My Thoughts After Reading The Heartland: Finding and Losing Schizophrenia

I just finished reading an interesting book about schizophrenia written by an ex-mental health nurse in the UK.  The book, The Heartland: Finding and Losing Schizophrenia was on a list of the best mental health books of 2019.  The author, Nathan Filer, takes an in-depth look at life with schizophrenia through the stories of five different people. Between each story he shares his opinion or educational asides. This book was well written and well thought out, but I personally disagreed with his main points.

While I do disagree with him, I still recommend reading his book.  The part I am focusing on is just that, a part of the book.  The personal stories alone are worth the read and you may find you agree with him, and if not, it provides a different perspective.

In The Heartland Mr. Filer focuses heavily on the need to get rid of psychiatric diagnoses as well as most if not all medical interventions.  One of the arguments he makes to that effect that I don’t quite understand is that perhaps the brains of people with schizophrenia just act differently.  Yes, yes they do, that I do not argue with, however many people experience great distress from their mental illness (or “differently working brain”) and can feel relief from medications.  

When someone’s pancreas is not producing enough insulin, then one might say it is working differently, but no one would suggest depriving them of insulin.  The only difference is that we know exactly what is wrong and why the medication prescribed works. Psychiatry is more mysterious than that since there are no blood tests and most medications are a mystery as to how or why they work.

Despite not knowing why a medication works, it has still been scientifically proven to make the desired difference (in some people).  This shows that there is something we can do to lessen the suffering caused by a mental illness and I think it would be cruel and even barbarric to deny people the care that is needed to ease their suffering.

As for Mr. Filer’s premise that we need to get rid of diagnosis, I disagree for several reasons.  One that is the most basic and personal is that having a diagnosis normalizes the illness. It does this by both telling the patient that what they are experiencing is not unique, and that we have even named it and come up with basic treatment guidelines.  Having a name for how I felt was such a relief. It meant that I was a part of a group of people who understood along with me the challenges of living in the world with the same basic set of symptoms.  

I also have trouble with the idea of getting rid of a diagnosis because of stigma.  The argument given for this is that these diagnoses are already stigmatized, and so patients experience stigma from society as well as themselves.  However, I think that if you are saying a set of symptoms are not a specific illness, then you are stigmatizing the person by saying, “the ‘problem’ that shall literally not be named” does not exist; even though the symptoms had previously been labeled as a diagnosable illness.  This would be confusing, hurtful, and a giant sign that society does not care enough to provide a name for the pain suffered by those with mental illness.

We are often told to think about our mental illness like diabetes, but if we don’t have a name for it, then how are we supposed to show it the same medical regard as we do for diabetes or other illnesses.  If bipolar does not exist, and therefore I experience these symptoms for an unnamed/unknown reason, then it would feel much more like a personal failing. If not an illness, then my symptoms are a sign that I cannot control myself and cannot function like others for some unknown reason.

I don’t think the problem is in creating and changing diagnoses as more is learned, I think the problem is that the stigma has become so bad that people think they would be better off trying to live with no diagnosis and often no medication.  There are already sadly far too many suicides and I can’t see how this would do anything but make more occur.

I’m curious what others think.  I recommend reading The Heartland, whether you find you agree or that you do not.  If anything, for me it has provided a lot to think about.


  1. Medications are lots better than the alternative. Getting the medications right is much more important than getting a spot on diagnosis. There is, for example, not much difference in treatment between schizoaffective and paranoid schizophrenia. Antidepressants can be prescribed for either diagnosis. I don’t think diagnoses can be gotten rid of but too much can be made of them. In terms of research fine-tuned diagnoses may be needed but clinically a broadly right diagnose is close enough.


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