Brain On Fire
"Too much light has come out of my darkness."
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Question Four
As Susannah fell mentally apart, her personality changed. Describe the change. How did that affect your like or dislike for her
"This irrational jealousy was wholly unlike me."
(Emotion, in everyday speech, is any relatively brief conscious experience characterized by intense mental activity and a high degree of pleasure or displeasure. Scientific discourse has drifted to other meanings and there is no consensus on a definition. Emotion is often intertwined with mood, temperament, personality, disposition, and motivation.)
Susannah went on an emotional roller coaster in this book. These emotions were often things that she hadn't experienced before, at least not often. For example, on page 11, she experiences jealousy. This is normal for some people but not for Susannah. Not only is she jealous, but she is irrationally jealous. On page 24, we also see her first feeling of helplessness and fear, which ultimately turned into anxiety. These were also new emotions for her. On page 43, she mentions a strong feeling of anger. This was not the last time Savannah would feel this feeling of anger. For example, on page 61, she expresses this feeling of anger again while in the car with her family. Besides anger, we see her feel emotions of depression, happiness, frustration, uncertainty, and confusion; all shown throughout the book. We can also see that she is afraid and frightened while in the hospital because in one of the videos she is asking the camera for "help". Lastly, we see her feel embarrassment, shame, and self conscious, especially after her time at the hospital. For example, on page 213 when Susannah describes her first time being back in the news room, her level of discomfort is evident, even though The Post has "raised" her. Clearly, social situations are difficult for her and heighten these negative, never before felt, emotions.
"I couldn't seem to focus."
(Cognition is the process of acquiring knowledge and understanding through thought, experience, and the senses. It encompasses processes such as knowledge, attention, memory and working memory, judgment and evaluation, reasoning and problem solving and decision making, comprehension and production of language. Human cognition is conscious and unconscious, concrete or abstract, as well as intuitive and conceptual. Cognitive processes use existing knowledge and generate new knowledge.)
Susannah's cognitive behavior changed steadily over the book. In the beginning, we see this happen while she is at her job. For example, she is unable to focus on assignments such as: being unprepared for work meetings, which we see on page 5, and unable to concentrate on the interview with John Walsh, which we can see on page 27. Once Susannah is placed in the hospital, her memory starts to go. Throughout her hospital stay, we can see that she starts to lose language. On page 106, the second week of her hospital stay, she was speaking in garbled sentences and stopped speaking in full sentences when before she is described as a "professional conversationalist". She also seems to lose all other cognitive abilities such as judgment, decision
making, and problem solving. When we jump ahead to page 152, the doctors officially assess Savannah's cognitive abilities. When Susannah was asked why she was in the hospital, she couldn't explain why. She was also suffering from phonemic paraphasia. She took several minutes to write her name and her handwriting was very poor. When Dr. Morrison tested her memory bank, she scored on the low end of average. Her abilities were also low in recreating pictures and copying down complex designs. On page 191 we see another assessment of Susannah's cognition. her concentration, speed, and accuracy on the test were dismal. Her working memory was in the 25% range and her visual working memory and ability to conjure up words from memory was worse. However, in other areas there was significant progress. her verbal function was superior, verbal abstract reasoning was in the high average, and she was capable of complex analytical thinking. Her final results of this assessment were that her weaknesses were concentration, memory, and finding the right words. On page 212, we see Susannah write her first successful article after her illness, which ran on July 28 and she returned to work in September.
Susannah's Behavioral Changes
Suannaha's Emotional Changes
Susannah's Cognitive Changes
Question Three
Describe Susannah’s cognitive, emotional and behavioral changes. Give concrete examples from the book. How can we explain the increasing anxiety? How do they relate to changes in severity of any mental disorder?
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"My nausea matched my anxiety"
Susannah starts to feel anxiety at the beginning of the book. On page 18, she expresses her anxiety over the loss of her lucky ring. We see her experience anxiety again on page 20, in chapter four. Susannah is at a concert with Stephen, his sister, and his brother in law. At the concert, she found herself screaming "I can't do this" and stood at the back of the concert and didn't enjoy or really remember the concert. Another example is on page 25. We have inside look at Susannah and Stephen's trip to Vermont. On this trip, when Susannah tried to ski, she experienced panic and a deep fear, even though she had skied before and never experienced this feeling. As we could see, her anxiety was increasing. This increase in anxiety can be explained on page 157. Because of her illness, anti-NMDA-receptor encephalitis, about two weeks after the initial flue like symptoms, psychiatric issues, which include anxiety, takes hold.
"No one wants to think of themselves as a monster."
(Behavior is the range of actions and mannerisms made by individuals, organisms, systems, or artificial entities in conjunction with themselves or their environment, which includes the other systems or organisms around as well as the physical environment. It is the response of the system or organism to various stimuli or inputs, whether internal or external, conscious or subconscious, overt or covert, and voluntary or involuntary.)
Susannah's behavioral changes, similar to emotions, can be seen throughout the book. For example, on page 8, she throws out years worth of work, which she said was completely uncharacteristic. On page 11, she goes through her boyfriends emails and drawers. On page 23, we see her come to the realization that she has not been keeping her apartment clean. This too was uncharacteristic. Other behaviors include: paranoia, which started with the bed bugs, and obsessions, like with the apples. Lastly, on page 119, we see that she shows catatonic behavior, meaning muscle tightness or lack of response to the environment.
Brain On Fire gives us an inside look at the life of Susannah Cahalan, a 24 year old women, who had been diagnosed with anti-NMDA-receptor autoimmune encephalitis. Her captivating story tells us not only how her doctors, friends, and family struggled to help her battle this disease, but how she came close to landing in a psyche ward; an unfortunate fate of too many suffering from this disease.
Let's explore question 1, 3, 4, and 6, from our assignment and take a deeper look at Susannah's fascinating, life changing, yet educational, story.
Susannah's symptoms were undoubtfully changing. Anyone could argue that she was bipolar, schizophrenic, and even an alcoholic. But who was right? Well, it turns out, no one was. Susannah was suffering from anti-NMDA-receptor-autoimmune encephalitis. However, her unique illness gives an inside look at these disorders and therefore we can sympathize with Susannah's doctor's frustrations and misdiagnoses.
Bipolar Disorder:
"She thinks it's possible that you're having a manic episode and that maybe you have bipolar disorder."
Susannah learned of bipolar disorder from her friend Julie. She had the symptoms: shift in mood, she was the right age, she had the manic episodes and the extreme depressive episodes. For example, on page 32-37, we see the entire circle of complete mania and depression while Susannah is at her place of work, The Post. On page 32 we see Susannah sobbing uncontrolably. Then a split of a second, she goes to happy, laughing even. This was followed by a panic, a quick phone call, and then another mania episode. Her friend Paul describes her as "talking a mile a minute" and "looking much better". Shortly after this conversation, another episode of depression followed. Days later, after her first visit with a psychiatrist, Susannah's diagnosis was that she was experiencing a mixed episode, which is typical of bipolar disorder. The doctor wrote that she was easily distracted, can't concentrate, total insomnia but not tired, and always impulsive. The psychiatrist prescribed Susannah an antipsychotic, Zypreza, to treat mood and thought disorder. This was not the the first and only doctor to suspect that Susannah had bipolar disorder. On page 84, Susannah is introduced to Doctor Khan who made notes that Susannah had paranoid ideation and ideas of reference. She suspected that she had bipolar I with "serious symptoms".
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Alcohol Withdrawal:
"Let me put this as delicately as possible. She's drinking too much and she's exhibiting the classic signs of alcohol withdrawal."
Dr. Bailey was convinced that Susannah had been drinking too much at some point, and therefore, alcohol withdrawal was the root of her problem. When we look at the root of alcohol withdrawal we can see why he thought this. She was anxious, not sleeping, couldn't concentrate, experiencing seizures and confusion, depressed, irritated, headaches, loss of appetite, and hallucinating, which are all symptoms of alcohol withdrawal.
Schizophrenia:
"Dr. Russo had changed the chief complaint in her daily progress note from "seizures" to "psychosis with possible seizures." And then finally to just "psychosis"."
Susannah's symptoms of schizophrenia are evident throughout the book. For example, on page 67, we see the night Susannah stayed at her father's house. She is convinced that her stepmother and her father are doing things and saying things that are not actually happening, such as: her stepmother calling her a "spoiled brat" and her father beating up her stepmother. These are hallucinations. That same night, she also thinks that the paintings in her father's house are alive. Another example is on page 88. Susannah believes that she is on the news and that her roommate is an undercover agent. Similar types, and also other types, of hallucinations and delusions happened quite often.
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As we read the book, we could see how Susannah's behaviors would continue to change, increase, or get worse; making it almost impossible to diagnose her with one illness or disorder.
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These relate to changes in any mental disorder because anxiety, cognitive, emotional, and behavioral changes are all side affects of mental disorders. People suffering from mental disorders will change in one way or another in these four areas. Depending on the severity of the change, it will determine the severity of the mental disorder.
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"Looking back at this time, I see that I'd begun to surrender to the disease, allowing all the aspects of my personality that I value-patience, kindness, and courteousness- to evaporate."
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Susannah's personality was described as: kind, patient, courteous, driven, talkative, fun, outgoing, responsible, and independent. That all changed; every single trait just mentioned- lost, but only temporarily. On page 43, we see her kind, patient, courteous personality turn to pure anger. This anger, rage even, can be seen multiple times throughout the book. For example, we see it again on page 61 while she is in the car with her family and again during her stay in the hospital when she screams to be "let out" of the hospital and "snarls" at nurses and doctors. She is also demanding when ever she wants something, which convinces herself that she is "powerful". Her independence is gone. She hated being treated like a child and babied, but it was clear that she could not live alone. She was no longer fun, talkative, or outgoing. Her ability to talk was lost in the hospital. She wasn't speaking in full sentence and people could barley understand her. Once out of the hospital, she thought of herself as "boring" and she still had trouble with small talk and social interactions. She felt awkward and uncomfortable around others. But post hospital stay, unlike while she was in the hospital, she was now aware of this drastic personality change. On page 217, after her run in with her ex-boyfriend, she expresses how she was now nothing like the pre-confident person he had once dated and how she hated herself for who she had become.
I wouldn't say that I disliked Susannah. I did not like the way she treated others during the time of her illness, but I understood it was her illness, so I didn't dislike her; it was the illness that I didn't like. The part that I disliked the most was how it made her treat others. She was mean, demanding, and all manners and respect for others was gone. It made me feel bad for her family and friends and doctors and nurses who were treating her.