Brain on Fire: My Month of Madness Summary

Brain On Fire

Brain on Fire: My Month of Madness

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Brain on Fire: My Month of Madness Summary

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Brain on Fire: My Month of Madness by Susannah Cahalan details the author’s experience with anti-NMDA receptor encephalitis, a disease that for Cahalan caused hallucinations and paranoia. The book opens with Cahalan working as a reporter for the New York Post, a publication she’d worked at since the age of seventeen, when she began as an intern. While she was finishing her degree at Washington University in St. Louis, the Post handed her an interview with a well-known pedophile and kidnapper. The year was 2009, and the interview she wrote seemed to set her up for instant success as a journalist in New York City.

At the time, there were bed bug infestations cropping up in the city, and one day Cahalan found two small bites on her arm. Certain that bed bugs must be the culprit, she hid the bites from coworkers and friends and had her apartment sprayed, despite there being no evidence of the pests. Hallucinations and paranoia were just the beginning of the disease that, as it turned out, had nothing to do with bed bugs.

Her colleagues, family, and boyfriend all noticed that she was acting differently, and soon the disease manifested physically. She suffered from slurred speech, awkward movements, and even seizures. Doctor after doctor assured her that her test results had come back negative for significant diseases. Yet her health continued to decline. It wasn’t until she was admitted to the medical school hospital at New York University that she was diagnosed.

However, that diagnosis didn’t come until after a four-week hospital stay. Until that day, doctors thought she had everything and anything from schizophrenia to cancer. It was Dr. Najjar who diagnosed her, by administering the clock test. This test involved asking her to draw the face of a clock. Susannah got all the numbers right, but not their location—she drew all of them on the right side of the clock. Dr. Najjar realized from that test that the right half of her brain was inflamed. Basically, her own antibodies were attacking her brain.

The disease is known also as Dalmau’s disease, after Dr. Dalmau, a doctor who studied this combination of symptoms that match both schizophrenia and brain inflammation. It took over a month of diagnostic tests and the right doctors to properly diagnose Cahalan. Her recovery took months. Finally, seven months after her diagnosis, she was able to return to work at the Post. Cahalan wrote about her ordeal in an article, then at more length in Brain on Fire.

The title comes from the diagnosis delivery. The doctor explained Susannah’s illness by telling her family that her brain was on fire. At the end of her book, Cahalan writes that she feels almost like her old self, but that she knows her disease changed something in her forever. While Cahalan believes that the two insect bites caused the disease, the exact cause is not identified.. Regardless of what caused the anti-NMDA receptor encephalitis in Cahalan’s case, the backdrop of the bed bug infestations creates a feeling of paranoia that mirrors what she felt throughout her illness. Eventually, she reveals that the disease is a type of autoimmune condition, and that it nearly took her life

Cahalan constructs the book with journalistic skill. She uses hospital surveillance videos, medical records, a journal her father kept during her illness, and interviews with those closest to her to reconstruct the time between the onset of her symptoms and her diagnosis. She also explores the history of the disease, which might, in fact, be tied to historical cases when people were thought to be possessed by demons.

The themes that grow from her gut-wrenching story include identity, love, isolation, redemption, and survival. The book has been called “stunningly brave.” Cahalan also received praise for her prose. What sets this memoir apart is not only the rarity of Cahalan’s disease, but also the fact that because she doesn’t recall it herself, she is solving the mystery of diagnosis along with the reader, creating tension in a situation that might otherwise lack it, since the reader knows the author survived, as she’s written the book about her struggles. However, for the reader, Cahalan’s life is not the only thing at stake. Her identity and personal relationships, and her ability to function professionally, all sit on the line. The knowledge that she survived this ordeal doesn’t answer the concern as to whether or not she could once more thrive.

Brain on Fire deals with all of these themes while keeping the reader wondering. It has not only captivated general readers, but also the medical industry. Because Cahalan’s disease is so rare, there is little documentation of it. The fact that her tests did not indicate this or any other disease makes her symptoms even more important—perhaps Brain on Fire will help doctors diagnose anti-NMDA receptor encephalitis with more efficiency than the process Cahalan was forced to endure.