Brain on Fire

Susannah Cahalan

3 ideas

1. Reporter misdiagnosed until clock-drawing test

   In 2009, 24-year-old New York Post reporter Susannah Cahalan developed paranoia, insomnia, hallucinations and seizures. Doctors attributed these in turn to alcohol withdrawal, mononucleosis and bipolar or schizoaffective disorder, while her MRI, EEG and bloodwork came back largely normal. Neurologist Souhel Najjar had her draw a clock, and she crowded all twelve numbers onto its right half, showing damage to the right hemisphere. A brain biopsy and spinal fluid tests then confirmed anti-NMDA receptor autoimmune encephalitis, and immunotherapy brought her close to full recovery.

2. Autoimmune disease can masquerade as psychiatric illness

   Antibodies attacking NMDA receptors in the brain can produce a sequence of symptoms that looks exactly like primary psychosis, including paranoia, mania, catatonia and delusions. When a case is labeled psychiatric too early, the search for a physical cause stops, and a treatable inflammatory disease can progress toward coma or death. The book argues that some patients confined to psychiatric wards or diagnosed with schizophrenia may have had an undiagnosed and reversible autoimmune condition.

3. Reconstructing a self from external records

   Cahalan had no memory of her month in the hospital, so she rebuilt it from hospital video footage, medical charts, her father's journal and interviews with family and doctors. This created a split between the 'me' who experienced events and the 'me' documented by others, and the two did not always agree. Identity during a gap in memory becomes something assembled from third-party evidence, and the patient becomes an investigative reporter of her own life.

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