I’ve had to leave the cafe I was in. I’d been there for about 45 minutes, nursing my cool drink and reading ‘The Shock of the Fall‘ by Nathan Filer on my kindle. I had to leave because as I got about 90% of the way through I was balling my eyes out and people were starting to look at me strangely.

It’s a remarkable book and I can see why it won the overall prize for the Costa Book Awards. I’ve only read one of the other nominated books of the year – ‘Life After Life‘ by Kate Atkinson.  It was really good but left me feeling uneasy and unsure as to what the outcome was for the main character. But I think that’s what she intended when she set about writing a book in which Ursula dies over and over again, living different parts of her life in different ways to produce different strands of reality and possibility.

But The Shock of the Fall is very different.  I don’t know if my reaction to the book is because I’ve worked with people with mental health problems or because I’ve lived with, and been in a relationship with someone, with a mental health and substance misuse problem, or just because it’s excellently written.

The book tells the story of Matthew, how he and his family react after his older brother dies when he is younger and then follows him into young adulthood as he develops schizophrenia.  Matthew’s narration of his own life jumps forward and back, hinting at the circumstances surrounding Simon’s death, but not revealing them until well into the novel.  It’s told very much in his own voice and the layout, even on an e-reader, very much reflects this – there are sections from a typewriter, computer, letters etc. At times reading it I felt as though perhaps I have more of a mental health problem than depressive episodes from time to time, but I think it’s more because I recognise the patterns of behaviour, the relationship strains that can come from bereavement and loss, the ridiculous terminology that comes along with the mental health system.  At one point a support worker refers to Matthew as a ‘Service User’, he said he thought he was a patient, paragraphs later she offers him a patient information booklet, to which he responds ‘I thought I was  a service user.’

It’s interesting and refreshing to see mental health being written about in this way – the way Matthew responds to letters from his care team, the meeting with various health professionals to discuss his care plan with very little input from Matthew himself.  He isn’t just writing, he’s engaging in writing behaviour.  I remember reading an article somewhere about a father talking about the terminology used around his autistic son.

‘Steven was transitioned into adult services six years ago. Soon after, he was taken into a care unit against all our wishes which resulted in a well-documented court case (Autistic man unlawfully detained, June 2011).

One of the unit’s ideas was that he should have a person-centred plan. He had to create a wish list, and came up with six things:

• Live at home with Dad
• Go on holiday to Somerset
• Have Christmas presents at home
• See Toy Story 3 at the cinema
• Have breakfast in the bacon shop
• Go swimming at Hampton open-air pool

All six wishes were refused because they were not considered to be in his best interests. To me, that’s not a person-centred plan, that’s a system-centred plan.’

The part of the article that this book reminded me of is quoted below:

‘Here are 10 jargon phrases I jotted down on the back of a beer mat, the kind of things which make Steven’s life sound even less “normal”:

1. I live in my home. Steven’s current placement is in the family home.

2. When I make a pizza, I’m making a pizza. When Steven makes a pizza, he’s increasing his independence skills (as overseen by an occupational therapist).

3. If I cry, I’m sad about something. If Steven cries, it is logged and analysed by the psychologist and positive behaviour team.

4. If I shout or swear, I’m angry about something. If Steven shouts or swears, it is challenging behaviour and new behaviour management plans need to be drawn up.

5. If I choose between steak or fish for my tea, I’m making a choice. If Steven chooses either steak or fish for his tea, he is beingempowered.

6. I have friends. Steven has a circle of support and influence.

7. If I’m asked what I want to do with my free time, I’m planning my hobbies. If Steven is asked what he wants to do with his free time, it’s hisperson-centred plan.

8. If I make an unwise choice, I’ve messed up. If Steven makes an unwise choice he may be lacking mental capacity.

9. If I sort my CDs into alphabetical order, I’m being a bit anal. If Steven sorts his Mr Bean DVDs into colour order, he is being inappropriately obsessive.

10. If I eat two Mars bars, I’m being a pig. If Steven eats two Mars bars, he is challenging boundaries.’

You can read the whole article here.

I don’t think that the mental health and care system sets out to segregate people through this kind of language, but it’s easy to do.  The people who work within the system do amazing jobs, and I don’t wish to take away from that in any way by writing about this, but the book challenges you to think about how people are treated.  Is there a better way?  I don’t know.

The Shock of the Fall is not simply about Matthew’s struggles with his mental health, it’s about his family, his friends, his guilt, his hope, his self expression.  It’s a book about families, loss, grief and searching for redemption for things that you really don’t need to.  It gives an insight into a life of someone with mental illness in the same way as Mark Haddon’s ‘The Curious Incident of the Dog in the Nighttime’ gave insight into Autism.

This is definitely not a book that I will just read and forget.  Matthew is a real character to me know and will hopefully inform the way I think about how we treat people with problems like his. At one point he says ‘I’m mental, I’m not an idiot’ which is something I think is easy to forget.

Get a copy of this book, give yourself a few hours to immerse yourself in it and I’m sure you won’t regret it.  Let me know what you think.