Neurologists and Firemen: A Review of Susannah Cahalan's "Brain on Fire"

Brain on Fire: My Month of Madness, Susannah Cahalan's first-hand account of a debilitating illness, is both disturbing and captivating. Disturbing, because we are reminded by her story that any of us could be (and many people are) hit with a serious illness out of the clear blue. Life is neither fair, nor predictable. Captivating, because how many of us could lose our mind, as Cahalan did, and chronicle the process of our mental death and resurrection? The story of what she endures while in diagnostic limbo necessarily relies on the observations and notes of family, friends, and physicians. Detective work permeates Cahalan's story on two different levels: the struggles of physicians who are trying to determine why a young woman suddenly begins exhibiting bizarre behavior, hallucinations, and seizures, and, at a higher level, the author's application of her skills as an investigative reporter in order to piece her story together. If you've ever seen someone suffer from an unexplained illness, you can't help but connect with Cahalan's family, if not the author herself. I have watched someone close to me struggle with an autoimmune disorder that has baffled many doctors and placed major constraints on this person's quality of life. Simply giving this person's disorder a name (a.k.a., a definitive diagnosis) has eluded most doctors. Susannah Cahalan was extremely fortunate to have been diagnosed and successfully treated for what is known as "anti-NMDA receptor encephalitis."

I have also watched - with heartache - someone else I cared for periodically descend into a serious mental illness, and felt helpless to do anything about it. We look to doctors for answers and when they are unable to give them, it plants a seed of fear, a fear that this person may never be the same again. I also know someone who, like the author, was evaluated by a neuropsychologist for a cognitive disorder. It is truly amazing what the administration of cognitive tests can reveal about brain function.

Cahalan's story has a happy ending. She is successfully treated and, with time, able to make a full recovery. But she reminds us that there are many others, every day, whose illness so baffles physicians that they may never be appropriately diagnosed. Though modern medicine is able to treat and prevent disease in ways we would have never guessed, it is both true and uncomfortable to accept that there are medical tragedies for which we have yet to find a cure.