Brain on Fire: My Month of Madness

“I refused to take it. I spit it out. I need out of here. I don’t belong here. I belong in a psychiatric ward. I belong in Bellevue. It’s not safe for me here.”

“Why is it not safe for you here?”

“Everyone is talking about me. They’re all talking about me and making fun of me behind my back. I belong in Bellevue where they can take care of my disorder. I don’t know why I’m here. I can hear what the nurses are saying about me. I can hear their thoughts, and they aren’t saying nice things.”

Dr. Khan wrote down “paranoid ideation.”

“You can hear their thoughts?” she repeated.

“Yes. The whole world is making fun of me.”

“What else can you hear?”

“The people on the TV are talking about me too.”

Dr. Khan wrote “ideas of reference,” a patient’s belief that newspaper articles, songs, or TV shows refer directly to him or her. “Do you have any history of family members with mental illness?”

“I don’t know. My grandmother might have had bipolar disorder. But they’re all crazy.” I laughed. Then I turned on her. “You know that I have the right to sign myself out, right? I can walk out of here. I can’t legally be held here against my will. I don’t want to talk anymore.”

Dr. Khan wrote down her differential diagnoses, which included “Mood Disorder, not otherwise specified” and “Psychotic Disorder, not otherwise specified.” She was concerned that, in light of the seizures and my history of melanoma, they should be looking for neurological causes.

If there was no underlying disease that could explain my sudden psychosis, she suggested bipolar I as a possible explanation. Bipolar I is a mood disorder characterized by a manic or mixed (both manic and depressive) episode. On a scale from 1 (most dire cases) to 100 (no symptoms), I received a score of 45, which translated to “serious symptoms.¹⁹” Dr. Khan recommended that the staff assign me a security guard, called a one-to-one, to try to prevent future escape attempts.

I can’t hear their voices anymore. Her skin is so smooth. I stare at the doctor’s cheekbones and pretty olive skin. I stare harder, harder, harder still. Her face swirls before me. Strand by stand her hair turns gray. Wrinkles, first just around her eyes, and then around her mouth and across her cheeks, now line her entire face. Her cheeks sink in, and her teeth turn yellow. Her eyes begin to droop, and her lips lose their shape. The striking young doctor ages right before my eyes.

I turn away and look at Stephen, who stares back at me. Stephen’s stubble morphs from brown into a muted gray; his hair turns white like snow. He looks like his father. Out of the corner of my eye, I watch the doctor. Now she is growing more radiant with each passing second. All the wrinkles on her face smooth out, her eyes grow pert and oblong, her cheeks gain baby fat, and her hair turns a deep chestnut brown. She’s thirty, twenty, thirteen.

I have a gift. I can age people with my mind. This is who I am. And they cannot take this away from me. I am powerful. Stronger than I have ever been in my life.

CHAPTER 18 BREAKING NEWS

Later that same day, a fifth doctor joined the team. My case had piqued the interest of Dr. Ian Arslan, a psychopharmacologist who topped six feet and who looked more like an aging hippie than a doctor. Because of his fondness for beat generation writers and his cerebral way of communicating abstract medical jargon, a colleague described him as a “walking beatnik dictionary.”

He had already heard about my escape attempts and paranoid delusions, so he approached my mother first, asking her to walk him through the past few weeks of my bizarre behavior. Then he interviewed my father. After a short interview with me, which yielded a vivid portrait of my dysfunction, he gathered statements from the nursing staff and even called up Dr. Bailey, who, according to Arslan’s notes, told him that I “drank excessively up to two bottles of wine per night.” Dr. Bailey’s estimate of my vices seemed to have substantially increased. Having summarized all of this, Dr. Arslan jotted down the two diagnoses he wanted to rule out: postictal psychosis and schizoaffective disorder. Knowing it would upset them, he did not share the second diagnosis with my parents.

The term schizoaffective disorder was introduced in 1933 in a much-quoted paper, “The Schizoaffective Psychoses”: “Like a bolt from the blue, full-blown delusions suddenly shatter the poise of a fully rational mind… and flare up without premonitory signs… .²⁰”

A more updated description defines it as a diagnosis when mood symptoms, which are characteristic of bipolar disorder, overlap with psychosis, which is symptomatic of thought disorders like schizophrenia. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, version IV-TR, the edition that was used during my hospital stay, defines the disorder as an “uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode.²¹” To earn such a diagnosis, a patient has to experience two or more of the following: positive symptoms, like delusions, hallucinations, and disorganized speech, and negative symptoms, such as mutism or general apathy.

EEG video, March 24, 11:06 p.m., 11 minutes

“Patient push button in room 1279. Patient push button in room 1279,” the prerecorded voice says. My hospital gown peeks through from the covers that are pulled up to my neck, and I hold a cell phone to my ear, talking animatedly into its mouthpiece. It is unclear if anyone is on the other end. I pick up the hospital-provided TV remote and speak into it. There is certainly no one at the other end of that conversation. I point to the camera accusingly, gesticulating wildly, and put my hands to my head in frustration.

“Oh my god,” I cry and hit the nurses’ call button.

“Can I help you?” a nurse says over the intercom.

“No, no, it’s okay.”

“Ma’am? Lady? Miss? I’m coming,” another nurse chimes in.

I’m mumbling to myself now. “I don’t know what’s happening. I’m going to turn my phone off.” I toss my cell phone to the foot of the bed. A nurse arrives with some pills, and I swallow them without hesitation, like I’m taking a shot of tequila. “I can’t have it on me. I’m on the news.”

The nurse answers, but too softly for the video to pick it up.

I begin to shout and kick my legs, and I grab for the nurse’s call button. “Please, please, please. I’m freaking out, I’m freaking out.”

“Patient push button in room 1279. Patient push button in room 1279.”

“Please put the TV back on. PLEASE PUT THE TV BACK ON!”

Ignoring my outburst, the nurse positions the guardrails to make sure they’re firmly in place.

“Don’t you see? I’m on TV, I’m on the news,” I howl. I pick up the TV remote and speak into it again. And then place my head in my hands and rock back and forth. “Please, please, please. Oh my god, oh my god. Please get me a doctor. Please get me a doctor. Please, please, please.”

The nurse leaves. There is a flushing of toilets. I stare straight up at the ceiling as if I am praying.

End of video.

“We’ll be investigating what’s happening with news reporter Susannah Cahalan, currently at New York University,” a coiffed female anchor announces. I am top-of-the-hour news.

“I’m on the news!” I call out. Nobody answers.

“Her father was recently arrested for the murder of his wife,” the anchor says as the camera pans to my father walking handcuffed through a sea of paparazzi, bulbs flashing, and reporters with their notebooks open and ready to lunge.

I’ve been so stupid. I shouldn’t have answered calls from coworkers. They are secretly writing