What is Brain on Fire: My Month of Madness about?

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.

The medical dimension is important and carefully rendered. Cahalan writes about how her symptoms were initially dismissed and misread, how she spent days being evaluated for drug use and psychiatric illness before a neurologist named Dr. Souhel Najjar — to whom the book owes an enormous debt — correctly identified what was happening. The book is a documented case of what happens when a medical system encounters a presentation it isn't equipped to recognize, and how close she came to permanent institutionalization with the wrong diagnosis.

Brain on Fire reads quickly. It is not stylistically adventurous — Cahalan writes in the clear, accessible voice of newspaper journalism — but the story is genuinely gripping, and the existential questions underneath it are real. Who are you when the person you were for a month was effectively someone else? What does the experience of near-madness do to how you understand the self? The book doesn't fully answer these questions, but it asks them seriously.