Brain on Fire

Brain on Fire is the memoir of Susannah Cahalan, a New York Post reporter who at the age of twenty-four began experiencing symptoms of psychosis. These ranged from episodes of paranoia to personality changes to more neurological findings such as grand mal seizures and visual changes. She was diagnosed with bipolar disorder and alcohol withdrawal by different professionals until finally being admitted to the hospital following a series of seizures. Cahalan herself has little memory of the time after this point; she reconstructed most of it from the hospital’s cameras, doctors’ notes, the journals of her parents, and anecdotes of friends and family.

Eventually, Cahalan was found to have a rare autoimmune disorder which causes brain inflammation; at the time, she was one of less than 200 cases diagnosed. The disease progression generally begins with psychotic-like symptoms and gradually leads to catatonia and death. Cahalan was lucky enough to be diagnosed and treated in time to reverse the effects of the inflammation. In Brain on Fire, she records not only the month of madness but also her recovery and her relationship with family and friends.

This book is scarily unsettling in a lot of ways. First, Cahalan was a healthy twenty-four year old, and it’s tough to hear the reminder that sometimes serious diseases can occur in healthy twenty-four year olds with no explained cause. Second, there is so little we know about the brain still. As she rightfully points out, how many people currently have a disease that presents as mental illness but has an underlying treatable cause? And how well do we understand the processes of mental illness anyway? Third, it’s scary to think it took her so long to find the appropriate diagnosis. One of the first doctors she went to diagnosed her with alcohol withdrawal syndrome because he rounded up her estimate of half a bottle of wine a night to two bottles per night. We still get told to do this in medical school, by the way – assume the patient’s “couple drinks a week” means “couple drinks a night.” How much harm are we doing by assuming that a patient is always lying? Other doctors assumed the diagnosis was just psychiatric because all of her lab tests came back negative when in reality, they were testing for the wrong thing.

Brain on Fire is clear, easy to read, and not loaded down with a lot of jargon. It is a great read for anyone interested in a patient’s viewpoint on her disease and recovery, especially a neurological “House MD” kind of disease.