Q&A with Susannah Cahalan, author of Brain on Fire

At 24, Susannah Cahalan had a great life: a job as a reporter at the New York Post, a new relationship with a musician and a happy family life. That all changed suddenly when she started experiencing a sequence of strange symptoms. In the space of one month, Cahalan found herself the victim of a rare disease that saw her bedridden and exhibiting psychotic-like behaviour. Thanks to the support of her family and the insight of one doctor, she managed to survive this at-times fatal condition. She talked to Chatelaine about why she wanted to document her experiences, including time she has no memory of.

Q: What made you want to become a writer?

A: For as long as I can remember, I have always wanted to be a writer. I can trace a distinct memory back to fourth grade, when I wrote a “book” about familial dysfunction based on the afternoons I spent glued to the TV watching the soap opera The Bold and the Beautiful with my babysitter. The book itself was deemed too scandalous for my elementary school class, especially when I used the word bastard and was barred from reading anymore aloud. I think that experience cemented my decision to one day be a writer.

Q: Why did you decide to write this book?

A: There are many reasons why I decided to write this book at this point in time, but two clear explanations jump out at me. For one, I jumped at the opportunity to exhume this lost time, one I had no memory of or real personal access to. Writing this book gave me a chance at catharsis, something I would have been able to achieve without the weight of a book-length project. The second — and by far the most important reason — was that I wanted to get my story out to as many people as possible, and I felt writing this book would be the best way to do just that.

Q: How long did it take you to write?

A: It took me a year to write the book and then another six months or so for edits and putting all the pieces together with my editor.

Q: What was the most difficult thing to write about in this book?

A: Emotionally the most difficult section of the book to write was the final part, otherwise known as the recovery section. Because it has the most memoir-like tone and because the thoughts and feelings were so personal and real to me (unlike those dark and unfocused parts of my months when I was in the throes of the illness), I found it far more painful to maneuver through. Unsurprisingly, that section required the most rewriting! From moment one, I was always fighting the idea of writing a memoir, but I was finally convinced by my editor that those serious questions, the investigation of the self, was necessary to the story. And she was right. Now, that’s my favorite part of the entire book.

Q: How did you re-create all those missing moments when you were unconscious or perhaps not fully aware of what was going on?

A: Recreating those missing sections took a bit of detective work. And thankfully I’ve had years of working at a tabloid under my belt, an occupation that has toughened me to the rigours of reporting. I had to track down any primary documents: medical records, emails, diaries, my parent’s shared hospital journal, etc. Then I had to fill in with interviews. I questioned everyone from the doctors and nurses on my floor to my parents, boyfriends and friends.

Q: What research did you do?

A: Along with the detective work I did to recreate that lost time, I also had to understand how the immune system and brain systems work (and then try to understand what happens when they malfunction). It was quite the undertaking, especially for someone whose highest level of study in those fields was in high school biology. So I first started trying to understand the “stupid questions” and got a book on immunology and neurology “for dummies” – no kidding – and started from the very bottom before I later started asking more advanced questions.

Q: What surprised you most about the experience you went through from a medical point of view? From a personal point of view?

A: I’m not quite certain how to answer this question, because so much of it was a surprise; however, I believe that the more shocking elements of that time for my whole family were the multitude of misdiagnoses from some of the top physicians in New York City. That was a shock and a lesson for us all. My own greatest surprise is more personal. It’s jarring to realize, especially at such a young age, how much we really are victim to our own bodies; how one small biological hiccup can cause you to lose everything.

Q: Has the focus of what you write about professionally altered since your experience?

A: Most certainly. Now I see everything through the lens of my experience and the aspects of medical science that I learned. I gravitate now to science in ways I never did before. I also believe I have more sympathy for people with mental illnesses than I ever did before, which colours the way I see many news stories, especially those in which I perceive there might be a misdiagnoses and mistreatment of people with mental illnesses.

Q: How has life changed for you since this all went on, if at all?

A: In many ways, I’ve skipped over my twenties and gone full-on into a more settled existence. I live with my boyfriend (the same Stephen in the book) and my dog, Gus. Maybe this is a natural progression from one’s middle twenties to late twenties, but somehow I feel that the disease grounded me and slowed me down a bit. I think I’d be in a very different situation had this not happened to me.

Q: How would you say you’ve changed?

A: This is such a difficult question. One concrete answer that I can give is that I have more purpose to my life now than ever before. I feel as if I’m here for a reason, as cheesy as that might sound, and that gives me a sense of meaning that my life was missing before.

Q: What do you hope people get out of reading Brain on Fire?

A: I hope those suffering find some solace; I hope families find inspiration; I hope doctors find some insight about how best to treat their patients; I hope everyone can learn something about their bodies they might not have known before. I think my editor put it best when she said she held her loved ones a little tighter after reading my book — I hope that happens for readers, too.

Q: What advice would you give people going through a medical crisis?

A: I don’t know if I’m the right person to answer this question. I feel my family might be better equipped. But I will say the best thing you can do in a medical crisis for someone else is to be an advocate. Everyone needs a support structure, especially during times of crisis, and it’s essential that when someone can’t fight for herself, she has a team of people willing to do battle for her.

Q: What was the most interesting thing you’ve discovered about writing a book as opposed to a newspaper article?

A: Voice plays such a primary role in a longer-form piece rather than a newspaper piece, and it’s been such a fun journey finding my own voice after years of writing in a specific style for a tabloid newspaper.

Q: Would you write another book, do you think? Are you working on something?

A: I’ve officially gotten the book-writing bug and plan to write another one very soon. Right now everything is in the early research stage, so nothing concrete to say just yet!