Brain on Fire tells the story of 24-year-old Susannah Cahalan, a journalist at the New York Post who suddenly contracts the disease anti-NMDA receptor autoimmune encephalitis. The disease temporarily changes Susannah from a driven, strong-willed, and passionate person into someone who is paranoid, angry, and mean. Most difficult for Susannah, who describes herself as a proudly independent person, is that the disease also makes her entirely dependent on her caregivers in the hospital, her family, and her boyfriend. As Susannah changes over the course of the memoir, she and her family continually question who she is and whether she'll ever be the same as she once was, and Susannah in particular chafes when she senses that her friends and family aren't able to see who she is due to the way her illness affects her body and brain. In this way, the memoir explores different modes of expressing and experiencing one's own identity or the identity of another person, as well as the ways in which questions of identity are entangled with health and the body.
When Susannah first becomes ill, her symptoms are primarily psychotic ones. She becomes paranoid about bedbugs and thinks that her boyfriend, Stephen, might be cheating on her. She becomes delusional and experiences intense mood swings, all of which are worsened by aural and visual hallucinations. These symptoms turn Susannah into a completely different person than the woman she was before she became ill. This leads her parents and Stephen to question who, exactly, this new person is—and whether this new person is still Susannah. When her family doesn't recognize Susannah's personality as her own at various points in her illness, they're actually perceiving that their memories of Susannah don't match up with the person in front of them. By explaining her personality and mood changes in terms of how well her brain is functioning at any given time, Susannah makes the very concept of personality into a matter of body chemistry. This approach makes Susannah's aggression in particular easier for her family to tolerate, as it shows them that she's not actually trying to be difficult or mean—she's simply at the mercy of her medical condition and her malfunctioning brain.
Susannah describes how her family, friends, and doctors came to think of her personality as being split into distinct identities: one before she became ill and one during her illness. This split is further complicated as she recovers, as doctors ask her at every appointment to rate how much she feels like her “old self” on a scale of 1-100. In the throes of her illness, her family talks often about "getting her back," implying that while she's ill, Susannah herself is gone. Susannah echoes this sentiment when she describes watching the EEG monitoring videos for the first time—she says that she doesn't recognize the crazed, fearful, and skinny girl who spoke into the TV remote and insisted that her coworkers were talking about her on the news. Because Susannah knows that that girl is definitely her but doesn't remember being her, this suggests that one's public or social identity—who others see a person as—isn't even always known to the person themselves. It's something that exists whether a person is aware of it or not, and it doesn't always necessarily match a person's intimate, personal identity that exists within their own mind. This becomes particularly apparent when Susannah begins to recover and notes that other people speak to her in slow, measured tones. They have no way of knowing that Susannah's mind is fully functional, unlike her body--and it's her poorly functioning body that keeps her from being able to properly perform for others her identity that exists in her recovering mind.
In the end, Susannah makes a full recovery and returns to a version that closely resembles her former driven self—though with some notable changes. She doesn't regain the full independence she enjoyed before her illness, and moves in with Stephen earlier than they'd planned due to her need for monitoring (though she shares that she did eventually regain full independence). Most distressing for Susannah, because she didn't have a teratoma (a type of tumor that's often responsible for instigating the onset of the disease), she's also at an increased risk for becoming ill again without warning. This leaves her with an underlying feeling of paranoia and heightened awareness about the tenuousness of her recovered identity, since she could easily return to being that girl from the EEG footage at any point.
Ultimately, the book suggests that identity as a whole isn't something fixed or static, or something separate from a person's body. There is the social aspect of identity—who others see as Susannah, based on their memories and judgments of her “self”—and then there is the personal aspect, which is most intimately explored over the course of Susannah’s disease. She doesn’t address questions of the soul or spirit apart from the body, perhaps because it is abundantly clear to her that one’s “self” is a very physical thing, which can be fundamentally changed by physical changes to the brain. Instead of holding up a “self” apart from the body, Susannah suggests that identity is formed chemically in the brain, and the brain can be a dangerously unreliable host.
Identity and Illness ThemeTracker
Identity and Illness Quotes in Brain on Fire: My Month of Madness
There are times when you feel like the best in the business, and other times when you're certain that you're a complete and total hack and should start looking for an office job. But in the end, the ups and downs even out. So why was everything in such upheaval for me? It had been weeks since I felt comfortable in my own journalist skin, and that frightened me.
"You don't have to do that," I insisted, my voice mellowing as I returned, almost instantly, to my old self. Manic episodes can fade away as quickly as they arise. "I don't want her to worry."
Even during this time when I hardly recognize myself, there are still shadows of the real Susannah, a person who cares what her family and friends think, who doesn't want to cause them pain.
Though my behavior was worsening day by day, it was still difficult for her to reconcile the old image that she had of her daughter as trustworthy, hard working, and independent with the new, unpredictable, and dangerous one.
"Her EEG was completely normal," Bailey protested, looking through my file. "MRI normal, exam normal, blood work normal. It's all normal."
"Well, she's not normal," my mom snapped as I sat there, quiet and polite with my hands folded in my lap. She and Allen had made a pact that they would not leave Dr. Bailey's office without getting me admitted to a hospital.
Unlike before, there are now no glimmers of the reliable "I," the Susannah I had been for the previous twenty-four years. Though I had been gradually losing more and more of myself over the past few weeks, the break between my consciousness and my physical body was now finally fully complete. In essence, I was gone.
Morrison wrote down "tenacious in her attempts." I seemed to realize I wasn't getting it right, which frustrated me deeply. It was clear that, for all my other impairments, I knew that I was not functioning at the level I was used to.
The raw panic makes me uncomfortable, but the thing that truly unsettles me is the realization that emotions I once felt so profoundly, so viscerally, have now completely vanished. This petrified person is as foreign to me as a stranger, and it's impossible for me to imagine what it must have been like to be her. Without this electronic evidence, I could never have imagined myself capable of such madness and misery.
I had asked him many times why he stayed, and he always said the same thing: "Because I love you, and I wanted to, and I knew you were in there." No matter how damaged I had been, he had loved me enough to still see me somewhere inside.
In many ways, during that recovery period at my mother's home, I associated the pills—and the fights they engendered—with her. In a practical sense, I needed her to portion out the pills because it was far too complicated a task for me at the time. In a more emotional sense, though, I began to feel that she, like the pills, embodied my contemptible dependence.
Perhaps because the diary provides physical evidence of my budding self...I can in essence begin to remember what it was like to be her, unlike the earlier Susannah from those paranoid diary entries before the hospital, who was more like a figment of a shadowy memory, so distant that she might have been a character in a horror movie.
It was one thing to live at my parents' house for a few months, knowing that I had my own place just a train ride away. Now my only home was with my mom; it was like a complete return to childhood.
When I worried about being fat forever...I was actually worried about who I was going to be: Will I be as slow, dour, unfunny, and stupid as I now felt for the rest of my life? Will I ever again regain that spark that defines who I am?
Buoyed by this new ability to explain, I began to research the disease in earnest and became obsessed with understanding how our bodies are capable of such underhanded betrayal. I found, to my frustration, that there's more we don't know about the disease than we do know.
"He's talking about my brain," I whispered, although I didn't understand then what these slides portrayed. All I knew was that a very intimate part of myself was on display in front of a hundred strangers. How many people can say that they've allowed others to literally see inside their heads?
Evil. To the untrained eye, anti-NMDA-receptor autoimmune encephalitis can certainly appear malevolent. Afflicted sons and daughters suddenly become possessed, demonic, like creatures out of our most appalling nightmares.
The girl in the video is a reminder about how fragile our hold on sanity and health is and how much we are at the utter whim of our Brutus bodies, which will inevitably, one day, turn on us for good. I am a prisoner, as we all are. And with that realization comes an aching sense of vulnerability.
The friends and relatives I interviewed would never have used the term skittish to describe me, but every now and then, when I'm on the subway and the colors seem brighter than normal, I think, Is it the lighting, or am I going crazy again?
Psychology professor Dr. Henry Roedigger calls what happened with the FLIGHT RISK band a form of social contagion: if one person remembers incorrectly and shares this with others, it can spread...
Did I harbor this false memory? Was I the one who spread it? I am sure I remember vividly seeing the words FLIGHT RISK on my arm. Or am I?