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personal vignettes into the narrative which provided delightful warmth and personality to the clinical descriptions and historical references with which the exceptional study abounds.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.
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.
I really enjoyed this book. The author, a hospital psychiatrist, tells a mix of stories about her experiences with patients. There are a number of stories throughout, such as about a women who eats objects (such as steak knives, forks, broken glass) when she is stressed, a women who thinks she might kill her son, and a man who believes his perfectly normal face is so scarred that he obsessively schedules surgeries. With these, and the other cases mentioned, the author discusses the patients lives and her attempts to work with them, as well as general background -- what the disorder might be, theories on its causes or cures, other related cases. For example, the discussion of BIDD (where people want to get amputations) is particularly interesting.
Besides being interesting and emotionally gripping -- because the reader gets caught up in the tragedy of the patients' lives -- the book also discusses and has the reader experience the short falls of the medical system. For example, the woman who swallows knives goes through very expensive treatment every time she comes in to the emergency room (which is often) yet is denied out patient care. As a result, she'll never have the support or counseling needed to get better, and a single hospital visit costs far more than a year of preventative treatment.
With the various cases you see the struggle the author goes through as a doctor -- we know very little, relatively speaking, about how the mind works so she has to rely on intuition to know whether a patient is faking it to get opiates, is bipolar or psychotic or obsessive -- yet at the same time she has to make regular decisions on treatment and whether the patient is a danger to themselves or others. The way the author deals with this ambiguity is particularly moving. In the book, as with the author's real life, we don't know what happens to patients. The author never knows if the patient she releases stays on medication and gets cured, or goes on to a life of misery or suicide. As a reader we want to know what happens, and not knowing makes the book all the more interesting.
A good read.
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.
on August 27, 2013
Combining her own personal life experiences as a partner and mother with those of patients she has witnessed as an inpatient psychiatrist on the east coast, gifted author Christine Montross bridges the gap between a book that is illuminating on the one hand and downright disturbing on the other. Most crucial to Montross' story is her ability to present unique patient histories with an insightful mind that is constantly on the lookout for new means of treatment while providing the reader access to historical data on the subject at hand.
One chapter not to be missed is titled "Your Drugs Take Away the Love" where Montross examines the world of madness as something stimulating creativity, writing, "Even if madness is at the root of some of the world's great creations, it is hard to imagine that if someone asked each of us to live an entire life of suffering in the service of the arts, we would agree to do so." Such statements are wound around the story of an enlightened man named Colin where Montross provides a scintillating "stop and think" challenge for the reader as to how she can treat Colin's psychotic tendencies.
Without doubt a meaningful contribution to her field that is also a learning experience for any reader, "Falling into the Fire" is a terrific follow-up to Montross' first book, "Body of Work." We can only hope that there are many such works to come.
on October 22, 2015
FALLING INTO THE FIRE: A PSYCHIATRIST’S ENCOUNTERS WITH THE MIND IN CRISIS, by Christine Montross, The Penguin Press, 2013, 239 pages.
. My daughter thoroughly enjoyed Montross' book and gsave to me on 2 August 2015. The reviews are mostly positive and deservedly so. Dr. Montross is amazingly candid about her personal life and her interaction’s with psychiatric patients. She skillfully describes how her personal experience, what she learned from her patients and her lessons from mentors and the psychiatric literature are intertwined to help her better understand all humans. While I don't always agree with her conclusions they are well thought out and well researched. She comes across as a very intelligent, thoughtful, caring and loving human.
While anyone can read this book for enjoyment and profit, it will be of special interest to psychiatrists and patients. Frank
From the very cover of Falling Into The Fire we get our first confirmation of author Christine Montross's unflagging humbleness. She supplies only her name, bare of any titular acronyms. She is in fact a medical doctor - a psychiatrist who has earned every right to announce and advertise her impressive credentials. But most fortunately, she is a VERY good writer who can incorporate her noteworthy eyebrows ("badly untended") and substantial height ("Amazonian") into a captivating book and somehow not make it all about HER.
If you are looking for psycho-drama-lit akin to Irvin Yalom's Love's Executioner, Falling Into The Fire is NOT that book. There's no snooping about progress notes and case histories; often we never hear about a patient's outcome. Instead, specific cases introduce surveys of psychiatry and related fields and in every chapter, the author exposes herself as a perennial student. (At one point she disarmingly admits that her treatment plan is "dishonest".)
Montross shares her process of learning difficult lessons, that effective medical professionals must overcome their inability to sit with their own discomfort and helplessness. (I don't think most doctors even think about this, let alone admit to this vulnerability.) When the predictably necessary topic of "do no harm" arises, she makes a carefully reasoned argument as to how this is not always possible nor even ethical in all situations. She can debate such a teasing ethics conundrum with compassion, relevant background, and current thinking.
Clearly, Christine Montross has retained her sense of wonder about humanity, which makes Falling Into The Fire so uniquely readable. I believe she's both an engaging writer and most certainly a stellar psychiatrist. I just hope I never have to review her performance on her day job.
Christine Montross's FALLING INTO THE FIRE provides a sympathetic but pragmatic look into the world of mental illness. The book is divided into five chapters, each focusing on a different condition. The first chapter is about patients who intentionally harm themselves. The second focuses on people with distorted views of their bodies. The third concerns the legal ability of doctors to hospitalize patients against their will. The fourth chapter regards the dangers of illnesses that are not easily defined. The fifth chapter describes patients whose bodies are overtaken by mental illness.
Montross uses the stories of real patients to provide examples of the disorders. This reminds me of neurologist and author Oliver Sacks, particularly his wonderful book THE MAN WHO MISTOOK HIS WIFE FOR A HAT: AND OTHER CLINICAL TALES. (A similar, although more technical, book is V.S. Ramachandran's PHANTOMS IN THE BRAIN.) Like Sacks, Montross is sympathetic towards her patients. Using the stories of real patients provides a human element to the book and reminds us of why it is relevant. Also like Sacks, Montross assumes no prior knowledge of psychology, making it a good introduction to the subject. Montross is a good writer who makes the subject clear and interesting. This book is recommended to anyone interested in mental illness, or psychology in general.
on October 24, 2013
Dr. Montross really, really pays attention, to the people she's with and to herself. And she is a very lyrical writer, an adjective I don't use lightly, and it lends poetry to her detailed and thoughtful prose. I am impressed.
Illness. Madness. Disease. Disorder. Pick one, pick all, add demonic possession if that works for you (hard to get that one past the FDA); a bit of history, a bit of personal experience and insight, and all very very readable.
Suffering, yes, and that's what inpatient psych hospitals are all about. Certainly these aren't the most horrible stories / illnesses I've ever heard about, and I'm sure the author has more / worse / other. The patient stories included in this book are ones that help to illustrate the thin and permeable border between what we call sanity and what we offer inpatient treatment for, and those two states are not always very different.
Interestingly, I read Falling into the Fire a few hours after listening to a podcast with Paul Ewald, who posits a germ theory of some diseases we currently don't understand. The ideas overlap. Doctors have always had to abide with patients who had problems then-current medical science could not solve; 100 years ago, it was polio and infections. Today, it's most of the SPMIs (among other conditions).
Excellent blend of story and science. I kept turning pages. Caught myself wondering if staying up super-late to finish a book about mental illness was itself a sign of bi-polar disorder. Medical books will do that to you.