the heartland by nathan filer

the evening standard june 6 2019

The Heartland, by Nathan Filer, pictured, who won the Costa Prize for his novel The Shock and the Fall, might be the most terrifying book published this year. It opens by putting the reader in the position of a schizophrenic patient being forcibly medicated against his will. The patient believes the medication contains poison but Filer (a former psychiatric nurse) must nonetheless administer it, apparently for the patient’s own good. 

His powers of empathy as a writer are such that this opening section had me physically recoiling, and anyone who has ever felt they are going mad will find resonance in these pages. The case studies are compelling as well as frequently heartbreaking and are enough in themselves to make The Heartland worth reading.  

Filer’s mission is bigger, however, than wanting his readers to identify with those suffering from schizophrenia. He wants to interrogate what the word means and unpick who such definitions serve.

There are few things more fascinating, if horrifying, than examining how these definitions have evolved: he reminds us that homosexuality was categorised as a mental illness until 1973. This passage also stopped me in my tracks: “Psychiatry’s problematic relationship with black people stretches back at least as far as the days of slavery in America, when a slave might be diagnosed with ‘drapetomania’ — the name given for the so-called mental illness of trying to flee from captivity.”

There is plenty to make you tear your hair out but Filer also offers less attention-grabbing stories of hope, not least from a psychiatric nurse who hears voices and sets up a patient-led support group. 

Filer tackles thorny issues such as the fact that the language surrounding mental illness, including the very phrase “mental illness”, is itself so problematic. His desire to look at schizophrenia in its entirety means the book occasionally lacks the joyous fluency of, say, The Boy with the Topknot, Sathnam Sanghera’s memoir of growing up with a schizophrenic father and sister. 

Many of Filer’s sentences, particularly when he describes the lack of a biological basis for diagnosing schizophrenia, made me screw my face up in concentration but he is companionable enough to offer such asides as, “It’s a lot to take in, isn’t it?” Besides which, no one would expect a book about schizophrenia — and how society deals with it — to be a breezy read. This is a painful, difficult book but I urge you to read it. As Filer says: it’s a beginning.

This review first appeared in the Evening Standard