Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis

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A doctor of uncommon curiosity and compassion confronts cases that challenge and deepen her practice

In Falling Into the Fire, psychiatrist and author of Body of Work Christine Montross reveals the complexities of navigating the mind’s treacherous terrain. Montross’s journey spans the course of her residency and her early years as an attending physician, and is shaped by a set of gripping patient encounters. Each case study presents its own ...

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Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis

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A doctor of uncommon curiosity and compassion confronts cases that challenge and deepen her practice

In Falling Into the Fire, psychiatrist and author of Body of Work Christine Montross reveals the complexities of navigating the mind’s treacherous terrain. Montross’s journey spans the course of her residency and her early years as an attending physician, and is shaped by a set of gripping patient encounters. Each case study presents its own line of inquiry, leading Montross to seek relevant psychiatric knowledge from diverse sources. She 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.

The majority of the patients we meet 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.

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? What then? 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.

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Editorial Reviews

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"Insanity is doing the same thing again and again and expecting a different result." The resilience of this quote (which has been misattributed to Einstein, Mark Twain, and Benjamin Franklin) exposes our endless fascination with the roots of madness and psychological problems. Psychiatrist and author Christine Montross (Body of Work) approaches the subject in ways that preclude simplistic aphorisms. In fact, her Falling Into the Fire reveals the often disturbing diversity of mental illness and similar appearing behaviors. Her stories of psychiatric ward patients are rendered with clarity and a deep sense of humanity, making this book much more than a cabinet of curiosities. Editor's recommendation.

Publishers Weekly
In describing her own experiences and providing a survey of both the history and the current state of the field, practicing psychiatrist and Brown University assistant professor Montross (Body of Work) tackles the professional, ethical, and moral difficulties of diagnosing and treating mental illnesses. By focusing on several galling case studies—such as that of Anna, an otherwise caring and compassionate mother plagued by obsessive thoughts of killing her young child—Montross exposes and explores the challenging, sometimes paradoxical role of psychiatric professionals. It becomes abundantly clear that in the field there are rarely simple solutions: it is often difficult to untangle a patient’s symptoms from environmental factors, and what some might consider destructive behavior may provide the patient with genuine relief. On top of all that, Montross must also contend with wearying anxiety, uncertainty, and doubts regarding the efficacy of her aid. “Try as we might,” she writes, “we simply cannot predict which of our patients... will leave the hospital healed, never to return.” Her accounts of the complexities of mental illnesses encountered in the field stand in stark contrast to the tidy descriptions of those illnesses presented in the Diagnostic and Statistical Manual of Mental Disorders, and her 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.” Agent: Kristine Dahl, ICM. (Aug. 5)
Library Journal
Montross (psychiatry, Brown Univ.; Body of Work) here presents a concise analysis of present-day practices in psychiatry based on encounters with patients whose stories provoked deeper exploration of psychiatry’s current definitions of what it means to “help” and/or “harm.” Her admission to having “more faith in medicine before becoming a doctor” suggests a lens of thinking that stretches beyond training to reveal a trustworthy experience. Montross juxtaposes current case studies with historic examples to discuss questions such as why do some people rise with fortitude to meet change and why do others pull back. Her poetic insights into how tragedies may be understood stir empathy, as Montross delves into the details of the history of her patients, some who inexplicably land in the hospital repeatedly for swallowing lightbulbs. This beautifully written book doesn’t offer answers but rather encourages compassion.

Verdict Recommended for readers interested in current practices in psychiatry and stories intersecting research and personal memoir.—Nadine Dalton Speidel, Cuyahoga Cty. P.L., Parma, OH
(c) Copyright 2013. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Kirkus Reviews
In her residency and now as a professor (Psychiatry and Human Behavior/Warren Alpert Medical School, Brown Univ.) and a hospital inpatient psychiatrist, Montross (Body of Work: Meditations on Mortality from the Human Anatomy Lab, 2007) describes her encounters with patients in crisis, first admitted to emergency rooms and then referred for hospital stays. The cases are bizarre: a woman repeatedly admitted for swallowing objects--light bulbs, pens, nails; a man who keeps tearing at his skin and hair, spending thousands on treatments to correct his "ugliness"; a woman so able to feign an epileptic seizure that staff feared she might die from status epilepticus; a mother terrified she would kill her infant, so she "hid all the knives." Montross writes of these encounters with a dramatic flair, ever empathetic but unsparing of occasional negative feelings, fears and frustrations. Diagnosis is not always easy. Even when a patient's back story reveals plausible causes of illness, there is little therapy can do if the patient is unwilling, given the limitations of insurance and the need to discharge patients once "stabilized." Oddly, patients afflicted with extreme forms of body dissatisfaction--who want a limb amputated, for example--are "cured" if the surgery takes place. In the absence of cures, Montross offers solace--just being there with a patient. She provides background and current thinking on the particular cases she describes, discusses the legal issues of involuntary treatment and inveighs against academics who see mental illness as one side of creative genius. As an antidote to her daily coping with extreme behaviors, Montross writes serenely of a home life with her family. No triumphs of modern psychiatry on display here, but rather a sympathetic portrait of seriously ill patients that could guide future practitioners on the art of helping, if not always healing, the sick.
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Product Details

  • ISBN-13: 9781594203930
  • Publisher: Penguin Group (USA)
  • Publication date: 8/1/2013
  • Pages: 256
  • Sales rank: 413,660
  • Product dimensions: 6.44 (w) x 9.10 (h) x 0.93 (d)

Meet 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.

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Customer Reviews

Average Rating 4.5
( 3 )
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Sort by: Showing all of 3 Customer Reviews
  • Posted December 20, 2013

    More technical....almost too much so

    I read Dr. Montross' first book shortly after it was mentioned in Brown Med the magazine of what was the Brown Medical School.

    I thoroughly enjoyed her successes and traumas with anatomy class.

    This book is much more technical and a little harder to read. Not the stuff to try to read on a busy day or at a busy time of the year.

    I'll have to go back to it several times before I finish.

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    Posted September 19, 2013

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  • Anonymous

    Posted December 20, 2013

    No text was provided for this review.

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