What I would have liked to read, based on the synopsys: a complex, realistic depiction of life and (unnatural) death on a mental health ward, driven by complex, well-rounded characters and suffused with atmosphere, with maybe some sarcasm, darkness and/or social commentary thrown into the mix.
What I got: a snarky, crass, unsufferable main character constantly hitting me over the head with juvenile oh-so-real language straight out of old school chick lit (thankfully no romance, though, so small mercies), over-explaining suspicions that were fairly simplistic to begin with.
I don't mean to disparage Mr. Billingham, but I did not get the impression that a lot of research went into this novel; in the Acknowledgements section, the author thanks a mental health nurse he apparently got some information from, and he's quite happy to repeatedly list types of medication (speaking of which, is it really common practice to let a patient sleep through dinner and the after-dinner rounds of medication?!? Wouldn't you at least make sure she took her pills?), but that's as deep as it gets. The other patients are mostly played for entertainment, their respective disorders nothing more than quirks, and they all seem to be quite content to be stuck where they are, boring though it may be; there's no sense of suffering (I mean let's face it, being mentally ill sucks) or despondency, and most of the time we don't even get a proper insight into what exactly is wrong with them, they're simply dudes who like to fling food at security cameras (convenient!) or talk about sex a lot, in a decidedly unthreatening Carry On kind of way. Apparently one of them is in the throes of some fairly serious long-term psychosis, but again, this is mainly played for laughs (mention his particular delusion, and watch him go crazy with fear! Funsies), and the descriptions, if you've ever looked into what an acute psychotic episode looks and feels like, don't even ring true.
Same goes for Anorexic Girl -- talk about someone else's love handles, and off she goes on another 5-hour walking bender up and down the corridors! Total riot! First of all, it doesn't really work that way (it's an internal compulsion, not something that's triggered by other people's weight problems), and secondly, it's not funny. (Why is she even there? Wouldn't she have been better off at a clinic specialising in eating disorders?) Alice herself supposedly suffers from PTSD, but again, I did not find any of that convincing.
All told, the hospital setting isn't much more than a gimmick. It should have been claustrophobic and unsettling, because what can be more fundamentally frightening than having control over your whole life taken away from you by a faceless institution while at the same time feeling the moorings of your identity coming loose?, but life on Fleet Ward felt like an extended stay at a particularly crummy B&B in the middle of nowhere.
Out of nowhere, there's some clunky Q&A-type dialogue thrown in regarding how the mentally ill are people too and what it's like to be afflicted, which I found pretty heavy-handed and lip service-y as well as structurally redundant, as it was the author's job to let us live inside the head of one such person -- I get that writing a coherent, structured novel from the perspective of a character who can trust neither her thoughts nor her recollection nor her perceptions is basically the toughest job imaginable, but, well, you know, if you take it on, you take it on, right? I could have done without that Deep Conversation with the café lady, as well as the cringe-inducing messaging between Alice and her former flatmate that added nothing to the narrative except a little padding (strings of emojis, anyone? I think I already used the word "juvenile", so I won't bring it up again).
There's a Twist at the end (*sigh* of course there is) that's apparently supposed to shock us, and then Another Twist I'm pretty sure was intended as a jaw-dropping surprise, but, well, both of them really weren't that surprising at all, especially the second one; I had my doubts about that one pretty much from the beginning.
In the end, this is just another beach read, and of course there's nothing really wrong with that; if you're simply looking for a few hours' entertainment that's a bit "different" and not too taxing AND you can stand the main character's voice and attitude, and are not too particular about the real-life effects of mental illness, Rabbit Hole will probably deliver. Sadly, I was hoping for a lot more.