“Falling into the Fire” By Psychiatrist Dr. Christine Montross

Psychiatrist Christine Montross is both an academic and a clinician—she teaches at Brown University and has experience treating inpatients. Falling Into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis is her new book.

The Book Structure

Meehan Crist, Los Angeles Times: “Each chapter begins with an encounter between Montross and a patient, then launches into an investigation of medicine and history inspired by that patient’s illness. Montross seamlessly weaves together history, reportage and memoir while reflecting on the difficult questions that arise as she digs into psychiatry’s past and interviews experts from its present.”

Kirkus Reviews: As an antidote to her daily coping with extreme behaviors, Montross writes serenely of a home life with her family.”

The Patients

Kirkus Reviews: “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.’”

Phyllis Hanlon, NY Journal of Books: “Be prepared to learn about some unusual conditions, including Jerusalem syndrome—’an acute ‘psychotic decompensation’ that afflicted 1,200 tourists to the Holy Land from 1980 to 1993’—and Stendhal syndrome, in which victims are overcome by beauty related to art and architecture.”

A Key Metaphor in Falling Into the Fire

Peter Kramer, Brown Alumni Magazine: “This sense of the enterprise’s imperfection leads Montross to her most constant metaphor for patient care: child-rearing. We meet her partner, playwright Deborah Salem Smith, and their young son and daughter. ‘It turns out,’ Montross writes, ‘that parenting and caring for psychiatric patients have their fair share of similarities. I mean that in all the ways in which that sentence can be interpreted: with love, and frustration, and gratification. With fear, and awe, and ineptitude.’

The Mentor

Phyllis Hanlon, NY Journal of Books:

…(A)s the author struggles with effective ways to treat these troubled patients, she seeks advice from a notable neuropsychiatrist who, instead of supplying a surefire treatment option, explains, ‘. . . you must abide with your patient.’ Basically he emphasizes the importance of creating a cooperative relationship in order to establish a reasonable path to recovery.

In time, the author comes to understand what ‘abiding with her patients’ entails. ‘I must face with them the uncertainty of what lies beyond. I must stand at the edge with them and peer over into the fathomless depths. If I tell my patients, as I do, that this life can be a tolerable one, that they can face their fears and their traumas, their visions and voices, their misery, then I must look at what I am asking them to endure and I must look at it full in the face,’ she writes.

Psychiatry

Publishers Weekly: “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.’”

Falling Into the Fire: Concluding Review

Publishers Weekly: “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.’”

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