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Falling Into the Fire is psychiatrist Christine Montross’s thoughtful investigation of the gripping patient encounters that have challenged and deepened her practice. The majority of the patients Montross treats in Falling Into the Fire are seen in the locked inpatient wards of a psychiatric hospital; all are in moments of profound crisis. We meet a young woman who habitually commits self-injury, having ingested light bulbs, a box of nails, and a steak knife, among other objects. Her repeated visits to the hospital incite the frustration of the staff, leading Montross to examine how emotion can interfere with proper care. A recent college graduate, dressed in a tunic and declaring that love emanates from everything around him, is brought to the ER by his concerned girlfriend. Is it ecstasy or psychosis? What legal ability do doctors have to hospitalize—and sometimes medicate—a patient against his will? A new mother is admitted with incessant visions of harming her child. Is she psychotic and a danger or does she suffer from obsessive thoughts? Her course of treatment—and her child’s future—depends upon whether she receives the correct diagnosis.
Each case study presents its own line of inquiry, leading Montross to seek relevant psychiatric knowledge from diverse sources. A doctor of uncommon curiosity and compassion, Montross discovers lessons in medieval dancing plagues, in leading forensic and neurological research, and in moments from her own life. Beautifully written, deeply felt, Falling Into the Fire brings us inside the doctor’s mind, illuminating the grave human costs of mental illness as well as the challenges of diagnosis and treatment.
Throughout, Montross confronts the larger question of psychiatry: What is to be done when a patient’s experiences cannot be accounted for, or helped, by what contemporary medicine knows about the brain? When all else fails, Montross finds, what remains is the capacity to abide, to sit with the desperate in their darkest moments. At once rigorous and meditative, Falling Into the Fire is an intimate portrait of psychiatry, allowing the reader to witness the humanity of the practice and the enduring mysteries of the mind
- Sales Rank: #177622 in eBooks
- Published on: 2013-08-01
- Released on: 2013-08-01
- Format: Kindle eBook
From Booklist
Psychiatrists regularly deal with people who are out of control, scared, suicidal, or despondent. “It is not a dull job,” Montross writes. Each chapter of her book revolves around a theme: difficulties in establishing a psychiatric diagnosis, patients who intentionally injure themselves, the responsibility of involuntary psychiatric hospitalization and treatment, patients who are preoccupied with and tormented by their essentially normal anatomy, and how the mind can make the body sick. Readers meet a mother who experiences recurrent thoughts of hurting her child, a young woman who won’t stop swallowing foreign objects (crushed light bulbs, AA batteries, and knives), otherwise sane people with normal legs desiring elective limb amputations, a man with either early schizophrenia or bipolar mania whose “bliss” is medicated away, and a woman with pseudoseizures (their origin is psychological, not neurological). Montross finds a sort of spirituality in her profession—“Healing is a kind of holiness,” “Every diagnosis is an act of faith.” Diagnoses rest upon a physician’s knowledge and judgment but also clinical intuition. We are all fragile and vulnerable creatures. Compassion counts. --Tony Miksanek
Review
Pauline W. Chen, M.D., The New York Times:
“Thought-provoking…Dr. Montross, an award-winning poet before attending medical school, is passionate about her work and her patients’ plight…She addresses these issues with intelligence; and by deftly intertwining her patients’ stories with historical facts, current research and ethical quandaries, she presents a moving and nuanced picture of the psychiatric patient and doctor relationship, and a riveting and thought-provoking look at mental health care.”
Los Angeles Times:
“Thoughtful and deeply compassionate…[Falling Into the Fire] is a fluid meditation on the limits of medicine and how Montross learned to care for ‘people nearly all of whom are in profound moments of crisis.’…This is not a doctor puzzling clues together like some real-world Dr. House; this is a doctor struggling to sit with the uncomfortable questions that arise when medicine doesn't have any answers.”
The New Yorker:
“Montross explores the practical, emotional, and philosophical challenges of working with patients whose illnesses of the mind are often intractable and deeply disturbing.”
The Washington Post:
“[Falling Into the Fire] draws a troubling but illuminating picture of what it’s like to be locked into unrelenting emotional and mental chaos…Montross does want to illustrate the ‘messy, unsatisfying, nonconforming human mind,’ but this is also her story—and the story of all those whose mission it is to comprehend and treat these perplexing illnesses…Montross inserts herself, along with her partner and two children, into the book, with powerful effect. Parenting and caring for patients have quite a bit in common, she explains, including love, frustration, ineptitude—and of course fear…Other details of Montross’s full and joyous family life serve to accentuate the humanity she brings to her work.”
Providence Journal:
“Writing with elegance and a sharp-eyed for detail a novelist might envy, Montross brings us examples of minds that, in her words, are ‘standing at the edge,’ if not already singed by the fire…Rare are such gripping accounts of the difficulties of treating mental disorders…I applaud the compassion and empathy she brings to what arguably is health-care’s most difficult specialty…Montross writes first and foremost as a person, as someone with a lively intellect and authentic emotions. She cares deeply about her patients. For these reasons, Falling Into the Fire is a significant book for anyone who has been touched directly or indirectly by passing or permanent disorders of the mind (and is that not pretty much everyone?)… [A] powerful book.”
Daily Beast:
"Falling Into the Fire is as good an account of the labyrinth of mental health care as you’re likely to read. [Montross’s] work in critical care psychiatric settings is the source material, and she launches from discussions of clients into larger questions about the nature of psychiatry and of mental health. Montross writes beautifully about the deep-seated illnesses that challenge therapist and psychiatrists."
The Sunday Telegraph (UK):
“Fascinating…[Montross] is very good at exploring the ethical issues raised by her practice…that there are no certain answers to these questions only makes them more absorbing…Montross writes beautifully.”
The Independent (UK):
“This account by a practising psychiatrist is the kind of confession doctors aren’t supposed to make: that they don’t always know what to do, and they may spend their entire working lives learning on the job…The relationship today between doctor and patient may be a long way from those 19th-century cases Montross occasionally refers to, but the issue of power is still a troubling one, as is our obligation to those who struggle to cope.”
Kirkus Reviews:
“A sympathetic portrait of seriously ill patients that could guide future practitioners on the art of helping, if not always healing, the sick.”
Publisher’s Weekly:
“…[Montross’s] intriguing analysis is anchored by the humble and empathetic voice of a psychiatrist working in a field wherein 'every diagnosis is an act of faith.'"
Shelf Awareness:
“Montross is pragmatic and compassionate in her attempts to understand the complexities of each individual's neurosis, intertwining research into early medical and psychiatric practices with reflections on her family as she searches for a medical treatment that will be effective—and that her patients will be willing to follow. Empathetic and informative, Falling into the Fire is a fascinating look into the convoluted world of psychiatry and mental illness.”
About the Author
Dr. Christine Montross is Assistant Professor of Psychiatry and Human Behavior, and Co-director of the Medical Humanities and Bioethics Scholarly Concentration at the Warren Alpert Medical School of Brown University. She is also a practicing inpatient psychiatrist. Dr. Montross’s previous book, Body of Work, was named an Editors' Choice by The New York Times and one of The Washington Post's best nonfiction books of 2007. She and her partner, the playwright Deborah Salem Smith, live in Rhode Island with their two young children.
Most helpful customer reviews
26 of 28 people found the following review helpful.
Sensitive, poignant and extremely worthwhile
By Trudie Barreras
Again, the opportunity to read for the Amazon Vine has presented me with an amazingly rewarding experience. Dr. Montross' book is an extraordinary excursion not only into some of the more bizarre expressions of - as her subtitle says - the mind in crisis, but also into the convoluted world of medical ethics. She even delves, with sensitivity and poignancy, into deep questions of the overlap between mental illness and spirituality, and problems of mortality.
Although some of the case studies Montross gives might seem to go beyond the plausible, I'll admit that I was absolutely convinced of their veracity in the very first chapter, titled "The Woman Who Needed a Zipper". As it happens, during my high school teaching years, one of our "motivational speakers" was a radiology technician who enthralled my students with X-rays showing a patient having exactly the same syndrome, who had swallowed an incredible array of objects - safety pins, nuts and bolts, blades of various sorts, and so on. Likewise, the author's poignant description of the tragic cases of mothers who had murdered their own children, as well as those who had NOT done so but feared their own impulses, reminded me of some of my own personal struggles with parenting. It is both sobering and reassuring to know that one is not alone in having had near homicidal (as well as suicidal) thoughts in moments of extreme stress.
Probably for me the most impressive insight that Christine Montross shared is the perception that in many circumstances where one is dealing with the extreme mental and emotional trauma, the true calling that both professionals and others often have is simply to "abide". She attributes this terminology to her colleague Dr. LaFrance, who mentored her in the treatment of what are classified as "conversion disorders" such as nonepileptic seizures and psychogenic motion disorders. This term implies a very deep level of compassionate and watchful presence - not trying to "fix" things, not engaging in frantic activity and interventions which may do more harm than good, but simply to be WITH the sufferer during the time of crisis.
In addition, Christine Montross gave an extremely vivid and honest discussion of her family life, her challenges as a parent who is also a doctor, and interwove various personal vignettes into the narrative which provided delightful warmth and personality to the clinical descriptions and historical references with which the exceptional study abounds. Although this is my first experience with her writing, when checking out her home page on the Internet, I found that she is also a published poet. I was not at all surprised.
11 of 12 people found the following review helpful.
An intriguing and touching book about psychiatric patients and the people who try to help them
By Cilla
I will admit that I am a tough critic when it comes to books about psychiatry because I am a psychiatrist myself. I don't think that this book was written with other mental health professionals as the main audience, yet I learned more about my field and was inspired by the stories of patients and their caregivers. The book is written so that "lay people" can get a glimpse into the world of psychiatry, which is often fascinating and heart-breaking at the same time. There are five chapters, an epilogue, and a prologue. Each contains the story of one or two patients the author, Christine Montrose, encountered in her practice. The patient vignettes are then used as a basis for a discussion of specific diagnoses, often including a look into the history of psychiatry. In each instance the diagnostic and ethical dilemmas as well as the treatment issues involving both the patient and the practitioner are explored.
Dr. Monstrose is an inpatient psychiatrist, so the types of mental illness and the severity of the disorders tend to be more extreme than what is generally seen in outpatient psychiatric practice. However, the issues of the relationship between patient and mental health professional, the frustrating aspects of working in a system where there are often too many "unknowns," and the challenges of dealing with the amazing and complicated mind are universal to the field of psychiatry wherever it is practiced. The author chose to high-light particularly difficult cases in order to discuss these issues in an interesting manner.
I have to admit that at first I felt the book dragged a bit and I feel that this could be improved by changing the first chapter. The book begins with the case of a severely depressed patient and a discussion of how mentally ill patients were treated in the past, particularly at Bethlem("Bedlam") Hospital in England. I think that it would be better if the case of one of the more unusual and "energetic" patients from subsequent chapters was used to start off the book. The information in the epilogue is good and I would still use it, but the lethargy of the patient got passed to the tone of the book at that point. This is perhaps a minor point, but I would be sorry to see readers give up on the book because the first chapter does not draw them in and make them not want to put the book down. The subsequent chapters do that.
Each chapter includes some personal vignettes from the author's life, serving to illustrate a point or to just provide the necessary balance of "health" in the midst of disease. I enjoyed getting to know the author in this way. I also appreciate how she wasn't afraid to reveal her own vulnerability and how that mirrors the vulnerability of every mental health professional and the practice of psychiatry as a whole. There is so much about the mind that is still unknown. I was touched by and could relate to the idea that when there doesn't seem to be anything that can be done, there is value in "the capacity to abide, to sit with the desperate in their darkest moments." The case studies include a patient who ingests foreign objects, a patient who had thoughts of killing her child, and a patient who felt his face was disfigured despite having a normal appearance. Dr. Montrose includes historical and recent information about the various disorders. For example, the chapter about the mother who is admitted due to thoughts of harming her child includes a discussion of the much-publicized Andrea Yates case.
I would recommend this book to anyone who is intrigued by the workings of the human mind. There is much "human interest" in this book to captivate the reader, but also a solid base of information about psychiatric disorders and the medical profession as a whole. The book is gritty and real, so I would add the caveat that it could be distressing for some readers, but I think there is enough hope and compassion in it to balance out the disturbing details that were necessary to a thorough discussion of the subject.
8 of 9 people found the following review helpful.
Looking into the Abyss
By Amateur curmudgeon
Dr. Christine Montross is a psychiatrist, she is also a mother, and a great storyteller. In her book "Into the Fire" she tells, as many doctors do, stories of patients she's treated, of lives she's touched. Doctors touch lives, and that is the attraction, the drug if you will, that keeps us coming back for the next hit. To touch somebody, a person, a life and make it better.
Of course psychiatrists touch something most doctors would prefer not to see, not to touch, and pretend it doesn't exist. Mental illness is not something that doctors, or people in general, like to relate to. It is too weird, too strange, to close to things we'd rather not acknowledge. It brings us face to face with the fear that we, too, could be so afflicted, so possessed; that our inner demons, and we all have them, would one day jump out of the cages where we confine them and take over the circus we call mind.
"When you look into the abyss, the abyss looks into you."
Dr. Montross looks into the abyss, and tells us what it's like. And she does not shrink when it looks back into her. She tells that too, in short, emotional personal stories, interjected between her case histories, like page markers in a book.
Good stuff.
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