Brain On Fire

This is the first chapter where the reader encounters neurologist Dr. Russo, who thinks Cahalan has postictal psychosis, or bipolar disorder. After one examination, Russo prescribes Cahalan antipsychotics. Dr. Siegel is a general practitioner who charms Cahalan’s mother, Rhona. He says to Rhona, “‘We will figure this out. Susannah will be fine.’ My mother clung to these words like a life raft and nicknamed the doctor ‘Bugsy’—her own gangster doctor” (82).

Dr. Khan, a psychiatrist, believes Cahalan has dissociative identity disorder or bipolar I, in part because Dr. Khan perceives how Cahalan looks to be a “visual picture to match the psychological one” and because Cahalan “was within the age range for psychotic breaks, which tend to occur in the late teens or early twenties, but also frequently happen later in life for women” (83).

Thus far, Cahalan’s doctors do not believe her self-diagnosis. They perform some investigations before ultimately misdiagnosing and mistreating her. They do ask more penetrating questions than previous doctors and are slower to draw conclusions. The doctors, and in turn Cahalan’s family, also use more precise language for her symptomology. Cahalan’s paranoid hallucinations continue and intensify, increasing the chances she will be moved from the floor for epileptics to the psychiatric ward.

Here, we meet Dr. Arslan, a psychopharmacologist. He performs the most comprehensive intake process thus far in Cahalan’s journey, interviewing those around her and digging deep into her past. Arslan thinks Cahalan has schizoaffective disorder and postictal psychosis (PIP), the symptoms including “delusions, hallucinations, and disorganized speech, and negative symptoms, such as mutism or general apathy” (87), and psychotic behavior following a cluster of seizures. These symptoms should last around 10 days.

Cahalan can no longer handle watching television. She believes everyone on TV is gossiping about her. She also thinks that everyone knows about her illness and that her reputation is ruined. Further, she is sure that her father is a murderer and has killed Giselle, among others. In an excerpt in italics, Cahalan writes what she hallucinates hearing and seeing on the local news--a broadcast about her mental illness and her father’s arrest for murder.

Cahalan’s treatment of staff, along with escape attempts, have put her on the brink of being forcibly removed from the ward. If she does not control her behavior or find a way to make the symptoms subside, she will be placed in the psychiatric ward.

Dr. Friedman, an internist, is startled by Cahalan’s blood pressure, which is exceptionally high. He believes this spike in pressure indicates a stroke or bleeding in her brain.

A glimmer of the old version of Cahalan comes out while her father is visiting. She hugs him and tells him to try to stay positive. Her father is overwhelmed by this moment, sharing it with the rest of the close family, except for James, who has been intentionally left in the dark about his sister’s illness. The family decides to rally behind her and commit to solving her medical mystery.

In this chapter, Cahalan provides more insight into her father’s character. We learn more about his emotional state before and during her illness. Her father kept a daily journal of Cahalan’s medical developments and his own feelings on the matter. Cahalan notes the emotional impact her illness had on him: “After my second escape attempt, he wrote a heartbreaking entry about praying that God would take him instead of me” (95).

For a short time, Cahalan’s psychosis recedes. While her mental health temporarily improves, her physical health wanes. She transfers to a private, peaceful hospital room overlooking the East River and FDR Drive. Cahalan begins crying out for help periodically, weak as she is. She believes staying in the hospital is killing her.

The doctors propose a spinal tap in the next stage of investigation, which triggers flashbacks for her parents, who still vividly recollect the pain James endured as an infant when he had to get a spinal tap to rule out meningitis. Although they are afraid, they give the go-ahead for Cahalan’s spinal tap.

Many nurses have now grown to love and care for Cahalan. Cahalan begins to regress mentally and age physically. She shows no signs of psychosis, but she does show signs of increased compulsion. Her cousin, Hannah, comes to visit. Hannah is the first person who has visited outside of her parents and boyfriend. Where she was once wild and violent, Cahalan is now eerily catatonic.

A stream of family and friends visit Cahalan. She is aware that while the visits do her some good, they can also be detrimental: “it would often leave me depleted and unable to communicate for hours afterward, as if I had devoted all my energy to acting normal” (111).

Cahalan is no longer able to read or complete complex tasks. Daily routine and visits from Stephen bring her joy and help to a degree. Cahalan begins journaling.