Brain On Fire

Cahalan awakes in a New York City hospital with a straitjacket on. She compares it to coming out of a bad hangover or an accident. Cahalan thinks her babysitter from childhood, Sybil, is with her, but she is unsure. She cannot trust her senses, causing her to panic. She does not know what is real, only that she can’t move or escape. She squints to read words on a band on her wrist that reads: “FLIGHT RISK.”

The reader is introduced to the world of Cahalan in 2009, in New York City. There are several important characters introduced. There is Paul, her longtime mentor at The New York Post. Cahalan’s friend, Angela, also works at The Post. Cahalan’s world is stable. She has worked at The Post for seven years. Cahalan is trying to solve her bedbug problem, something that has plagued many New Yorkers. Although this picture of her world conveys stability, this is where Cahalan herself begins to unravel. She is imagining bugs that do not exist. She is throwing away years of collectibles she holds dear. She is exhibiting behaviors and traits that are unlike her. Cahalan keeps this behavior to herself. In addition to uncharacteristic behaviors, she is experiencing paranoia, hallucinations, problems with impulse control, and intense physical pain.

The reader meets more of the people to whom Cahalan is closest. We learn about her mother, Rhona, and stepfather, Allen. We learn about Cahalan’s birth father, whom is never mentioned by first name. Cahalan and her father are not close; he has remarried and did not tell Cahalan or her brother that he had remarried until a year into his new marriage. Cahalan introduces the reader to Stephen, her boyfriend, who is a musician and cook, and whom she describes as devoted and loving. Cahalan’s headaches develop into full-blown migraines. Her paranoia intensifies. Her outbursts are often unleashed on Stephen, a man who has given her nothing to ever be suspicious about; now, however, Cahalan finds herself accusing him of seeing other people secretly. Cahalan is not herself; she is jealous, and she violates people’s privacy and judges them without evidence. She begins to lose the ability to tell how much time has passed. Her body pains increase, and she begins to develop problems with circulation and prolonged sensations of numbness.

Cahalan finally decides to seek professional help regarding these dramatic changes in her health. She seeks out her gynecologist, Dr. Rothstein, and Dr. Bailey, a neurologist. After appointments with them, she is given an MRI, a basic neurological exam, and told she has mononucleosis. Past this, all the results of her tests show that Cahalan is healthy. Cahalan withholds some of her symptoms during the two doctors’ respective examinations. They do not press her and take her word for her condition. The pain, numbness, and tingling she experiences on the left side of her body increases in frequency and intensity. Cahalan is both relieved and disgusted by the diagnosis of mono. She misplaces her lucky ring in Dr. Bailey’s office, which her future self perceives as a symbol of her physical and mental wellness. Cahalan admits that up to this point in her life, her attitude toward her own health has been lazy and neglectful.

Cahalan continues to present behaviors that are wildly out of character for her. The activities and people she once found most enjoyable are now painful. Her personality shifts wildly; Cahalan becomes shy, more lethargic, and has no appetite. Every activity she attempts is laborious and exhausting. She experiences multiple, consecutive emotional breakdowns and severe mood swings (sometimes within seconds) at work. She is no longer able to hide that something is very wrong. Her father offers some assistance, including cleaning her now-filthy apartment, which is in such a state because her condition is directly affecting her ability to function as an autonomous adult. Cahalan wants to disagree with her father’s assessment of her apartment, but she can’t: “He was right: it was squalid. Dirty clothes littered the floor. The trash can was overflowing. And the black garbage bags, which I’d packed during the bedbug scare and before the exterminator had come to spray three weeks earlier, still covered the room” (23).

Cahalan, Stephen, and her parents are seeing greater and more intense oscillations in Cahalan’s moods and behavior. Her once-stellar job performance is now highly inconsistent. This devastates Cahalan, as being a reporter at The Post has been a dream of hers for years. Further, her usually stable personality is growing more impulsive as time goes on. Cahalan wants to take trips without planning; she jumps from decision to decision in seconds. In one moment, she is decisive and confident; in the next moment, she is struck with sudden and deep panic. Cahalan continues to lie and withhold information about her condition from her boyfriend, her doctor, her parents, her coworkers, and even herself.

Although Cahalan has been failing at work, her new editor, Steve, gives her a pass and offers her an assignment to interview John Walsh from the television show America’s Most Wanted. Cahalan does a poor interview; she is unprepared, and her affect is very strange. The interview is cut short due to her awkwardness. As it concludes, she tries to gracefully exit, but fails miserably: “But as I walked, I could barely maintain my balance, bumping into the walls of the hallway, reaching for the door to open it for [others] but missing the handle by a solid foot” (29). Cahalan seeks out a friend who is a librarian. Rather than ask her for help from the library’s resources, she asks for a tarot card reading. Cahalan struggles to focus during the reading. She is exhibiting signs of a person who has consumed hallucinogens and is experiencing a “bad trip,” but Cahalan never takes drugs.

Rather than provide her with healthcare, the people around Cahalan ply her with alcohol, thinking this will help her. Her workmates, Angela and Paul, are aware that something is very wrong with her. They begin to confide in each other. Cahalan’s symptoms extend to insomnia, drastic weight loss, and even more severe mood swings. The oscillations between her moods are quicker and more intense, to the point where some are suspicious that she has schizophrenia, a disorder that affected a former coworker. Finally, as Cahalan (who has barely eaten for two weeks) is unable to enjoy a home-cooked meal by Stephen, and after chain-smoking cigarettes all night, she begins to explain to Stephen how she has not slept for some time. As she confides in him, she has a massive seizure and blacks out.