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One day, Susannah Cahalan woke up in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. Her medical records -- from a month-long hospital stay of which she had no memory - showed psychosis, violence, and dangerous instability. Yet, only weeks earlier she had been a healthy, ambitious twenty-four-year-old, six months into her first serious relationship and a sparkling career as a cub reporter.Susannah's astonishing memoir chronicles the swift path of her illness and the lucky, last-minute intervention led by one of the few doctors capable of saving her life. Weeks ticked by and Susannah moved inexplicably from violence to catatonia. The exhausted doctors were ready to commit her to the psychiatric ward, in effect condemning her to a lifetime of institutions, or death, until Dr. Souhel Najjar - nicknamed Dr. House - joined her team. He asked Susannah to draw one simple sketch, which became key to diagnosing her with a newly discovered autoimmune disease in which her body was attacking her brain.
Reviews (6)
Publisher's Weekly Review
In 2009, Cahalan was in a serious relationship and her career as a reporter at the New York Post was taking off. But suddenly, as she tells it in this engaging memoir, she began suffering from a bizarre amalgam of debilitating symptoms including memory loss, paranoia, and severe psychosis that left her in a catatonic state that moved her close to death. Physicians remained baffled until one extraordinary doctor determined that Cahalan was "in the grip of some kind of autoimmune disease." Released from the hospital after 28 days, she had no memory of her stay there. DVDs recorded in the hospital were the only link she had to her startling condition. "Without this electronic evidence, I could never have imagined myself capable of such madness and misery," she writes. Focusing her journalistic toolbox on her story, Cahalan untangles the medical mystery surrounding her condition. She is dogged by one question: "How many other people throughout history suffered from my disease and others like it but went untreated? The question is made more pressing by the knowledge that even though the disease was discovered in 2007, some doctors I spoke to believe that it's been around at least as long as humanity has." A fast-paced and well-researched trek through a medical mystery to a hard-won recovery. (Nov.) (c) Copyright PWxyz, LLC. All rights reserved.
Booklist Review
*Starred Review* In this fascinating memoir by a young New York Post reporter previously known for going undercover as a stripper and writing a butt-implant story headlined Rear and Present Danger, Cahalan describes how she crossed the line between sanity and insanity after an unknown pathogen invaded her body and caused an autoimmune reaction that jump-started brain inflammation, paranoia, and seizures. Her divorced parents put aside their differences and rose to the occasion, sitting by her during the month she was confined to the hospital, about which she remembers nothing. Her boyfriend stayed with her, and one wonderful doctor, noticing that she walked and talked like a late-stage Alzheimer's patient, was determined to get to the bottom of her medical mystery. Luckily, she was insured, because her treatment cost $1 million. Cahalan expertly weaves together her own story and relevant scientific and medical information about autoimmune diseases, which are about two-thirds environmental and one-third genetic in origin. So, she writes, an external trigger, such as a sneeze or a toxic apartment, probably combined with a genetic predisposition toward developing aggressive antibodies to create her problem. A compelling health story.--Springen, Karen Copyright 2010 Booklist
New York Review of Books Review
IN the vast and growing literature of affliction there is essentially one story: how the writer and her loved ones made it through. From a literary point of view, everything depends on the sensibility of the narrator, her comportment both as the teller and as the main character in her own tale. The reader's resistance to these stories can be strong. Severe illness, by its nature, narrows the focus; the palette of experience both intensifies and shrinks; we crawl into the bush, figuratively speaking, and wait out our fate, fighting to survive. There is little suspense: the existence of the memoir is testament to the fact that the author has lived to tell the tale. But what hard-won nugget of wisdom has she brought back from her brief descent into a hell that most of us, for now, have been lucky enough to avoid? Can she give her ordeal meaning beyond the brute fact of the thing itself? One thing you don't want to be to your doctor is "an interesting case." Susannah Cabalan had the bad luck of being a unique and baffling one: profoundly sick, deteriorating with dangerous speed, yet her MRIs, brain scans and blood tests were normal. "My diagnosis had been discussed in almost every major medical journal," she tells us with an air of pride and exhausted wonder, "including the New England Journal of Medicine, and The New York Times." "Brain on Fire" is at its most captivating when describing the torturous process of how doctors arrived at that diagnosis - an extremely rare autoimmune disease almost undocumented in medical literature. The illness presented itself in malevolent fashion, with symptoms of bipolar disorder and schizophrenia, which are often indistinguishable from each other in their early stages: grandiosity, paranoia, bouts of irrational rage, incomprehensible utterances and flat catatonic-like affect. There were also seizures, with "blood and foam" spurting out of Cahalan's mouth, that suggested not mental illness but a neurological disorder. Cahalan has the narrative advantage of having no memory of what happened to her, except for unreliable, almost hallucinatory flashes, like being strapped to her hospital bed as a "flight risk." This temporary outage gives her an opportunity to ponder the mystery of her self, and how quickly our assumed knowledge of who we are can be radically altered. Cahalan employs her journalistic skills (she works as a reporter at The New York Post) to explain the fascinating medical intricacies of her illness and how it compromises NMDA receptors in the brain, "vital to learning, memory, and behavior." Of deeper interest is her attempt to become a historian of her lost self, piecing together the facts of her ordeal from her father's diaries, the recollections of her mother and her boyfriend, and the forensic evidence of medical and psychological records. Looking at hospital videos, she is shocked to see a young woman she can barely recognize as herself, cowering in bed and uttering repeatedly, and with difficulty, the word "please," as if begging for help. Reading her own disjointed diary entries of the time "is like peering into a stranger's stream of consciousness." SALVATION came in the form of a gifted neurologist, profoundly attuned to her symptoms, and the decisive diagnostic tool turned out to be a piece of paper and pen: Cahalan's skewed drawing of a clock revealed more about what was going on in her brain than the battery of expensive tests she underwent. Her treatment cost about a million dollars. At its best, Cahalan's prose carries a sharp, unsparing, tabloid punch in the tradition of Pete Hamill and Jimmy Breslin. But when the acute period of her illness passes and she chronicles the slow process of her recovery, the writing falls flat. Here was the chance to make good on her ambition to inquire into the "deepest part of the self - personality, memory, identity - in an attempt to pick up and understand the pieces left behind." Instead, Cahalan is locked in the dull passage of those weeks, dutifully informing us of her 15-minute walks, her decision to take spin class, her forays out to family gatherings and parties. Finally, and bravely, she crawls back to her old vivacious self. "However, when I look at photographs taken of me 'post,' versus pictures of me 'pre,' there is something altered, something lost - or gained, I can't tell - when I look into my eyes." Michael Greenberg is the author of "Hurry Down Sunshine" and "Beg, Borrow, Steal: A Writer's Life."
Guardian Review
One morning, Susannah Cahalan woke from dreams of bedbugs to find two red dots on the main vein in one arm. She called an exterminator to comb through her Manhattan apartment; he found nothing at all. But bedbugs had been in the news, and danced insistently through her mind, and she could not believe him. She demanded he fumigate the place anyway. She was so preoccupied with the bedbugs that she forgot, for the first time in her career as a reporter for the New York Post, to prepare for an ideas meeting, a humiliating experience. Back at her desk, a colleague reassured her. "'Thanks, Ang,' I said, sipping my lukewarm coffee. 'Things just aren't going my way.'" It's a line straight out of the newsroom scenes in the TV version of Superman - Cahalan, a girl from the New Jersey suburbs who has a wide-eyed love of what she does (and the prose to go with it), presents a blithe, upbeat, tabloid world, where scams are uncovered, celebrities stalked, and bad guys get their just deserts. It's instructive, for instance, that she says her first big scoop for the paper, an interview with a prisoner obtained while she was still at college, caused a national debate about tabloid ethics and methods, but she does not explain exactly what her methods were, or even briefly reflect on whether those who worried about them had a point. The experience simply whetted her appetite for more. Partly (though not entirely) this is the imperviousness of gilded youth. Brain on Fire is an account - comprehensively, impressively reported - of how this imperviousness was punctured in the most dramatic possible way. A few days after the bedbug incident, Cahalan found herself alone in her boyfriend's flat, searching obsessively - and uncharacteristically - through his emails and letters for proof of betrayal. A sharp, migraine-like pain cracked through her brain, accompanied by nausea. She felt a tingling in her left hand, which then went numb. A neurologist, and an MRI, found nothing amiss; her gynaecologist suggested possible glandular fever, which was also soon discounted. But the symptoms continued to build: panic attacks in public places, more uncharacteristic and dramatic failures at work. She began to ricochet between wild weeping and absurd happiness; she paced floors, unable to settle; insomnia became the norm. And then, one night, she suffered a full-blown seizure and blacked out. The neurologist diagnosed stress and too much partying; a psychiatrist diagnosed possible bipolar disorder. Another seizure, another visit to the neurologist, an EEG, and a dismissive technician. "I've seen this dozens of times, mostly with bankers and Wall Street guys who come in here all stressed out. There's nothing wrong with them. It's all in their heads." Cahalan, increasingly delusional, thought the technician was a hired actor administering an elaborate punishment for her erratic behaviour. This was the beginning of a terrible month, almost all of which she cannot remember, because her illness obliterated her short-term recall, but which she has painstakingly reconstructed from the accounts of her family, her doctors, some erratic diaries and some hospital video. Delusions - that people were speaking to her out of the TV, or that her father had murdered his girlfriend - were joined by paranoid hallucinations, cruel aggression and desperate attempts to escape. The list of possible diagnoses lengthened: epilepsy, multiple personality disorder, schizo-affective disorder, bipolar disorder. Her blood pressure was dangerously high and she was increasingly unable to walk properly, complete simple cognitive tasks, or even speak, but test after test for physical ailments came back negative. The only thing anyone knew for sure was that her white cell count was up, and that she was worsening by the day. Unable to control her mouth or tongue, she began to drool and grimace and to make constant involuntary chewing motions. Eventually she began to enter a catatonic state. She is both forensic and sensitive throughout about the effect of all this on those closest to her; their panic and helplessness, and in particular their increasing fear that she would be transferred from the epilepsy unit to the psychiatric ward. This was the point (with a Hollywood inevitability one would expect in a book such as this) at which her saviour appeared, in the form of a moustache-pulling Syrian neurologist, Dr Souhel Najjar. Her mother even called him a real-life Dr House. He asked her to draw a clock. After a few attempts, she did so - with all the numbers squashed into the right-hand side: low-tech, indisputable proof that the right hemisphere of her brain was seriously inflamed. "Her brain is on fire," he told her parents. "Her brain is under attack by her own body." Focused treatment began immediately. Cahalan is never in any doubt about the extent of her luck: the luck in finding a sensitive doctor who listened to her, and took her case on its own merits; the luck of being admitted to a cutting-edge centre in a cutting-edge city (there was nothing low-tech about her treatment, which involved, among many other things, infusions containing antibodies from 1,000 people, at $20,000 per infusion; she eventually cost her insurer $1m); the luck of timing - the disease had been discovered only three years previously; the luck, above all, not to have been diagnosed with a psychiatric disease and treated accordingly. Researchers, she writes, believe that NDMA autoimmune encephalitis has been around as long as humanity. That it has often been misdiagnosed as schizophrenia, or autism, or - given that in children particularly it can produce mutism, hyper-sexuality, violence, convulsions, crab-walking, hissing, grunting - as pure evil, leading to attempts at exorcism. What percentage of patients condemned to mental institutions or lifelong heavy medication, asks Najjar, might actually be suffering inflammation of the brain? But there are other, equally troubling questions that she only touches on. During one hospital stay, she finds herself next to a woman who is diagnosed with colon cancer and responds with thankful prayer. "I understand her relief, how important it is for your illness to have a name." But an even greater relief, in Cahalan's case, is that her suffering turned out to have a clearly physiological cause. Physical illness is neutral, easily comprehensible, and is not seen as connected with the thinking, feeling self in the way that mental illness is. There is a frightening hierarchy implied in part of a note that Cahalan's father taped to a wall on the epilepsy ward: "Susannah is a wonderful young woman who deserved your hard work." The overwhelming feeling, while Cahalan was ill, was one of shame. She hid her condition from colleagues until she could explain it, and even then she felt she had to prove her return to "normality". A physiological explanation is the pot of gold everyone is searching for, from health providers to drug companies; finding it makes everything easier, and frequently more lucrative. Why embark on the uncertain business of talking therapy, for example, when you can prescribe some pills? Stories like Cahalan's provide a wild hope - Najjar was engulfed with requests for help after she wrote about her case - and it is true that there is a growing group of autoimmune diseases being discovered that directly affect the brain, and must be chased as aggressively as possible. It was not an easy road, and relapse is possible at any time, but Cahalan eventually recovered. Her boyfriend stood by her, her relationships with her parents (after a distinctly rocky period in her mother's case) deepened and matured, and her colleagues took her back with open arms. All this, too, was extraordinary, unusual luck. Except that now she knows it for what it is. To order Brain on Fire for pounds 13.59 with free UK p&p call Guardian book service on 0330 333 6846 or go to guardian.co.uk/bookshop - Aida Edemariam One morning, Susannah Cahalan woke from dreams of bedbugs to find two red dots on the main vein in one arm. She called an exterminator to comb through her Manhattan apartment; he found nothing at all. But bedbugs had been in the news, and danced insistently through her mind, and she could not believe him. She demanded he fumigate the place anyway. She was so preoccupied with the bedbugs that she forgot, for the first time in her career as a reporter for the New York Post, to prepare for an ideas meeting, a humiliating experience. Back at her desk, a colleague reassured her. "'Thanks, Ang,' I said, sipping my lukewarm coffee. 'Things just aren't going my way.'" Another seizure, another visit to the neurologist, an EEG, and a dismissive technician. "I've seen this dozens of times, mostly with bankers and Wall Street guys who come in here all stressed out. There's nothing wrong with them. It's all in their heads." Cahalan, increasingly delusional, thought the technician was a hired actor administering an elaborate punishment for her erratic behaviour. There are other, equally troubling questions that she only touches on. During one hospital stay, she finds herself next to a woman who is diagnosed with colon cancer and responds with thankful prayer. "I understand her relief, how important it is for your illness to have a name." But an even greater relief, in Cahalan's case, is that her suffering turned out to have a clearly physiological cause. Physical illness is neutral, easily comprehensible, and is not seen as connected with the thinking, feeling self in the way that mental illness is. There is a frightening hierarchy implied in part of a note that Cahalan's father taped to a wall on the epilepsy ward: "Susannah is a wonderful young woman who deserved your hard work." The overwhelming feeling, while Cahalan was ill, was one of shame. She hid her condition from colleagues until she could explain it, and even then she felt she had to prove her return to "normality". - Aida Edemariam.
Kirkus Review
A young journalist's descent into her own baffling medical mystery. In her debut memoir, New York Post reporter Cahalan recounts her struggle to understand an unremembered month lost to illness. Cobbled together from interviews, medical records, notebooks, journals and video footage, the author conjures the traumatic memories of her harrowing ordeal. What began as numbness in her hands and feet soon grew into something more serious, climaxing in a terrifying seizure witnessed by her boyfriend. "My arms suddenly whipped straight out in front of me, like a mummy," she writes, "as my eyes rolled back and my body stiffened.Blood and foam began to spurt out of my mouth through clenched teeth." The mystery thickened as doctors struggled to agree on a diagnosis. While the uncertainty proved maddening for her family members, however, it was also what bonded them together. Cahalan's estranged parents, in particular, found a common purpose as a result of their daughter's plight, putting her health before old hardships. After numerous tests revealed nothing, an observed increase of white blood cells in her cerebrospinal fluid eventually clued in medical professionals. Diagnosed with anti-NMDA-receptor encephalitis--a rare autoimmune disease with a cure--Cahalan and her family embarked on the long, hard road to recovery. Through the lonesomeness of her illness, a community emerged, the members of which were dedicated to returning the author to her former life as a beloved daughter, sister, lover and friend. A valiant attempt to recount a mostly forgotten experience, though the many questions that remain may prove frustrating to some readers.]] Copyright Kirkus Reviews, used with permission.
Library Journal Review
A New York Post reporter whose work has also has been featured in the New York Times, Cahalan, at age 24, seemed launched into life; she was building a successful career as a journalist, had met a man with whom she shared common interests, and seemed perfectly healthy. Until, that is, she woke up in a hospital with no memory of going there or of the previous month. She created this memoir using her father's journal, her medical records, and interviews with family and friends. The book is interesting as a work of reconstructive journalism and as a record of methods the doctors tried and failed to use on her behalf. The author's own reading adds authenticity and poignancy. VERDICT For those interested in medical memoirs. ["Cahalan's hip writing style, sympathetic characters, and suspenseful story will appeal to fans of medical thrillers and the television show House," read the review of the New York Times best-selling Free Pr: S. & S. hc, LJ 11/1/12.-Ed.]-Pam Kingsbury, Univ. of North Alabama, Florence (c) Copyright 2013. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
