5 Rated Books Book Reviews The Dare

The (Nonfiction) Dare: Brain on Fire by Susannah Cahalan

IT’S BACK! The Dare is back!

Years ago, we had a regular feature called The Dare (and its sibling, the Guest Dare) in which we dared each other to read books outside of our comfort zone. For no real reason, we stopped doing those until we decided to bring it back this year. So without further ado: The Dare 2.0.

Today, the dare is a little bit different. This time, in a true testament of strength, we’ve both agreed to review a category completely outside of our comfort zones: nonfiction. Thea takes on Brain on Fire by Susannah Cahalan (a memoir/medical thriller about a young journalist recounting the months of illness and diagnosis of a rare autoimmune disorder). Tomorrow, Ana will post her Dare, Gossip of the Forest by Sara Maitland (about the intertwined relationship between fairy tales and actual forests). Wish us luck!


Brain on FireTitle: Brain on Fire

Author: Susannah Cahalan

Genre: Nonfiction, Memoir

Publisher: Free Press
Publication date: November 2012
Hardcover: 264 pages

A gripping memoir and medical suspense story about a young New York Post reporter’s struggle with a rare and terrifying disease, opening a new window into the fascinating world of brain science.

One day, Susannah Cahalan woke up in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. Her medical records—from a month-long hospital stay of which she had no memory—showed psychosis, violence, and dangerous instability. Yet, only weeks earlier she had been a healthy, ambitious twenty-four year old, six months into her first serious relationship and a sparkling career as a cub reporter.

Susannah’s astonishing memoir chronicles the swift path of her illness and the lucky, last-minute intervention led by one of the few doctors capable of saving her life. As weeks ticked by and Susannah moved inexplicably from violence to catatonia, $1 million worth of blood tests and brain scans revealed nothing. The exhausted doctors were ready to commit her to the psychiatric ward, in effect condemning her to a lifetime of institutions, or death, until Dr. Souhel Najjar—nicknamed Dr. House—joined her team. He asked Susannah to draw one simple sketch, which became key to diagnosing her with a newly discovered autoimmune disease in which her body was attacking her brain, an illness now thought to be the cause of “demonic possessions” throughout history.

With sharp reporting drawn from hospital records, scientific research, and interviews with doctors and family, Brain on Fire is a crackling mystery and an unflinching, gripping personal story that marks the debut of an extraordinary writer.

Standalone or series: Standalone book

How did I get this book: Bought

Format (e- or p-): Ebook

Why the Dare: I have a secret fascination with certain types of nonfiction books – particularly intriguing biographies and memoirs. In the case of Brain on Fire, I had heard rave reviews from all the professional review sources, I’d heard about the book on television news outlets and on NPR. My interest in the book was piqued by the premise (mystery diagnosis, real life Doctor House minus the drug problem, etc) – and when I learned that Cahalan’s mystery diagnosis could have been the same disease responsible for people thought history supposedly suffering from demonic possession, I knew I had to read this memoir.


At twenty-four years old, Susannah Cahalan’s life is trending upward. She has paid her dues as an intern and beat writer for the New York Post, and her career as an incisive young reporter is just starting to take off. She has a loving family, and she’s six months into her first serious relationship (I love yous are exchanged).

That promising career and budding romance, however, all comes crashing down over the course of a few short weeks, when Susannah’s health and mental state rapidly deteriorate. A former straight-A student, and a highly intelligent and emotionally stable young woman, Susannah suffers from increasingly acute paranoia and psychosis, followed by seizures, uncontrollable physical tics, and eventual catatonia. The doctors are baffled as her tests come back normal and negative for all known illnesses with her symptoms and Susannah’s diagnosis remains a mystery as doctors rule out a wide arc of potential ailments. Her diagnosis shifts from alcoholic withdrawals, to psychological illness (bipolar disorder, schizophrenia), to epilepsy, meningitis, herpes, hepatitis, and cancer – all to no avail. Finally, after a long month of hospitalization, Doctor Souhel Najjar – a renowned specialist in mystery diagnoses, earning him the title of the Real-life House MD – solves the case, and Susannah’s elusive illness (an extremely rare autoimmune disease) is finally diagnosed and treated.

Brain on Fire is the news story of Susannah Cahalan’s career – in this investigative journalistic memoir, she reconstructs the days leading up to her illness (paranoia over imagined bedbug bites, intense mood swings, increasing mania and delusions) to the missing month of her hospitalization and diagnosis, and the recovery period thereafter. Susannah’s recounting is all the more remarkable, as she has pieced together this account from the memories, notes, and recordings of others – Susannah herself has no recollection of the weeks she spent in NYU’s epilepsy wing, although she has copious notes, witnesses, and video of that period of time.

It’s a hard thing to review nonfiction, especially an autobiographical memoir. How do you criticize the work without being judgmental and criticizing someone’s life? I will do my best to walk this very fine line, and apologize in advance for my ineptitude in this particular genre. What I will say is this: I found the overall story behind Susannah’s illness and diagnosis fascinating, and I love Cahalan’s journalistic skill as she pieces together the fragments of her past to form a cohesive story. That said, while the book starts out fairly strong, it quickly loses steam after Susannah is diagnosed (about halfway through the narrative). Instead of focusing on those clues and the investigative story of Susannah’s missing month of memory, Brain on Fire focuses, oddly, on the minutia of Susannah’s family and friends – there are lots of car rides and teary embraces, recountings of walks, spin class, and so on. The momentum of the book is off-kilter, especially the later parts of Cahalan’s story following diagnosis, as the book peters out in a needlessly protracted denouement.

Pacing issues aside, I have one other major problem with Cahalan’s memoir: the treatment of mental illness.

Susannah is repeatedly described as a capable, smart, vivacious young woman. One who has always played by the rules, who is considered, kind, and intelligent, who would never crack under stress. When doctors initially ascribe her illness to a psychological cause, her parents are vehemently opposed to the possibility that Susannah could suffer from mental illness. Susannah herself is vehemently opposed to this, by the very nature of writing this in her memoir.

“Well, Susannah’s insisting that she’s manic-depressive. Do you think that’s a possibility?”

James thought on this for a moment. “No. Not in the least. That’s just not Susannah. Sure, she can be excitable and temperamental, but she’s not depressive. She’s tough, Mom. We all know that. She deals with a lot of stress, but she handles it better than anyone I know. Bipolar doesn’t make any sense to me.”

“Me neither,” my mom said. “Me neither.”

And after diagnosis:

My mother smiled for the first time in weeks. It was a strange relief for her to finally have confirmation that something physical, as opposed to emotional, was happening to me.

Later in the book, after Susannah is diagnosed and treated, Cahalan writes that her father leaves a note to the epilepsy ward staff at NYU, saying:

Susannah is a wonderful young woman who deserved your hard work.

All of this in combination is deeply, intensely problematic. The implication of these different statements and tone throughout the book is that mental illness is something that only weak people suffer from; that Susannah – beautiful, smart, middle class Susannah – couldn’t possibly have a psychological illness. Worse, that last note from Susannah’s father implies that there are those out there (e.g. mentally ill patients without “real” physiological diseases) who do not deserve the hard work of doctors. Mental illness is real and it affects millions of individuals in the United States alone – it is not a function of weakness, and those afflicted with mental illness are not in any way lesser than those afflicted with physiological illness.

Furthermore, Brain on Fire is the story of a very privileged young woman in the United States (blonde, blue-eyed, white, from the well-off suburbs with two parents that love and stand by her side through her entire ordeal). One can’t help but think, what about the other people who suffer from Susannah’s extremely rare disorder? What about those without health insurance, or the support system of Cahalan’s family, or who don’t have access to this type of medical attention? I wish Cahalan had – even tangentially – examined these issues.

Ultimately, Brain on Fire has promise, but leaves much to be desired. This book is a miss, for me.

Notable Quotes/Parts: From the excerpt:

I don’t remember how I got home after the interview or how I filled the hours in the wake of yet another professional debacle, but after still another sleepless night—it had now been over a week since I’d slept fully—I headed to the office. It was a gorgeous early March morning, the sun was out, and the temperature was a crisp thirty degrees. I had walked through Times Square twice a day for six months, but today, once I hit the rows of billboards at its center I was accosted by its garish colors. I tried to look away, to shield myself from shock waves of pigment, but I couldn’t. The bright blue wedge of an Eclipse gum sign emitted electric swirls of aqua and made the hair on the back of my neck stand up. I could feel the colors vibrating in my toes. There seemed to be something exquisite about that rush; it was simultaneously enervating and thrilling. But the thrill lasted only a moment when, to my left, the moving scroll of “Welcomes you to Times Square” caught my attention and made me want to retch in the middle of the street. M&M’s on an animated billboard to my left pirouetted before me, forging a massive migraine in my temples. Helpless in the face of this onslaught, I covered my eyes with mittenless hands, stumbling up Forty-Eighth Street as if I had just gotten off a death-defying roller coaster, until I hit the newsroom, where the lights still felt bright but less aggressive.

“Angela, I have to tell you something strange,” I whispered, concerned that people might be listening in, thinking I was crazy. “I see bright colors. The colors hurt my eyes.”

“What do you mean?” she asked, worry evident in her smile. Every day my behavior had been growing increasingly erratic. But it wasn’t until this morning that my ramblings had begun to frighten her.

“Times Square. The colors, the billboards: they’re so bright. Brighter than I’ve ever seen them before.”

“You must be really hung over.” She laughed nervously.

“I didn’t drink. I think I’m losing my mind.”

You can read the full excerpt online HERE.

Rating: 5 – Meh, strong early high notes are diluted with a weak finish; this, plus, the overall uncomfortable messaging (regarding mental illness) equals ambivalence

Buy the Book:

(click on the links to purchase)

Ebook available for kindle UK, nook, kobo, sony, google play & iBookstore


  • janicu
    July 18, 2013 at 4:41 pm

    The word “Advertisement” seems to have gotten inserted in a weird place in that excerpt.

    I was interested in maybe checking this book out (not that into non-fiction either, but every so often I am tempted). Hmm, wonder how I would interpret the insistence that her problem was not mental illness but something else. On one hand it’s a great story, on the other the way mental illness is portrayed suggests a lack of experience with it. I might still look for this one, just to learn the story.

  • Jamie
    July 18, 2013 at 5:58 pm

    As someone with a mental illness, with a poor family with a lot of mental illness, I know quite a lot about weakness. Weakness is the difference between me and what I don’t want to be. Being helpless and knowing you’re helpless and still fighting, well, I think that takes quite a lot of strength. The thought of reading this book makes me very uncomfortable.

  • Catherine
    July 19, 2013 at 12:55 am

    It’s unfortunate the author didn’t take this opportunity to bring some better understanding to mental illnesses, however, I commented because I actually have a small nitpick with your review:
    “those afflicted with mental illness are not in any way lesser than those afflicted with physiological illness.” <-even this statement (your own) is still characterizing mental illness incorrectly. Mental illness is a physiological illness. That's because psychology, emotions, etc are all physical processes. They require biological substrates. To put it more clearly, mental illnesses present with all sorts of concrete physical changes in the brain, and in other parts of the body. The behavioural symptoms that we see, and the emotional symptoms the patient experiences are just the visible symptoms we associate with those diseases. But at the same time, patients are experiencing less visible (to the naked eye) physical changes in their body. The behavioural symptoms arise from those physical changes. This is why psychosis, depression, anxiety, etc can be symptoms of infections, Vitamin B12 deficiency, or whatever. Because those behavioural/emotional visible changes are just one symptom of the disease state. There is not really a mind/body division. "Mind" processes have a neuro-chemical basis. I think that's a large part of why mental illness is stigmatized. People still want to believe that their mind or identity is separate from their body. But that's not true, and it really only takes some reading of intro psychology type info or even case studies on pubmed. But without some personal experience, I think it can be hard to understand quite what that means. I think we actually essentially agree, since you state that mental illness "is not a function of weakness". Yes, mental illness does not occur due to some character defect, an inability to handle the normal stress of life that everyone else handles, or something similar. However, it is a physiological disease, because we are physical beings, so everything that we experience mentally has a physical basis. Not sure if I explained this well . . . but it's always kind of sad to see how mental illness is continually misrepresented.

  • Kate & Zena
    July 19, 2013 at 2:44 am

    The thing that is sad is her condition is as much an auto-immune disorder as it is a mental illness. Did she completely forget to listen to that? It basically started attacking parts of her brain and that’s why she started hallucinating and having paranoia. Her incredibly rare disorder is classified as both an auto-immune disorder and a psychiatric disorder (it will be in the DSM-V.)

    She’s not recovered by any means mentally if she’s still denying any part of her disorder is psychological. As I’m reading what she has, I can see why they decided to add it to the DSM. It’s a freaking scary disorder. I thought having Epilepsy was scary since I black out at the most inconvenient times; this is scarier!

    (And I really dislike people who think mental illness is mind over matter. It isn’t. We have three generations of mental illness in my family. It isn’t mind over matter! Mental illness is genetic as well.)

  • Thea
    July 19, 2013 at 9:12 am

    Janicu – Thanks for the heads up (copy and paste from a website sometimes includes weird misplaced things like that “Advertisement”)! If you do give this one a chance, I’d be interested to see what you think? It is (at least for the first part of the book) an engaging story and overall reviews have been very positive. Let me know what you think!

    Jamie – Thank you so much for your comment. And this:

    Being helpless and knowing you’re helpless and still fighting, well, I think that takes quite a lot of strength.

    YES, absolutely. I completely agree with you.

    Catherine – Thank you so much for your comment, and I apologize for my own ignorance/ineptitude. Of course you are absolutely right, in that the mind *is* a part of the body, and that mind processes have neurochemical bases. By definition, then, any human disease would be a physiological one because it would in some way affect some part of the body.

    I guess what I was trying to say – very poorly, and perhaps very ignorantly (I apologize again, I *am* very ignorant in this arena and want to learn and understand) – is that there seem to be differences in the way doctors approach illnesses of the “mind” versus illnesses of the “body.” Even though the mind is part of the body, there is a divide (I think?) for example between neurologists, who would treat the physical brain/nervous system state, versus psychiatrists, who would diagnose and treat mental illness.

    That said… things aren’t so cut and dry and easily delineated. Like you say, psychosis, anxiety, depression can be symptoms of other underlying diseases (this is in fact the case for Susannah Cahalan in this book). What bothered me so much in the book is the pervasive feeling of fear and superiority – psychosis was a symptom of Susannah’s non-emotional (her words, not mine) disease.

    I think I’m rambling now. But I do really appreciate your comment, and apologize for causing any offense in my ignorance.

    Kate & Zena – I read it as Cahalan saying that her disorder was completely “physical,” but presented psychological symptoms. There is a very deep vein of fear, throughout the book, of mental illness and an insistence by Cahalan and her family that she is a “strong” “deserving” individual, therefore there must have been suffering from some underlying “physical” disease – the implication being that she wasn’t the kind of person (i.e. a weak person) that would succumb to mental illnesses like depression, schizophrenia, bipolar disorder, etc.

    And THAT is what made me so intensely uncomfortable and angry with the book. NO. Just. NO.

  • Kate & Zena
    July 19, 2013 at 10:25 am

    Thea– Oh, definitely, I completely understand what you are talking about. It’s still a stigma that exists today; you must be “weak” if you have a mental disorder. But, there are many kinds of disorders that run into the mental area (Autism, Cerebral Palsy, Epilepsy….all of which I have) that I really dare someone to call another person with a mental illness “weak.” They are truly some of the strongest people I know. Mental illness pulls many families apart…but it brings some so much closer together. My family certainly wouldn’t be as close had it not been for all the mental illness that has occurred in my family. We call ourselves The Nut Ward. Ha ha ha!

  • Thea
    July 19, 2013 at 10:43 am

    Kate & Zena – NICE, I like it!

    I also should mention, there is a part of this book when Cahalan, who spends the month confined in the epilepsy ward at NYU, reflects on her father who repeatedly thinks (I quote) “[my daughter] is not one of these people” (“these people” being epileptic patients on the same floor). I had the urge to fling my e-reader at a wall.

  • Kate & Zena
    July 19, 2013 at 10:57 am

    Thea- You certainly have more control than my mom or me. There would have been one book hurling through the air splatting against a oft-marked white wall. It would slide down the wall, pages crumpled, sagging in defeat.

    I just can’t tolerate that. I have a great amount of leniency for people because Epilepsy, and how to treat a seizure properly, still isn’t talked about in schools like it should be. That just ticks me off.

  • Catherine
    July 19, 2013 at 8:49 pm

    Thea- In retrospect I can see that parts of my comment were unnecessarily and inaccurately harsh, sorry! Spending so much time down the rabbit hole of mental illness research makes me forget that most people are not down there with me! Heh.
    As far as a mind/body divide in treatment . . well I guess the easiest way to show that even that is not precisely the case is the fact that psychiatrists tend to prescribe medication like antidepressant, anxiolytics, etc, all treating the hypothetical physical causes of the mental illnesses. I want to emphasize hypothetical here, because the fact is we don’t really know what’s going on in these illnesses. There are hypotheses, and then treatments are made based on those hypotheses (frex: you have depressive symptoms because your serotonin is low, so here’s an SSRI to increase serotonin. Of course, the question still remains as to WHY is serotonin low). For some people some medications work, and for others they don’t. This really just shows how heterogeneous the population of patients all being classified as having one disease is, and leads to the question of diverse pathophysiology, and well, misdiagnosis, as in the case of the author. Anyways, the field itself is a bit of a mess, so not a huge surprise that people’s perceptions of mental illness is a bit off. I think maybe you were alluding to cognitive therapy a bit in the mind/body thing? This gets iffy, because clearly talk therapy is a component of this, and just the action of engaging with someone and having them listen to you can be therapeutic. But the hypotheses this is based on are, like with the hypotheses that medicating these conditions is based on, kind of incomplete. Ie/ one hypothesis is that mental illnesses like depression develop because of negative schemas that people develop as children or adolescents (I am worthless/useless, etc) due to stress, and the schemas are reactivated when the person experiences stress again. You can already see that this does not apply to everyone, since onset of depression is not necessarily associated with stress, and the question still remains as to why some people developed these schemas and others didn’t (which would have to be a physical reason, really). Plus, from what I’ve heard, while cognitive therapy does provide some coping mechanisms, it’s still COPING, not a return to a normal non-ill state. But experiences will vary, of course. Anyways, the comment is way too long already, but I did want to say that this field is still evolving a lot, so how some things were conceptualized may turn out to be wrong, or only partially right. I am watching the slow creep of evolutionary and nutrigenomic reasoning into these conceptualization, personally.

  • Catherine
    July 19, 2013 at 8:57 pm

    *looking over the wiki entries on some of this stuff, I gotta say that some of it is a bit odd/inaccurate. Grain of salt, I think.

  • Kendra
    July 21, 2013 at 6:46 pm

    Thea- That’s weird that the dad would make a comment implying that people with epilepsy were part of the same “less deserving” group as those with mental health issues. Epilepsy is firmly planted in the neurological camp of illnesses, not the psychiatric (which seems to be where the prejudice is aimed). But I guess if you’re ignorant about one you can be just as ignorant about the other.

    Kate & Zena- I’m surprised that her disease would be in the DSM, usually one of the criteria is that the symptoms can’t be explained by any other diagnosis. Interesting.

  • Keeley Arnold
    July 5, 2014 at 1:56 pm

    I didn’t really see what you saw with the treatment of mental illness. It just looked to me like how any parent or sibling would reacted when they find their child or sibling is diagnosed with an illness: disbelief. Most parents want to believe their children are “normal”. But reading this post I do see what you saw, and it does make sense.

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    July 5, 2014 at 2:02 pm

    […] perspectives (and I’m not saying they’re wrong, I can see their point) check them out here and […]

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