As we are a hospital based book club some of the members work with people in mental health departments which allowed us some insight into how the drugs that Matt would have to take would affect him. This gave us an added depth of understanding of why he might chose not to take the drugs as they make people feel sick, and foggy. This is compared to how they might feel when they aren't taking the drugs, which may mean that they do things they don't mean to but at least they feel well while doing them.
We discussed why we thought he may have developed schizophrenia, maybe it was due to the shock of the fall, or perhaps it was a genetic influence. During the course of the book we see that Matt's mother has definite problems with regards depression, possible Munchausen syndrome by proxy when she takes Matt repeatedly to the doctor for trivial or even no reason.
As we have already read a book recently about a fictional mental health department in the US for children who harm themselves and others which treated each child individually and with great care we found it depressing to read about Matts experience. He seemed to be left to his own devices a great deal of the time and merely spent it smoking and sleeping. We weren't sure if this was simply his remembrances of this situation which are tainted by his issues or whether the department was trying to give him as little stimulation as possible to stop him having any adverse reactions. This wasn't made clear.
The ending felt very optimistic, we think that Matt may have gained some control over his issues by accepting them and accepting the fact that he needs to take medication and be watched over for his own safety. We also felt that he had accepted his brothers death and now knows that he wasn't entirely responsible for the things that happened. This means that he will have to let go of his schizophrenic connection to his dead brother, but he seems to be able to do this at the end of the book. As with a lot of mental health issues this may not be the case permenantly.
Overall we gave this book 5 out of 10.