About 30 pages in and unable to find my bearings, I flipped to the end of this novel — well, not the actual end, to the acknowledgements (always fascinating) and after them a very handy ‘Q & A with Nathan Filer’. And  there I found the key I needed. As part of a creative writing MA, Filer had taken a module in Suspense Fiction. So then I knew where I was — namely in a story with a question mark hanging over it until the end. Sorted. And hooked.

The Shock of the Fall has just won the Costa Book of the Year Award, the first debut novel to win it since 2006 and described by the judges as ‘so good it will make you feel a better person’. (I squirmed a bit at that.)

The story is told by Matt Homes, a 19-year-old schizophrenic haunted by the death of his Downs syndrome brother, Simon, ten years earlier when the boys were on a family camping holiday. A tragic accident or did Matt kill his brother? That’s the delayed revelation bit.

In mental health language, Matt has ‘writing behaviour’. With flashbacks, hallucinations, lists of slightly lunatic medical questions and drug side effects, a hospital diary recording endless empty days and with added typographical tricks, drawings and asides to the reader, Matt bashes out his story of loss, grief and guilt when allowed time on the clinic’s computer or on an old typewriter provided by his understanding Nanny Noo, all the time struggling with the ‘disease with the shape and sound of a snake’ which ultimately has him sectioned in a psychiatric hospital.

The novel is a worthy winner, as moving, witty and pereceptive about Matt, about the way in which he keeps his dead brother alive within him, as about the grief of his parents and their sometimes inept but loving attempts to help him. The dialogue is wonderfully deft, the story moves at a lickety split pace and even the smallest characters are vividly described.

Every now and again I found myself remembering a comment by Julian Symons on Doestoevsky, to the effect that the value of a distorted vision is that it enables us to recognise a true or clear vision. Matt’s ‘vision’ provides us with some gems — ‘dead people still have birthdays’; ‘reading is a bit like hallucinating’; ‘there’s a use-by date when it comes to blaming your parents’; and the child, not on the naughty step, but ‘the watching stair’, a place which, one feels, is surely where childhood lives.

Filer, a registered mental health nurse and now a lecturer in creative writing, has clearly used his considerable knowledge both of the mental health service and of mental illness in the writing of this novel. He’s never sentimental, though he does provide a healing resolution for Matt who, in the process of reliving his childhood and the loss of his brother, has to lose him again. Matt isn’t cured. We’re told that he’s been back in hospital and will be again — there’s no easy happy ending. Still, Filer delivers pain and joy. One’s grateful for that.