‘I took a lot of things for granted before, like the scientific validity of diagnosis. I didn’t think too much about the efficacy of medication; I just assumed it was the right thing to do.’

In fact, as Mr Filer says, opinion is split even among mental health professionals on the usefulness of psychiatric diagnosis.

Mental health nurses should remain informed and interested

He says debates on stigma, diagnosis, causes of mental illness, delusions and hallucinations, and on psychiatric medication, are characterised by ‘increasingly polarised positions’.

‘I have tried to take a balanced approach in the book,’ he says. ‘My sense is that there is an interaction at play between our genes and our environment.’

Overall, his message for mental health nurses is about remaining informed and interested, despite the strain on the health service.

‘It is important to stay curious, interrogate ideas, not take things for granted, and to continue to investigate, to ask why we are doing what we are doing in terms of treatment and intervention.’

Mr Filer acknowledges the ‘huge pressures’ in today’s nursing and says he is ‘extremely proud’ to be a qualified mental health nurse.

Striving to understand the experiences of other people

‘Nursing was a big part of my life for a long time and mental health nursing is an extraordinarily important and entirely noble profession,’ he says.

‘What better vocation is there than to move into the line of work where you are striving to improve the quality of life for some of the most vulnerable members of society?’

‘Hopefully I am able to demonstrate the fragility of mental health for all of us, and that it serves us all to be part of these conversations’

Mr Filer highlights how as both a nurse and a writer there is a need for empathy.

‘As a mental health professional and as an author, it is about striving to understand the experiences of other people and being part of an empathetic process.’

He says his latest book The Heartland emerged after readers of his first book, about a bereaved man with mental illness, got in touch to share stories of living in the shadow of mental ill health.

‘What felt different for me was that I had the luxury of spending hours listening to people’s stories and having the opportunity to see beyond symptoms.’

The role of author rather than nurse

Another difference in bearing witness to people’s stories in the role of an author rather than as a nurse is that doing so comes with ‘much less clearly defined boundaries’, says Mr Filer.

‘I was not thinking as a nurse. I was just there to hear people’s stories and try to articulate them.’

World Mental Health DayAn important aspect of his work is to show that there are fewer differences between people with a serious mental illness such as schizophrenia and those without one than is often believed.

‘Hopefully I am able to demonstrate the fragility of mental health for all of us, and that it serves us all to be part of these conversations.’

Finally, he says, the book is ‘not all about schizophrenia’ but rather a touchstone to explore the concept of mental illness more broadly.

The story of the patient who became a nurse

The final case study in The Heartland: Finding and Losing Schizophrenia, author Nathan Filer’s non-fiction exploration of mental illness, is that of a nurse called Jasper.

A senior nurse with a specialist service, Jasper works with men whose psychotic experiences have made them a risk to themselves and others.

Jasper started hearing voices when he was six. First the voice was that of Peter Parker, or Spider Man, then that of a comforting, reassuring female figure who spoke to him with kindness.

'His experiences were not especially therapeutic'

Later these voices became distressing, as Mr Filer describes in the book.

‘Voices that drifted through open windows, through cracks in the walls, and who hated him.’

In the years after Jasper finished his degree, and struggling with increasing paranoia, he was finally referred to mental health services.

His experiences were not especially therapeutic, writes Mr Filer.

'I wanted to understand what was behind those questions'

Jasper had little that was good to say about the ‘steroidal goliath of a mental health nurse’ who first assessed him, with clinical, invasive and disconnected questions.

Jasper says in the book: ‘One of the reasons for my going into psychiatric nursing was because I wanted to understand what was behind my assessor asking those questions.

‘So becoming a nurse was almost a way to understand the system, to begin to see whether I trusted the system, to see whether I got it. Because the confusion I felt in the first assessment was just so great.’

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