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;

Story

Nathan Filer on why we must reimagine mental healthcare

by Alexandra Havas

Stories/593 , Issues/Mental Health , Issues/Healthcare

Sydney NSW

16th Oct 2019

This mental health nurse and novelist believes we must lead with empathy.

As a teenager, I was a bibliophile with a generalised anxiety diagnosis who constantly looked for myself in the books I devoured. Sadly, I didn't have much luck. What I usually found were grossly stereotyped incarnations of characters with mental health problems, which only worsened my shame.

In Australia, 65% of people with mental health issues don't seek help. Despite being part of the (relatively speaking) lucky 35%, I still wish mental health nurse, author, and BIg Anxiety Festival prize winner Nathan Filer was writing in my formative years. His debut novel The Shock of the Fall sensitively portrays a young man's personal struggle with the death of his brother in a way that encourages readers to relate with empathy. I interviewed him in the lead up to his October talk on The Language of Madness when he will encourage us to reimagine care and rethink mental health labels and anti-stigma campaigns.

HOW DO YOU THINK NOVELS LIKE YOUR THE SHOCK OF THE FALL HELP SOCIETY UNDERSTAND AND NORMALISE MENTAL HEALTH ISSUES?

I'll begin by saying that I never considered The Shock of the Fall to be about mental health issues, per se. It wasn't a 'campaign novel', and neither did I write it with the aim of normalising anything. That said, he does develop mental health problems as the story progresses - including experiencing psychosis. If the book succeeds in normalising this it is because by the time the reader is confronted by how poorly Matthew has become they already see him as a human being. They have a sense of the causes of his distress and are - hopefully - able to empathise with him. Empathy is key. Reading novels is an extended exercise in empathy, of placing ourselves into the experience of others.

HOW HAS YOUR EXPERIENCE AS A MENTAL HEALTH NURSE SHAPED THE WAY YOU IMAGINE MENTAL HEALTHCARE REFORM?

As a mental health nurse I was working within a particular model of healthcare, often called the 'medical model'. This places an emphasis on biological causes and medical treatments. In other words, framing mental illness - at least in part - as the consequence of chemical imbalances within the brain, which other chemicals might be used to redress. In researching and writing my new book, The Heartland: Finding and Losing Schizophrenia, I've been forced to reappraise some of these ideas. Though I still believe biology is a crucially important factor, it has become increasingly clear to me that what we call mental illness is also a social phenomenon.

One of its strongest predictors, for instance, is poverty. Living in poverty increases a person's likely exposure to a whole range of stressors and potentially traumatising events, while simultaneously reducing access to resources that might help us overcome these. Other social causes include childhood adversity, including being subject to abuse or living in an environment with sustained exposure to parental conflicts. When I think about mental healthcare reform now, I see that it will not be enough to simply invest in mental health services - though of course, we should still do that. We must also look upstream and tackle some of the social injustices and cruelties that are driving a man in the first place.

WHY DO YOU THINK MENTAL HEALTH LABELS SUCH AS "SCHIZOPHRENIC" CAN BE DETRIMENTAL AND COMPOUND THE EXISTING STIGMA AROUND MENTAL HEALTH ISSUES?

Psychiatric labels such as 'schizophrenia' can be helpful, insofar as they may help people to feel less alone. They can also be useful when people are trying to access the right care and social support. On the flip side, they often come loaded with stigma, creating a sense of hopelessness, fear, and shame.

Importantly, there are significant issues with the science underpinning these diagnoses. It's not widely appreciated that the overwhelming majority of psychiatric labels aren't arrived at by looking at brain scans or blood tests or anything of the sort. They can't be. These tests do not exist. A lack of objectivity means that psychiatrists often disagree on what diagnosis to give a patient, and anyone who spends any amount of time in psychiatric services invariably ends up collecting multiple diagnoses.

In recent decades there has been a staggering proliferation in the number of officially recognised mental illnesses. This has become entangled in politics. For instance, it may serve the interests of those in positions of political power that a young millennial who's falling apart while struggling to pay two thirds of their zero-hours salary to rent a mouldy room in a shared flat is suffering from a 'panic disorder' (something that can be neatly conceptualised as existing within their brain) than to countenance the possibility that the real sickness is located elsewhere.

Schizophrenia is perhaps the most contested of all the labels. There is credible and often fiercely acrimonious debate across the fields of psychiatry, psychology, genetics, neuroscience, and various mental health charities and campaign groups over everything from causes and risk factors to categorisation and treatments, and indeed as to whether the diagnosis has outlasted its usefulness (if it ever was useful) and should be rebuilt from scratch or abandoned entirely.

I don't claim to have the answers, but these are exactly the kind of big and important debates that I seek to explore in my book.

Nathan Filer will be talking about The Language of Madness at the Big Anxiety Festival on 23 October, 630pm at Lower Town Hall.

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