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The Heartland: finding and losing schizophrenia
This Book Will Change Your Mind About Mental Health, originally published as The Heartland: Finding and Losing Schizophrenia, presents a balanced summary of the controversy around the biological model of mental ill health, along with the model's effect on service design and culture, and society’s understanding of and relationship with its own and others' mental health.
336 pages, Paperback
First published June 4, 2019
203 people are currently reading
4128 people want to read
About the author
Nathan Filer
13 books536 followersNathan Filer is a writer and lecturer in creative writing. His stand-up poetry has been a regular fixture at festivals and spoken-word events across the UK and has been broadcast on BBC 3 television and radio 4, 7, and 5 Live. He is also a BBC Best New Filmmaker and holds an MA in creative writing from Bath Spa University. He lives in Bristol with his partner and their daughter.
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Displaying 1 - 30 of 284 reviews
December 21, 2020
This book has definitely changed my way of thinking. Although it is ostensibly about schizophrenia, it is just as much about all other mental illnesses. The most interesting part of the book was the critique of the DSM.
All entries in the DSMV are by committee. So one year 1996 It was agreed that homosexuality was a mental illness, in 1997 they thought differently and it was removed. Also in 1996 there was female masochistic syndrome, ie. if you get beaten up you were asking for it. Thanks to the influence of feminists this was also removed. Thereby also removing the excuse of rich, violent men who hit their wives and girlfriends from employing psychiatrists to diagnose the same in the women they were in court for having beaten up.
An 'expert' was asked why there were 5 symptoms necessary for schizophrenia to be diagnosed. He replied that they thought 4 wasn't enough and 6 was too many. What is scientific about diagnosing a serious mental illness like that?
All in all, I found the discussions on symptoms and the DSM most interesting. The DSM Is a for-profit book that is the bible of the medical business, an extremely high profit one. There is an alternative used by most of the non-US world, the public health based ICD - International Classification of Diseases - published by the WHO and used by more than a 100 countries.
In DSM there was a misprint in autism spectrum disorder. With the symptoms, the word 'OR' had been written instead of 'AND' so lots more people got diagnosed who didn't have it at all! But can you really trust a manual that is profit-oriented and some of whose committees are satisfied if their members, judging what are symptoms and which should be included, have only a diploma from an afternoon's lecture in a hotel ballroom as their sole qualification? (And are now also qualified to be therapists and charge vast sums of money to people desperate for help for their children.).
All entries in the DSMV are by committee. So one year 1996 It was agreed that homosexuality was a mental illness, in 1997 they thought differently and it was removed. Also in 1996 there was female masochistic syndrome, ie. if you get beaten up you were asking for it. Thanks to the influence of feminists this was also removed. Thereby also removing the excuse of rich, violent men who hit their wives and girlfriends from employing psychiatrists to diagnose the same in the women they were in court for having beaten up.
An 'expert' was asked why there were 5 symptoms necessary for schizophrenia to be diagnosed. He replied that they thought 4 wasn't enough and 6 was too many. What is scientific about diagnosing a serious mental illness like that?
All in all, I found the discussions on symptoms and the DSM most interesting. The DSM Is a for-profit book that is the bible of the medical business, an extremely high profit one. There is an alternative used by most of the non-US world, the public health based ICD - International Classification of Diseases - published by the WHO and used by more than a 100 countries.
In DSM there was a misprint in autism spectrum disorder. With the symptoms, the word 'OR' had been written instead of 'AND' so lots more people got diagnosed who didn't have it at all! But can you really trust a manual that is profit-oriented and some of whose committees are satisfied if their members, judging what are symptoms and which should be included, have only a diploma from an afternoon's lecture in a hotel ballroom as their sole qualification? (And are now also qualified to be therapists and charge vast sums of money to people desperate for help for their children.).
June 6, 2019
After the tragicomic genius of Mr Filer's debut novel, The Shock of the Fall, about a young boys struggles with schizophrenia and possibly modelled around his own experiences, he now moves on to write a non-fiction work which actively debunks the myths and downright lies told about those who suffer from it. I have to start by saying that I have no first-hand experience of this mental illness myself, and I don't know anyone who has the condition, but I am endlessly intrigued by lots of topics and I do campaign for the stigma still associated with mental health to be banished. Sadly, that is not anywhere near a reality as of yet.
The Heartland is an essential, much-needed exploration of schizophrenia and represents it in an authentic, accessible and eminently readable style. It's a complex, nuanced topic, but it is explored in a very open and honest manner and one-hundred years of controversy and conflicts surrounding the serious health condition is discussed too. There are still people who question its existence. What was most fascinating, but not really a surprise to me, was the correlation between mental health conditions and poverty. He also discusses other interesting correlations.
I learned a lot from this informative work, and the way it was punctuated with anonymised cases illustrating the reality of schizophrenia was inspired. I found myself profoundly moved. This is a powerful and enlightening read which opened my eyes and taught me much about the condition. It's full of compassion and well-researched facts and statistics, and I truly hope it sets straight the record straight on the misinformation front. Simply superb. Many thanks to Faber & Faber for an ARC.
The Heartland is an essential, much-needed exploration of schizophrenia and represents it in an authentic, accessible and eminently readable style. It's a complex, nuanced topic, but it is explored in a very open and honest manner and one-hundred years of controversy and conflicts surrounding the serious health condition is discussed too. There are still people who question its existence. What was most fascinating, but not really a surprise to me, was the correlation between mental health conditions and poverty. He also discusses other interesting correlations.
I learned a lot from this informative work, and the way it was punctuated with anonymised cases illustrating the reality of schizophrenia was inspired. I found myself profoundly moved. This is a powerful and enlightening read which opened my eyes and taught me much about the condition. It's full of compassion and well-researched facts and statistics, and I truly hope it sets straight the record straight on the misinformation front. Simply superb. Many thanks to Faber & Faber for an ARC.
unfinished
June 13, 2019I read the first 58 pages. Filer was completely unprepared when he arrived to work in a psychiatric hospital outside Bristol. This book is a record of what he learned: about the history of schizophrenia as a diagnosis, its social stigma, and the experience of living it via speaking to patients and hearing their stories. I read the first of those stories, about Erica, a fashion journalist who became so paranoid that she was being hunted down for committing unwitting crimes that she tried to commit suicide. I’ve read a lot of books of anonymized case studies recently, and compared to some (especially Nancy Tucker’s That Was When People Started to Worry), this is dull and not very enlightening. I also found myself irritated by Filer’s habit of hedging around all his terms with “so-called,” and the title is all wrong – people seeing just the two words “The Heartland” on the spine will have no idea that this is a book about mental illness. (They might be thinking it’s about the American Midwest, or whatever.)
July 26, 2019
I knew very little about schizophrenia before reading ‘The Heartland’, other than a fact from Crazy Like Us: The Globalization of the American Psyche: that those diagnosed with it have better outcomes in developing countries than developed. Filer mentions this while acknowledging that his focus is on the UK. The book is structured around a series of case studies of schizophrenia sufferers, which are recounted in a sensitive and moving fashion. Between and within them, Filer discusses the uncertainties around the diagnosis, causes, and treatments for schizophrenia. I found this riveting and read the whole thing in a single sitting. The stated aim is to challenge popular misconceptions about the illness, in particular the media portrayal of schizophrenia sufferers as dangerous, violent, and criminal. I liked these sensible comments about the limitations of campaigns to overcome the ‘stigma’ of mental illness:
Filer comments that such campaigns don’t actually increase knowledge about how to help people with mental illness, nor do they provide resources to make that help accessible. Another theme is that schizophrenia and other mental illnesses aren’t consistently diagnosed. Although I’ve read other critiques of the DSM, this statement about its dominance was notable:
(This, incidentally, is another reason why I want to get out of academia. I vastly prefer writing book reviews for fun than journal papers for work.)
‘The Heartland’ considers the higher incidence of schizophrenia in underprivileged groups, noting that there may also be a genetic influence, yet huge uncertainties remain around causation. Moreover, some argue that rather than trying to identify causes, research should focus on alleviating symptoms. I found the idea of schizophrenia as a vulnerability to psychosis a useful way of approaching it. The discussion of delusions and hearing voices was also nuanced and thought-provoking. I appreciated Filer’s perspective as a former mental health nurse, and that several more such nurses are introduced in the book. Most notably, a nurse with schizophrenia himself who cares for others with the same diagnosis. The book concludes on an emotionally resonant note by describing the support group this nurse leads.
Although I enjoyed ‘The Heartland’, the tone of the writing was a bit dissonant at times. Between the seriously tragic material, there are frequent light-hearted jokes in footnotes. I presume the intention was to prevent the narrative becoming too heavy and putting off readers, but I found most of the jokey comments incongruous. The writing style also tends towards sentence fragments, if that is an issue for you. Since I started marking student essays, it has become difficult for me not to notice and disapprove of sentence fragments, although I probably use them myself. Overall, I found the presentation of the case studies and the actual information excellent, while the intermittent flippant asides were only a slight drawback.
...Because if it’s impossible to speak about mental health without talking about stigma, it’s equally impossible to seriously consider stigma without talking politics.
“Every single government seems to have leapt on the anti-stigma campaigns,” argues Johnstone. “Theresa May among others. But what are they doing to stop people being targeted by the benefits office? To the huge increase in inequality? The rise of zero hours jobs? These are the things that drive people mad. It’s no kind of answer to say that as long as we’re happy to say we’ve got schizophrenia that we’re making progress. It’s absolutely nonsense. It’s insulting. And it’s politically motivated. Does the current government or the previous one want to talk about discrimination? No, they don’t. Do they want to make themselves look very well-meaning by talking about anti-stigma? Yes, they do.”
Filer comments that such campaigns don’t actually increase knowledge about how to help people with mental illness, nor do they provide resources to make that help accessible. Another theme is that schizophrenia and other mental illnesses aren’t consistently diagnosed. Although I’ve read other critiques of the DSM, this statement about its dominance was notable:
He’s highly sceptical of the DSM, dismissing it as a parochial American system that’s nothing to do with us.
So why, I ask, do its categories continue to be the bedrock of so much clinical discussion and research, even in the UK?
His answer strikes me as both honest and shocking: “It is true that researchers like myself, we often have to use DSM criteria in our research papers,” he acknowledges. “And the reason for that is our publications have got to get into American journals because your survival in the university system depends on your impact factor. And your h-index.”
(This, incidentally, is another reason why I want to get out of academia. I vastly prefer writing book reviews for fun than journal papers for work.)
‘The Heartland’ considers the higher incidence of schizophrenia in underprivileged groups, noting that there may also be a genetic influence, yet huge uncertainties remain around causation. Moreover, some argue that rather than trying to identify causes, research should focus on alleviating symptoms. I found the idea of schizophrenia as a vulnerability to psychosis a useful way of approaching it. The discussion of delusions and hearing voices was also nuanced and thought-provoking. I appreciated Filer’s perspective as a former mental health nurse, and that several more such nurses are introduced in the book. Most notably, a nurse with schizophrenia himself who cares for others with the same diagnosis. The book concludes on an emotionally resonant note by describing the support group this nurse leads.
Although I enjoyed ‘The Heartland’, the tone of the writing was a bit dissonant at times. Between the seriously tragic material, there are frequent light-hearted jokes in footnotes. I presume the intention was to prevent the narrative becoming too heavy and putting off readers, but I found most of the jokey comments incongruous. The writing style also tends towards sentence fragments, if that is an issue for you. Since I started marking student essays, it has become difficult for me not to notice and disapprove of sentence fragments, although I probably use them myself. Overall, I found the presentation of the case studies and the actual information excellent, while the intermittent flippant asides were only a slight drawback.
May 26, 2019
First of all, "The Shock of the Fall" made me cry - proper, ugly crying. It was such a powerful book. That meant I was really excited to read Nathan Filer's latest book. Secondly, I'm a Child Psychiatrist, so I know a bit about this stuff, so I was interesting to see how he approached the topic of schizophrenia.
I loved this book. Filer covers all the current controversies in the exploration of schizophrenia in an accurate and accessible way. It's extremely readable, and he has the ability to take complex subjects and explore them and unpick them. He really looks at the vicious cycle of poverty, trauma and mental health problems, and how they are interrelated. That aspect of it was great, and I hope lots of people read it.
For me, however, it was the way he used stories to humanise the debate that was the most powerful aspect of this book. I cried again, actually. That's OK - he's telling painful stories about painful things. As a professional in the field, I was given a space to reflect on the people that I work with, and the realities of their lives. I found that immensely moving.
I'm going to be recommending this book to a lot of friends and colleagues.
I loved this book. Filer covers all the current controversies in the exploration of schizophrenia in an accurate and accessible way. It's extremely readable, and he has the ability to take complex subjects and explore them and unpick them. He really looks at the vicious cycle of poverty, trauma and mental health problems, and how they are interrelated. That aspect of it was great, and I hope lots of people read it.
For me, however, it was the way he used stories to humanise the debate that was the most powerful aspect of this book. I cried again, actually. That's OK - he's telling painful stories about painful things. As a professional in the field, I was given a space to reflect on the people that I work with, and the realities of their lives. I found that immensely moving.
I'm going to be recommending this book to a lot of friends and colleagues.
July 7, 2019
Well-written and really enlightening discussion of the issues around our current understanding of schizophrenia: what it is; it’s diagnosis; and it’s treatment.
June 8, 2019
Excellent, informative, accessible read
I find it almost a shame that the title of this book refers specifically to so called 'Schizophrenia', when it is in fact a valuable read which applies to - I think - all areas of mental health difficulties.
Jargon is explained, the tone is professional and approachable, with some humour and humbleness - making this book accessible to a whole range of readers.
The thoughts, feelings, opinions and research of a wide range of professionals, those with lived experience, friends, family, carers of 'service users', as well as the author's own ideas have been included to give a well-rounded, well-structured explanation of the areas which affect those of us who struggle with threat responses, living in survival mode a lot of the time, and trying to get by.
Whether you identify as having mental health challenges (isn't that all of us?) or if you know someone who does (yep, that's all of us, again) I really believe that you will increase your awareness and understanding of what it means to be a human being.
I find it almost a shame that the title of this book refers specifically to so called 'Schizophrenia', when it is in fact a valuable read which applies to - I think - all areas of mental health difficulties.
Jargon is explained, the tone is professional and approachable, with some humour and humbleness - making this book accessible to a whole range of readers.
The thoughts, feelings, opinions and research of a wide range of professionals, those with lived experience, friends, family, carers of 'service users', as well as the author's own ideas have been included to give a well-rounded, well-structured explanation of the areas which affect those of us who struggle with threat responses, living in survival mode a lot of the time, and trying to get by.
Whether you identify as having mental health challenges (isn't that all of us?) or if you know someone who does (yep, that's all of us, again) I really believe that you will increase your awareness and understanding of what it means to be a human being.
August 12, 2020
Well worth reading for the fantastic revelatory interviews and the telling critiques of the DMS. Those critiques should be enough to make us suspicious about the whole validity of psychiatry. Puzzling, however, is the fact that the author discloses so much and yet still seems to support the system and the practice. He seems comfortable with electroconvulsive therapy (brain toasting) and the use of medications (most often mind straitjackets) without consent. Quite rightly he puts ‘so called’ in inverted commas before schizophrenia, but is quite happy to leave ‘cure’ and ‘got better’ without that questioning punctuation. I , of course, want to add those marks. Read it and take all the wonderful things it has to offer, but do so critically. There is something not quite right about what is being served.
July 6, 2019
Will probably be the most important book I read this year. Filer was able to articulate my own sense of unease about the lack of attention we pay to inequality, poverty, and exclusion in causing mental illness as well as the pointlessness of well meaning attempts to ‘talk about it’ if there’s no actual support available. Very well written and accessible and so much empathy for the various individuals whose stories are told here.
January 24, 2021
The book didn't change my mind about mental health. Perhaps there were a few eye-openers (it was interesting to read about how anti-psychotic medication actually works) but it wasn't a book full of revelations, which given the title I had expected.
March 18, 2023
Fjoew, what can I say? Dit boek is wijs, belangrijk, grappig, krachtig en hartverscheurend tegelijk. En maakt de titel voor mij absoluut waar.
July 30, 2019
I received this book through Netgalley in exchange for an honest review.
This book had a really profound effect on me. Whilst I work in the mental health field, I tend to see people on the lower end of the scale. Those who suffer with anxiety and depression. Schizophrenia is not something I would typically work with and as such know very little about.
I read Filer's debut novel The Shock of the Fall a few years back and really enjoyed it. So when I saw that he had a non-fiction book out which follows a similar theme, I was very pleased.
It is a thought provoking read, questioning diagnostic and medicating practices, mental health stigma vs discrimination, that recovery from a mental illness really means, and more besides. Filer introduces us to the symptoms of Schizophrenia, the impact it has on the lives of those with it as well as their families, and the experiences they have with the mental health professionals there to support them, all through hearing the stories of six individuals (and some of their family members).
It's well written and insightful. I think everyone should read it, whether you have schiophrenia, work with people who have it, work within the mental health field, or not. It really gets you thinking.
This book had a really profound effect on me. Whilst I work in the mental health field, I tend to see people on the lower end of the scale. Those who suffer with anxiety and depression. Schizophrenia is not something I would typically work with and as such know very little about.
I read Filer's debut novel The Shock of the Fall a few years back and really enjoyed it. So when I saw that he had a non-fiction book out which follows a similar theme, I was very pleased.
It is a thought provoking read, questioning diagnostic and medicating practices, mental health stigma vs discrimination, that recovery from a mental illness really means, and more besides. Filer introduces us to the symptoms of Schizophrenia, the impact it has on the lives of those with it as well as their families, and the experiences they have with the mental health professionals there to support them, all through hearing the stories of six individuals (and some of their family members).
It's well written and insightful. I think everyone should read it, whether you have schiophrenia, work with people who have it, work within the mental health field, or not. It really gets you thinking.
February 2, 2020
This book was fascinating. I often find reading books about mental illness quite difficult - as someone who struggles myself with my mental health, books and essays on the topic can sometimes leave me feeling misrepresented or frustrated or judged. And yes, this book left me feeling frustrated, but not in the way that the topic was explored, rather with the issues in the systems that are used to deal with mental health, and has inspired me to continue to campaign for better support.
This was a compelling introduction to schizophrenia, which I recognise as an extremely misunderstood condition, and I learnt so much, and also, despite not necessarily agreeing with all of the arguments explored, the consideration of a number of debates in the field of psychiatry was so so interesting!
I would recommend this book to EVERYONE, an absolutely fascinating read.
This was a compelling introduction to schizophrenia, which I recognise as an extremely misunderstood condition, and I learnt so much, and also, despite not necessarily agreeing with all of the arguments explored, the consideration of a number of debates in the field of psychiatry was so so interesting!
I would recommend this book to EVERYONE, an absolutely fascinating read.
March 1, 2020
Good but flawed. The parts where the author interviews people were hugely interesting and I would have loved a book full of them. There were two things that dragged this down, unfortunately:
1) the tone was unnecessarily informal. The jokes about Ant and Dec just seemed pointless and made it seem like the author wasn’t taking his job seriously.
2) the analysis of the interviews got quite tedious towards the end and increasingly disconnected from the interviews. More human experiences would have been more affecting.
1) the tone was unnecessarily informal. The jokes about Ant and Dec just seemed pointless and made it seem like the author wasn’t taking his job seriously.
2) the analysis of the interviews got quite tedious towards the end and increasingly disconnected from the interviews. More human experiences would have been more affecting.
October 26, 2022
Wasn't awful but put me in a huge reading slump. Classic case of author trying to be funny and relatable and failing miserably.
February 14, 2025
This Book Did NOT Change My Mind About Mental Health.
UK books, what's up with these clickbaity, tabloid, honestly meaningless titles? I'm fed up with them. This book is about schizophrenia and psychosis, but the title doesn't exactly tell you that. This is probably not the author's fault, but the title still made me annoyed with the book from the get-go👌
(Btw, I listened to the audiobook read by the author)
It didn't exactly ease my annoyance when the author started saying "so-called" before every psychiatric term, because of "controversy", like this: "so-called schizophrenia", "so-called mental illness", and so on.
Do you know what's more controversial than the term mental illness!? Putting "so-called" in front of the term every time you say it!!!!
Do you want me to constantly question everything at a word-for-word level while reading? Because that is quite frankly exhausting!
And I was not satisfied with his surface-level explanation for including the so-called's. A little more of an in-depth analysis of this controversy would have been nice.
One last criticism: even though I think it's extremely important to be critical about psychiatric drugs, I am still a little worried that the way it's portrayed here, people will become all "medication is bad" after reading this, which is also unfortunate. Despite all their downsides, we should keep in mind that psychiatric drugs are life-saving for many people.
Now that I've told you about all my dislikes, let's move on to the positives😁
Fortunately, my annoyance eventually lessened, and I was able to get invested in the poignant stories that made up around half of the book.
I found the story about the young boy with hebephrenic schizophrenia to be really enlightening (and heartbreaking), since I've never quite understood this subcategory of schizophrenia. It shows how extremely varied (heterogenous) schizophrenia can be as an illness. I hope the mother of this boy is doing okay today❤️
Also, one of the other stories about a mother was quite unlike anything I've read about schizophrenia before. The fact that these children lived with their mother in that state of mind for such a long time, is almost unfathomable.
So, yeah, I guess it wasn't too bad, overall🙃
UK books, what's up with these clickbaity, tabloid, honestly meaningless titles? I'm fed up with them. This book is about schizophrenia and psychosis, but the title doesn't exactly tell you that. This is probably not the author's fault, but the title still made me annoyed with the book from the get-go👌
(Btw, I listened to the audiobook read by the author)
It didn't exactly ease my annoyance when the author started saying "so-called" before every psychiatric term, because of "controversy", like this: "so-called schizophrenia", "so-called mental illness", and so on.
Do you know what's more controversial than the term mental illness!? Putting "so-called" in front of the term every time you say it!!!!
Do you want me to constantly question everything at a word-for-word level while reading? Because that is quite frankly exhausting!
And I was not satisfied with his surface-level explanation for including the so-called's. A little more of an in-depth analysis of this controversy would have been nice.
One last criticism: even though I think it's extremely important to be critical about psychiatric drugs, I am still a little worried that the way it's portrayed here, people will become all "medication is bad" after reading this, which is also unfortunate. Despite all their downsides, we should keep in mind that psychiatric drugs are life-saving for many people.
Now that I've told you about all my dislikes, let's move on to the positives😁
Fortunately, my annoyance eventually lessened, and I was able to get invested in the poignant stories that made up around half of the book.
I found the story about the young boy with hebephrenic schizophrenia to be really enlightening (and heartbreaking), since I've never quite understood this subcategory of schizophrenia. It shows how extremely varied (heterogenous) schizophrenia can be as an illness. I hope the mother of this boy is doing okay today❤️
Also, one of the other stories about a mother was quite unlike anything I've read about schizophrenia before. The fact that these children lived with their mother in that state of mind for such a long time, is almost unfathomable.
So, yeah, I guess it wasn't too bad, overall🙃
May 21, 2021
An intriguing discussion around mental health, and more specifically - schizophrenia by a mental health nurse who has first hand experience of patients living with it.
I thought this was a well written and thorough look at how and why schizophrenia presents itself. The author draws on his own patients experiences and observations throughout his career thus far. I felt some pages waffled on a bit too much and didn’t add much to the overall progression of the book. I found myself glossing over some passages which didn’t necessarily strengthen my understanding of what the author was trying to educate me on.
Overall - a fresh look at mental health unlike some of the other books of a similar theme. It flits between part education and part memoir, which can feel a bit confusing at times. However, if you are interested in this area, it’s worth a look.
I thought this was a well written and thorough look at how and why schizophrenia presents itself. The author draws on his own patients experiences and observations throughout his career thus far. I felt some pages waffled on a bit too much and didn’t add much to the overall progression of the book. I found myself glossing over some passages which didn’t necessarily strengthen my understanding of what the author was trying to educate me on.
Overall - a fresh look at mental health unlike some of the other books of a similar theme. It flits between part education and part memoir, which can feel a bit confusing at times. However, if you are interested in this area, it’s worth a look.
August 23, 2023
A fascinating and important book on psychosis, schizophrenia and treatments, looking at it holistically, historically and medically. Filer is a well informed, engaging author with an easy to read voice.
February 22, 2021
Ok, 4.5*. I just wish this book was longer (what Filer shows us is just a tip of the iceberg). But I'm going to recommend it to my work colleagues nonetheless (we are working with young people with complex trauma, and I think this book could be really helpful in our day to day interactions with those young people (and with each other)).
August 6, 2022
Thought provoking
March 26, 2023
This book HAS changed my mind about mental health. I really enjoyed reading it not only because it is so informative and shares interesting life stories but also thanks to the author's writing style and sense of humour. And never before have I underlined so many sentences in a book.
July 10, 2019
Awalnya, saya ingin membaca buku ini karena buku ini terbitan Faber & Faber, sebuah lini penerbitan besar di Inggris yang saya tahu yang beberapa penulisnya menerbitkan buku di penerbit ini seperti Orhan Pamuk dan T.S. Elliot. Dan intuisi saya terhadap buku ini enggak mengecewakan.
Buku ini terbagi menjadi 5 bab besar dengan beberapa sub bab kecil setelah 5 Bab besar tersebut. Bab pertama mengisahkan seorang wartawan fashion bernama Erica yang merasa dirinya sebagai "penjahat" nomor satu di Britania Raya yang sebenarnya dia gak pernah berbuat kriminal apa2. Ia merasa dirinya sebagai penjahat dikarenakan waham paranoidnya dalam buku ini Erica disebut seringkali mengalami waham rujukan atau delusion of reference, ia merasa dirinya diinteli oleh badan intelejen Inggris M15 yang memasukkan sebuah chip ke dalam mesin faks miliknya. Dan setiap kali dia membaca berita yang ada di media massa hal itu merujuk kepada dirinya. Selama bergulat dengan penyakit skizofrenia, Erica sempat tidak mengkonsumsi obat-obatan dari dokter, ia menganggap dirinya memiliki kekuatan super seperti dukun atau seorang shaman dan hal itu tentu saja memperburuk kondisi mentalnya. Dalam istilah psikologi dan psikiatri yang disebut dalam buku ini, Erica dianggap masuk dalam kategori asonogsia dimana ia merasa tidak sakit tapi realitas di sekelilingnya yang sakit. Dalam akhir Bab pertama ini, akhirnya Erica bisa berdamai dengan penyakitnya dan memiliki pemahaman yang lebih baik dari sebelumnya tentang penyakitnya tersebut. Setelah melewati kisah Erica di bab pertama, ada 2 sub bab kecil yang menjelaskan mengenai pemahaman penyakit skizofrenia dan sub bab lainnya adalah mengenai stigma dan diskriminasi sosial kebanyakan orang pada penderita skizofrenia. Dari keseluruhan kisah yang ada di dalam buku ini, kisah mengenai Erica mungkin adalah yang menjadi favorit saya.
Pada Bab Besar kedua, ada kisah mengenai seorang tentara bernama James yang memiliki delusion of grandeur atau waham kebesaran. James memiliki waham kalau dirinya semacam messianic figure yang memiliki misi tertentu di dunia ini. Saya sebenarnya banyak menskip bagian kisah James ini dan langsung masuk ke dalam bagian diagnosa penyakitnya, karena saya menemukan banyak kata2 kasar yang dinarasikan oleh penulisnya, maklum saya agak enggak kuat dengan kisah cerita bahkan itu novel dan cerita pendek yang menggunakan kata-kata yang kasar. Kalau saya melihat kasus tentara bernama James ini, mungkin saya jadi teringat dengan salah satu cerita pendek yang pernah ditulis Mas Yusi dalam kumpulan cerita pendek Muslihat Musang Emas, perihal seorang nabi yang ingin memegang payudara seorang perempuan. Untuk melihat kajian yang mungkin bisa saya rujuk kepada pembaca, ada buku non-fiksi tulisan Ahmad Fauzi dengan judul Skizofrenia dan Asal-Usul Agama. Mungkin bagi sebagian pembaca, buku Ahmad Fauzi dan (saya sendiri pun demikian) agak kontroversial, tapi sepertinya gak ada salahnya juga untuk mengetahui opini penulis lokal negeri ini mengenai pendapatnya tentang skizofrenia.
Pada Bab Besar ketiga, Inti cerita berpusat pada hubungan Ibu dan Anak. Ibu Clare dan anaknya Joe. Salah satu anak laki-laki Clare yang bernama Joe didiagnosa menderita skizofrenia hebefrenik. Sebelum didiagnosa menderita skizofrenia hebefrenik, Joe seringkali meminum-minuman keras dan beberapa kali memakai kanabis. Secara kejiwaan, Joe sangat tidak stabil. Periode Joe menenggak minuman keras dan mengkonsumsi kanabis ini masuk dalam kategori usia young adult atau dewasa muda. Mark, suami Clare tak mampu merawatnya, dan Joe akhirnya dimasukkan ke dalam lembaga rehabilitasi mental di kawasan Huntington. Banyak penelitian skizofrenia menunjukkan orang-orang dengan usia 18-40 tahun adalah orang-orang yang paling rentan terkena penyakit skizofrenia. Walaupun ada orang yang menderita skizofrenia juga lebih muda atau lebih tua daripada hasil penelitian itu, tergantung stressor negatif yang dialami individu tersebut. Dalam istilah psikologi Freudian ada yang disebut dengan schizophrenogenic mother, yaitu sebuah gaya pola asuh seorang Ibu yang bisa mengembangkan kepribadian skizofrenia kepada anak yang diasuhnya. Namun setelah mengalami banyak gugatan oleh para ahli psikologi dan psikiater, konsep schizophrenogenic mother ini dianggap sebagai pandangan misoginistik dari Sigmund Freud. Gugatan para ahli tentang schizophrenogenic mother ini juga diulas dalam buku Nathan Filer ini.
Pada Bab besar keempat, menceritakan seorang Ibu penderita skizofrenia bernama Brigid yang memiliki empat orang anak. Brigid tidak mampu merawat anak2nya dengan baik pasca ia didiagnosa menderita skizofrenia. Fokus dalam Bab besar keempat ini terutama hubungan Brigid sebagai seorang Ibu penderita skizofrenia dan Kate sebagai seorang anak. Untungnya dengan ketidakberfungsian Ibu dalam keluarga ini tak lantas membuat anak-anaknya juga menderita penyakit mental, bisa dikatakan keempat anak Brigid "survive". Sama seperti Erica dan James, Brigid didiagnosa penyakit skizofrenia paranoid, ia memiliki delusion of persecutory dimana ia merasa dirinya akan dicelakakan oleh orang lain. Dan selama puluhan tahun hidup dalam penyakit skizofrenia ini, Brigid akhirnya meninggal dengan kondisi kanker yang boleh dikatakan sebagai kegagalan total organ tubuh. Dokter mendiagnosa Brigid menderita kanker yang sudah menjalar kemana-mana, mulai dari paru-paru, ovarium, liver dan hampir semua bagian tubuhnya yang lain.
Pada Bab besar kelima dalam buku ini, menceritakan kisah Jasper yang pengalaman penyakit skizofrenianya agak mirip dengan Erican terutama perihal waham rujukan. Ia merasa dirinya sering diledek atau dicemooh ole tetangga di sekitarnya. Dalam kisah ini, Jasper yang diwawancarai oleh penulisnya mengatakan kalau sebenarnya ia termasuk seorang yang berpikir rasional namun entah mengapa setiap kali dihadapkan dengan waham rujukan dan suara bisikan-bisikan yang dialaminya, ia selalu kalah. Dan yang sebenarnya bikin agak unik ialah, suara bisikan-bisikan dalam pikirannya yang diterima oleh Jasper mirip seperti suara Peter Parker (tokoh fiktif dalam film Spiderman). Saya gak mau kasih spoiler lebih banyak tentang bab ini.
Tapi secara keseluruhan, saya bukan hanya menekankan lima kisah penderita skizofrenia dalam Bab ini, tapi saya menemukan beberapa hal baru yang saya ketahui tentang penyakit skizofrenia. Misalnya tentang ketidak adaan gen 22q11 di beberapa kromosom penderita skizofrenia. Menurut penelitian biologi yang diungkap oleh penulisnya, ketidak-adaan gen 22q11 cenderung membuat individu tersebut mengidap skizofrenia. Lalu, ada perihal penyakit Williams Syndrome yang biasa dialami oleh anak-anak. Williams Syndrome ini adalah sebuah gangguan dimana seorang anak memiliki perkawanan yang berlebih dengan teman-temannya yang lain. Orang dengan Williams Syndrome ini rata-rata memiliki ekspresi wajah yang berbeda dengan orang normal, bisa dicek di Wikipedia. Di Wikipedia saya lihat orang dengan gangguan Williams Syndrome ini memiliki IQ yang rendah dengan para penderitanya cuma memiliki IQ dari 40 sampai 112 dengan rerataan nilai 69,32 yang berarti sudah masuk kategori mild idiocy. Orang-orang dengan gangguan Williams Syndrome ini bisa mengembangkan kepribadian pencemas dan phobia. Nah, Williams Syndrome ini berkaitan dengan child abuse di masa kanak-kanak yang dibahas Nathan Filer sebagai pemicu terjadinya penyakit skizofrenia di masa dewasa. Kalau memperhatikan beberapa penderita skizofrenia di masa dewasa, ada beberapa penderitanya yang juga memiliki raut wajah yang tidak sesempurna orang kebanyakan, entah itu pengaruh secara genetik atau obat-obatan anti depresan yang mereka konsumsi.
Ada benang merah yang menjadi daya tarik tulisan Nathan Filer di buku ini yaitu tentang penghapusan stigma kepada penderita skizofrenia. Nathan Filer yang memiliki latar belakang sebagai seorang perawat di lembaga rehabilitasi mental mengatakan kalau mayoritas penderita skizofrenia jarang melakukan tindakan kekerasan kepada orang lain, bahkan kadang-kadang justru orang dengan gangguan skizofrenia yang menjadi korban kekerasan. Misalnya, saja, saya ingat dengan novel Eka Kurniawan tentang Seperti Dendam Rindu, Harus Dibayar Tuntas tentang seorang janda berpenyakit mental yang akhirnya diperkosa karena tidak waras.
Di bagian2 paling terakhir buku ini, saya juga mendapat pemahaman kalau orang-orang dengan gangguan skizofrenia menurut penelitian lebih banyak yang "survive" di negara2 dunia ketiga dimana keberfungsian sosial masih bisa diusahakan dalam artian penderita skizofrenia bisa sembuh secara sosial (bukan secara medis) karena mereka bisa berinteraksi dengan banyak orang yang jarang ditemukan di negara2 dengan sistem kapitalis-industrialis. Pembaca tentu sudah banyak tahu kalau di negara2 dengan sistem kapitalis-industrialis, kasus bunuh diri adalah hal yang jamak ditemui.
Buku ini terbagi menjadi 5 bab besar dengan beberapa sub bab kecil setelah 5 Bab besar tersebut. Bab pertama mengisahkan seorang wartawan fashion bernama Erica yang merasa dirinya sebagai "penjahat" nomor satu di Britania Raya yang sebenarnya dia gak pernah berbuat kriminal apa2. Ia merasa dirinya sebagai penjahat dikarenakan waham paranoidnya dalam buku ini Erica disebut seringkali mengalami waham rujukan atau delusion of reference, ia merasa dirinya diinteli oleh badan intelejen Inggris M15 yang memasukkan sebuah chip ke dalam mesin faks miliknya. Dan setiap kali dia membaca berita yang ada di media massa hal itu merujuk kepada dirinya. Selama bergulat dengan penyakit skizofrenia, Erica sempat tidak mengkonsumsi obat-obatan dari dokter, ia menganggap dirinya memiliki kekuatan super seperti dukun atau seorang shaman dan hal itu tentu saja memperburuk kondisi mentalnya. Dalam istilah psikologi dan psikiatri yang disebut dalam buku ini, Erica dianggap masuk dalam kategori asonogsia dimana ia merasa tidak sakit tapi realitas di sekelilingnya yang sakit. Dalam akhir Bab pertama ini, akhirnya Erica bisa berdamai dengan penyakitnya dan memiliki pemahaman yang lebih baik dari sebelumnya tentang penyakitnya tersebut. Setelah melewati kisah Erica di bab pertama, ada 2 sub bab kecil yang menjelaskan mengenai pemahaman penyakit skizofrenia dan sub bab lainnya adalah mengenai stigma dan diskriminasi sosial kebanyakan orang pada penderita skizofrenia. Dari keseluruhan kisah yang ada di dalam buku ini, kisah mengenai Erica mungkin adalah yang menjadi favorit saya.
Pada Bab Besar kedua, ada kisah mengenai seorang tentara bernama James yang memiliki delusion of grandeur atau waham kebesaran. James memiliki waham kalau dirinya semacam messianic figure yang memiliki misi tertentu di dunia ini. Saya sebenarnya banyak menskip bagian kisah James ini dan langsung masuk ke dalam bagian diagnosa penyakitnya, karena saya menemukan banyak kata2 kasar yang dinarasikan oleh penulisnya, maklum saya agak enggak kuat dengan kisah cerita bahkan itu novel dan cerita pendek yang menggunakan kata-kata yang kasar. Kalau saya melihat kasus tentara bernama James ini, mungkin saya jadi teringat dengan salah satu cerita pendek yang pernah ditulis Mas Yusi dalam kumpulan cerita pendek Muslihat Musang Emas, perihal seorang nabi yang ingin memegang payudara seorang perempuan. Untuk melihat kajian yang mungkin bisa saya rujuk kepada pembaca, ada buku non-fiksi tulisan Ahmad Fauzi dengan judul Skizofrenia dan Asal-Usul Agama. Mungkin bagi sebagian pembaca, buku Ahmad Fauzi dan (saya sendiri pun demikian) agak kontroversial, tapi sepertinya gak ada salahnya juga untuk mengetahui opini penulis lokal negeri ini mengenai pendapatnya tentang skizofrenia.
Pada Bab Besar ketiga, Inti cerita berpusat pada hubungan Ibu dan Anak. Ibu Clare dan anaknya Joe. Salah satu anak laki-laki Clare yang bernama Joe didiagnosa menderita skizofrenia hebefrenik. Sebelum didiagnosa menderita skizofrenia hebefrenik, Joe seringkali meminum-minuman keras dan beberapa kali memakai kanabis. Secara kejiwaan, Joe sangat tidak stabil. Periode Joe menenggak minuman keras dan mengkonsumsi kanabis ini masuk dalam kategori usia young adult atau dewasa muda. Mark, suami Clare tak mampu merawatnya, dan Joe akhirnya dimasukkan ke dalam lembaga rehabilitasi mental di kawasan Huntington. Banyak penelitian skizofrenia menunjukkan orang-orang dengan usia 18-40 tahun adalah orang-orang yang paling rentan terkena penyakit skizofrenia. Walaupun ada orang yang menderita skizofrenia juga lebih muda atau lebih tua daripada hasil penelitian itu, tergantung stressor negatif yang dialami individu tersebut. Dalam istilah psikologi Freudian ada yang disebut dengan schizophrenogenic mother, yaitu sebuah gaya pola asuh seorang Ibu yang bisa mengembangkan kepribadian skizofrenia kepada anak yang diasuhnya. Namun setelah mengalami banyak gugatan oleh para ahli psikologi dan psikiater, konsep schizophrenogenic mother ini dianggap sebagai pandangan misoginistik dari Sigmund Freud. Gugatan para ahli tentang schizophrenogenic mother ini juga diulas dalam buku Nathan Filer ini.
Pada Bab besar keempat, menceritakan seorang Ibu penderita skizofrenia bernama Brigid yang memiliki empat orang anak. Brigid tidak mampu merawat anak2nya dengan baik pasca ia didiagnosa menderita skizofrenia. Fokus dalam Bab besar keempat ini terutama hubungan Brigid sebagai seorang Ibu penderita skizofrenia dan Kate sebagai seorang anak. Untungnya dengan ketidakberfungsian Ibu dalam keluarga ini tak lantas membuat anak-anaknya juga menderita penyakit mental, bisa dikatakan keempat anak Brigid "survive". Sama seperti Erica dan James, Brigid didiagnosa penyakit skizofrenia paranoid, ia memiliki delusion of persecutory dimana ia merasa dirinya akan dicelakakan oleh orang lain. Dan selama puluhan tahun hidup dalam penyakit skizofrenia ini, Brigid akhirnya meninggal dengan kondisi kanker yang boleh dikatakan sebagai kegagalan total organ tubuh. Dokter mendiagnosa Brigid menderita kanker yang sudah menjalar kemana-mana, mulai dari paru-paru, ovarium, liver dan hampir semua bagian tubuhnya yang lain.
Pada Bab besar kelima dalam buku ini, menceritakan kisah Jasper yang pengalaman penyakit skizofrenianya agak mirip dengan Erican terutama perihal waham rujukan. Ia merasa dirinya sering diledek atau dicemooh ole tetangga di sekitarnya. Dalam kisah ini, Jasper yang diwawancarai oleh penulisnya mengatakan kalau sebenarnya ia termasuk seorang yang berpikir rasional namun entah mengapa setiap kali dihadapkan dengan waham rujukan dan suara bisikan-bisikan yang dialaminya, ia selalu kalah. Dan yang sebenarnya bikin agak unik ialah, suara bisikan-bisikan dalam pikirannya yang diterima oleh Jasper mirip seperti suara Peter Parker (tokoh fiktif dalam film Spiderman). Saya gak mau kasih spoiler lebih banyak tentang bab ini.
Tapi secara keseluruhan, saya bukan hanya menekankan lima kisah penderita skizofrenia dalam Bab ini, tapi saya menemukan beberapa hal baru yang saya ketahui tentang penyakit skizofrenia. Misalnya tentang ketidak adaan gen 22q11 di beberapa kromosom penderita skizofrenia. Menurut penelitian biologi yang diungkap oleh penulisnya, ketidak-adaan gen 22q11 cenderung membuat individu tersebut mengidap skizofrenia. Lalu, ada perihal penyakit Williams Syndrome yang biasa dialami oleh anak-anak. Williams Syndrome ini adalah sebuah gangguan dimana seorang anak memiliki perkawanan yang berlebih dengan teman-temannya yang lain. Orang dengan Williams Syndrome ini rata-rata memiliki ekspresi wajah yang berbeda dengan orang normal, bisa dicek di Wikipedia. Di Wikipedia saya lihat orang dengan gangguan Williams Syndrome ini memiliki IQ yang rendah dengan para penderitanya cuma memiliki IQ dari 40 sampai 112 dengan rerataan nilai 69,32 yang berarti sudah masuk kategori mild idiocy. Orang-orang dengan gangguan Williams Syndrome ini bisa mengembangkan kepribadian pencemas dan phobia. Nah, Williams Syndrome ini berkaitan dengan child abuse di masa kanak-kanak yang dibahas Nathan Filer sebagai pemicu terjadinya penyakit skizofrenia di masa dewasa. Kalau memperhatikan beberapa penderita skizofrenia di masa dewasa, ada beberapa penderitanya yang juga memiliki raut wajah yang tidak sesempurna orang kebanyakan, entah itu pengaruh secara genetik atau obat-obatan anti depresan yang mereka konsumsi.
Ada benang merah yang menjadi daya tarik tulisan Nathan Filer di buku ini yaitu tentang penghapusan stigma kepada penderita skizofrenia. Nathan Filer yang memiliki latar belakang sebagai seorang perawat di lembaga rehabilitasi mental mengatakan kalau mayoritas penderita skizofrenia jarang melakukan tindakan kekerasan kepada orang lain, bahkan kadang-kadang justru orang dengan gangguan skizofrenia yang menjadi korban kekerasan. Misalnya, saja, saya ingat dengan novel Eka Kurniawan tentang Seperti Dendam Rindu, Harus Dibayar Tuntas tentang seorang janda berpenyakit mental yang akhirnya diperkosa karena tidak waras.
Di bagian2 paling terakhir buku ini, saya juga mendapat pemahaman kalau orang-orang dengan gangguan skizofrenia menurut penelitian lebih banyak yang "survive" di negara2 dunia ketiga dimana keberfungsian sosial masih bisa diusahakan dalam artian penderita skizofrenia bisa sembuh secara sosial (bukan secara medis) karena mereka bisa berinteraksi dengan banyak orang yang jarang ditemukan di negara2 dengan sistem kapitalis-industrialis. Pembaca tentu sudah banyak tahu kalau di negara2 dengan sistem kapitalis-industrialis, kasus bunuh diri adalah hal yang jamak ditemui.
July 20, 2019
An excellent book: well-written (with a little humour here and there), backs up its claims with research and covers an interesting topic. Nathan Filer is a mental health nurse and uses schizophrenia as the starting point to look at various issues within mental health and its treatment, by combining personal accounts with related discussion. It's particularly interesting that he chooses to look both at the conventional, Western view of mental health and its treatment and views more aligned with the "anti-psychiatry" movement. So there is discussion about how diagnoses are arrived at by observing symptoms and giving labels to those which tend to cluster together - it's a lot more arbitrary than diagnosing a health condition which has a clear microbial cause or can be seen on scans and such - and whether these labels mean anything beyond describing symptoms (I know some people find their diagnoses very helpful though, so I'm not taking sides here). There is analysis of schizophrenia within a wider social context and how race and poverty may affect diagnosis and the experience of mental health issues. He also explains how psychosis can feel to those experiencing it, and talks about treatment options and how anti-psychotics in particular have a lot of unwanted side effects - to the point where people who have been unwell for a long time may in fact be unwell at least partly because of their medication (though, as with diagnoses, he acknowledges that medication can have a vital role to play for some people). The only thing that was perhaps missing from this book was a look at how mental health is approached by non-Western medicine, but the author does say that he set out only to look at a Western (primarily UK based) context, so that's fair enough, though he does throw in at the end the interesting fact that people who have an episode of psychosis outwith Western healthcare systems are less likely to have a relapse of their condition.
January 3, 2020
I loved this. It's quite gentle and open in tone rather than a furious indictment of anything in particular, but does a good job laying out how complex the diagnosis and treatment of so-called schizophrenia is. (Borrowing the 'so-called' from Filer, who makes a good case for 'schizophrenia' not really existing as a fixed and knowable condition at all, and perhaps being better understood on a spectrum.) And it's really good on the complicated relationship between psychosis and delusions and people's environment, upbringing and experiences. I'm not sure how controversial any of this might be within the mental health community. But to me the whole book was extremely nuanced and thoughtful, and reframed the way I think about mental illness and distress.
August 23, 2019
I would strongly recommend this for anyone - well okay, everyone - who has limited contact with psychosis mental health illnesses and services. Filer strips back so many of the myths - that medication is always worth it; that sane and insane are distinct states; that diagnoses are meaningful, that caring for the mentally ill is rewarding and done with joy - here with empathy and humour, making the read feel rich and easy despite very difficult subject matter. Perhaps, however, if like me you have been through some of this as a carer, sufferer or professional, you might find it more of a light touch, with little that is new insight.
May 29, 2020
I had the pleasure of hearing Nathan speak at the RCN last year. In addition to giving insight into different peoples experiences with so-called schizophrenia, this book continues conversations we need to have about possibly over-used biomedical approaches to mental health. What could we be doing better? In general nursing, mental health patients are burdened by stigma and anyone with a label of psychosis even more so. I’ve taken a lot from this book and will continue to develop how I can support patients living with mental health conditions.
July 1, 2019
As a former psychiatric nurse myself I found this a profoundly moving and thought provoking book. Professionally it was always easier to stick a label on a patient in the hope that the treatment plan automatically set out for them would result in the desired removal of all evidence of an illness. This book has helped me to re evaluate that perception and wonder why I had to categorise everything in such bland, black and white teens as ‘ill or well.’
March 29, 2020
Again, another book I had bought that seemed so promising. The extract I had read when first picking up the book really stood out to me, which is why I ended up buying it. But the format lost my interest. The stories were fascinating, if the entire book was based on just those this would be a winner for me. But the narrative that follows lost my interest, and I found myself skipping just to read the true stories.
This entire review has been hidden because of spoilers.
December 7, 2019
This has been super important in helping me to understand some mental health issues related to people first and foremost, and to the not so sturdy world of diagnosis and medication. My words aren’t doing this justice, but this book has changed my perspective on things to be that bit more encompassing and that bit less judgemental.
January 26, 2025
Don't be fooled by the title. This book is about schizophrenia, not some softer version of contemporary narrative on mental health in general. Very well written, great mixture of research, practice and commentary. Personal stories cut the deepest. Chapters on medication and treatment are one the best I've come across. Highly recommended.
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