As I described in a recent post about the novel “Our Lady of Alice Bhatti”, the Wellcome Book Prize is celebrating its 10th anniversary this year and I decided to explore this year's shortlist a bit more. One of the judges of this year's award is Elif Shafak and one of the shortlisted books is Ottessa Moshfegh's “My Year of Rest and Relaxation”. While I'm naturally drawn to reading more fiction than nonfiction, this award encompasses both kinds of writing so it's a good chance for me to read a nonfiction book I probably wouldn't have got to otherwise. The prize centres around new books that engage with some aspect of medicine, health or illness. Arnold Thomas Fanning's “Mind on Fire” recounts his lifelong struggle with mental health issues. He vividly describes the unwieldy chaos of manic episodes where extreme feelings and fantasies lead him to take drastic action as he careens through cities and airports shocking or outright terrifying people along the way. It's powerful how he conveys that to his manic mind he's following a logical course of action, but of course on the outside his actions are insensible. He also discloses the sensations of debilitating depression when he sometimes physically can't move and his thoughts revolve constantly around suicide. He eloquently expresses how all-consuming these states are and that “Within it there is no without it.” This illness not only wreaks havoc on his own health, but severely impinges upon the lives of his family and friends as well. Fanning powerfully documents his heartrending, difficult journey.

One of the biggest difficulties in understanding manifestations of mania and depression is how these conditions can exist both as a mental health issue and normal human emotions. It's common for people who suffer from severe cases of this to not have it taken as a medical condition. Instead they are encouraged to buck up and smile instead of frowning as Fanning is encouraged to do by an acquaintance at one point. Fanning concedes that feelings may arise that “may be related to my bipolar disorder, but they are also common human experiences that I share with others. At times I am happy; at times I am sad and I suffer. I have good times, and not so good times. This is life, not illness.” The culmination of his journey marks a point he reaches where he's able to live a stable and productive life, but the extremity of his emotions in this period are very distinct from periods where he was unwell and unable to function. He cites the elements needed for recovery and wellness as being “therapy, medication, exercise, meaningful work (creative, as well as occupational) and a loving relationship and relationships with friends and family.” However, it's extremely difficult to achieve all of these things at once when resources such as money, health care or employment aren't available or support from friends or family isn't available. This combined with a stigma surrounding mental health issues and Fanning's own overwhelming feelings of self-defeat make his path to recovery a long and difficult one.

The book also meaningfully describes how recovery is never a state which will be absolute or constant. There are periods where he seems to have stabilised but due to changes in medication, pitfalls in his creative endeavours in playwriting and screenwriting career or his employment status and/or difficulties in his relationships or environment can send him spiralling into extreme episodes again. His story shows how the fear of relapse can add more anxiety to his state of being. Equally there can be a crushing sense of guilt surrounding the justified wariness from the people closest to him who've been negatively impacted by his breakdowns. Fanning's memoir poignantly conveys all these things and his overall journey gives a moving personal take on issues surrounding mental health. However, there were sections which lingered on details to do with his childhood, certain relationships or creative aspirations which detracted from the momentum of his tale and the impact of his message. I appreciate how he wanted to fully flesh out his life, but the focus at times strayed from the main focus of the issues involved. Nevertheless, I was touched by the honesty of his story and enlightened by the long winding journey of his struggles.

This year marks the 10th anniversary of the Wellcome Book Prize, an award which celebrates fiction and non-fiction that engages with some aspect of medicine, health or illness. The intention of the prize is to raise public involvement and debate around the subject of medicine and health. It’s such a unique focus amongst book prizes whose categories are more general. The prize is indelibly linked to the extraordinary institution that is the Wellcome Collection. This is a free museum and library in central London which engages with the public about issues of health and is a rich resource for many. For instance, Jessie Greengrass wrote the bulk of her novel “Sight” (one of my favourite novels from last year) while working and conducting research in its library – something which is very evident in the text from the way it engages with the history of medicine.

So, to help celebrate this prize’s anniversary, I decided to peruse its history of entrants and read a book that was shortlisted for the prize in 2012. “Our Lady of Alice Bhatti” by Mohammed Hanif is a darkly comic novel that begins with the novel’s titular hero Alice being interviewed for a nursing position at the dilapidated Sacred Heart Hospital for All Ailments in Karachi. It’s a chaotic establishment where blood is sold, medicine is pilfered and nurses are regularly molested (in one vividly horrific scene Alice defends herself with a razor blade). Alice implements simple hygienic procedures which improve the health of many patients, but as a medical facility its run more on faith than it is on science. So when an apparent miracle occurs people flock to the establishment in the hope of being magically cured. It’s a struggle for the rational, but Alice’s main dilemma is overcoming the stigma against her lower caste and Christian background. She seeks to rise above her origins, but things go badly awry.

Hanif’s writing brings the vibrancy and humanity of the city and Pakistani society to life as well as its manifold problems. Running parallel with Alice’s story are the shady dealings of the Gentlemen’s Squad, a police unit that uses strong-arm tactics and is basically a law unto itself. Teddy Butt a bodybuilder (and body waxer) is a freelance thug-for-hire who does odd jobs for them. Alice marries and attaches herself to him in the hope of gaining his protection but when their relationship becomes untenable she finds herself in even more danger. The story shows the absurdities of institutions which are run on reactionary ideas – most poignantly in the hospital’s approach to healthcare both by patients and doctors. The book’s final prologue is a heartrending lament that includes an indictment made by Alice’s father who highlights distinctions between those are deified in our society and those whose memories are besmirched. It’s a compelling and forceful novel.

I’ll be especially interested to follow the prize this year as the chair of judges is author Elif Shafak. A longlist will be announced in February, followed by a shortlist in March and the winner later in the Spring.