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Chapter 46
Themes
Key
LitCharts assigns a color and icon to each theme in Brain on Fire: My Month of Madness, which you can use to track the themes throughout the work.
Identity and Illness
Storytelling, Memory, and Emotion
Love and Family
Responsibility and the Medical System
Summary
Analysis
Susannah interviews Stephen, her family, Dr. Dalmau, and Dr. Najjar about her disease. What strikes her immediately is the biggest mystery of her disease: how many people throughout history have suffered and never been diagnosed, given that the disease was only discovered in 2007. Susannah explains that in the 1980s and 90s, a Canadian pediatric neurologist described movement disorders caused by "encephalitis of an unknown origin." A 1981 paper talked about "acquired reversible autistic syndrome" in children. About 40 percent of sufferers are children, though their symptoms differ from adults: they throw temper tantrums, become hypersexual, and are often diagnosed with autism.
The revelation that this is not a new disease is a reminder that the medical community at large has a long way to go, as many doctors still don't know about a variety of illnesses and ailments, and researchers are discovering new illnesses and cures all the time. Understanding that plenty of people throughout the ages have gone through what Susannah did and then died reinforces Cahalan's assertion that she was truly lucky to be in the right place at the right time.
Themes
Depending on where a person lived, the disease might also have been described as an evil possession by a demonic spirit. Susannah describes a scene from the film “The Exorcist” in which a young girl spends days in convulsions, speaks in a strange voice, crab-walks, and spews blood. This film depicts many of the symptoms of the disease in children, and Susannah notes that Stephen cannot watch the film because it makes him think of Susannah's seizures and strange panic attacks. Susannah wonders how many children have been "exorcised" over the years and then left to die when they don't get better, and how many people are in psychiatric wards or nursing homes when the treatment for the disease is relatively simple.
By bringing up The Exorcist and exorcisms in general, Cahalan shows that a lack of knowledge doesn't just lead to dying from the disease—it leads to misguided attempts to "cure" whatever is believed to be going on, and it's not even considered a disease in these cases. There are major consequences when diseases aren't treated as the medical conditions they truly are, particularly given how simple the treatment for anti-NMDA receptor autoimmune encephalitis could be. This also once again places Susannah’s story in a wider cultural narrative, and offers an interesting perspective on historical events from long ago.
Themes
One of Dr. Dalmau's colleagues introduces Susannah to an Indian proverb about blind men attempting to identify an elephant. Each man grabs a different part and describes something different, and this proverb is often used to describe the process of researching the brain. By researching different parts of the brain and afflictions, particularly schizophrenia and autism, researchers hope to paint a more complete picture of the brain. The colleague suggests that a small percentage of people diagnosed with both autism and schizophrenia likely have an autoimmune disease, but testing to diagnose those diseases is cost-prohibitive.
Cahalan begins to show that research into this one brain affliction will surely help a number of other fields of medicine, simply because the brain and the body are so interconnected. However, the proverb also suggests that the different modes of studying the brain are disparate and often considered to be disconnected. There are still steps that need to be taken to consider the body as a fuller entity.
Themes
Susannah shares that her treatment cost over a million dollars, and she was even fortunate enough to have good insurance and family members who could pay for what insurance wouldn't cover. Other people, however—particularly those on Medicaid—aren't so lucky. To combat this, psychologists and neurologists are pushing for studies that allow a more holistic look at the body and brain. Dr. Najjar takes this a step further. He suggests that some forms of mental illness are actually caused by inflammatory brain conditions.
Dr. Najjar's line of research is still ongoing: recent studies suggest that some patients with depression show more improvement when they take an anti-inflammatory along with antidepressants. Cahalan's mention of her insurance is a reminder of her relative “luck” and privilege in this situation, which many others don’t or didn’t have.
Themes
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Susannah contacts Dr. Bailey as she researches her article. He hasn't heard of anti-NMDA receptor autoimmune encephalitis, despite the fact that Susannah's case had been widely published in medical journals. The fact that Dr. Bailey, a leading neurologist, hadn't heard of the disease showcases what's wrong with medicine in the US. Susannah says that to him, she was just one of many patients he had to see in one day. Susannah is the exception to the rule in that she managed to obtain a diagnosis and survive.
This discovery about Dr. Bailey reinforces some of the issues in the medical community that Cahalan wants to highlight. Though Dr. Bailey is certainly partly at fault, the medical system itself often doesn't allow doctors to do their jobs effectively.
Themes
For Susannah, the hardest part about writing the article is handing over her EEG tapes to the photo editor of the paper. She has to help him open the files and catches a glimpse of herself, skinny and crazy. Seeing herself on screen makes it abundantly clear to Susannah that humans' hold on sanity is fragile, and the human body can revolt in horrifying ways. That night, Susannah has anxious dreams. She reasons that they stem from anxiety about how people perceived her in the hospital and how they perceive her now. However, regardless of her anxiety, Susannah's article runs on October 4.
This moment of realization for Susannah is the final step in understanding the true implications of her disease and of disease in general: bodies themselves are unreliable, and they're fully capable of tormenting and changing the "selves" that inhabit them in a number of ways. The fact that Susannah still worries about how others perceive her suggests that her performed identity doesn't yet fully match what's happening inside—but also that any kind of identity is constantly in flux as people live their lives and have new experiences.
Themes
