Published by Free Press
Publication date: November 13th 2012
You are an outgoing, ambitious journalist already writing for The New York Post at age twenty-four. Suddenly, you start feeling a little off—no appetite, fatigue, and you’re pretty sure people are talking about you. The physical problems increase as do the mental ones—you know people are talking about you and you can see things that no one else can. Your confidence ebbs and flows and your behavior becomes increasingly erratic. Finally, you have a seizure but even then the medical community is not sure what to make of you as all your tests come back normal. Even after a second seizure one neurologist persists in diagnosing you as going through alcohol withdrawal and the rest lean towards a psychiatric problem. You’re admitted to the epilepsy ward of a respected New York hospital and monitored via camera 24/7 but there are still no answers and your condition deteriorates. If this sounds like a journey into hell, it was for Susannah Cahalan.
Finally, through a test as simple as drawing hours on a clock face, a new neurologist was able to move towards an answer that was confirmed after Cahalan underwent a brain biopsy. She had anti-NMDA-receptor autoimmune encephalitis, a disease so rare that, in 2007, she was only the 217th person to be diagnosed. In essence her body was attacking her brain and causing inflammation. Like many autoimmune diseases, its cause is still unknown but is thought to be a combination of virus and genetic predisposition. In Brain on Fire: My month of Madness Cahalan recreates her month of madness as best she can, given the fact that she has no memory of that time. Instead, she relies on the copious notes, journals, and medical records of family and professionals.
From here on, I remember only very few bits and pieces, mostly hallucinatory, from the time in the hospital. Unlike before, there are now no glimmers of the reliable “I”, the Susannah I had been for the previous twenty-four years. Though I had been gradually losing more and more of myself over the past few weeks, the break between my consciousness and my physical body was now finally fully complete. In essence, I was gone.
Cahalan’s journalistic skills serve her well in Brain on Fire. She is thorough and self-aware, even about the fact that there was a time when she was completely lost to herself. She covers a lot of territory, much of it medical but, while that is interesting and informative, it is her personal story that is at the heart of the book. There is the descent into madness which is frightening enough but also the very long and slow recovery process. Despite diagnosis and treatment there was no guarantee she would recover completely. It is this painfully personal prose that connects the reader to the author and keeps Brain on Fire from being a dry scientific text. Instead, it is scary, intense, and profoundly human.