Brain on Fire is New York Post reporter Susannah Cahalan’s gripping memoir about her horrific experience with a rare brain inflammation. The attack first manifested itself behaviorally—hallucinations, impulsive actions, anxiety—so Cahalan’s case was misunderstood and misdiagnosed as mental illness. After descending into a nearly catatonic state, a brilliant doctor correctly diagnosed Cahalan’s affliction as anti-NMDA-receptor autoimmune encephalitis. In simpler terms, Cahalan’s autoimmune system attacked her brain for no known reason.
Although Brain on Fire necessarily has some science in it, the narrative is strong and compelling. Short chapters, intense scenes, and Cahalan’s own stubborn spirit move the story forward with dramatic energy. My own memories of a family member’s recent serious illness are still fresh in my mind, so Cahalan’s description of medical misdiagnoses, hospital staffers, in-home nursing care, and pharmaceutical side effects ring chillingly true.
Through the use of her parents’ journals, hospital videotapes, and medical records, Cahalan takes readers through the process of reconstructing events that she doesn’t remember. Because Cahalan emerged from her illness and wrote the book, it isn’t really a spoiler to say that Brain on Fire has a more or less happy ending. Although patients with susceptible autoimmune systems have no guarantees against relapse, Cahalan is thankfully able to share her story.
Near the end of Brain on Fire, she wonders how many of those suffering from anti-NMDA-receptor autoimmune encephalitis are misdiagnosed and treated as hopelessly mentally ill. Cahalan questions whether some of those diagnosed with autism are actually suffering from some sort of serious but treatable brain inflammation.
The heroes in Brain on Fire are Cahalan’s supportive family, friends, and colleagues, as well as the doctors who keep asking questions and searching for answers when others gave up or gave in to convenient but inaccurate theories about her illness. Although she downplays her own heroism, it’s easy to admire Cahalan for not giving up on herself, and for the unflinching way she shares deeply personal fears and physical frailties.