Good Reads: Brain on Fire

Brain-on-FireI recently finished reading one of the most captivating books I’ve read in a long time; Brain on Fire by Susannah Cahalan.

The New York Times review of the book is below. I highly suggest reading it. It offers a terrifying look into a woman’s struggle with a rare, mostly unknown disease and how unequipped most of the medical community is on handling such cases.

In the vast and growing literature of ­affliction there is essentially one ­story: how the writer and her loved ones made it through. From a literary point of view, everything depends on the sensibility of the narrator, her comportment both as the teller and as the main character in her own tale. The reader’s resistance to these stories can be strong. Severe illness, by its nature, narrows the focus; the palette of experience both intensifies and shrinks; we crawl into the bush, figuratively speaking, and wait out our fate, fighting to survive. There is little suspense: the existence of the memoir is testament to the fact that the author has lived to tell the tale. But what hard-won nugget of wisdom has she brought back from her brief descent into a hell that most of us, for now, have been lucky enough to avoid? Can she give her ordeal meaning beyond the brute fact of the thing itself?

One thing you don’t want to be to your doctor is “an interesting case.” Susannah Cahalan had the bad luck of being a unique and baffling one: profoundly sick, deteriorating with dangerous speed, yet her MRIs, brain scans and blood tests were normal. “My diagnosis had been discussed in almost every major medical journal,” she tells us with an air of pride and exhausted wonder, “including the New England Journal of Medicine, and The New York Times.”

Brain on Fire” is at its most captivating when describing the torturous process of how doctors arrived at that diagnosis — an extremely rare autoimmune disease almost undocumented in medical literature. The illness presented itself in malevolent fashion, with symptoms of bipolar disorder and schizophrenia, which are often indistinguishable from each other in their early stages: grandiosity, paranoia, bouts of irrational rage, incomprehensible utterances and flat catatonic-like affect. There were also seizures, with “blood and foam” spurting out of Cahalan’s mouth, that suggested not mental illness but a neurological disorder.

Cahalan has the narrative advantage of having no memory of what happened to her, except for unreliable, almost hallucinatory flashes, like being strapped to her hospital bed as a “flight risk.” This temporary outage gives her an opportunity to ponder the mystery of her self, and how quickly our assumed knowledge of who we are can be radically altered. Cahalan employs her journalistic skills (she works as a reporter at The New York Post) to explain the fascinating medical intricacies of her illness and how it compromises NMDA receptors in the brain, “vital to learning, memory, and behavior.”

 Looking at hospital videos, she is shocked to see a young woman she can barely recognize as herself, cowering in bed and uttering repeatedly, and with difficulty, the word “please,” as if begging for help. Reading her own disjointed diary entries of the time “is like peering into a stranger’s stream of consciousness.”

Salvation came in the form of a gifted neurologist, profoundly attuned to her symptoms, and the decisive diagnostic tool turned out to be a piece of paper and pen: Cahalan’s skewed drawing of a clock revealed more about what was going on in her brain than the battery of expensive tests she underwent. Her treatment cost about a million dollars.

At its best, Cahalan’s prose carries a sharp, unsparing, tabloid punch in the tradition of Pete Hamill and Jimmy ­Breslin. But when the acute period of her illness passes and she chronicles the slow process of her recovery, the writing falls flat. Here was the chance to make good on her ambition to inquire into the “deepest part of the self — personality, memory, identity — in an attempt to pick up and understand the pieces left behind.” Instead, Cahalan is locked in the dull passage of those weeks, dutifully informing us of her 15-minute walks, her decision to take spin class, her forays out to family gatherings and parties.

Finally, and bravely, she crawls back to her old vivacious self. “However, when I look at photographs taken of me ‘post,’ versus pictures of me ‘pre,’ there is something altered, something lost — or gained, I can’t tell — when I look into my eyes.”

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