Brain On Fire: My Month of Madness

  • Susannah Cahalan
  • Free Press
  • 288 pp.

A young journalist reports on her foray into madness.

Reviewed by Michael Causey

Reporters are taught to be objective and keep themselves out of the story, whether it’s by a cultured journalism professor or a grizzled city desk editor. I suspect New York Post reporter Susannah Cahalan, author of Brain On Fire: My Month Of Madness, does a good job of keeping that important distance while working her beats on a big metropolitan newspaper.

But what works in newsprint is less effective in a book focusing on an individual living through a terrifying and mysterious ordeal. Cahalan’s publisher promises “sharp reporting … in a swift and breathtaking narrative” of a personal nature. Well, they nailed two out of three. What’s often missing is the “breathtaking” human and more personal side of the story. It’s as if Brain On Fire is trying to be two conflicting books at once: a reporter’s investigation and a chilling personal account.

Cahalan offers a journalist’s description of the baffling illness confronting her: “One day, I woke up in a strange hospital room, strapped to my bed, under guard, and unable to move or speak,” she recounts. Her medical records — from a month-long hospital stay — showed an almost immediate onset of psychosis, violence, and dangerous instability. Yet weeks earlier she’d been a thriving, healthy 24-year-old, six months into her first serious relationship and beginning a career as a reporter at the New York Post.

The undefined illness spread quickly, baffling Cahalan and doctors alike. Just as she was about to be committed to a psychiatric institution, Dr. Souhel Najjar — nicknamed Dr. House — joined her medical team. He asked her to draw one simple sketch, which became key to diagnosing Cahalan with a newly-discovered autoimmune disease in which her body was attacking her brain, an illness now thought to be the cause of “demonic possessions” throughout history.

It’s an odd choice to largely treat one’s self like a subject in what is really a harrowing first-person chronicle, and that’s what Cahalan has chosen to do here. She does it well. But the book suffers because just as she begins to offer some inner fears and remembrances, she veers into other details that slow the story.

At the book and narrative’s chronological midpoint, for example, Cahalan feels the need to tell us the history of the plasma exchange she’s about to receive. Apparently, the process originated with a Swedish dairy cream separator created in the late 1800s designed to set apart curds from whey. But a once-vibrant young woman is suffering from what seems like inexplicable madness, and including this kind of detail is a bit confusing. Why would I care about the origin of the plasma exchange when a woman could be dying?

To be sure, Cahalan does express some of her deepest fears during her ordeal. And to be fair, she cannot remember large swaths of the experience. To detail those times, she got access to some DVDs made of her in the hospital, and culled the diaries and recounting of family and friends who were around her.

Perhaps it is inevitable as a coping mechanism, or the way Cahalan’s brain processed the craziness she was feeling, but even in some of the more personally revealing portions of the book there remained some of the reporter’s detachment that dragged the narrative down.

Watching one of the DVDs of her odd behavior in the hospital, Cahalan writes, “On the screen, I stare straight ahead, lying on my back as rigid as a statue, my eyes the only feature betraying the manic fear inside. Then those eyes turn and concentrate on the camera, on me now. … The video self hides her face under the covers, clutching the blanket so hard her knuckles turn white. ‘Please,’ I see myself plead on video again. Maybe I can help her.”

The tone is a confusing and even melodramatic mix of personal insight and clinical distance. Cahalan’s story is sometimes interesting and even inspiring at times, and she’s a good writer, but that stubborn reporter’s cool objectivity at its center is simultaneously Brain On Fire’s greatest strength and its greatest weakness.

 Michael Causey is a reporter who has written about medical and FDA related issues for more than a decade.

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