Hospice spends the majority of its time at that precipice, straddling an emotional expanse that's both morbid and racked with guilt, self-loathing and desperation. And while this might not sound like the most pleasant way to spend the best part of 50 minutes, The Antlers manage to create an intoxicating ambient landscape within which Silberman exercises his cathartic right. But to simply call the landscape "ambient," and be done with it, sells it horribly short.

While Silberman's frail Jeff Buckleyesque falsetto and jittery, irony-free confessions have a tendency to create more questions than answers, The Antlers' implicit grasp of musical cause and effect dictates exactly how the listener feels, from Prologue's first disquieting mechanical breaths to Epilogue's final eerie fairground melody. Illustrating a masterful grasp of musical subtlety, Hospice is a haunting landscape, as fantastical as it is frustrated, enthralling as it is encompassing.

Prologue continues with a sudden, sharp rush of sound. It's as though someone has been chemically awakened from sleep. Creepy, twitching electronica borrowed from Thom Yorke's Eraser project accompanies the patient through a drugged-up haze of bleach-white corridors and sliding doors. Silberman barely sings as the album quietly segues into Kettering, he's only able to whimper: "And walking in that room / when you had tubes in your arms / those singing morphine alarms / out of tune."

It soon transpires that Silberman's care was not always welcome: "You said you hated my tone / it made you feel so alone" and that life is not always meant to go on: "I didn't believe them / when they told me that there / was no saving you." Although the song rouses itself into a skyscraping Sigur Rós-inspired half-climax, the sombre, helpless mood soon kicks back in.

It comes with a slight sense of relief when Hospice occasionally and unexpectedly shifts out of its sleep-deprived, drug-addled gloom and lapses into the fervent, boiling-over tension of Sylvia. Silberman's outbursts and the musical landscape's propensity to recollect or quietly confess before it BARKS OUT its frustrations means this isn't an album to get quickly comfortable and intimate with.

Rather, it keeps its audience sat in the hospital waiting room, waiting for news, on the frayed edges of tension. The beautiful, sprawling morass of Atrophy calls the bereft landscaping of Mojave 3 to mind as it weaves relationship breakdown into the bleakness: "In your dreams I'm a criminal / horrible / sleeping around / while you're awake / I'm impossible / constantly letting you down."

Amid the maudlin gloom and despite the convulsive waves of passive aggression, there are genuine chinks of light. Both the Neutral Milk Hotel-inspired Two and the twinkling Velvet Underground chamber-pop of Bear provide vestiges of hope on which to cling. As does Shiva, with its beautifully timed and underplayed brass-laden serenade. During Wake, those glimmers of light slowly transform into mighty celestial beams. Silberman softly cries out: "I'm letting people in," as a stunning crescendo of church organs, gospel singers, trumpets and crashing cymbals brings an end to Silberman's isolationism and speaks of some kind of salvation at the end of it all.

In a similar fashion to Bon Iver's For Emma, Forever Ago, Hospice succeeds by conveying deeply personal traumas as universally appreciable truths, until one man's lonely, painful catharsis transmogrifies into something panoramic and shared by all. And though the world will always ponder over the great imponderables, one can't help feel that Peter Silberman may well have found the answers he was looking for.

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Mercury Prize 2009 nominees