Brain on fire My month of madness

IN the vast and growing literature of affliction there is essentially one story: how the writer and her loved ones made it through. From a literary point of view, everything depends on the sensibility of the narrator, her comportment both as the teller and as the main character in her own tale. The reader's resistance to these stories can be strong. Severe illness, by its nature, narrows the focus; the palette of experience both intensifies and shrinks; we crawl into the bush, figuratively speaking, and wait out our fate, fighting to survive. There is little suspense: the existence of the memoir is testament to the fact that the author has lived to tell the tale. But what hard-won nugget of wisdom has she brought back from her brief descent into a hell that most of us, for now, have been lucky enough to avoid? Can she give her ordeal meaning beyond the brute fact of the thing itself? One thing you don't want to be to your doctor is "an interesting case." Susannah Cabalan had the bad luck of being a unique and baffling one: profoundly sick, deteriorating with dangerous speed, yet her MRIs, brain scans and blood tests were normal. "My diagnosis had been discussed in almost every major medical journal," she tells us with an air of pride and exhausted wonder, "including the New England Journal of Medicine, and The New York Times." "Brain on Fire" is at its most captivating when describing the torturous process of how doctors arrived at that diagnosis - an extremely rare autoimmune disease almost undocumented in medical literature. The illness presented itself in malevolent fashion, with symptoms of bipolar disorder and schizophrenia, which are often indistinguishable from each other in their early stages: grandiosity, paranoia, bouts of irrational rage, incomprehensible utterances and flat catatonic-like affect. There were also seizures, with "blood and foam" spurting out of Cahalan's mouth, that suggested not mental illness but a neurological disorder. Cahalan has the narrative advantage of having no memory of what happened to her, except for unreliable, almost hallucinatory flashes, like being strapped to her hospital bed as a "flight risk." This temporary outage gives her an opportunity to ponder the mystery of her self, and how quickly our assumed knowledge of who we are can be radically altered. Cahalan employs her journalistic skills (she works as a reporter at The New York Post) to explain the fascinating medical intricacies of her illness and how it compromises NMDA receptors in the brain, "vital to learning, memory, and behavior." Of deeper interest is her attempt to become a historian of her lost self, piecing together the facts of her ordeal from her father's diaries, the recollections of her mother and her boyfriend, and the forensic evidence of medical and psychological records. Looking at hospital videos, she is shocked to see a young woman she can barely recognize as herself, cowering in bed and uttering repeatedly, and with difficulty, the word "please," as if begging for help. Reading her own disjointed diary entries of the time "is like peering into a stranger's stream of consciousness." SALVATION came in the form of a gifted neurologist, profoundly attuned to her symptoms, and the decisive diagnostic tool turned out to be a piece of paper and pen: Cahalan's skewed drawing of a clock revealed more about what was going on in her brain than the battery of expensive tests she underwent. Her treatment cost about a million dollars. At its best, Cahalan's prose carries a sharp, unsparing, tabloid punch in the tradition of Pete Hamill and Jimmy Breslin. But when the acute period of her illness passes and she chronicles the slow process of her recovery, the writing falls flat. Here was the chance to make good on her ambition to inquire into the "deepest part of the self - personality, memory, identity - in an attempt to pick up and understand the pieces left behind." Instead, Cahalan is locked in the dull passage of those weeks, dutifully informing us of her 15-minute walks, her decision to take spin class, her forays out to family gatherings and parties. Finally, and bravely, she crawls back to her old vivacious self. "However, when I look at photographs taken of me 'post,' versus pictures of me 'pre,' there is something altered, something lost - or gained, I can't tell - when I look into my eyes." Michael Greenberg is the author of "Hurry Down Sunshine" and "Beg, Borrow, Steal: A Writer's Life."

Brain on Fire PREFACE At first, there's just darkness and silence. "Are my eyes open? Hello?" I can't tell if I'm moving my mouth or if there's even anyone to ask. It's too dark to see. I blink once, twice, three times. There is a dull foreboding in the pit of my stomach. That, I recognize. My thoughts translate only slowly into language, as if emerging from a pot of molasses. Word by word the questions come: Where am I? Why does my scalp itch? Where is everyone? Then the world around me comes gradually into view, beginning as a pinhole, its diameter steadily expanding. Objects emerge from the murk and sharpen into focus. After a moment I recognize them: TV, curtain, bed. I know immediately that I need to get out of here. I lurch forward, but something snaps against me. My fingers find a thick mesh vest at my waist holding me to the bed like a--what's the word?--straitjacket. The vest connects to two cold metal side rails. I wrap my hands around the rails and pull up, but again the straps dig into my chest, yielding only a few inches. There's an unopened window to my right that looks onto a street. Cars, yellow cars. Taxis. I am in New York. Home. Before the relief finishes washing over me, though, I see her. The purple lady. She is staring at me. "Help!" I shout. Her expression never changes, as if I hadn't said a thing. I shove myself against the straps again. "Don't you go doing that," she croons in a familiar Jamaican accent. "Sybil?" But it couldn't be. Sybil was my childhood babysitter. I haven't seen her since I was a child. Why would she choose today to reenter my life? "Sybil? Where am I?" "The hospital. You better calm down." It's not Sybil. "It hurts." The purple lady moves closer, her breasts brushing against my face as she bends across me to unhook the restraints, starting on the right and moving to the left. With my arms free, I instinctually raise my right hand to scratch my head. But instead of hair and scalp, I find a cotton hat. I rip it off, suddenly angry, and raise both hands to inspect my head further. I feel rows and rows of plastic wires. I pluck one out--which makes my scalp sting--and lower it to eye level; it's pink. On my wrist is an orange plastic band. I squint, unable to focus on the words, but after a few seconds, the block letters sharpen: FLIGHT RISK. Excerpted from Brain on Fire: My Month of Madness by Susannah Cahalan All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.