Brain on Fire: My Month of Madness by Susannah Cahalan

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Brain on Fire: My Month of Madness by Susannah Cahalan

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Category: Autobiography
Rating: 4/5
Reviewer: Richard T Watson
Reviewed by Richard T Watson
Summary: This is the story of New York Post reporter Susannah Cahalan's mystery illness and her descent into madness, the deep soul-searching prompted when the disease called into question basic assumptions about the author's personality, and her slow road to recovery. At times moving, at times graphic, but always unflinchingly honest.
Buy? Maybe Borrow? Yes
Pages: 288 Date: November 2012
Publisher: Particular Books
External links: Author's website
ISBN: 978-1846147395

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One day Susannah Cahalan was a bright, outgoing tabloid reporter in New York, with a promising career ahead of her. Within weeks a mysterious illness reduced her to an incoherent shadow of her former self, struggling with basic tasks, and left doctors at one of the world's top medical centres baffled. In Brain on Fire, Cahalan – now in the 'post-recovery' stage of her life – attempts to recapture the memories and events from the her 'month of madness' before diagnosis and cure.

In many ways it's a cathartic process (for the reader too, by the end), with Cahalan using her journalistic skills to piece together what happened from her own fragmented memory and interviews with doctors, friends and family. She also uses a collection of notebooks, journals and scribbles, some written by her in a time she has no recollection of at all. It feels as though Cahalan comes to terms with the disease that possessed her by researching it and trying to understand it, and finally by writing about it (she's a journalist, after all). By the final chapters, the reader is also much more informed about the symptoms and the workings of the human brain – without there ever being an information overload or any overly technical jargon.

To say the disease – NMDA-receptor autoimmune encephalitis, in which the body's immune system attacks the brain – possessed Cahalan isn't an exaggeration. There are a few similarities with demonic possession, and the disease itself is suggested as a possible explanation for symptoms previously explained as possession: seizures, hallucinations, paranoia, hysteria, motor problems like physical spasms and an apparent ability to stay in uncomfortable positions for a long time. Cahalan was also unable to remember basic words and suffered a physical numbness down one side.

But don't let that put you off. Cahalan's background as a tabloid reporter comes through in every page and Brain on Fire is a highly readable account of a young woman losing her grip on reality, clinging on through the love of her family and the hard work of medical staff. The chapters are short and punchy, often about the length of a story from Cahalan's beloved New York Post, and very easy to whip through. Cahalan's style here is personal, inviting the reader into the depths of the most terrifying time of her young life with charm and generosity. The narrative is littered with anecdotal evidence (mostly about Cahalan), employing the classic tabloid tactic of giving some personal colour to what could be a drab science story. Although the thrust of the story is the quest for a medical diagnosis, Cahalan brings the human interest to the fore and gives the reader chance to care about the subject.

Inevitably though, there are surgical procedures and plenty of time in hospital. Cahalan tackles the more invasive details bravely, but squeamish readers – if they're scared of needles – should perhaps skip the middle chapters.

One thing that Brain on Fire really brings home is the difficulty of diagnosing mental health issues and the lack of understanding that faces people with some of the symptoms Cahalan describes. There are a whole host of varied mental health diseases, and those suffering from them can easily be lumped into one group or another (like 'schizophrenic' or 'autistic') and treated (or judged) accordingly – perhaps wrongly. Cahalan gives an example of the difficulties here when one early consultant exaggerates the amount of alcohol she drinks and wrongly diagnoses alcohol withdrawal, prescribing an anti-seizure medication and sleep instead of partying. It's not the first time mental health has been misunderstood, and probably won't be the last.

These are very personal illnesses, as they concern and affect the personality of the sufferer, in fact they can alter the very essence of the patient's being, as Cahalan discovers. Her book describes a period when there was a different Susannah Cahalan, and the earlier woman has vanished, drowned under misfiring neurons and a rampaging immune system's debilitating effects.

A point raised again and again in Brain on Fire is that the brain is a very complicated organ, and we are nowhere near a complete understanding of it. Cahalan was only the 217th person diagnosed with NMDA-receptor autoimmune encephalitis since its discovery in 2007: how many people before then were treated for the wrong illness, mistreated, or even exorcised? Or, for that matter, how many people with mental health issues in general have been misunderstood?

Since her recovery – perhaps only temporary, as she knows – Cahalan has become involved with stories of other people being diagnosed with the same type of encephalitis, and is doing something to raise awareness of the condition. If you're interested in mental health, or in the human psyche, then this very personal exploration of both is bound to interest you.

If the medical-procedural aspect of this book appeals to you, then you might also like Diagnosis: Dispatches from the Frontlines of Medical Mysteries by Lisa Sanders, which also has things in common with the TV show House, M.D.

However, the focus in Brain on Fire is on the personal experience, not the medicine, and in that respect it's like Alice Peterson's Another Alice, which also features a young woman whose career and life are put on hold by a debilitating, unexpected disease.

Buy Brain on Fire: My Month of Madness by Susannah Cahalan at Amazon You can read more book reviews or buy Brain on Fire: My Month of Madness by Susannah Cahalan at

Buy Brain on Fire: My Month of Madness by Susannah Cahalan at Amazon You can read more book reviews or buy Brain on Fire: My Month of Madness by Susannah Cahalan at


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