Tuesday, November 29, 2016

Review of "Brain On Fire: My Month of Madness" by Susannah Cahalan




At the age of 24 Susannah Cahalan was doing just fine. She was lively, talkative, and fun-loving; she worked as a reporter for the New York Post; she lived in an apartment in Hell's Kitchen; and she had a great boyfriend named Stephen.

Then Susannah began to change: she forgot to prepare for an important work meeting; started to get migraines; felt compelled to snoop through Stephen's things; developed numbness.....then pins and needles. Before long these symptoms morphed into intense crying; rambling speech; facial grimaces; chewing motions; puppet-like movements; aggressive behavior; out-of-body experiences; seizures; paranoia; and delusions. Susan started to imagine that people were saying nasty things about her (or to her) and became convinced that her father had killed his wife (who was alive). In time, Susannah could hardly walk or speak.

Susannah saw doctor after doctor and had numerous medical and psychological tests, but physicians couldn't agree on a diagnosis. Suggestions included: excessive drinking and partying; anxiety attacks; epilepsy; bipolar disorder; schizoid disorder; schizophrenia; meningitis; encephalitis; and more. Eventually, Susannah broke down completely and had to be hospitalized. At this point, Susannah 'lost' a month of her life.....she has no memory of this period. However, Susannah was able to reconstruct this time using hospital videos, doctors' files, interviews with medical personnel, recollections of friends and family, and a journal kept by her parents.

Susannah might have descended into permanent psychosis, or even died - but was lucky enough to be diagnosed by a Syrian neurologist, Dr. Souhel Najjar. Dr. Najjar determined that Susannah had a rare autoimmune disorder called "anti–NMDA receptor autoimmune encephalitis" - in short, antibodies from Susannah's immune system were attacking her brain.

Dr. Najjar prescribed an intensive and prolonged regimen of steroid drugs, which ultimately halted the antibody assault on Susannah's head. The question remained.....could she recover completely? Fortunately Susannah had enormous support from her parents, stepparents, and Stephen - as well as excellent medical care (and good insurance).

In this memoir Susannah presents a thorough and vivid description of her descent into 'madness' and her difficult step by step recovery - which required her to re-learn how to walk, talk, and interact with people. Susannah also provides general information about the brain, how it works, how memories are formed, etc. This is interesting and accessible to the lay person.

Susannah's case became a 'cause celebre' - with articles in medical journals and newspapers as well as television appearances. As it turns out, the widespread publicity benefitted people who shared Susannah's illness, but were misdiagnosed. Some doctors, seeing articles about anti–NMDA receptor autoimmune encephalitis, were able to re-assess their patients. In some cases, this saved lives.

One BIG lesson I took away from this book is that it's very important to find the right doctor and get the correct diagnosis. As Susannah points out, people throughout history who were thought to be psychotic may have had anti–NMDA receptor autoimmune encephalitis.....or some other organic brain disorder. Of course this is true about health issues in general - ongoing research and new information often sheds light on previously 'mysterious' maladies.

I'd recommend this book to readers interested in memoirs about illness and recovery, especially brain disorders.

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