Falling Into the Fire

April 15, 2013
In describing her own experiences and providing a survey of both the history and the current state of the field, practicing psychiatrist and Brown University assistant professor Montross (Body of Work) tackles the professional, ethical, and moral difficulties of diagnosing and treating mental illnesses. By focusing on several galling case studies—such as that of Anna, an otherwise caring and compassionate mother plagued by obsessive thoughts of killing her young child—Montross exposes and explores the challenging, sometimes paradoxical role of psychiatric professionals. 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.” 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.” Agent: Kristine Dahl, ICM.

May 1, 2013
In her residency and now as a professor (Psychiatry and Human Behavior/Warren Alpert Medical School, Brown Univ.) and a hospital inpatient psychiatrist, Montross (Body of Work: Meditations on Mortality from the Human Anatomy Lab, 2007) describes her encounters with patients in crisis, first admitted to emergency rooms and then referred for hospital stays. 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." Montross writes of these encounters with a dramatic flair, ever empathetic but unsparing of occasional negative feelings, fears and frustrations. Diagnosis is not always easy. Even when a patient's back story reveals plausible causes of illness, there is little therapy can do if the patient is unwilling, given the limitations of insurance and the need to discharge patients once "stabilized." Oddly, patients afflicted with extreme forms of body dissatisfaction--who want a limb amputated, for example--are "cured" if the surgery takes place. In the absence of cures, Montross offers solace--just being there with a patient. She provides background and current thinking on the particular cases she describes, discusses the legal issues of involuntary treatment and inveighs against academics who see mental illness as one side of creative genius. 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.

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