47 pages • 1 hour read
Susannah CahalanBrain On Fire
Nonfiction | Autobiography / Memoir | Adult | Published in 2012A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
Philosophy: Existentialism and Epistemology
One of the consequences of Cahalan’s experience with autoimmune encephalitis is how much she begins to question the nature of self, the nature of reality, and the nature of knowledge. In understanding and recounting what happened to her and how it affected those around her, Cahalan learns that human memory is a strange beast.
Cahalan experiences several moments where she hallucinates, is paranoid, and disconnects from reality. The most prominent of these states include her breakdown at her father and Giselle’s house, when she thought the pair had kidnapped her, her paranoia concerning Stephen’s fidelity, and her belief that the newscasters were talking about her on the television and that her father murdered his wife. While all of these instances reveal a disconnect from reality, the major incident that influences Cahalan’s understanding of her own identity is when she blacks out for a prolonged period in the hospital: “this was the beginning of [her] lost month of madness” (72). When she retraces her steps and watches videos from that time, now on the other side of recovery, she wonders how fluid or firm reality really is. To add to her confusion, many of the memories that she has from that time that she attributed to her illness, turn out to be real memories, such as the memory of the “Purple Lady” a nurse on her ward; “If all I remember are hallucinations, how can I rely on my own mind? To this day, I struggle with distinguishing fact from fiction” (242).
Cahalan questions if she will ever return to her “old self,” and even questions what being her “old self” actually means. She shares her inquiries regarding what makes a self, and whether a self is worth holding on to. She decides that it is, as long as those who loved her prior still do and want her back. Cahalan faces intense, repeated existential conundrums as people ask her the seemingly innocuous question, “How are you?” She sincerely does not know how to answer, and because of the effects of her disease, her emotions are often skewed, contributing to her social awkwardness and social anxiety, which she eventually largely overcomes.
As Cahalan rebuilds her life, she questions how people know what they know, and how they trust in what they think they know.
Epiphany and Self-Awareness Versus Denial and Self-Sabotage
Cahalan does not keep track of her symptoms as they grow, nor does she put trust in any of her work colleagues, old friends, boyfriend, or family regarding the degeneration of her health. She knows that she is not behaving as her normal self. She is unable to independently determine what the issue is and why it has occurred. She has been a writer nearly her whole life and has been a journalist for seven years at the start of the book, but she fails to self-assess and articulate her issues to her family.
Cahalan denies that she has a problem because she is scared to know the true depth and nature of said problem. She does this at the start of her story, and she does this after she has been diagnosed, treated, and released from care at NYU. When her doctors point out her cognitive difficulties, Cahalan notes the despondency she feels and why she discontinues these checkups: “these sessions only highlighted my inner disunity, and I was loathe to continue. I never returned for a follow-up” (193). It is not until the final chapters that the author demonstrates awareness of how her tragic flaw contributed to her experience, although she directly expresses no regrets regarding what happened to her. Cahalan is in denial about her condition both early on and later, during critical stages of recovery. The denial of the full extent of her injuries is costly and sabotages her close relationships, her career, and her life multiple times.
Cahalan, contrarily, experiences a few epiphanies during and after her treatment. She makes realizations that positively affect her life and the lives of others, including Dr. Najjar. Cahalan makes real progress in her recovery when she is 100% honest with herself about her abilities and challenges. She also makes progress in her recovery when she is not self-conscious, is relaxed, and not overthinking. In times when she is most relaxed, such as riding home with her family after being released from care, attending a family backyard BBQ, or riding home in a car from the movies, Cahalan makes huge strides in regaining and rebuilding her sense of self and her life.
Writing as a Form of Memory
There are several key figures in Brain on Fire that use writing as a form of memory. Cahalan’s profession as a journalist is one based on research and writing. She writes about the journals she has kept since she was a young girl. Throughout her illness, she writes. Cahalan speaks directly to the reader, repeatedly regarding how a key factor in her ability to reconstruct this narrative is the heavy reliance upon forms of writing—both her own and the writing of others. No matter what Cahalan’s state of consciousness was, she has a record of that form.
Cahalan’s mother, Rhona, keeps notes, too. She keeps long lists of questions that she wants to ask, and has asked, to doctors. She keeps notes of Cahalan’s symptoms, including a timeline of when they appeared, disappeared, and reappeared. Cahalan’s father keeps what he calls a “log” of all of the appointments with healthcare professionals—but this log also reveals some of his darkest moments during Cahalan’s illness.
The people closest to Cahalan and those who were the most directly involved in her treatment relied upon forms of writing for a couple of reasons. First, they relied upon writing as a record of events because often they were told that Cahalan was normal or that they were just plain wrong about what was happening to her—that they were unreliable. It’s through these family writings that Cahalan recognizes her parents’ internal struggles. Her father wishes he were the one in pain rather than her: “After my second escape attempt, he wrote a heartbreaking entry about praying that God would take him instead of me” (95), while her mother downplays the seriousness of Cahalan’s illness to cope.
Another reason why several characters relied upon writing as a form of memory is because, as Cahalan learns on her journey of healing and self-discovery, human memory is fallible. Even though it is possible to make errors in writing, readers are quietly urged to believe that writing is more reliable than unrecorded, human experience, although there is value in and purpose to fallible, human recollection as well.
