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Book Review: The Shock of the Fall by Nathan Filer

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“I should say that I am not a nice person. Sometimes I try to be, but often I’m not. So when it was my turn to cover my eyes and count to a hundred – I cheated.”

Despite his self-deprecating disclaimer, I liked Matthew – the tale’s main character – from the moment I read his opening line an affection remained throughout this beautiful little book. The Shock of the Fall is the debut novel of Nathan Filer, who earlier this year won the prestigious Costa Book Award. It is the tale of a young psychiatric patient and his relationship with mental illness.

As a child Matthew lost his 10-year-old brother, as he edges towards adulthood his mind unexpectedly decides that his dead brother still exists; exists and wants to play! Matthew allows you into his muddled world of schizophrenia in the most tangible way: the milestone childhood moments, the complexities of family dynamics and the mental health issues which seem scattered throughout his family tree; the pain of loss and unrelenting grief; the little and not so little incidents which shape one’s mind. Eventually Matthew comes to terms with a haunting mental illness, which is not so easy to shake off.

The author in a compelling authentic first person voice beckons you into Matthew’s life as he deals with his illness: the uncertainty between reality and madness, the voices, the delusions and the loneliness. As the reader you are invited to contemplate the complexity, pitfalls, inner battle and internal monologue of a young man who is getting to grips with his own mind.  The compulsion to turn each page is as much to do with the fascinating depiction of a person suffering from schizophrenia, as it is to do with the suspense of the story, which is masterfully maintained as we are drip fed information about his brother’s mysterious death.

This book is a clever tale of ‘insight’ the number one buzzword in the professional world of mental health. Insight is the unspoken destination in every patient care plan, every occupational therapy class and the aim of every potent tablet or injection which is, with consent or not, administered to patients locked up in psychiatric units. It is the magic word given to describe a patient who finally acknowledges that they are in fact unwell.

This journey of insight is strikingly illustrated as Matthew explains the difference between physical and mental afflictions: “If you have HIV or cancer or athletes foot you can’t teach them anything. When Ashley Stone was dying of meningitis, he might have known he was dying, but his meningitis didn’t know. Meningitis doesn’t know anything. But my illness knows everything that I know. That was a difficult thing to get my head around. But the moment I understood it, my illness understood it too.”

It is almost impossible not to find yourself entirely on the side of Matthew. I was rooting for him at every turn: excited for him during his brave decisions, sad for him when they backfired, proud of him for his good choices and empathetic and upset on his behalf for the unlucky events and atrocities that he encountered.

Throughout, the author manages to deftly catch the dynamic of mental health services and the monotonous routine of a Michael’s life as a ‘sectioned’ patient. The boredom of life on a psychiatric ward, the tone of the mental health professionals, the awkward care plan meetings, the forced medication and of course the support staff who won’t let you leave the hospital – all expressed with such animation and detail that for much of the story I believed I was reading a set of memoirs. The author’s ten-year background in psychiatric nursing is clear to see.

What sets this novel apart is the balance and combination of humour, sensitivity and gut-wrenching reality weaved throughout this tale. Towards the end of the story there is a precious moment, a tearful hug between two people, where Matthew finally allows himself to cry for all the things for which he had refused to a shed a tear for.  He describes it as crying which came from nowhere but in fact didn’t come from nowhere at all, it came from all the things he had let himself forget:  “For each morning of waking believing for the shortest time that everything was normal, everything was okay, before the kick in the guts reminder that nothing was. Here was every adult conversation that faltered into silence the second I entered into the room.”  This moment captures what I love most about this book.  This brilliant, bright, likable, sensitive lead character who is also in his own words completely ‘mad’.

As a mental health lawyer, every time I step on to a psychiatric ward, what stands out to me is the overwhelming vulnerability of those who are locked up in hospitals. The Shock of the Fall captures this perfectly. It seamlessly illuminates the humanity of our society’s unwell, people who are so often unsympathetically regarded as crazy.  This novel is so astute and portrays mental illness with such a respectfulness, deftness and simplicity. It is not only very impressive, but also, with the number of sectioned patients in this country continually rising, it makes this an incredibly important piece of work.