Brain on Fire: My Month of Madness

Book by: Susannah Cahalan
Review by: Matthew Hoekstra
Academic Success
University of Minnesota, Morris

Susannah Cahalan’s breathtaking and terrifying memoir, Brain on Fire, chronicles the weeks preceding her illness, her month long hospitalization of which she has no memory, and recovery.  The book offers numerous themes on which student affairs professionals can pull; perseverance, grit, persistence, determination, patience, positive thinking, and hard work – all important traits to instill in students.            

The memoir opens with the author convinced of a bed bug infestation, and preoccupied by this thought, Cahalan uncharacteristically neglects her work as a reporter at the New York Post. After returning home, Cahalan dismisses her ailments as the flu, and speculates on where she might have contracted the bug, attributing it to a sneeze on the subway. It is unknown how she acquired her illness, but the author notes that the episodes that followed nearly sent her to an asylum (p. 9).

Cahalan’s health continues to deteriorate as her symptoms mount – migraines, tingling and eventual numbness in her left hand, insomnia, racing thoughts, anxiety, fatigue, nightmares, nausea, hallucinations, and episodes of mania and psychosis – eventually leading Cahalan to the doctor. An initial MRI and EEG came back normal. Skeptical of the doctor’s initial diagnosis (alcohol withdrawal), Cahalan’s mother pleads with the doctor for hospitalization. Eventually Cahalan is admitted to the epilepsy unit at NYU Medical Center, where she becomes catatonic.

A specialist was asked to review Cahalan’s case. Neuropathologist Dr. Souhel Najjar discovered, after a brain biopsy, that Cahalan had anti-NMDA-receptor autoimmune encephalitis. With the diagnosis came the treatment plan that saved Cahalan’s life. The next morning, and with the prognosis still unclear, Cahalan was discharged from the hospital. Once the treatment began, Cahalan began to slowly recover. Through determination and hard work, Cahalan returned to work nearly seven months after she had left.

This book may not be a traditional one for student affairs professionals, but the lessons provided will benefit staff and students alike. One example is determination. Throughout her story, Cahalan exhibits great determination. She wants to improve. Another important theme is that of fragility. The book provides a grim reminder of how fragile physical and mental health can be -- offering a parallel to some of the students we work with daily. In addition, another theme running largely in between the lines until Cahalan addresses it directly in the latter part of the book is that of access and privilege. In many ways she is fortunate. She has medical insurance, access to wonderful healthcare facilities, and is supported by many medical specialists and her family. Finally, Cahalan’s story serves as a powerful reminder that we may not know the full story of the students sitting in front of us. They may have experiences we cannot fathom.

Cahalan’s prose is sharp and engaging and her story riveting. A minor quibble, however, is that that her recovery is not explored at the same pace or level of rigor and detail as her hospital stay. Nevertheless, this book is highly recommended.