Brain on Fire

My Month of Madness

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About The Book

An award-winning memoir and instant New York Times bestseller that goes far beyond its riveting medical mystery, Brain on Fire is the powerful account of one woman’s struggle to recapture her identity.

When twenty-four-year-old Susannah Cahalan woke up alone in a hospital room, strapped to her bed and unable to move or speak, she had no memory of how she’d gotten there. Days earlier, she had been on the threshold of a new, adult life: at the beginning of her first serious relationship and a promising career at a major New York newspaper. Now she was labeled violent, psychotic, a flight risk. What happened?

In a swift and breathtaking narrative, Susannah tells the astonishing true story of her descent into madness, her family’s inspiring faith in her, and the lifesaving diagnosis that nearly didn’t happen. “A fascinating look at the disease that . . . could have cost this vibrant, vital young woman her life” (People), Brain on Fire is an unforgettable exploration of memory and identity, faith and love, and a profoundly compelling tale of survival and perseverance that is destined to become a classic.

Excerpt

Brain on Fire PREFACE
At first, there’s just darkness and silence.

“Are my eyes open? Hello?”

I can’t tell if I’m moving my mouth or if there’s even anyone to ask. It’s too dark to see. I blink once, twice, three times. There is a dull foreboding in the pit of my stomach. That, I recognize. My thoughts translate only slowly into language, as if emerging from a pot of molasses. Word by word the questions come: Where am I? Why does my scalp itch? Where is everyone? Then the world around me comes gradually into view, beginning as a pinhole, its diameter steadily expanding. Objects emerge from the murk and sharpen into focus. After a moment I recognize them: TV, curtain, bed.

I know immediately that I need to get out of here. I lurch forward, but something snaps against me. My fingers find a thick mesh vest at my waist holding me to the bed like a—what’s the word?—straitjacket. The vest connects to two cold metal side rails. I wrap my hands around the rails and pull up, but again the straps dig into my chest, yielding only a few inches. There’s an unopened window to my right that looks onto a street. Cars, yellow cars. Taxis. I am in New York. Home.

Before the relief finishes washing over me, though, I see her. The purple lady. She is staring at me.

“Help!” I shout. Her expression never changes, as if I hadn’t said a thing. I shove myself against the straps again.

“Don’t you go doing that,” she croons in a familiar Jamaican accent.

“Sybil?” But it couldn’t be. Sybil was my childhood babysitter. I haven’t seen her since I was a child. Why would she choose today to reenter my life? “Sybil? Where am I?”

“The hospital. You better calm down.” It’s not Sybil.

“It hurts.”

The purple lady moves closer, her breasts brushing against my face as she bends across me to unhook the restraints, starting on the right and moving to the left. With my arms free, I instinctually raise my right hand to scratch my head. But instead of hair and scalp, I find a cotton hat. I rip it off, suddenly angry, and raise both hands to inspect my head further. I feel rows and rows of plastic wires. I pluck one out—which makes my scalp sting—and lower it to eye level; it’s pink. On my wrist is an orange plastic band. I squint, unable to focus on the words, but after a few seconds, the block letters sharpen: FLIGHT RISK.
Brain on Fire CHAPTER 1 BEDBUG BLUES
Maybe it all began with a bug bite, from a bedbug that didn’t exist.

One morning, I’d woken up to find two red dots on the main purplish-blue vein running down my left arm. It was early 2009, and New York City was awash in bedbug scares: they infested offices, clothing stores, movie theaters, and park benches. Though I wasn’t naturally a worrier, my dreams had been occupied for two nights straight by finger-long bedbugs. It was a reasonable concern, though after carefully scouring the apartment, I couldn’t find a single bug or any evidence of their presence. Except those two bites. I even called in an exterminator to check out my apartment, an overworked Hispanic man who combed the whole place, lifting up my sofa bed and shining a flashlight into places I had never before thought to clean. He proclaimed my studio bug free. That seemed unlikely, so I asked for a follow-up appointment for him to spray. To his credit, he urged me to wait before shelling out an astronomical sum to do battle against what he seemed to think was an imaginary infestation. But I pressed him to do it, convinced that my apartment, my bed, my body had been overrun by bugs. He agreed to return and exterminate.

Concerned as I was, I tried to conceal my growing unease from my coworkers. Understandably, no one wanted to be associated with a person with a bedbug problem. So at work the following day, I walked as nonchalantly as possible through the newsroom of the New York Post to my cubicle. I was careful to conceal my bites and tried to appear casual, normal. Not that “normal” means a lot at the Post.

Though it’s notoriously obsessed with what’s new, the Post is nearly as old as the nation itself. Established by Alexander Hamilton in 1801, it is the longest continually run newspaper in the country. In its first century alone, the paper crusaded for the abolition movement and helped promote the creation of Central Park. Today the newsroom itself is cavernous yet airless, filled with rows of open cubicles and a glut of filing cabinets packed with decades of unused, forgotten documents. The walls are freckled with clocks that don’t run, dead flowers hung upside down to dry, a picture of a monkey riding a border collie, and a big foam Six Flags finger, all memorabilia from reporters’ assignments. The PCs are ancient, the copy machines the size of small ponies. A small utility closet that once served as a smoking room now holds supplies, and is marked by a weathered sign warning that the smoking room no longer exists, as if someone might accidentally wander in for a cigarette among the monitors and video equipment. This has been my eccentric little world for the past seven years, since I started here as a seventeen-year-old intern.

Especially around deadline, the room buzzes with activity—keyboards clacking, editors yelling, reporters cackling—the perfect stereotype of a tabloid newsroom.

“Where’s the fucking picture to go with this caption?”

“How is it that he didn’t know she was a prostitute?”

“What color were the socks of the guy who jumped off the bridge?”

It’s like a bar without alcohol, filled with adrenaline-soaked news junkies. The cast of characters here is unique to the Post: the brightest headline writers in the business, the hardened newshounds hunting after exclusives, and type-A workaholics who possess the chameleon ability to either befriend or antagonize almost anyone. Still, on most days, the newsroom is subdued, as everyone silently combs through court documents, interviews sources, or reads newspapers. Often, like today, the newsroom is as quiet as a morgue.

Heading toward my desk to start the day, I wove through the rows of cubicles marked by green Manhattan street signs: Liberty Street, Nassau Street, Pine Street, and William Street, throwbacks to a time when the Post was actually flanked by those downtown streets in its previous home at the South Street Seaport. My desk is at Pine Street. Amid the silence, I slid into my seat beside Angela, my closest friend at the paper, and gave her a tense smile. Trying not to let my question echo too loudly across the noiseless room, I asked, “You know anything about bedbug bites?”

I often joked that if I ever had a daughter, I’d want her to be like Angela. In many ways, she is my newsroom hero. When I first met her, three years before, she was a soft-spoken, shy young woman from Queens, only a few years older than me. She had arrived at the Post from a small weekly paper and since then had matured under the pressure of a big-city tabloid into one of the Post’s most talented reporters, churning out reams of our best stories. Most late Friday nights, you’d find Angela writing four stories on split screens simultaneously. I couldn’t help but look up to her. Now I really needed her advice.

Hearing that dreaded word, bedbugs, Angela scooted her chair away from mine. “Don’t tell me you have them,” she said with an impish smile. I started to show her my arm, but before I could get into my tale of woe, my phone rang.

“You ready?” It was the new Sunday editor, Steve. He was just barely in his midthirties, yet he had already been named head editor of the Sunday paper, the section I worked for, and despite his friendliness, he intimidated me. Every Tuesday, each reporter had a pitch meeting to showcase some of his or her ideas for that Sunday’s paper. At the sound of his voice, I realized with panic that I was completely unprepared for this week’s meeting. Usually I had at least three coherent ideas to pitch; they weren’t always great, but I always had something. Now I had nothing, not even enough to bluff my way through the next five minutes. How had I let that happen? This meeting was impossible to forget, a weekly ritual that we all fastidiously prepared for, even during days off.

Bedbugs forgotten, I widened my eyes at Angela as I stood back up, gamely hoping it all would work out once I got to Steve’s office.

Nervously, I walked back down “Pine Street” and into Steve’s office. I sat down next to Paul, the Sunday news editor and close friend who had mentored me since I was a sophomore in college, giving him a nod but avoiding direct eye contact. I readjusted my scratched-up wide-framed Annie Hall glasses, which a publicist friend once described as my own form of birth control because “no one will sleep with you with those on.”

We sat there in silence for a moment, as I tried to let myself be comforted by Paul’s familiar, larger-than-life presence. With his shock of prematurely white hair and his propensity to toss the word fuck around like a preposition, he is the essence of a throwback newsman and a brilliant editor.

He had given me a shot as a reporter during the summer of my sophomore year of college after a family friend introduced us. After a few years in which I worked as a runner, covering breaking news and feeding information to another reporter to write the piece, Paul offered me my first big assignment: an article on the debauchery at a New York University fraternity house. When I returned with a story and pictures of me playing beer pong, he was impressed with my chutzpah; even though the exposé never ran, he assigned me more stories until I had been hired on full time in 2008. Now, as I sat in Steve’s office wholly unprepared, I couldn’t help but feel like a work in progress, not worthy of Paul’s faith and respect.

The silence deepened until I looked up. Steve and Paul were staring at me expectantly, so I just started talking, hoping something would come. “I saw this story on a blog . . . ,” I said, desperately plucking up wisps of half-formed ideas.

“That’s really just not good enough,” Steve interrupted. “You need to be bringing in better stuff than this. Okay? Please don’t come in with nothing again.” Paul nodded, his face blazing red. For the first time since I’d started working on my high school newspaper, journalism disagreed with me. I left the meeting furious at myself and bewildered by my own ineptitude.

“You okay?” Angela asked as I returned to my desk.

“Yeah, you know, I’m just bad at my job. No big deal,” I joked grimly.

She laughed, revealing a few charmingly crooked incisor teeth. “Oh, come on, Susannah. What happened? Don’t take it seriously. You’re a pro.”

“Thanks, Ang,” I said, sipping my lukewarm coffee. “Things just aren’t going my way.”

I brooded over the day’s disasters that evening as I walked west from the News Corp. building on Sixth Avenue, through the tourist clusterfuck that is Times Square, toward my apartment in Hell’s Kitchen. As if purposely living the cliché of a New York writer, I rented a cramped one-room studio, where I slept on a pullout sofa. The apartment, eerily quiet, overlooked the courtyard of several tenements, and I often awoke not to police sirens and grumbling garbage trucks but to the sound of a neighbor playing the accordion on his balcony.

Still obsessed with my bites, despite the exterminator’s assurance that I had nothing to worry about, I prepared for him to spray the place and spent that night discarding things that could be harboring bedbugs. Into the garbage went my beloved Post clips, hundreds of articles reminding me of how bizarre my job is: the victims and suspects, dangerous slums, prisons and hospitals, twelve-hour shifts spent shivering inside photographers’ cars waiting to photograph—or “pop”—celebrities. I had always loved every minute of it. So why was I suddenly so terrible at it?

As I shoved these treasures into the trash bags, I paused on a few headlines, among them the biggest story of my career to date: the time I managed to land an exclusive jailhouse interview with child kidnapper Michael Devlin. The national media were hot on the story, and I was only a senior at Washington University in St. Louis, yet Devlin spoke to me twice. But the story didn’t end there. His lawyers went nuts after the article ran, launching a smear campaign against the Post and calling for a judicial gag order, while the local and national media began debating my methods on live TV and questioning the ethics of jailhouse interviews and tabloids in general. Paul fielded several tearful phone calls from me during that time, which bound us together, and in the end, both the paper and my editors stood by me. Though the experience had rattled me, it also whetted my appetite, and from then on, I became the resident “jailhouser.” Devlin was eventually sentenced to three consecutive lifetimes in prison.

Then there was the butt implant story, “Rear and Present Danger,” a headline that still makes me laugh. I had to go undercover as a stripper looking for cheap butt enhancements from a woman who was illegally dispensing them out of a midtown hotel room. As I stood there with my pants around my ankles, I tried not to be insulted when she announced that she would need “a thousand dollars per cheek,” twice the amount she charged the woman who had come forward to the Post.

Journalism was thrilling; I had always loved living a reality that was more fabulist than fiction, though little did I know that my life was about to become so bizarre as to be worthy of coverage in my own beloved tabloid.

Even though the memory made me smile, I added this clip to the growing trash pile—“where it belongs,” I scoffed, despite the fact that those crazy stories had meant the world to me. Though it felt necessary at the moment, this callous throwing away of years’ worth of work was completely out of character for me. I was a nostalgic pack rat, who held on to poems that I had written in fourth grade and twenty-some-odd diaries that dated back to junior high. Though there didn’t seem to be much of a connection among my bedbug scare, my forgetfulness at work, and my sudden instinct to purge my files, what I didn’t know then is that bug obsession can be a sign of psychosis. It’s a little-known problem, since those suffering from parasitosis, or Ekbom syndrome, as it’s called, are most likely to consult exterminators or dermatologists for their imaginary infestations instead of mental health professionals, and as a result they frequently go undiagnosed. My problem, it turns out, was far vaster than an itchy forearm and a forgotten meeting.

After hours of packing everything away to ensure a bedbug-free zone, I still didn’t feel any better. As I knelt by the black garbage bags, I was hit with a terrible ache in the pit of my stomach—that kind of free-floating dread that accompanies heartbreak or death. When I got to my feet, a sharp pain lanced my mind, like a white-hot flash of a migraine, though I had never suffered from one before. As I stumbled to the bathroom, my legs and body just wouldn’t react, and I felt as if I were slogging through quicksand. I must be getting the flu, I thought.



This might not have been the flu, though, the same way there may have been no bedbugs. But there likely was a pathogen of some sort that had invaded my body, a little germ that set everything in motion. Maybe it came from that businessman who had sneezed on me in the subway a few days before, releasing millions of virus particles onto the rest of us in that subway car? Or maybe it was in something I ate or something that slipped inside me through a tiny wound on my skin, maybe through one of those mysterious bug bites?

There my mind goes again.

The doctors don’t actually know how it began for me. What’s clear is that if that man had sneezed on you, you’d most likely just get a cold. For me, it flipped my universe upside down and very nearly sent me to an asylum for life.

Reading Group Guide

This reading group guide for Brain on Fire includes an introduction, discussion questions, and ideas for enhancing your book club. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.


Introduction

One day, Susannah Cahalan woke up in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. Her medical records—from a month-long hospital stay of which she had no memory—showed psychosis, violence, and dangerous instability. Yet, only weeks earlier she had been a healthy, ambitious twenty-four-year old, six months into her first serious relationship and a sparkling career as a cub reporter. Susannah’s astonishing memoir chronicles the swift path of her illness and the lucky, last-minute intervention led by one of the few doctors capable of saving her life. As weeks ticked by and Susannah moved inexplicably from violence to catatonia, $1 million worth of blood tests and brain scans revealed nothing. The exhausted doctors were ready to commit her to the psychiatric ward, in effect condemning her to a lifetime of institutions, or death, until Dr. Souhel Najjar—nicknamed Dr. House—joined her team. He asked Susannah to draw one simple sketch, which became key to diagnosing her 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.  

Topics & Questions for Discussion 

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?

Enhance Your Book Club

    
 
1. Write about an important experience or event in your own life. Consider how this event changed you as a person. How did others react or respond to this event? What can others learn from an account of your experience? Next, rewrite this story incorporating information from interviews of one or two people who witnessed this same event. How do the two accounts differ? How accurate is each version? Which is more believable? Does your memory of the event differ substantially from that of the subjects you interviewed? Use this exercise as a platform to initiate discussion about truth, memory, perspective, and point-of-view in literature.   
 
2. Research and discuss other medical mysteries. You might consider sources such as Lisa Sanders’s Diagnosis column in The New York Times, which inspired the hit television show House. What do these stories have in common with Cahalan’s story? Consider and discuss your own experiences awaiting diagnosis and treatment of medical conditions. How did you and others around you react to this experience? How are these experiences like or unlike Cahalan’s experience? What can we learn by considering these experiences collectively?   
 
3. Have a film night. You might screen episodes of the Discovery channel’s Mystery Diagnosis or the fictional drama House. What connections can you draw between these mysteries and Cahalan’s real-life medical mystery?   
 
4. Read and discuss other works that challenge the mind-body connection. For instance, Malcolm’s Gladwell’s Blink: The Power of Thinking Without Thinking (Little, Brown, & Company, 2005) examines the brain’s ability to instantaneously interpret information. How do such works lead us to a better understanding of ourselves and our potential? What misconceptions do these works correct? What do you find reassuring about these works? Alternatively, how are these works challenging?   
 
5. Consider Brain on Fire alongside other memoirs, comparing style, narration, structure, and other formal elements. How do the works compare and how do they differ? What issues related to truth and bias in memoir surface within these stories? What do we find most compelling about these memoirs? What do these works reveal about identity, experience, and self-reflection? In addition to what we learn about the subject of each memoir, what do these books allow us to realize about others and ourselves? What, then, does this reveal about memoir as a genre and about literature as a didactic tool?

About The Author

Photograph by Julie Stapen

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.

Product Details

  • Publisher: Simon & Schuster (August 2013)
  • Length: 288 pages
  • ISBN13: 9781451621389

Raves and Reviews

“Captivating…Cahalan’s prose carries a sharp, unsparing tabloid punch in the tradition of Pete Hamill and Jimmy Breslin.”

– New York Times Book Review

“A fascinating look at the disease that – if not for a nick-of-time diagnosis – could have cost this vibrant, vital young woman her life.”

– People magazine

“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

“Swift and haunting.”

– Scientific American

“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 (starred review)

"An intense, mesmerizing account of survival. . . Cahalan's deft descriptions of her spooky hallucinations could be right out of a Poe terror tale."

– BookForum

“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

“Focusing her journalistic toolbox on her story, Cahalan untangles the medical mystery surrounding her condition…A fast-paced and well-researched trek through a medical mystery to a hard-won recovery.”

– Publishers Weekly

"The best reporters never stop asking questions, and Cahalan is no exception...The result is a kind of anti-memoir, an out-of-body personal account of a young woman's fight to survive one of the cruelest diseases imaginable. And on every level, it's remarkable.....Cahalan is nothing if not tenacious, and she perfectly tempers her brutal honesty with compassion and something like vulnerability. It's indisputable that Cahalan is a gifted reporter, and Brain on Fire is a stunningly brave book. But even more than that, she's a naturally talented prose stylist — whip-smart but always unpretentious — and it's nearly impossible to stop reading her, even in the book's most painful passages....Brain on Fire comes from a place of intense pain and unthinkable isolation, but finds redemption in Cahalan's unflagging, defiant toughness. It's an unexpected gift of a book from one of America's most courageous young journalists."

– NPR.org

“What is most impressive about “Brain on Fire” is that Cahalan has little recollection of her month of insanity…. Thanks partially to her talent as a journalist and to the fact that her parents kept journals, Cahalan was able to recapture her month, leaving no holes in the narrative.”

– The Daily Texan

“Compelling…a New York Post reporter recounts her medical nightmare.”

– Mental Floss

Awards and Honors

  • Heather's Pick - Fiction

Resources and Downloads

Freshman Reading:

Campbell University (2014/2015)

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