In This Book Will Change Your Mind About Mental Health, Nathan Filer, a former mental health nurse with the UK’s National Health Service, explores the myths and misconceptions surrounding schizophrenia – an illness that, he writes, affects around one in a hundred people worldwide – through the personal experiences of four interview subjects, and their family members, in the UK and Ireland.

As someone whose own family has a long history of mental illness – including a cousin and an aunt with schizophrenia – I was pleased to note that Filer has chosen his interview subjects with care. There are stories of both tragedy and triumph, and of shades in between.

Filer’s nuanced characters – ranging from a struggling mother of four, to a successful freelance journalist – are of particular importance for the lay reader, given the intensely negative connotations associated with schizophrenia as a diagnosis.

When you say the word out loud – as Filer encourages us to do on page 5 – you experience vulnerability. You cannot help but look around, wondering if anyone has overheard you.

Because, truth be told, for all the anti-stigma campaigns, and the extent to which Irish society has evolved to become more tolerant and inclusive, our notions of schizophrenia are still deeply influenced by the distortions and exaggerations of popular culture – such as the film One Flew Over the Cuckoo’s Nest.

Filer, who now works as a mental health researcher in Bristol, is himself no stranger to using mental illness as a canvas. His first book, The Shock of the Fall, was a critically acclaimed novel about a young man confronting – and attempting to overcome – a “strange and commonly misunderstood illness” that Filer does not name, but which he confirms in This Book Will Change Your Mind About Mental Health, as being, essentially, schizophrenia.

But what, exactly, is schizophrenia?

Filer tells us that it is derived from the Greek words skhizein – which means “to split” – and phr?n, which translates as “mind”. Naturally, this can lead to the conclusion that someone diagnosed with schizophrenia has a split personality – at least one of which, we might assume, could potentially be unpredictable, if not dangerous.

But that assumption, Filer points out, is wrong. He quotes Professor Elyn Saks, a mental health expert who has a schizophrenia diagnosis. Her description is of a “mind [that] is not split but shattered”.

In purely medical terms, schizophrenia is characterised by a cluster of symptoms – from disordered thinking to delusions and hallucinations – that present in different ways, and to different levels of severity, in each individual person.

While some schizophrenia sufferers do resort to violence, there are many more who wouldn’t dream of hurting another soul. Likewise, the severity of the illness – and the extent to which sufferers are able to resume normal functioning – is dependent upon a whole range of factors that cannot easily be pigeonholed.

Indeed, as Filer goes on to explain, even the term “schizophrenia” has long been fraught with controversy, having emerged from an early twentieth century debate between two German psychiatrists – one of whom viewed it as a physical illness, the other as psychological. Filer stakes out his own position by referring to it as “so-called schizophrenia” – not to dismiss it as illusory, but to “explore broader notions of health, suffering and the whole curious absurdity of being human”.

Fortunately for the lay reader, this is about as academic as the book gets – and Filer soon switches to exploring this hypothesis through the eyes of his four main characters.

First up, we meet Molly.

Molly is the product of a prosperous middle-class family that suddenly implodes when her father has an affair, and her mother takes up drinking. Scarred by what she calls The Clusterfuck, Molly begins to act out at school. By the time she graduates, she’s abandoned her goal of getting into a good university, and taken up work as a cleaner so that she can buy nice dresses and go clubbing.

Molly eventually pulls herself together, and goes on to complete a fashion degree. She moves to London, and gets a job as the assistant to the deputy fashion editor of a major newspaper. The Clusterfuck, it seems, is over.

Except that, thanks in part to her unresolved issues with self-esteem, Molly has become what she terms a “functioning bulimic”.

In a bid to force herself to eat more, she starts smoking cannabis – knowing that it will give her the munchies in the early hours. The trouble is, she soon realises that she’s being watched. By her friends. By her family. And by MI5.

Filer goes on to chart Molly’s downward spiral – as well her efforts to remain gainfully employed. Despite believing that she is “Britain’s most-wanted criminal”, she holds down jobs as a journalist, medical receptionist, and fashion lecturer. She also goes on to obtain a second degree, in journalism, and manages to move to New York.

“I find Molly’s capacity to have kept going through all of this, without any help from anyone, to be more than a little humbling,” Filer writes.

It’s a fitting statement. Whereas mental illness is often seen as a moral weakness or character flaw, the Molly we come to know is an intelligent, well-rounded person with extraordinary levels of resilience.

The same can also be said for the book’s main Irish character. Brigid, a former nurse, is the mother of four children whom she raises entirely on her own. Brigid passed away at the age of 62, after many years of ill health, and her story is told in retrospect by her daughter, Kate, a Dubliner who works as a doctor.

Brigid’s mental illness first reveals itself in an obsession with a photograph of the Virgin Mary. One photograph soon becomes many, and she also becomes suspicious of her husband, a fellow nurse. Eventually, she comes to believe that he’s having an affair. The couple split, and the husband is never seen again.

Brigid, Filer writes, soon becomes an example of what is called the “drift hypothesis”. It’s a phenomenon in which people who have previously been well – and successful – gradually drift downwards in terms of their economic and social status, once they become unwell.

In Brigid’s case, she and her four children eventually end up in damp, poor-quality social housing, with not even enough money to turn on the heating in the winter. She is never properly diagnosed – or treated – and spends most of her time drawing maps and diagrams that she believes will solve global problems such as war and famine. Yet she somehow manages to take care of her children – to feed and clothe them; and to sell off what little she owns, to pay for school books.

Many years later, while studying medicine at Trinity College, Kate flicks through a textbook and recognises her mother’s symptoms as schizophrenia. She makes contact with her family GP, and her mother eventually obtains the treatment she needs.

But instead of feeling a sense of relief at finally figuring out what has been going on, Kate experiences intense feelings of guilt at having taken so long to put the pieces of the puzzle together.

It’s a common feeling – one that affects many family members of those suffering from mental illness. But, as Filer points out when he and Kate meet for coffee at a south Dublin cafe – with “lots of avocado on the menu” – Kate had been a child when her mother first got sick. There was no way she could have known the signs and symptoms of schizophrenia at that age.

Still, Kate remains tormented. And there’s another feeling, too. A lingering sense of social stigma as a result of her childhood experiences.

“Vulnerable people like we were are always sympathised with in the abstract – but not when they become real,” she says.

At the end of the book, Filer once again asks the reader to say the word “schizophrenia” out loud. Does it feel different this time? he asks.

For me, it did. I stopped thinking of schizophrenia as something scary and all-encompassing, and started seeing it as an illness like any other. One that affected its sufferers, but did not necessarily have to dominate or define entire identities.

James Graham is a freelance journalist based in Co. Meath. He is currently working on his first book, an historical novel set in France in 1940.

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