Like the rest of the Orwell prize shortlist, Milkman has a theme rather than an agenda. Always capacious, the genre of political fiction can now accommodate authors such as Ali Smith, Rachel Kushner, Paul Beatty and Jonathan Coe. As George Orwell wrote: "No book is genuinely free from political bias. The opinion that art should have nothing to do with politics is itself a political attitude." Much harder to find, however, is an example of what one might call the campaigning novel: that subset that includes classics by the likes of Charles Dickens and Émile Zola alongside fiction-cloaked manifestos, memoirs and works of reportage.
As junior doctors who work on acute inpatient psychiatric wards, serious mental illness is our daily reality. We have, therefore, watched the controversies around Todd Phillips’s Joker – in which Joaquin Phoenix plays a troubled loner who turns to violence – with professional interest. The film’s dominance in the debate about portrayals of mental illness in the movies comes at a curious time. Recently, we’ve witnessed great leaps of awareness about relatively common mental-health issues such as depression and anxiety, and with that awareness, increasing dismissal of the sort of unhelpful prejudices that used to surround them.