In 2005, Jason Pierce was working on a collection of songs whose main subject matter was death and mortality. Then, he contracted advanced periorbital cellulitis and then developed bilateral pneumonia, ending up in intensive care and close to death.

Thankfully, he survived, and that experience understandably hangs heavy over Songs In A&E. Titles such as Death Take Your Fiddle tell their own story, but almost every track has a blissful, almost otherworldly feel, linked together by some short ethereal instrumentals entitled Harmony 1-6.

Whatever the story behind the album, the resulting record is Pierce's finest and most consistent since the classic Ladies And Gentlemen We Are Floating In Space. Admittedly, not much new ground is trodden musically - it's the same wonderful mish-mash of blues, rock, gospel and edgy psychedelia, with many mentions of The Lord and fire - but the songs are Pierce's strongest for over a decade.

The aforementioned Death Take Your Fiddle sounds like it was recorded on Pierce's actual deathbed, backed by what genuinely sounds like a respirator and Pierce wheezing his way through lyrics such as "think I'll drink myself into a coma, I'll take any way out I can find". Harrowing it may be, but it's also powerfully affecting.

There's a huge, uplifting gospel element to Soul On Fire, probably the album's most commercial moment, and the 7 minute long Baby I'm Just A Fool sounds almost perky, all strummed acoustics, 'do-do-do's on the chorus, while a string section swells majestically all the time. Yet if you're fearing that Pierce's near-death experience has turned him soft, think again.

You Lie You Cheat is as loud as they come, squealing, distorted guitars and feedback laid on top of each other while Pierce sounds almost distressed as he spits the lyrics out. Even better is Yeah Yeah - if you can imagine Bob Dylan's Subterranean Homesick Blues under the influence of some serious psychotropic drugs, you're nearly halfway there.

Yet overall, this is an album of beauty, redemption and hope. The Harmony instrumentals that link the songs together are far from filler, with Harmony 5 in particular sounding like something that Amélie film score composer Yann Tiersen would make, while The Waves Crash In is a simple love song, made all the more effective for its lack of flourishes. The same is true of the folky ballad Don't Hold Me Close, with some lovely backing vocals from film director Harmony Korine's wife Rachel.

Some may listen to Songs From A&E and dub Jason Pierce a one-trick pony. Which may be true, but what a trick he's managed to perfect.

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Mercury Prize 2009 nominees