Susannah Cahalan - Brain on Fire - My Month of Madness

Later that evening, an on-call neurologist came to conduct a second basic health history. Immediately she noticed that I was “labile,” meaning prone to mood swings, and “tangential,” meaning that I skipped from topic to topic without clear transitions. Nonetheless, I did manage to describe my history of melanoma before I began to grow so illogical that the interview had to be postponed.

“So what year was it that you were diagnosed?” the neurologist asked.

“He’s playing a trick on me.”

“Who’s playing a trick on you?”

“My dad.”

“What do you mean?”

“He’s changing into people. He’s turning into different people to play tricks on me.”

The neurologist wrote “unclear if hallucinating” on her consultation form and prescribed a low-dose of the antipsychotic drug Geodon, often used to treat the symptoms of schizophrenia. She put in a request for a member of the psychiatric team to perform a closer examination.

Not only did I believe that my family members were turning into other people, which is an aspect of paranoid hallucinations, but I also insisted that my father was an imposter. That delusion has a more specific name, Capgras syndrome, which a French psychiatrist, Joseph Capgras, first described in 1923 when he encountered a woman who believed that her husband had become a “double.” 12For years, psychiatrists believed this syndrome was an outgrowth of schizophrenia or other types of mental illnesses, but more recently, doctors have also ascribed it to neurobiological causes, including brain lesions. 13One study revealed that Capgras delusions might emerge from structural and circuitry complications in the brain, such as when the parts of the brain responsible for our interpretations of what we see (“hey, that man with dark hair about 5’10”, 190 pounds looks like my dad”) don’t match up with our emotional understanding (“that’s my dad, he raised me”). It’s a little like déjà vu, when we feel a strong sense of intimacy and familiarity but it’s not connected to anything we actually have experienced before. When these mismatches occur, the brain tries to make sense of the emotional incongruity by creating an elaborate, paranoid fantasy (“that looks like my dad, but I don’t feel like he’s my dad, so he must be an imposter”) that seems to come straight out of The Invasion of the Body Snatchers.

EEG video, March 24, 1:00 a.m., 6 minutes

I am sleeping in bed, wearing a green and brown striped T-shirt and a white cotton hat. The ivory bedsheets are pulled up to my throat, and the cushioned guardrails are at their highest level, making the bed look, from above, like an adult-sized bassinet. I sleep in a fetal position, clutching my pillow. In a moment or two, I awake; fiddle with my cap, looking upset; and pull at the patient ID band on my right hand, folding my arms over my chest. I grab for my cell phone.

End of tape.

I need to pee. I snatch up my pink backpack and unplug the cord and head to the shared bathroom. As I lower my black leggings and my underwear to my knees, I can’t shake the feeling that I’m being watched. I look to my right, and a big brown eye peers in at me from a slit in the door.

“Get the fuck away from me!”

I cover my private parts, lift my pants, and sprint back to bed, pulling the covers to my eyes. I call my mom.

“They’re trying to hurt me. They’re making fun of me. They’re putting shots in my arm,” I whisper, trying to keep my voice low enough so that the other three patients and the nurse manning the in-room station can’t hear me.

“Susannah, please try to stay calm. I promise you no one is trying to hurt you,” my mom says.

“They’re spying on me. They watch me when I go to the bathroom.”

She pauses before speaking again. “Is this true?”

“How can you ask me that? Do you think I’d make it up?”

“I’m going to talk to them about this,” she says, her voice growing frenzied.

“Do you think they’ll tell you, ‘Yeah, we’re abusing your daughter’? Do you think they’ll admit that?”

“Are you sure this is happening, Susannah?”

“Yes.”

I hang up on her as I hear the shuffling of feet. A nurse walks near my bed. “Please don’t use the phone with the EEG equipment. It interferes. And it’s late. Everyone is sleeping.”

Then she whispers, softly, tauntingly, without moving her lips, “I see you on the news.”

“What did you say?”

“Why you no let your father in? He’s a good man,” the nurse says, her voice wafting around me like a vapor until she disappears behind the curtain.

Everyone is out to get me. I’m not safe here. I look up at the video cameras. They are watching me. If I don’t leave now, I will never get out alive. I grab a handful of electrodes and pull. A patch of hair comes out with it, but no pain registers. Absently, I stare at the virgin roots of my dyed blond hair and then reach for more.

That night, I dashed out of the hospital room and into the hallway, where a group of nurses caught up to me and returned me to the AMU room as I battled ferociously, kicking and screaming. It was my first, but not my last, attempt at escape.

Deborah Russo, an attending neurologist on the epilepsy floor, visited me on the second day to conduct yet another examination. She came during the morning shift, accompanied by doctors, nurses, and a few med students. They were “the team.” Knowing about my escape attempt the night before, Dr. Russo sized up the room and confirmed that all seizure precautions were being maintained before moving on to the basic neurological exam: “touch your nose, stick out your tongue,” etc. I interrupted her midreview.

“You need to let me out of here. I don’t belong here,” I confided, looking nervous. “They’re all saying bad things about me.”

“Who’s talking to you?”

“The people on the TV.”

Dr. Russo allowed me to ramble on for a few minutes before redirecting me. “Can you tell me a little about how you felt before you came to the hospital?”

“I felt like I disappeared.”

“Can you explain what that means?”

“It felt like I was tired. I was tired until today.”

Russo wrote down “too tangential and disorganized to give us a full history” and continued with her exam. “I’m going to ask you some basic questions, and you do your best to answer them, okay? What is your name?”

“Susannah,” I said, craning my neck toward the TV set.

“What year is it?”

“You don’t hear that? They’re talking about me. Look, look, they’re talking about me right now.”

“Susannah, would you try to answer my questions?” Dr. Russo said, motioning for a nurse to turn off the television set. “What year is it?”

“2009.”

“Who is the president?”

“Obama.”

“Where are you?”

“I need to get out of here. I need to leave. I need to go.”

“I understand. But where are you right now?”

“The hospital,” I answered, caustically. Dr. Russo moved on, shining a light into my pupils with a small flashlight, checking for constriction and eye movement. All normal.

“Susannah, please smile for me.”

“No more. I don’t want to do this anymore,” I said.

“It won’t take long.”

“I want out now!” I screamed, launching myself off the bed. The team waited out my outburst, but even once I was calm again, I continued to pace, tugging at my EEG leads and lunging toward the door. “Let me out of here!” I snarled at the team, trying to push my way out of the room. “Let me go home!”