First came an innocuous-seeming fear of bedbugs. Bubbly, outgoing 24-year-old New York Post reporter Susannah Cahalan had awakened with a few unexplained red dots on her left arm, and since there was a citywide bedbug scare at the time, she was sure her tiny studio apartment was infested. When a careful search turned up nothing, she called an exterminator, who assured her that the place was bug-free. Still agitated, she insisted on an extensive, expensive spraying; then she filled garbage bags with her old, treasured newspaper clips, which she believed may have housed the vermin. This intense purge left her only with a jabbing head-pain and a sense of terrible foreboding.
So began Cahalan’s month-long descent into insanity and near-death, which she recounts in her harrowing, medical-mystery memoir, “Brain on Fire.” Only late in her odyssey did she learn that an obsessive fear of bugs can be an early sign of looming psychosis.
In the first weeks, Cahalan experienced alternating periods of normalcy and strange overreactions to ordinary events. As she walked down a corridor to meet John Walsh of “America’s Most Wanted” for an interview, she felt that her perspective had narrowed, “as if I were looking down the hallway through a viewfinder,” she writes. “The fluorescent lights flickered, and the walls tightened claustrophobically around me. As the walls caved in, the ceiling stretched sky high until I felt as if were in a cathedral. I put my hand on my chest to quell my racing heart and told myself to breathe.” Not only was she unable to wing her way through this prized interview, she wasn’t even coherent, and the article never ran in the newspaper.
As her symptoms ebbed and flowed, Cahalan had brief periods of respite — a sense that what she thought was the flu or mononucleosis had only been transitory. True, she was experiencing tingling and numbness in her hands — particularly her left hand, the side of her body where the red spots had first appeared. She was also suffering from sleeplessness, loss of appetite, migraine headaches and waves of fathomless dread. One morning, as she emerged from the subway, the garish colors on the Times Square billboards seemed to physically assault her. She could feel the “shock waves of pigment” vibrating through her body, and she wanted to retch. She was changing in ways that made her unrecognizable to herself — becoming forgetful at work, bursting into tears, consumed by the sense that she wasn’t real and that others around her were also imposters.
Eventually, a prominent neurosurgeon examined Cahalan and pronounced her normal. He attributed her increasingly florid symptoms to too much partying and drinking — a diagnosis that never changed, even after she had three seizures and became manic and paranoid. She ricocheted from having an exaggerated sense of control over her environment — she believed she could age people or make them younger with her mind — to a terror that her father had kidnapped her and brought her to the New York University epileptic ward, after having beaten her stepmother to death. Cahalan was certain that the nurses on her ward were whispering bad things about her and that her mental deterioration was being broadcast to the world on TV. Then, as the disease worsened, she sank slowly into a mute, motionless state of catatonia.
Despite the unwavering support of her parents — who, though divorced and remarried to other partners, joined forces in their daily vigils at their daughter’s bedside, and the remarkable loyalty of her boyfriend, Stephen, who was sure the real Susannah was “in there” — the illness continued on its relentless downward trajectory. After many blood tests, MRIs, CAT scans and a PET scan revealed nothing abnormal, a spinal tap was ordered. This provided the first clue that the patient’s mysterious condition had a neurological basis, for Cahalan’s cerebrospinal fluid contained an unusually high number of white blood cells. By now, though, the persistently optimistic doctor overseeing her case had become stymied by his inability to diagnose her illness and had withdrawn abruptly — a frightening moment for those who love her. Cahalan’s care had now been turned over to an esteemed NYU doctor — a Syrian emigre named Souhel Najjar.
During a neurological examination of Cahalan, Najjar had an “aha!” moment. He asked her to draw a clock and the numbers on its face. She did, but she crowded all of the numbers from 1 to 12 on the right side of the clock so that 12 landed on the place where 6 should appear. This was a clear sign that one of her cerebral hemispheres was not functional. Najjar informed Cahalan’s parents that her brain was inflamed because of an auto-immune reaction in her body. It is with this diagnositic information that this heaven-sent physician hit what can only be described as a medical home run in the last inning of a desperately losing game.
Cahalan’s tale is told in straightforward journalistic prose and is admirably well-researched and described. Because she has no memory of her “month of madness,” the story rests on doctors’ notes and recollections, hospital films, her father’s journals, both parents’ recounting of what happened, and the reminiscences of her devoted boyfriend and those of her many friends and relatives. This story has a happy ending, but take heed: It is a powerfully scary book.
BRAIN ON FIRE
My Month of Madness
By Susannah Cahalan
Free Press. 264 pp. $25