Brain on Fire Author: Susannah Cahalan
Brain on Fire Author: Susannah Cahalan
Review By: Chelsea Lowther
We first meet Susannah Cahalan, a bright aspiring journalist at a prominent New York newspaper, facing the mundane problem of bed bugs in her new downtown apartment. However, not all is as it seems- Brain on Fire is Susannah’s gripping real life account of her “descent into madness.” What begins as a slight obsession over bed bugs quickly turns into a downward spiral of recurring psychotic episodes, seizures, and day long memory lapses. Susannah carefully chronicles her month long stay at the NYU Langone Medical Centre and the slew of tests and physicians that follow, leaving readers eager to know: what exactly is wrong with her and will she ever return to her normal self?
Brain on Fire is a poignant reminder to seasoned veterans and future physicians not to lose track of the patient in the middle of a medical mystery. We are introduced to Susannah’s first neurologist, Dr. Bailey, who quickly dismisses her illness as alcohol withdrawal. We later learn that Susannah confronts Dr. Bailey with her final diagnosis and he tries to explain that he saw over 35 patients that day. The exchange is cringeworthy to say the least and a haunting indication that second opinions are sometimes worthwhile.
Susannah is on a roller coaster of diagnoses (bipolar disorder, schizophrenia, and epilepsy) and assessments (spinal taps, blood work, and psychological testing) that ring with such detail you are left wondering why textbooks cannot be written with the same creative prose. We cannot help but feel for Susannah’s family and boyfriend who receive one negative test after another. Infectious disease? No. Autoimmune disorder? No. Encephalitis? No. Is she crazy? To be determined.
When all seems lost we are reminded that science usually has the last word. A single publication from 2005 in Annals of Neurology has prompted Susannah’s second neurologist, Dr. Najjar, to send her spinal fluid and blood sample to a research laboratory headed by neuro-oncologist Dr. Joseph Dalmau at the University of Pennsylvania. As we wait for the results on Susannah’s 25th day in her locked down epilepsy unit, a final round of neuropsychological tests reveal she is cognitively regressed to the point that she could no longer identify a pen. This current picture of Susannah is contrasted with images of her earlier self: a smart, tenacious 24-year-old on the brink of her dream career.
Amidst the medical jargon and eerie video surveillance descriptions is a deeply personal tale of one woman’s experience into madness. All the details of which were gathered from her foggy memory, medical records, psychological test results, family members, friends, nurses, physicians, and even her unit security guards. We learn how Susannah’s illness affects her commonly feuding parents, new boyfriend, as well as new and old friends. We empathize with her parents as they struggle to deal with the “new” Susannah, balancing between her current disability and the desire to grant her independence.
Hidden undertones in her memoir is the sneaking belief that anything- even the locked down epilepsy unit- is better than a psychiatric ward. Hospital staff even goes as far as to threaten to send her to the psychiatric unit if she does not start behaving better. While I find this book to be well-written, captivating, and chock-full of interesting medical information I cannot help but put it into the category of popular media that continues to perpetuate the stigmatization of individuals with mental illness. For if you do not have a clearly defined biological explanation for your abnormal behavior, well, then we would rather not say too much. Having said that, I believe anyone with an interest in medical mysteries will enjoy this book and I promise the ending will be sweetly satisfying and scientifically intriguing!