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Brain on Fire: My Month of Madness
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Cynthia | 1 comments I'm not going to lie guys many of these questions came from litlovers discussion questions- see full list here http://www.litlovers.com/reading-guid...

Here's a link for an interview Susannah Cahalan did as well if anyone is interested https://bigthink.com/world-in-mind/br...

1) What did you learn about the brain? the medical community/hospital practices? her autoimmune disorder? potential neorological and mental illnesses? What surprised you the most? What scared you the most?


2) Susannah doesn't remember much of what happened to her, and what she does remember is based on her memories when she-- to put it frankly was absolutely mad. Knowing this and remembering this book is a non-fiction memoir, at any point did you feel her writing was unreliable. Why or why not?

3) In the author’s note, Cahalan says that her book is “a journalist’s inquiry into that deepest part of self—personality, memory, identity.” What does her story reveal about these three subjects? How does her account challenge our preconceptions of these three subjects? Alternatively, how does her account confirm or bolster what we already know and believe about these three subjects?

4) The characters in Brain on Fire—friends, family, medical personnel, and even Cahalan herself—frequently consider if she may be suffering from some form of mental illness. What does the book reveal, then, about our way of thinking about mental illness? For instance, what does Cahalan’s story suggest about the relationship between psychology and neurology? What preconceptions does it reveal about our understanding of mental illness as a society? How does this story help to highlight the necessity of compassionate responses to those who are ill?

5) Why do you think Susannah Cahalan's story was important to share with readers?


Manny Schwimmer | 6 comments Cynthia wrote: "I'm not going to lie guys many of these questions came from litlovers discussion questions- see full list here http://www.litlovers.com/reading-guid......"

1) What did you learn about the brain? the medical community/hospital practices? her autoimmune disorder? potential neorological and mental illnesses? What surprised you the most? What scared you the most?

I had never heard of NMDA-receptor antibody encephalitis before reading this book. Even more broadly, I had never really considered that our immune system actively protects the brain from infections. My wife and at least a few friends have been diagnosed at some point with autoimmune conditions affecting various organ systems, so the final diagnosis was easy for me personally to digest.

What surprised me the most? The fact that Calahan’s condition was diagnosed correctly at all. I shudder to think of how dangerously close she came to being labeled a lost cause and institutionalized for life or dying young from brain damage. She was extremely lucky on multiple counts. For one, she had a highly supportive and tolerant family who kept her safe. Second, how about that loyal, loving boyfriend! She’d better put a ring on it. Third, her family had the financial resources and basic literacy to make reasonable health care decisions on her behalf. Fourth, living in America certainly gave her an edge because she had better access to physicians like Dr. Nayyar than someone in a less privileged country. Finally, she developed the condition at the right time in history. Had her symptoms started years before 2007, who knows if she would have been diagnosed at all?

What Calahan described about her experience with the medical and hospital community did not surprise me. Her story reminded me that any doctor, no matter how renowned they are, can fail to keep an open mind when their patient’s symptoms don’t fit their preferred diagnosis. I think of her neurologist as an example. I was disappointed by his insistence that she was a closeted alcoholic, despite any concrete evidence.

2) Susannah doesn't remember much of what happened to her, and what she does remember is based on her memories when she-- to put it frankly was absolutely mad. Knowing this and remembering this book is a non-fiction memoir, at any point did you feel her writing was unreliable. Why or why not?

No, because she was honest in communicating when her memory about past events was fuzzy. She also describes a meticulous process of piecing together that phase of her illness as a journalist – specifically, interviewing family, friends, physicians, and nursing staff. There were even recordings of her bizarre behavior from the EEG monitoring room that provided visual evidence of her behavior. Calahan also shared her emotions and embarrassing moments about delving into that dark period of her life. It might have been possible to write the book without expressing her vulnerability as much as she did. In my eyes, this made her retelling of the story more trustworthy.

3) In the author’s note, Cahalan says that her book is “a journalist’s inquiry into that deepest part of self—personality, memory, identity.” What does her story reveal about these three subjects? How does her account challenge our preconceptions of these three subjects? Alternatively, how does her account confirm or bolster what we already know and believe about these three subjects?

Her story drives home the reality that all three aspects of self are grounded in our brain’s physical anatomy. A person’s personality, memory, and identity can transform completely or disappear when the brain is damaged enough by the body’s own immune system or an external source. Calahan’s story is not the first to reveal this, but it is a keen reminder that our behavior can be more biologically driven than we realize.

Personality, memory, and identity also seem to be rooted in the brain at a deep level. Like Calahan, a person can temporarily lose all three elements of their self, but with the right treatment and time, they can rediscover who they are at a fundamental level. I thought this was a reassuring take-away message.
Keep in mind that I’m not speaking to whether we humans have a spirit or soul.

4) The characters in Brain on Fire—friends, family, medical personnel, and even Cahalan herself—frequently consider if she may be suffering from some form of mental illness. What does the book reveal, then, about our way of thinking about mental illness? For instance, what does Cahalan’s story suggest about the relationship between psychology and neurology? What preconceptions does it reveal about our understanding of mental illness as a society? How does this story help to highlight the necessity of compassionate responses to those who are ill?

Mental illness is not necessarily mental illness! Cahalan is our point in case. Her symptoms were entirely driven by her neurological condition. Still, they imitated several mental illnesses that were plausible at particular points in her illness. It was only possible to diagnose her correctly after seeing the forest for the trees and watching her symptoms change over time. There was also no way she could choose or control her own behavior. Think of how scary that is, and how she behaved during the “lost” period of her illness (e.g., the hurtful words she spewed at her dad).

Another way to put it: the book gives us evidence that neurology (the physical health of our brain and nervous system) can affect our psychology (the way we think and behave) more than we’d like to admit. In cases like Cahalan’s, symptoms are driven by neurology, and there is no guarantee a person with a mental illness will be able to manage their own behavior. Advocacy groups, patients, and medical communities all over the world have been fighting to change how we think about mental illness.
I think it begs the question: when a guy walks into a coffee shop and is a total jerk to the barista, how much of his behavior is under his control? What if he is suffering from a neurological condition like Cahalan’s? Statistically, it’s unlikely but possible.

As for compassionate responses to those who are ill, I think this quote rings true: “Be kind for everyone you meet is fighting a hard battle”. We really do not know who is ill (diagnostically speaking) and who is not.

5) Why do you think Susannah Cahalan's story was important to share with readers?

Absolutely. It has increased awareness about a rare neurological illness that might otherwise not have known about it. Had it not been for Cahalan sharing her story, at least some patients suffering it might have been diagnosed because of it. She wrote about one father who forced his daughter’s doctor to read Cahalan’s first published article about her illness, and it led the doctor to correctly diagnosis after testing for NMDAR encephalitis.

Her story is also a powerful reminder that mental illness is beyond a person’s control. Whether it is driven by a neurological condition like encephalitis or a neurotransmitter deficiency, mental illness is not a choice. It is only reasonable to treat someone with symptoms of a mental illness with compassion, the way we would treat someone with a heart condition.


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