Falling Into the Fire

Falling Into the Fire

A Psychiatrist’s Encounters with the Mind in Crisis

Additional Formats
  • Hardcover
  • ISBN 9781594203930
  • 256 Pages
  • Penguin Press
  • Adult


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

Falling Into the Fire

Falling Into the Fire

Christine Montross


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.”


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