Book Review: Falling Into the Fire

By David Amirsadri

“At the Heart of the dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg or your brain, it’s still an illness and there should be no distinction.”

— Michelle Obama

The mind is a strange thing. At one moment, the human brain is the source of unparalleled beauty and ingenuity, creating timeless art, elegant equations, and remarkable symphonies. To think is to progress. But this is limited by the very real possibility that the mind could malfunction. The deep anguish of depression, the torture of schizophrenia, and the compulsions of addiction are Hell.  These are bonafide medical maladies, diseases with specific neurobiological bases. Their treatments are clear, and their effects manageable.

Yet, despite advances in pharmacology, psychology, and neuroscience, mental illness remains overlooked. The ravaged brain is stigmatized, and the suffering of the mentally ill is exacerbated because of this. Those infirm of mind are “weak.” They are told to “get over” their problems, as if this were a legitimate solution. Their illnesses are seen as moral failings, not as health problems. It is for these reasons that the voices of medical professionals and advocates for the mentally ill are of the utmost importance. In an age when the mentally ill are blamed for the most heinous acts in society, it is the voices of the medical and mental health community that will guide society towards a more enlightened understanding of the mind in crisis. 

Falling Into the Fire, by Christine Montross, is a book that gives us a peak into a world that most would prefer to ignore. Montross, a practicing inpatient psychiatrist and a poet, unlocks the door to her psych unit, allowing the layperson a glimpse of a patient population greatly misunderstood. Montross writes masterfully, with the clinical expertise of a physician and the acute sensitivity of an artist. She eschews turgid academic prose, while simultaneously avoiding the irrational spiritualization of psychiatric and neurological damage. In Falling into the Fire, Montross paints a portrait of her profession through the discussion of specific patients she has cared for in her medical career.

We are introduced to such figures as Lauren, a woman who compulsively swallows household objects in the face of difficult situations, leading to her repeated hospitalization. Abused and neglected as a child, this dangerous coping mechanism acts as a surrogate for the attention and care that she was denied in her youth. We meet Eddy, a man plagued by Body Dysmorphic Disorder. Though seemingly normal to onlookers, Eddy believes himself to be repellent and hideous. He seeks to correct his imagined flaws through copious amounts of plastic surgery, even going so far as to sandpaper his skin to rid himself of acne scars that aren’t really there. All of this leads to financial and social ruin for Eddy, a masochistic, expensive, and ineffective solution to cosmetic problems that don’t really exist.

Throughout Falling into the Fire, Montross demonstrates the many intricate ways that mind, body, and brain are interconnected. Like the three sides of a triangle, a human being cannot exist without the stability of all three. Interwoven through the book are frank discussions of suicide, self-harm, and psychosis. Montross is unafraid to engage the reader in discussion of these serious topics. Throughout her book, Montross includes vignettes, discussing the ways that her patients inspired self-reflection. Montross is unafraid to parse through the science behind the disorders plaguing her patients, and unapologetically makes the case for her profession. Falling into the Fire is a frank portrait of modern medicine– the ways it heals, and the ways it fails. Montross’s self-reflection, and at times her self-doubt, demonstrate her humility. Montross’s work bridges the gap between mind and brain– she simultaneously assumes the role of the modern physician and the healing shaman. In Falling into the Fire, Montross removes stigma through education. Montross recognizes that ignorance is the root of all prejudice, and provides the remedy.