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Betrayed by her brain, a journalist pieces the nightmare together

Susannah Cahalan


Brain on Fire
Susannah Cahalan
Free Press

In 2009, Susannah Cahalan was confidently breezing through her 20s without a hint of a quarter-life crisis. An ace reporter at the New York Post since the precocious age of 17, she already had national exclusives under her belt. She had her own Manhattan apartment and a devoted musician boyfriend, Stephen. Pretty and beloved by colleagues and family, she was living what is for many young women a fantasy.

She woke up one day not feeling herself. Worried about phantom bedbugs, she uncharacteristically forgot an important meeting with an editor. Her left hand became numb. She was crying one moment, ecstatic the next. Rooms seemed out of proportion, as if she were Alice lost in Wonderland.

She took a few afternoons off, hoping to feel better. One night, however, she woke Stephen with her horrific moans.

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"I was sitting upright, my eyes wide open, dilated but unseeing. … My arms suddenly whipped straight out in front of me, like a mummy, as my eyes rolled back and my body stiffened," she writes. "I was gasping for air. My body continued to stiffen as I inhaled repeatedly, with no exhale. Blood and foam began to spurt out of my mouth through clenched teeth."

Cahalan was having a seizure – only the most dramatic in what had been a string of mild ones, she later learned. Deep inside her brain, something was very wrong, and it was getting worse by the day.

Cahalan's Brain on Fire: My Month of Madness tells the page-turning story of her family's frantic search for a diagnosis. It comes amid a spate of memoirs of youthful struggles with mental illness and abuse, among them Margaux Fragoso's Tiger, Tiger, Jeanette Winterson's Why Be Happy When You Could Be Normal? and, also just published, Ellen Forney's graphic novel about bipolar disorder, Marbles.

Because her illness was as brief as it was severe, however, Cahalan's book is no pained confessional of past traumas. It's a breakneck neurological detective novel, with a team of doctors racing to understand what is happening to her.

At first, they stumbled. A misdiagnosis of alcoholism allowed Cahalan to slip further down her rabbit hole of madness. Her first-person perspective of an illness hell-bent on eradicating her personality is terrifying. Once warmly social, she became paranoid, convinced loved ones were imposters (that's known as Capgras Syndrome). Once a conversationalist, she now drooled and slurred her words. Once fiercely independent, she now needed 24-hour care.

Cahalan the narrator can soon go no further. After another major seizure, she fell into psychosis, then catatonia. Mercifully for her, this came with profound memory loss; of her stay at New York University's Langone Medical Center, she remembers little besides her own flickering hallucinations. So Cahalan the journalist seamlessly picks up the thread of her story, mining hospital video recordings and the journal her estranged parents used to communicate with one another to piece together her lost time, just as if she were a reluctant New York Post subject.

After a battery of tests turned up nothing, Cahalan seemed doomed for transfer to a psychiatric ward, where, without a diagnosis, she would have faced decline and death. At the last moment, Syrian-born neurologist Souhel Najjar – known for cracking mystery cases – was assigned to her.

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Putting aside MRIs and EEGs, he handed her paper and asked her to draw a clock face. She drew numbers on one side of the face only. It was a breakthrough. One hemisphere of her brain was inflamed, under attack by her own body.

Although it may not seem that way, Cahalan was incredibly lucky. She was suffering from an auto-immune disease discovered only three years earlier, and she made a complete recovery. After she told her story in the Post, others certain they have the illness inundated her with calls, both pleasant and not. One father said her article helped him find a diagnosis for his daughter. Another man, resentful, wanted to know why Cahalan recovered but his wife did not.

The tale sparkles with vivid, human details: She hates the TV show Friends, for example, but when her brain deteriorates, she suddenly thinks it's funny. But her just-the-facts prose sometimes seems at pains to describe something as elusive as the crumbling of one's own selfhood. Here, I hungered a little for Fragoso's lyrical gifts. And some characters remain murky. Despite Stephen's pivotal role in Cahalan's recovery, he is a cipher. They had been dating for just four months when she fell ill. Did he ever question how long he could go on?

Although recovered, Cahalan lives with guilt over the fact that she survived at all – many others without access to the same top-tier doctors (or insurance; her medical bill was about $1-million) have languished undiagnosed. Here, Brain on Fire has the potential to change untold lives. For that reason alone, it's a much-needed achievement.

Sarah Barmak lives in Toronto and writes about culture and ideas.

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