Christine Montross is a psychiatrist at Butler Hospital in Rhode Island, and in “Falling Into the Fire” she introduces us to many of the patients she has met and treated in the locked wards there. We meet 25-year-old Lauren, who has been hospitalized 23 times in the past four years, each time for ingesting something dangerous: light bulbs, batteries, barbecue skewers, scissors, pins — the inventory goes on. We meet 34-year-old Eddie, who has spent some $50,000 on multiple treatments to “repair” his skin — skin that nobody else finds unattractive. We encounter the gentle and blissful Colin, a disciple of Amma the Hugging Saint and her doctrine of love, who is so focused on his spiritual quest that he forgets to eat. And there’s Anna, terrified and ashamed of her persistent thoughts of stabbing or drowning her 15-month-old son.
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. 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. The circumstances for probing and healing these troubled psyches are far from ideal these days, she notes. In this era of managed care and brief hospitalizations, psychiatry has been reduced to little more than crisis management, and we feel Montross’s frustrations as she stabilizes and releases patients who are still unwell — only to see them readmitted again and again.
Yet this is not a political book, nor is it a whine about the hegemony of insurance companies or the perils of psychiatric drugs. Montross prescribes antipsychotic drugs when called for, to stabilize patients in crisis, but she also draws on a range of therapeutic approaches, including psychoanalysis and attachment theory, focusing on her patients as human beings with human afflictions. Her patients’ neurons are certainly misfiring, but these individuals have just as certainly led beleaguered lives with fractured relationships. Montross describes the challenging task of sorting all that out and designing the most effective interventions case by case.
Mental disorders are idiosyncratic and often defy categorization, yet clinical categories are crucial. Montross makes this point with the case of Anna, the mother who was terrified of killing her son. In her situation, a plausible diagnosis of psychosis would lead to one treatment approach, and an equally plausible diagnosis of obsessive-compulsive disorder to quite another. A misdiagnosis, and a misguided course of action, could have catastrophic consequences.
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. Her own visceral maternal fears of inadvertently hurting her children reflect Anna’s terrors, but Montross’s are fleeting and normal, and they make Anna’s more unbearable by contrast. Other details of Montross’s full and joyous family life serve to accentuate the humanity she brings to her work.
Montross’s case studies collectively emphasize the point that Jamison was making in that lecture: Mental illness is all-consuming, eclipsing even the most basic of life’s pleasures. It is not something to be celebrated as heroic or ingenious. Indeed, many of these patients’ symptoms make them thoroughly unlikable — rude, insulting, selfish. The sad reality is that the mentally ill often drive away the very people who love them and might support them, including, in many cases, their psychiatrists.
Kristina Morgan’s “Mind Without a Home” dramatizes this truth about mental illness. It is her account of living with schizophrenia, and nobody will mistake it for art. The writing and thinking are fragmented, unpolished, repetitive, sometimes incomprehensible and annoying. The narrative has no sense of proportion, detailing trivial interactions and jumping over months and years. What’s more, it’s not really possible to know what’s real, what’s imagined and what’s fabricated.
Yet Morgan’s memoir should not be ignored. It takes us inside her whirling inner life and leaves us as disoriented as she must be all the time. We experience her dysfunction, and it’s not comfortable. Some readers will grow impatient with what seems at times like gibberish, just as her family and friends and counselors often do. Others will find it eye-opening and insightful.
“Mind Without a Home” is published by Hazelden, a publisher that specializes in books on addiction and recovery from addiction. This is notable because, although Morgan’s subtitle is “A Memoir of Schizophrenia,” it could just as well have been called a memoir of alcoholism or — more accurately — madness and addiction together. Many of the seriously mentally ill are also addicts, and in Morgan’s case, her drinking undermines her potential for managing her schizophrenia, which in turn exacerbates her stressful life and her alcoholism. This story of her dual struggle is raw and untutored and far from triumphant, but if it makes more people aware of this common and destructive dynamic, it is an important document.
is writer-in-residence at the Association for Psychological Science, where he writes the “We’re Only Human” blog.