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Directing the gaze: A discussion of writing, psychiatry and criminal justice

Author and psychiatrist Christine Montross discussed her work and read excerpts from her books at a recent event at Stanford.

Christine Montross, MD, recalled that the night before she attended medical school, she feared that she was giving up her opportunity to write. “And then, I entered into the anatomy lab and was asked to touch and cut open a dead body and of course I had to write about that experience to make sense of it," she explained.

What followed was a career pairing clinical work with nonfiction writing, which Montross, a psychiatrist at Brown University, discussed at the recent Annual Pegasus Physicians Lecture at Psychiatry Grand Rounds on campus.

Montross explained that her early experiences in medical school turned into her first book: Body of Work: Meditations On Mortality From The Human Anatomy Lab. She shared a passage:

I hold the three bones in place in a straight line and bend them at the joint and put the bones down on the floor. The movement is utterly human. Unquestionably so. I look at them, now separated on my carpet and think, bones! just bones... The most alarming moments in anatomy are not the bizarre, the unknown. They are the familiar.

Montross currently works at an inpatient psychiatrist hospital — Butler Hospital —in Providence, Rhode Island: “I absolutely love my job but in it I see a great deal of suffering." When not at the hospital, she commits several days a week to writing. Montross said her second book, Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis, grew out of a desire to help people understand the struggles her patients endure.

She shared an excerpt:

We all live beneath a veil of invulnerability. Mental illness pierces the veil and those who suffer from it dwell with their fragility in plain view.

My role as the psychiatrist is not to try to repair the veil but to strengthen my patients so that they can live. So that they can suffer less. So that they can hope...

I must stand at the edge with them and peer over at the bottomless depths. If I tell my patients, as I do, that this life can be a tolerable one, that they can face their fears and their traumas, their visions and voices, their misery, than I must look at what I am asking them to endure, and I must look at it full in the face.

In addition to her work at Butler, Montross explained that she conducts “competency to stand trial” evaluations in jails and prisons. This work has led her to critically examine the criminal justice system. “I think about what we know about how a healthy mind can be ravaged by isolation. What does it do to a child’s mind to be alone in a cell for 23 hours a day? What does it do if this is the case for a year?”

She said she plans to focus on the issue in her forthcoming book on mental illness and the criminal justice system.

She read:

We passed one cell in which a boy was alone, standing on his toilet. Neck craned. Stretching his face toward the ceiling and talking out loud at full speed. I said nothing, assuming the boy was mentally ill... But walking through the prison hallways, we then passed another boy in another cell in the exact same position, doing the exact same thing. At which point I knew my conclusion was wrong.

'Why are they standing on their toilets?' I asked the C.O.... 'They figured out they can talk to each other through the vents.That’s the only way they’ve got to talk to each other...'

This is the human pull for connection. The lengths of discomfort and risk and innovation that human beings will go to in order to reach out to one another.

“I didn’t understand it when I took on that first project, but I understand now. My intention in my writing all along: about dead bodies, about mental illness, and now about jails and prisons is to look where people do not wish to look. To direct the gaze towards something that we’re inclined to avert our eyes,” Montross said.

Photo by Len dela Cruz

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