By Ng Ziqin
Raffles Reads is a collaboration between Raffles Press and Times Reads which aims to promote a reading culture among Singaporean students.
Non-fiction has a bad rep for being too stuffy, too boring, too educational. How could anyone possibly feel engaged in a book with neither a plot nor a plucky protagonist to root for? Many non-fiction authors—and readers—seem to have forgotten that we read books to be entertained, not just to look or sound impressive when posed the commonplace question of ‘what are you reading now?’
It might be clear by this point that I have a slight vendetta against non-fiction. This might also have been what put me off finishing the book and submitting my review—originally due December 2020—in a timely manner. But while I don’t usually make a habit of reading non-fiction, I must say that This Book Will Change Your Mind About Mental Health was quite unlike any other non-fiction book I’ve ever read.
Written in compelling and engaging language
Apart from being a qualified mental health nurse, the author, Nathan Filer, is also an award-winning novelist. Perhaps it’s this experience in fiction writing which gives This Book Will Change Your Mind About Mental Health a surprising sensitivity to narrative engagement. Unlike other popular psychology books which tend to focus on statistical evidence or recount anecdotes—if any—in a clinical, lifeless and passive voice, Filer puts the stories of his interviewees front and centre. His narrative chapters, which feature the stories of five interviewees living with mental disorders (‘The Journalist’, ‘The Soldier’, ‘The Mother’, ‘The Community’ and ‘The Keyholder, the Non-Keyholders and The Voices’) are told in a voice so vivid and compelling that I find myself checking to make sure they’re still being told in the third.
Take, for instance, this scene from ‘The Soldier’, the chapter on James, a man who developed schizoaffective disorder while enrolled at a military academy:
“He couldn’t control his breathing. Why was it so hard to breathe? His eyes stung with tears, he couldn’t get enough air in his lungs. He was hyperventilating. He tore at his shirt.
The door opened hard, slamming against the wall. The big bastard provo sergeant stormed in, gripped a hand round James’s throat, pinned him against the wall. ‘What the fuck is wrong with you?’ he demanded.
‘Nothing. Nothing. Nothing,’ James replied.”
Even in the non-narrative chapters, Filer’s personality shines through with his Terry Pratchett-esque use of footnotes and almost-conversational writing style.
A rigorous examination of key debates
Granted, any book can be fun. But what’s really admirable is that the book’s attention to narrative and being engaging has not led to a compromise in intellectual rigour. The narrative chapters are interspersed within eight other chapters which follow what is perhaps a more conventional non-fiction format, exploring issues at the heart of the mental health field—insight, diagnosis, causes, and chemical treatment—in a language that is accessible to the layperson while simultaneously preserving the complexities of the issues being discussed.
In his very first chapter, Filer sets the tone for the rest of the book by discussing the role of language in framing discussions on mental health issues—does it matter if you call someone a ‘patient’ or a ‘service user’ or a ‘survivor’? Should it matter?
“Yes, it’s a dispute about language, but in the mad, mad world of mental healthcare language is everything. A simple truth, which we will confront in more detail later, is that the overwhelming majority of psychiatric diagnoses aren’t arrived at by looking at blood tests or brain scans or anything of the sort. Rather, it is the words people say—or do not say—as interpreted by professionals, that as much as anything else will determine a diagnosis. And the language of diagnosis, for better or worse, has the power to profoundly alter people’s lives.”
Did this book change my mind about mental health?
Yes, in three main ways. In essence, how this book changed my mind about mental health is that it made me realise that there is still far too much that we don’t yet know about it.
Before reading this book, I must admit that I did not know much about schizophrenia at all, apart from the two-dimensional media portrayals of people with schizophrenia as being volatile and dangerous (think James McAvoy in M. Night Shyamalan’s Split).
“Let’s be clear about this from the start: schizophrenia does not mean split personality. Neither does it mean multiple personalities. But declaring what it isn’t is a good deal easier than asserting what it is.”
The first way Filer changed my mind about mental health: psychiatric diagnoses should not be taken as gospel, but as very rough and educated guesswork on the part of experts who are still trying to figure things out.
This is because psychiatric diagnoses are often not informed by objective and verifiable biological signs, but by committees of psychiatrists who agree on a set of definitions and diagnostic criteria based on prior observations. But such criteria are obviously too narrow to encompass the full range of subjective experiences that any given mental health patient might present with, making mental illnesses difficult to diagnose. Requirements for arriving at a diagnosis can also seem arbitrary—for example, the decision that a person would need to be experiencing a minimum of five separate symptoms to warrant a diagnosis of major depression was apparently arrived at because “four seemed like just not enough, and six seemed like too much”.
This is further complicated by the thorny history of psychiatry—other conditions which were once classified as mental illnesses, such as homosexuality and ‘pre-menstrual syndrome’, are no longer considered mental illnesses today due to social progress and people having more informed perspectives.
Secondly, while we might often view medication as the solution to mental illness, the truth is that chemical treatment is not a silver bullet. In fact, antipsychotic drugs like chlorpromazine often come with side effects (from weight gain to Parkinson-like movement disorders called dyskinesia) that might potentially be worse than the mental illness itself. This is seen most clearly in the chapter ‘The Mother’, where the titular mother, Clare, blames her son’s suicide on the cocktail of drugs he was given to treat his schizophrenia.
Yet in the words of Jim Read, a psychiatric service user stakeholder whom Filer quotes, “For every person who says their life has been ruined by psychiatric drugs, there is someone who believes they have been saved by them, and many more who just don’t know, who have been taking them for years and wonder if their lives would have been better or worse if they had been free of them.” The debate on antipsychotic drugs is thus very much one that still has no definite answer.
Finally, reading this book (in particular, the chapter titled ‘The Community’) helped me to realise the profound role that a person’s community might play in either exacerbating or remedying their mental illness.
In ‘The Community’, Kate recounts the story of her mother, Brigid, who lived with delusions that she was the chosen prophet of the Virgin Mary. Brigid’s delusions negatively impacted her ability to care for her children, and Kate and her siblings lived in hunger, poverty, and perpetual uncertainty. Her youngest brother started school two years late because Brigid was unable to organise plans for his education and only started when authorities threatened to prosecute (instead of offering to help or find out what the bigger problem was).
Kate’s reflections on this period of her life are as follows:
“People leave you to yourself. They assume that if you have problems someone else is dealing with those problems. It’s the same if you see someone else talking to themselves in the street. You assume they’re okay. Yes, they’re odd. You mightn’t want to be their friend or get to know them or chat about the weather. You might avoid standing next to them. But you’re not going to think: ‘That person’s talking to themselves, that’s a problem, let’s do something about it.’ And if that was your attitude to everyone, that would be awful as well.”
The only (minor) complaint that I had was that even though the book’s title claimed it would be about mental health as a whole, Filer seemed to focus mostly only on schizophrenia and other psychotic mental disorders (as opposed to non-psychotic disorders like depression or anxiety). However, his choice to focus on this particular area of mental health can also be somewhat explained by the fact that Filer refers to schizophrenia as the “heartland of psychiatry” in the introduction; the “bloody battleground upon which the fiercest ideological disputes about madness and its meanings are fought”.
Beyond the colourful cover and the bold title, This Book Will Change Your Mind About Mental Health is a fresh, insightful exploration into the tumultuous world of psychiatry and mental health. And unlike other pop psychology books, this one actually lives up to the title.