The Shock of the Fall By Nathan Filer, book review: 'Moved by the dark humour in a poignant debut'

Nathan Filer's debut novel recently won the Costa First Novel Award. Written by a psychiatric nurse, it is a tragi-comic look at a man's descent into schizophrenia. The novel is written from the point of view of 19-year-old Matthew, who starts off recalling a holiday 10 years earlier with his parents and brother Simon, who had Down's syndrome. We learn early on that Simon died during that holiday, though we don't find out exactly how until later.

Soon afterwards, we learn that Matthew is attending the day ward of a psychiatric hospital, and that he has to have injections at regular intervals. Slowly, the story of the disintegration of his mental state unravels, accompanied by Matthew's child-like illustrations.

Filer develops Matthew's character with immense sympathy and sensitivity and the simple prose is spot on as the plain, honest voice of a teenager. Comparisons with Mark Haddon's The Curious Incident of the Dog in the Night-Time are apt; both writers capture young people with aplomb, and describe illnesses of the mind in ways that convey the pain and confusion powerfully while maintaining dark humour. Peripheral characters are beautifully developed: Matthew's fussing mother, consumed by grief; his equally devastated but solid father; his doting grandmother; his friend Jack who is unsure of how to deal with the mentally ill Matthew. Filer ratchets up the suspense masterfully: although we know early on that Simon dies, the build-up to finding out exactly how it happened is gripping.

Being a psychiatric nurse, Filer has captured the development and the symptoms and signs of schizophrenia perfectly. There is the gradual decline in personality, withdrawal, and neglect of self-care.

Then there are the florid symptoms – auditory hallucinations (hearing voices), and delusions, such as the belief that other people are transmitting thoughts through the TV or controlling one's mind. Filer brings to vivid life the experience of being in a psychiatric institution. He describes perfectly the monotony of imposed routine, the hours of deadening boredom, the temptation to flout drug regimes that cause terrible side effects. He has a smart eye for human foibles: the consultant psychiatrist trying to be benevolently approachable; agency staff who attempt to build up rapport with patients while failing to get even their names right; staff who are too distant or too matey, or, sometimes, just right.

This is a poignant, moving story that well deserves its Costa win.