Brain On Fire

Brain on Fire (2012) is a memoir by New York Post writer Susannah Cahalan that details her struggle with a rare autoimmune disease, anti-NMDA-receptor autoimmune encephalitis. Cahalan recollects the journey through illness that took her from a normal, 24-year-old journalist to a misdiagnosed psychotic patient, and back again. In 2018, Netflix released a film based on Cahalan’s story, produced by Cahalan and Charlize Theron.

Plot Summary

Cahalan wakes in a hospital with no understanding of how she got there. We learn she has been in the hospital for a month, and during this time, she has been delusional and violent. Cahalan notes that, because of this “black out” period, where she is incapable of remember an entire month in the hospital, she may be an unreliable narrator.

Cahalan describes her life before her illness: She has friends, is a journalist at the New York Post, and has a stable romantic relationship. Although her parents are divorced and relatively stoic and private, Cahalan maintains healthy relationships with her parents, step-parents, and especially her younger brother, James. She first begins exhibiting symptoms of paranoia while she’s trying to rid her apartment of bed bugs, and her symptoms slowly escalated to extreme paranoia, an inability to focus, hallucinations, body pain, and migraines. She begins to lash out at those around her, including her boyfriend, Stephen, whom she accuses of being unfaithful. She finally seeks the help of medical professionals and is misdiagnosed with mononucleosis (mono) as her symptoms persist and heighten.

Cahalan’s performance at work becomes inconsistent, and her illness affects her balance and memory. Her family begins to see that she’s having trouble caring for herself, and her father helps her clean her apartment. She eats very little, and while having a meal with Stephen, she has a seizure. She blacks out and awakens in a hospital, where the doctor, Dr. Bailey, blames her symptoms on alcoholism and possible bipolar disorder. A psychiatrist, likewise, does little to accurately diagnose or help Cahalan.

Cahalan moves back to her childhood home in Summit, New Jersey with her mother, Rhona, and her stepfather, Allen. She’s there for a short while before returning to New York City, where her friends party with her.

When Cahalan has dinner with her father and stepmother, Giselle, Cahalan has a psychotic episode and becomes convinced that they’ve kidnapped her. Cahalan’s father and her mother, Rhona, admit Cahalan to NYU, Langone Medical Center. There, Dr. Bailey continues to assert that she’s suffering from alcoholism, even as her behavior becomes more psychotic and violent. As she checks in, she has another seizure, beginning her month-long blackout. During this space of time, she recollects some things, but Cahalan also pieces moments together from the video footage of her room at NYU, medical records, and journal entries.

More neurologists, psychopharmacologists, and psychologists examine her and diagnose her with a host of illnesses: Capgras syndrome (imposter syndrome), bipolar disorder, dissociative identity disorder, schizoaffective disorder, and postictal psychosis. Cahalan’s family, upset by her psychotic episodes, keep a community journal of her diagnoses, condition, and their personal thoughts on the matter. Her father, in particular, is moved when Cahalan shows a spark of her old self. Cahalan’s psychosis begins to wane, and the hospital moves her to a new room. Still, her physical health continues to dissipate.

Another doctor, Dr. Najjar, takes over her case, and he intends to try some experimental immunotherapy with Cahalan. When these methods fail, Dr. Najjar asks Cahalan to perform a simple test: Draw a clock. Cahalan draws the clock, but she puts all of the numbers to one side. This tendency, Dr. Najjar asserts, is indicative of anti-NMDA-receptor autoimmune encephalitis. Dr. Najjar explains it as a “brain on fire;” the autoimmune disorder causes Cahalan’s body to attack itself, inflaming her brain. This correct diagnosis is the beginning of Cahalan’s healing process.

Cahalan has trouble walking, talking, and writing. She moves back in with her mother and stepfather, and when she’s well enough to go out in public, she faces ostracization for her “odd” behavior, which is due to her poor physical health. She learns through medical testing that the illness has also affected her mental acuity. She resolves to work on her recovery. Slowly, she begins accepting assignments from The New York Post again, and she writes her own story for an article.

Through Cahalan’s article, Dr. Najjar finds public recognition and awards. He tells Cahalan his story: He was a poor student, and his father never believed he would amount to much. When he brought home good grades, his father insisted that he was cheating. His teacher, however, believed in him, and he became a doctor and a specialist in the United States. With the extra media attention, Dr. Najjar won the approval of his father.

The narrative consists of several textual elements that are intentionally interwoven abruptly for visceral, shock value. Much of the text consists of the voice of Cahalan after her release from the hospital and has experienced multiple stages of recovery over a few years. There are other pieces of the text that are excerpts from journals entries by her father, her mother, and herself. Other pieces of the text are medical scans and sections of Cahalan’s actual medical records.