Lift Up Your Hearts!

Brain on Fire: My Month of Madness by Susannah Cahalan (Simon & Schuster, 2012)

I enjoy reading medical stories, but they carry a risk: it's all too easy for me to look over my shoulder and imagine the patient's symptoms creeping up on me. It's a good thing that anti-NMDA-receptor autoimmune encephalitis is primarily a young person's disease.

This rare and bizarre condition looks for all the world like a severe psychiatric disorder, but occurs when something provokes a person's immune system to attack his brain. What, why, and how are still unknown, but it's usually curable, if caught and treated—a very expensive process—in time. Susannah Cahalan was the 217th person to be diagnosed with this disease, and if she had not been in the right place at the right time, would probably have been committed to a mental hospital for the rest of her shortened life. If she had had his strength, she could easily have played the part of the Gadareme demoniac.

Thanks mostly to being at a great hospital (NYU), and ending up (after several false starts) with just the right doctors, Cahalan made a full recovery. But while anti-NMDA-receptor autoimmune encephalitis and similar brain disorders are now much more likely to be caught than they were in 2009 when Cahalan fell ill, this is still a cautionary tale of the importance of second (or third or fourth) opinions, and of searching for physical causes for abnormal mental conditions. Autism and schizophrenia are just two of the diagnoses that are sometimes erroneously given to patients with these autoimmune disorders. Unfortunately, the specialized tests needed for proper diagnosis are currently too invasive and too expensive to be used routinely.

Brain on Fire is a gripping, well-written, and important book—even if, once again, I found myself regretting the demise of the censor's blue pencil.