Brain on Fire (Calahan)

Brain on Fire: My Month of madness
Susannah Calahan, 2012
Simon & Schuster
288 pp.
ISBN-13: 9781451621389



Summary
One day in 2009, twenty-four-year-old Susannah Cahalan woke up alone in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. A wristband marked her as a “flight risk,” and her medical records—chronicling a month-long hospital stay of which she had no memory at all—showed hallucinations, violence, and dangerous instability. Only weeks earlier, Susannah had been on the threshold of a new, adult life: a healthy, ambitious college grad a few months into her first serious relationship and a promising career as a cub reporter at a major New York newspaper. Who was the stranger who had taken over her body? What was happening to her mind?

In this swift and breathtaking narrative, Susannah tells the astonishing true story of her inexplicable descent into madness and the brilliant, lifesaving diagnosis that nearly didn’t happen. A team of doctors would spend a month—and more than a million dollars—trying desperately to pin down a medical explanation for what had gone wrong. Meanwhile, as the days passed and her family, boyfriend, and friends helplessly stood watch by her bed, she began to move inexorably through psychosis into catatonia and, ultimately, toward death. Yet even as this period nearly tore her family apart, it offered an extraordinary testament to their faith in Susannah and their refusal to let her go.

Then, at the last minute, celebrated neurologist Souhel Najjar joined her team and, with the help of a lucky, ingenious test, saved her life. He recognized the symptoms of a newly discovered autoimmune disorder in which the body attacks the brain, a disease now thought to be tied to both schizophrenia and autism, and perhaps the root of “demonic possessions” throughout history.

Far more than simply a riveting read and a crackling medical mystery, Brain on Fire is the powerful account of one woman’s struggle to recapture her identity and to rediscover herself among the fragments left behind. Using all her considerable journalistic skills, and building from hospital records and surveillance video, interviews with family and friends, and excerpts from the deeply moving journal her father kept during her illness, Susannah pieces together the story of her “lost month” to write an unforgettable memoir about memory and identity, faith and love. It is an important, profoundly compelling tale of survival and perseverance that is destined to become a classic. (From the publisher.)



Author Bio
Susannah Cahalan is a news reporter at the New York Post whose award-winning work has also been featured in The New York Times. She lives in Jersey City, New Jersey. (From the publisher..)



Book Reviews
Brain on Fire is at its most captivating when describing the torturous process of how doctors arrived at [the] diagnosis…At its best, Cahalan's prose carries a sharp, unsparing, tabloid punch in the tradition of Pete Hamill and Jimmy Breslin.
New York Book Review


Cahalan's tale is told in straightforward journalistic prose and is admirably well-researched and described. Because she has no memory of her "month of madness," the story rests on doctors' notes and recollections, hospital films, her father's journals, both parents' recounting of what happened, and the reminiscences of her devoted boyfriend and those of her many friends and relatives. This story has a happy ending, but take heed: It is a powerfully scary book.
Washington Post


For the neurologist, I highly recommend this book on several grounds…First, it is a well-told story, worth reading for the suspense and the dramatic cadence of events…Second, it is a superb case study of a rare neurologic diagnosis; even experienced neurologists will find much to learn in it…Third, and most important, it gives the neurologist insight into how a patient and her family experienced a complex illness, including the terrifying symptoms, the difficult pace of medical diagnosis, and the slow recovery. This story clearly contains lessons for all of us.
Cognitive and Behavioral Neurology


The bizarre and confounding illness that beset the 24-year-old New York Post reporter in early 2009 so ravaged her mentally and physically that she became unrecognizable to coworkers, family, friends, and—most devastatingly—herself… She dedicates this miracle of a book to "those without a diagnosis".... [An] unforgettable memoir.
Elle


In 2009, Cahalan was in a serious relationship and her career as a reporter at the New York Post was taking off. But suddenly, as she tells it in this engaging memoir, she began suffering from a bizarre amalgam of debilitating symptoms including memory loss, paranoia, and severe psychosis that left her in a catatonic state that moved her close to death. Physicians remained baffled until one extraordinary doctor determined that Cahalan was “in the grip of some kind of autoimmune disease.” Released from the hospital after 28 days, she had no memory of her stay there. DVDs recorded in the hospital were the only link she had to her startling condition. “Without this electronic evidence, I could never have imagined myself capable of such madness and misery,” she writes. Focusing her journalistic toolbox on her story, Cahalan untangles the medical mystery surrounding her condition. She is dogged by one question: “How many other people throughout history suffered from my disease and others like it but went untreated? The question is made more pressing by the knowledge that even though the disease was discovered in 2007, some doctors I spoke to believe that it’s been around at least as long as humanity has.” A fast-paced and well-researched trek through a medical mystery to a hard-won recovery.
Publishers Weekly


This fascinating memoir by a young New York Post reporter…describes how she crossed the line between sanity and insanity…Cahalan expertly weaves together her own story and relevant scientific information…compelling.
Booklist


New York Post reporter Cahalan details the madness that briefly robbed her of her independence and ability to write.... Verdict: A compelling, quick read with a moving message. Cahalan's hip writing style, sympathetic characters, and suspenseful story will appeal to fans of medical thrillers and the television show House. Brief, informative biology and abnormal psychology discussions throughout the text will interest science students without slowing the narrative. Because Cahalan's condition is rare and its causes unknown, this book may save lives and promote empathy for those struggling with mental illness. —Chrissy Spallone, Philadelphia Yearly Meeting Lib.
Library Journal


A young journalist's descent into her own baffling medical mystery. In her debut memoir, New York Post reporter Cahalan recounts her struggle to understand an unremembered month lost to illness. Cobbled together from interviews, medical records, notebooks, journals and video footage, the author conjures the traumatic memories of her harrowing ordeal..... Diagnosed with anti-NMDA-receptor encephalitis—a rare autoimmune disease with a cure—Cahalan and her family embarked on the long, hard road to recovery.... A valiant attempt to recount a mostly forgotten experience, though the many questions that remain may prove frustrating to some readers.
Kirkus Reviews



Discussion Questions
1. A quote from the philosopher Friedrich Nietzsche appears at both the beginning and end of Cahalan’s memoir: “The existence of forgetting has never been proved: we only know that some things do not come to our mind when we want them to.” Why do you think Cahalan chooses to recall this quotation at both the story’s start and end? How does it correspond to Cahalan’s tale and its major themes? In addition to the content of the quotation, why is it particularly poignant that the author would choose a quote by Nietzsche to bookend her work?

2. Evaluate and discuss the style and genre of Brain on Fire. Cahalan describes the book as a memoir, but she also says that it reportage. She acknowledges using help from other sources since she has little to no memory of many of the happenings recounted in the book. In the author’s note she goes so far as to describe herself as an “unreliable source.” How does this detail affect our experience of and response to her story? What does this indicate about truth and bias in storytelling? What complex issues does it raise in our understanding of works designated as nonfiction?

3. In the author’s note, Cahalan says that her book is “a journalist’s inquiry into that deepest part of self—personality, memory, identity.” What does her story reveal about these three subjects? How does her account challenge our preconceptions of these three subjects? Alternatively, how does her account confirm or bolster what we already know and believe about these three subjects?

4. Brain on Fire is divided into three parts and fifty-three chapters. Why is this structure meaningful and important? How does it correspond to some of the major subjects and themes of the book? How does this structure affect our comprehension of the work or our emotional experience of it as readers?

5. Consider and discuss the various reactions to Cahalan’s illness as chronicled in her book. Are the responses uniform or varied? Are they expected or unexpected? What about Cahalan’s own responses to her illness and what she endures? Consider the response she recalls having while she was suffering versus her response after her treatment and recovery. What does consideration of these responses reveal about our responses to the mysterious and the unknown?

6. Consider and discuss your own reactions as readers to what you encounter on the page—at the opening of the story and as the story continues to its conclusion. How did your thoughts, feelings, and opinions change throughout?

7. In Chapter 22 (p. 83), Cahalan refers to a quote by William F. Allman’s book Apprentices of Wonder: Inside the Neural Network Revolution: “The brain is a monstrous beautiful mess.” What does Allman mean by this? What does it reveal about the workings of the brain? How does this correspond to what we find revealed in Cahalan’s book?

8. The characters in Brain on Fire—friends, family, medical personnel, and even Cahalan herself—frequently consider if she may be suffering from some form of mental illness. What does the book reveal, then, about our way of thinking about mental illness? For instance, what does Cahalan’s story suggest about the relationship between psychology and neurology? What preconceptions does it reveal about our understanding of mental illness as a society? How does this story help to highlight the necessity of compassionate responses to those who are ill?

9. Cahalan incorporates many epigraphs, quotes, and references to famous figures—Nietzsche, Aristotle, Virginia Wolff, and many others—in her story. What may be the primary reason or reasons for these being included and why are they important?

10. Cahalan has titled her memoir Brain on Fire. What does this title mean and where does it come from?

11. Consider the role of faith in the story—not only religious faith, but also faith defined more broadly to include support for others, faith in one’s self (think not only of Cahalan’s story but of Dr. Najjar’s story), hope and resilience. What role does faith seem to play in success and recovery both for Cahalan and those around her?

12. What are some of the reasons that Cahalan may have chosen to share her story with the public? What lessons can we ultimately learn from her unique story?
(Questions issued by publisher.)

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