"If we tentatively take a seat in this debate, the first thing that will become clear is that there is no uncontroversial language when talking about mental illness-and that includes the term 'mental illness'." This brilliant book by the author of the Costa Book of the Year-winning novel The Shock of the Fall is a totally immersing and deeply humane non-fiction book about schizophrenia—how we perceive it, and how we treat people who have it.
Drawing on his own experience as a psychiatric nurse, his reading of the literature, and a series of in-depth interviews with former patients, relatives and mental health experts, Filer has compiled a sort of cosy fireside companion to the perplexities of the schizophrenic conundrum – I refer to his chatty way of engaging the reader and do not mean to trivialize the substance of what he says. In a field where inter-professional rivalry exists, opinion is polarized and debate frequently marked by militantly held positions, Nathan Filer has produced a balanced account. This is a well-researched, serious, empathetic, deeply human book.
[Filer] takes nothing for granted, analysing all the assumptions. He uses inverted commas for ‘schizophrenia’, because diagnoses vary between countries and even between clinicians. This is no disrespect to the latter, but simply a reflection of the complexity of the illness. And yet Filer’s sharp intellect never replaces empathy... Most importantly, Filer speaks with understanding and sensitivity to individual sufferers... And yet Filer is no anti-medication activist, acknowledging that drugs are usually required. His view is wholly balanced.
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.
Mental illness is “messy and chaotic” but that doesn’t mean we shouldn’t keep trying to make sense of it. This impressive book advocates that we all need to be part of the conversation.
What is any mental illness diagnosis supposed to mean? And who gets to decide? And what happens then? Filer digs into ostensible causes and symptoms; stigma and language; past and current treatments. He wants to discover and articulate how a mental illness leaves its print on the people who live with it or in its proximation. The book, then, is not the equivalent of a professor addressing a lecture theatre, which is what makes it so effortlessly readable. Instead, Filer is a player-manager. His selection of quotes, facts and detail had me raising my eyebrows in exclamation, circling a phrase in recognition, mentally filing away an intrigue or twitching in distress... Occasionally, there are flashes of humour (as when Filer trashes the later films in the Jaws franchise). But it’s the fascinating nuggets of information he unearths that make this book so successful. (How social media is replacing religion as one of the most frequent sources of paranoid delusions, for example.) It is written with a gentleness that has both its subjects and readers in mind. If I was going to be picky, I would make two criticisms: The Heartland is very UK- and US-focused (which Filer himself acknowledges). And the final segment of the book is probably less easy to follow than his earlier free-flowing style, unless you’re extremely weird like I am and well into the lateral occipital complex. Still, The Heartland is a book that everyone should read
Alternating discussion of the key clinical and theoretical debates with vivid and at times deeply moving case studies, Filer does a brilliant job of bringing order and humanity to a seemingly chaotic scene... Other experts chip in informatively and sometimes revealingly along the way. We make it up as we go along, concedes one eminent diagnostician with a twinkle in his eye. Filer, to his credit, remains open-minded, without particular allegiance to either of the warring camps in the tiresome conflict between psychology and biological psychiatry. The case histories are beautifully narrated... Most affecting, for this reader anyway, is the story of a mother losing her son, first through the disintegration of his mind... Removing them from the abstractions of psychopathology and the interdisciplinary warfare of health professionals, drawing out their stories in respectful conversation, Filer makes these troubled people reachable, fathomable. If, to varying degrees, they remain ‘other’, they are not alarmingly so. He hopes that his book will become ‘part of the conversation’ about mental illness. It surely deserves to be.
[After the publication of The Shock of the Fall], Filer started to get emails from readers inspired to share their stories, which were sometimes upsetting and sometimes hopeful, and almost always without the beginning, middle and end that Filer had been able to craft in his novel... [The Heartland], then, is a conversation including lots of interviews that seeks to “untangle a few of the more pernicious myths and stereotypes that the very word ‘schizophrenia’ so stubbornly evokes”. Filer’s tone is warm, engaging and open-hearted, although he warns us early on that there is no uncontroversial language when it comes to mental illness, including the phrase “mental illness”... He looks at the science, but remains focused on the people. He is keen to point out that a diagnosis of schizophrenia is not a life sentence and that “meaningful and sustained recovery” can and frequently does happen... The interviews are rigorous and sensitive. There is no sense that Filer is seeking to confirm his own views, but rather that he is animated by curiosity and a desire to tease out difficult truths... This is a beautifully written book that brims with compassion and wit. The tone remains questing and buoyant even as we move through lives devastated by so-called schizophrenia. I hope it will be widely read and discussed.