Brain On Fire

At the start of this chapter, Cahalan awakes in a hospital room. She violently objects to being in the hospital. Her mother and stepfather, Allen, take her to her childhood home in Summit, New Jersey. There, she tries to rest, but her symptoms persist and begin to horrify both her mother and Allen. Cahalan’s self-imposed isolation increases, and she turns away calls and inquiries about her well-being.

Dr. Bailey misdiagnoses Cahalan as suffering from alcoholism. He adds she may be showing early signs of bipolar disorder because of work stress and partying. The results from his examinations continue to claim that, overall, she is healthy. Bailey prescribes Cahalan the anti-seizure medication Keppra.

Dr. Levin is the first psychiatrist that treats Cahalan during this period of illness. She practices on the Upper East Side of Manhattan, prescribing the antipsychotic Zyprexa after her initial meeting with Cahalan. The interview and patient intake process is notably short, and she doesn’t ask Cahalan many questions. Dr. Levin does not go far enough back in Cahalan’s history for information about her health. When Cahalan blurts out her own self-diagnosis of her condition, Dr. Levin takes her word as gospel without sufficient evidence: “‘So tell me a bit about why you’re here,’ she asked, cleaning her glasses. ‘I’m bipolar.’ ‘I’m sorry,’ [Dr. Levin] said. ‘Say that again?’ ‘I’m bipolar.’ She nodded as if agreeing with me” (52). Neither Cahalan’s mother nor her brother agree that Cahalan is an alcoholic or manic-depressive.

Friends and coworkers continue to take Cahalan to bars because they think drinks with friends will fix her problems. Their good-natured attempts at aid actually have the opposite effect, with Cahalan cracking under the pressure exerted by her illness in public places. In a bout of late-night clarity, Cahalan and Stephen profess their love and commitment to each other, but this clarity is ephemeral, as Cahalan lapses in and out of what seems like trances in between intense outbursts. She is trailing off in conversation more often and constantly having false moments where she believes she has solved the mystery of her condition.

While at her childhood home in Summit, she keeps journals of her thoughts and feelings. This journal writing helps her keep calm until she has yet another and even more intense seizure.

Cahalan is a completely different person due to her illness. She throws violent tantrums any and everywhere. She is severely petulant and stubborn. She shows that she is capable of self-harm, lacks impulse control, has paranoid delusions, and has no consideration for the consequences of her actions. She is aware she is treating her boyfriend and her parents with disdain. Her doctors continue to tell her and her family, “There’s nothing wrong with you,” (64). They say she drinks too much wine, parties too much, and may have borderline personality disorder.

Cahalan’s paranoia increases and intensifies even more. She is experiencing a nearly constant stream of multisensory hallucinations. Cahalan, along with her father and his second wife, Giselle, visit her studio apartment in Hell’s Kitchen because she misses her independent life in NYC. Although she is not ready to live on her own again, her family is hoping that a visit to her old life will help jumpstart and refresh her.

Giselle and her father clean her apartment. They take Cahalan back to their home in Brooklyn Heights and cook a family meal. There, Cahalan exhibits an intense and terrifying oscillation of moods, along with sudden amnesia, and she accuses her father and Giselle of kidnapping her.

Cahalan’s parents, who have not been on good terms because of their messy divorce, put aside past differences for the sake of Cahalan, working together to figure out what’s wrong with her. They collaborate on a plan and agree that hospitalization is the next step, but not commitment (to a psychiatric ward). Dr. Bailey continues to vehemently insist that Cahalan is suffering from alcohol withdrawal. Her parents continue to disagree. Dr. Bailey recommends the NYU/Langone Medical Center. As her family initiates the check-in process in the lobby of the center, Cahalan experiences yet another seizure, the biggest and worst one yet. She writes that “this was the beginning of [her] lost month of madness” (72).