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What it argues
Brain on Fire is Susannah Cahalan's account of the month she spent in a New York hospital in 2009, during which she experienced psychosis, paranoia, violent behavior, catatonia, and seizures — and was nearly committed to a psychiatric facility before a doctor correctly diagnosed her with anti-NMDA receptor encephalitis, a newly described autoimmune disease in which the body attacks the brain. The disease had only been named two years before her illness. Cahalan, who was twenty-four at the time and a reporter for the New York Post, reconstructed the month from medical records, hospital surveillance footage, and accounts from the people who were there, because she remembers almost none of it herself.
The reconstruction is the most interesting formal aspect of the book. Cahalan is essentially piecing together a story in which she is both the subject and an unreliable narrator by definition — the version of herself in the hospital was not her, and she had no access to that period through memory. She relies on what others saw and recorded, and the book has the texture of investigative reporting applied to one's own collapsed self. The disease had produced a person who hit nurses, issued religious proclamations, and behaved in ways the people who loved her found unrecognizable. She had to learn who she had been.
What it gets right
- 1.
Anti-NMDA receptor encephalitis mimics psychiatric illness so closely that many patients are still misdiagnosed and institutionalized rather than treated for the underlying disease.
- 2.
Memory is not a reliable record even of experiences we think we should recall. Cahalan had no access to a month of her own life, and had to reconstruct it from external sources.
- 3.
The self is not as continuous or stable as most people assume. The person Cahalan was during her illness was in important ways a different person, using her body.
What it covers
Who wrote it
Susannah Cahalan is an American journalist and author based in New York. She was a reporter and feature writer for the New York Post before and after her illness. Brain on Fire, published in 2012, was adapted into a Netflix film in 2016. Her second book, The Great Pretender, published in 2019, examines the history of psychiatric diagnosis through the story of the Rosenhan experiment. Cahalan has become an advocate for patients with anti-NMDA receptor encephalitis and related autoimmune neurological conditions.
