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Falling into the Fire: A Psychiatrist's Encounters with the Mind in Crisis [Paperback]

Christine Montross
4.0 out of 5 stars  See all reviews (4 customer reviews)
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Book Description

6 Feb 2014

A woman habitually commits self-injury, ingesting light bulbs, a box of nails, zippers and a steak knife. A new mother is admitted with incessant visions of harming her child. A recent graduate, dressed in a tunic and declaring that love emanates from everything around him, is brought to A&E by his alarmed girlfriend. These are among the patients new physician Christine Montross meets during rounds at her hospital’s locked inpatient ward – and who we meet as she struggles to understand the mysteries of the mind, most especially when the tools of modern medicine are failing us. Beautifully written and deeply felt, Falling into the Fire is an intimate portrait of psychiatry and a moving reminder, in the words of the New York Times, of ‘our fragile, shared humanity’.

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Falling into the Fire: A Psychiatrist's Encounters with the Mind in Crisis + The Last Asylum: A Memoir of Madness in our Times + The Shock of the Fall
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Product details

  • Paperback: 256 pages
  • Publisher: Oneworld Publications (6 Feb 2014)
  • Language: Unknown
  • ISBN-10: 1780743661
  • ISBN-13: 978-1780743660
  • Product Dimensions: 13.5 x 21.6 cm
  • Average Customer Review: 4.0 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Bestsellers Rank: 306,192 in Books (See Top 100 in Books)

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Product Description


'Montross explores the practical, emotional, and philosophical challenges of working with patients whose illnesses of the mind are often intractable and deeply disturbing'

(The New Yorker)

'A piercing portrait of psychiatry... Montross seamlessly weaves together history, reportage and memoir while reflecting on the difficult questions that arise as she digs into psychiatry’s past.'

(Los Angeles Times)

'An absorbing glimpse into the darker rooms of the human mind. Christine Montross offers a personal guided tour through fascinating case histories and reveals how very much our minds are our selves, and not always operating in our own best interests.'

(Andrea Gillies, author of Keeper and The White Lie)

'A mind-boggling inventory of psychiatric pathologies… Dr Montross, an award-winning poet before attending medical school, is passionate about her work and her patients’ plight… The book emphasizes neither their madness nor our sanity in the face of mental disease, but our fragile and shared humanity.'

(New York Times)

'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.'

(Daily Beast)

'Montross exposes and explores the challenging, sometimes paradoxical role of psychiatric professionals… Her intriguing analysis is anchored by [a] humble and empathetic voice.'

(Publishers Weekly)

'Her poetic insights into how tragedies may be understood stir empathy, as Montross delves into the details of the history of her patients… This beautifully written book doesn’t offer answers but rather encourages compassion.'

(Library Journal)

'Montross writes of [her] encounters with a dramatic flair, ever empathetic but unsparing of occasional negative feelings, fears and frustrations... 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.'

(Kirkus Reviews)

'These stories are fascinating in the macabre way that psychiatric case studies can be, but Falling into the Fire is not a mere catalogue of human oddities… Her patients' neurons are certainly misfiring, but these individuals have just as certainly led beleaguered lives with fractured relationships… Powerful.' 

(Washington Post)

‘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… revealing.'


'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.' 


'Christine Montross is the latest recruit to our distinguished line of literary psychologists… Montross goes into a great deal of interesting detail.'

(Daily Mail)

'With humanity and clarity, psychiatrist and poet Christine Montross intersperses the harrowing stories of five of the patients she met and treated… her compassion shines through.'



(Press Association)

‘Compelling… Falling into the Fire is a fine addition to a body of writing – including the work of Paul Broks, Kay Redfield Jamison and Oliver Sacks.’


‘Lucid, fluent [and] absorbing… nestles into a burgeoning genre of mental health books focusing on individual patient experiences rather than self-help prescriptions’ 

(Sunday Business Post)

About the Author

Dr Christine Montross is Assistant Professor of Psychiatry and Human Behaviour at Brown University and a practising inpatient psychiatrist with an MFA in poetry. Her writing has appeared in literary journals and women’s magazines as well as the New York Times. She lives in Providence, Rhode Island.

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Customer Reviews

4.0 out of 5 stars
4.0 out of 5 stars
Most Helpful Customer Reviews
Before becoming a psychiatrist, Christine Montross was a poet - I have looked for her poetry, but sadly I have not found any yet - and this really comes across within this book. Despite including medical language and obviously dealing with dark subject matter, Montross's writing style is very accessible.
FALLING INTO THE FIRE is her account of what it was like working within the world of psychiatry. She is open and honest about the struggles and achievements along the way, making this a very 'real' and humane book. Mental illness is so often feared, avoided or misunderstood but here, Montross tries to break some of these barriers down.
One idea I was particularly struck by was the notion of abiding with someone who is experiencing pain. As a counsellor, I come across clients who are in emotional pain, rather than physical pain, but the idea of abiding through this with that client is an interesting one.
I would certainly recommend this for anyone who works as a professional in any kind of health care setting - psychiatrists, doctors, social workers, counsellors etc should get a lot out of this book.
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Easy and interesting to read and yet disappointing: too "bitty", the fascinating cases described, stay unresolved often because of the "System" psychiatrists work in and the biological approach to emotional problems of modern psychiatry,
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5.0 out of 5 stars Five Stars 5 Aug 2014
By Carole
Format:Paperback|Verified Purchase
Beautifully movingly written account by Dr Montross.....a cliche but a "must read" for anyone in the field.
Very worthwhile.
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2 of 5 people found the following review helpful
4.0 out of 5 stars Fascinating look at mental health issues 4 Mar 2014
Format:Kindle Edition|Verified Purchase
A real insight into mental illnesses and the quandry the medics have in treating an injured mind. For anyone wanting a look into what happens in mental health care this gives a realistic look at the many and varied aspects of mental health and the difficulties faced by both patient and doctor..
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Amazon.com: 4.3 out of 5 stars  67 reviews
20 of 21 people found the following review helpful
5.0 out of 5 stars Sensitive, poignant and extremely worthwhile 9 July 2013
By Trudie Barreras - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product (What's this?)
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.
6 of 6 people found the following review helpful
5.0 out of 5 stars Looking into the Abyss 28 July 2013
By Amateur curmudgeon - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product (What's this?)
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.
6 of 7 people found the following review helpful
5.0 out of 5 stars An intriguing and touching book about psychiatric patients and the people who try to help them 22 July 2013
By Cilla - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product (What's this?)
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.
3 of 3 people found the following review helpful
4.0 out of 5 stars Fascinating book 21 July 2013
By M. Hyman - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product (What's this?)
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.
2 of 2 people found the following review helpful
4.0 out of 5 stars A Fascinating Look at Abnormal Psychology 19 Sep 2013
By Falkor The White Luck Dragon - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product (What's this?)
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.
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