Rise and fall

Abstract

It's never easy to review a book that's already won a literary prize and is at the time of writing longlisted for a second. Nathan Filer's The Shock of the Fall was perhaps a surprising candidate for Costa Book of the Year, a first novel about psychiatric care from a creative writing lecturer who is also a mental health nurse. It's narrated by Matthew, a 19-year-old inpatient tapping out his life story on a psychiatric ward computer. We're made aware from the outset that Matthew might not be the most reliable of narrators since the first thing he tells us is that he is “not a nice person”, and the second is that he believes memory itself to be unreliable. We have to piece together the events of Matthew's childhood, in particular the death of his brother, but as we do so the ward environment begins to impinge. Filer reminds us of the boredom engendered by lack of therapeutic structure and notes how staff (the student social worker who reads over Matthew's shoulder; the chummy occupational therapist who permits Matthew short bursts of computer time) are often uncomfortable acknowledging the power they wield. The novel has a curiously light touch and a feel of the young adult market about it. Filer stated in an interview for The Guardian that he read both The Catcher in the Rye and The Curious Incident of The Night-Time while he was writing, so perhaps this is unsurprising. There is, however, a bitter edge to The Shock of the Fall as it explores Matthew's development within the jagged confines of a home irrevocably damaged by bereavement. The Shock of the Fall has been well received within the mental health community. Filer maintains his nursing registration by working occasional shifts and it shows; his depiction of the ward and tone of letters attempting to enforce Matthew's Community Treatment Order struck a chord with many service users. For me there is a slight sense of wanting more, engendered perhaps by such huge critical success. But there is much for professionals to reflect on regarding the purpose of inpatient treatment and the role of life experiences in psychosis, while those with no experience of mental health services should find a little light shed on the workings of “the system”. Amen to that.