Brain on Fire: My Month of Madness

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by Susannah Cahalan


  I was out of the house with Stephen when they arrived. My father let James off in the driveway, because my parents, though on far better terms than before, were still not friendly enough for home visits. James watched a Yankees game while he anxiously anticipated my arrival. When he heard the creaking of the back door, he jumped up from the couch.

  The image of me walking through the door will remain with him forever, he says. I was wearing oversized, scratched-up glasses, a white cardigan that was two sizes too big, and a mid-length black tent dress that billowed out around me. My face was puffy and unrecognizably distorted. As I wobbled up the steps and through the doorway on Stephen’s arm, it seemed as if I had both aged fifty years and lost fifteen, a grotesque hybrid of an elderly woman without her cane and a toddler learning to walk. Even as he watched me, several beats passed before I noticed him in the room.

  For me, it was an equally powerful encounter. He had always been my kid brother, but now he had become a man overnight, complete with stubble and broad shoulders. He looked at me with such a devastating mixture of surprise and sympathy that I almost fell to my knees. It wasn’t until I saw the look on his face that I realized how sick I still was. Perhaps it was the closeness between us as siblings that brought this realization to the fore, or maybe it was because I had always considered myself an older custodian to baby James, and now the roles were clearly reversed.

  As I wavered there in the doorway, James and my mom ran over to embrace me. We all cried and whispered, “I love you.”

  CHAPTER 37

  WILD AT HEART

  When I wasn’t attending doctors’ appointments, my parents allowed me to walk alone to Summit’s quaint downtown to get coffee at Starbucks, though they didn’t yet sanction solo train trips to visit Stephen in Jersey City. So James mostly drove me around.

  It took about a week after James returned from school for him to feel comfortable with this new subdued and disoriented sister. I liked to believe that over the course of our lives, I had played a primary role in James’s hipness—sending him Red Hot Chili Peppers CDs at camp, introducing him to Radiohead, giving him tickets to a David Byrne show in Pittsburgh—but now he was the one introducing me to new things. He prattled on about this singer or that movie that we had to see; I had nothing to add.

  Despite my being bad company, James spent a lot of his time with me. He worked nights at a nearby restaurant, but when he was free, he would drive me down to the local ice cream parlor for a cup of mint chocolate chip ice cream with chocolate sprinkles, a treat I indulged in at least thirty times during that strange spring and summer. Sometimes we even went twice in one day. We also spent many of our afternoons watching Friends, a show that I had never liked before but now became fixated on, though James still disliked it. When I laughed, I would cover my mouth with my hands, but then forget they were there, keeping them by my face for several minutes before mechanically returning them to my sides.

  At one point I asked my brother to drive me to town so that I could get a pedicure in preparation for my stepbrother’s upcoming wedding. He dropped me off, and I told him that I would call him in an hour, but when my father came to Summit from Brooklyn to check on me and found that I had been gone twice as long without word (I had stopped off for a cup of Starbucks coffee before heading to the salon, which lengthened the trip), he panicked. They frantically canvassed the town, until my father paused in front of Kim’s Nail Salon.

  He peered into the darkened windows of the spa’s storefront and caught sight of me in a massage chair. I looked dazed, staring straight ahead, like I was sleeping with my eyes open. A pool of spit was forming around my lower lip. A few middle-aged women, “Summit moms” as they are called, were throwing uneasy glances in my direction. They seemed to be silently encouraging one another to “check out that crazy girl.” My father would later tell me that he was so furious at them he had to move away from the window, prop himself up against the neighboring storefront, and collect himself. After a moment, he took a deep breath and entered the spa with a big smile, his voice booming around the room: “There you are, Susannah. We’ve been looking all over for you!”

  Later the same week, my mom took off work and suggested that we go shoe shopping in Manhattan. As I examined various flats at an Upper East Side store, the salesperson approached my mother.

  “Oh, she’s so nice and quiet. What a sweet girl,” the saleswoman commented cheerfully. It was clear that she thought I was slow.

  “She’s not sweet,” my mom hissed, enraged on my behalf. Luckily, I missed the whole exchange.

  I fell asleep on my mother’s shoulder the way back on the train; the medication and the residual cognitive fatigue from my healing brain made concentrating on acting normal incredibly draining.

  Back in Summit, as we headed down the stairs from the train platform, I heard my name. I chose to ignore the voice at first. Not only was I still not quite sure what was real and what was in my head, but the last thing I wanted was to see someone I knew. The second time I heard my name, though, I turned around and saw an old high school friend, Kristy, walking toward us.

  “Hi, Kristy,” I said. I was trying to make my voice loud and confident, but it came out in a whisper. My mom noticed and spoke for me.

  “We were just shopping in the city. We got some shoes,” she said, pointing to our bags.

  “That’s nice,” Kristy said, smiling politely. She had heard that I was sick, but had no idea that the problem was with my brain. For all she knew, it had been a broken leg. “How are you?”

  I struggled to conjure the loquaciousness that had once been a primary aspect of my personality, but in its place found a deep blankness. My inner life was so jumbled and remote that I couldn’t possibly summon up breezy conversation; instead, I found myself focusing on how flushed my face had become and the pool of sweat forming in my armpits. I realized then how great a skill it is to be social.

  “Goooooood.” I drawled out the word like I had enough marbles in my mouth for a game of mancala. My mind continued to circle around that vast emptiness. Say something! I screamed inside, but nothing came. In the silence, I felt the sun beat down on my shoulders. Kristy stared at me with concern. After an awkward moment, she waved her hand and explained that she was running late.

  “Well, it was really good seeing you,” she offered, turning to leave.

  I nodded and watched her glide through the door to the station. I nearly broke down right there in the street. It was amazing how powerless I felt at that moment, especially compared to the superhuman control I had enjoyed during the height of my psychosis. My mom took my hand, realizing the magnitude of this soul-crushing moment, and led me out to the car.

  . . .

  Despite all this nerve-wracking, zombie-like behavior, James too, like Stephen, saw moments where the “old Susannah” would shine through. Everyone held out hope that I would eventually return. One evening when Hannah came to visit, we sat in the family room watching Blue Velvet, a movie by David Lynch, a favorite director of mine. As the first fifteen minutes of the movie played, James and Hannah bantered about its terrible acting. I said nothing, but much later, after they had moved on to a different conversation, I interrupted them to point out, “It’s on purpose. The acting. That was David Lynch’s style. It’s much better in Wild at Heart.”

  James and Hannah quieted, nodding their heads solemnly. Though they didn’t speak about it that night, both would later remember this moment as another confirmation that my old personality was intact, just buried.

  CHAPTER 38

  FRIENDS

  Besides the walks to Starbucks, the Friends episodes, and the drives to the ice cream parlor, I spent most of my time in a state of perpetual anticipation as I waited like a puppy for Stephen’s arrival on the commuter train to Summit.

  Because I couldn’t drive, my Mom, Allen, or James had to chauffeur me to the station. One afternoon while my mother and I sat in the car, waiting for him, my mom pointed and said, “There
he is! He looks so different!”

  “Where?” I said, scanning the crowd. Only when he reached the passenger side window did I finally recognize him: He had shaved his beard and cut his shaggy, cheekbone-length hair into a dapper, slicked-back 1940s hairstyle. He looked even more handsome than usual. As I watched him enter the car, I was suddenly filled with an aching feeling of gratitude that I had found such a selfless, devoted person. It’s not as if I hadn’t known that all along; it was just that at that very moment, I couldn’t contain the deep love I had for him, not only for staying with me, but also for providing me with security and meaning at a very difficult time in my life. I had asked him many times why he stayed, and he always said the same thing: “Because I love you, and I wanted to, and I knew you were in there.” No matter how damaged I had been, he had loved me enough to still see me somewhere inside.

  Though he claims he could see the old me, most other people found it hard to relate. A few days later, I agreed to attend a homecoming party for one of Stephen’s and my closest friends, Bryan, who had briefly returned home from Austin, Texas. When we arrived, the grill was going in Bryan’s mother’s backyard and adults of various ages sat around eating burgers, playing bocce ball, and chatting. As I joined the party with Stephen and his sisters, I felt the air get leeched from the room as everyone seemed to gawk at the sick girl. Though this was likely all in my mind—many of the people had no clue that I had been sick, and even more of them had never met me before—I felt as if I were the center of attention in the worst way.

  Yet my friends who were there would later tell me that I seemed unnaturally happy, beaming a plastic and fixed ear-to-ear smile. Maybe that was some sort of self-preserving body armor, a mask to keep the frightening hordes at bay.

  At the party, hardly anyone asked me about my hospital stay, though the people who had heard about it approached me diffidently, eyes downcast, seemingly shamed by their knowledge, however slim, of what had befallen me. To these friends, it was like losing me in plain sight while the substitute Susannah was still there to remind them of the person who I had been before. All the while, my mind encircled itself with questions: Did they hear I was in the hospital? Did they hear I was crazy? Instead of engaging, I found myself fixedly staring them down, unable to converse. Eventually I gave up trying and concentrated on eating the juicy watermelon and hamburgers cooked on the grill.

  But I had my savior: Stephen. People called him the “Susannah whisperer,” because he seemed to sense what was unspoken. At the party, he stood by my side, never once letting me stray too far from his watchful gaze. When people who hadn’t been debriefed came up to chat with me, he took the reins in the conversation, not something that the normally laid-back, California-cool Stephen did, but something that was now necessary. When I couldn’t speak, he spoke for me. Like my plastic smile, Stephen became another layer in my protective armor.

  At one point, an old friend, Colleen, who had heard about my hospital stay from Stephen’s sister Bridget, noticed that as I ate a piece of watermelon, the red juices dribbled down my chin and onto my dress. She felt conflicted: Tell me or let it be? She didn’t want to embarrass me, but she didn’t want to let me go on looking like a clueless child. Luckily, before she had to make the decision, Stephen wiped the watermelon juices from my chin.

  After an hour at the party, I gave Stephen a look, and he nodded back knowingly. It was time to go.

  My second organized social experiment occurred the last week of May at my stepbrother, David’s, wedding. I was initially supposed to be a bridesmaid and had purchased the dress just before I got sick, but after I got out of the hospital the bride gently suggested that it might be best if I no longer took part in the ceremony.

  Obviously, I thought then, she’s embarrassed by me.

  I realize now that she was acting out of concern, but it was proof to me then that I had become a burden. Normally I was someone people wanted to include—Stephen and I had even been voted “most fun couple” at one wedding we attended prior to my illness—but now I had become a source of shame. This stung and whittled away at my fragile self-worth, which had taken such a thrashing over the prior months.

  Still, I was determined to prove to her and the rest of the wedding party that I still “had it.” I styled my hair with a straightening iron to cover up my biopsy scar and bought a bubble-gum-pink dress, while Stephen wore a mod-style suit with a skinny tie. A mere month after the reunion at Rachael’s house, going to the wedding represented a significant step forward in my recovery process. I was nearly past the period where I looked and acted noticeably awry, though my face was still puffy from the steroids and my words were still faltering and largely monosyllabic. If you didn’t look too closely, though, Stephen and I seemed like an ordinary hipster couple.

  The ceremony took place in a manor in Hudson Valley, New York, where grapevines dangled along the gates and wildflowers bloomed as far as the eye could see. Stephen and I spent most of the party standing by the makeshift kitchen, where the caterers entered and exited carrying plates of hors d’oeuvres. I don’t know if it was the steroids, which can cause an increase in appetite, but I was ravenous.

  At the beginning of the night, my mom made me promise that I would drink only one glass of wine. I all but rolled my eyes when I agreed and then went ahead and drank several flutes of champagne. If there’s one thing about me that has been confirmed by my illness, it’s my tenacity, or bullheadedness, or whatever else you want to call it. Even though my brain was still repairing itself and it’s undoubtedly dangerous to mix alcohol with antipsychotics, I insisted on drinking. I didn’t care how self-destructive it might be—this was something tangible that connected me to the “normal” Susannah. If the old Susannah had a glass of wine or two with dinner, so would this Susannah. I couldn’t read, could hardly make small talk, and couldn’t drive a car, but, dammit, I was going to have a few glasses of champagne at a wedding. My mother tried to stop me, but she knew she had no control over my vices: I was going to do what I pleased. Ultimately the wine represented independence, and everyone around me decided it was best not to stamp out what remained of my dignity.

  When the song “Build Me Up Buttercup” came on, I even did the twist with Stephen. In my mind, I rocked the dance floor, ignoring the aches and pains in my shins and the fact that I was tiring much more quickly than ever before. (I would later learn from my stepfamily, however, that instead of moving like a pro, I just looked robotic and dazed.)

  Despite my attempts at seeming blithe and careless, I was hyperattuned to the different ways people were treating me. Since this was a family event, the first question out of everybody’s mouth was, “How are you?” It was an unanswerable question at this stage. But that wasn’t the worst part. It was the falsely enthusiastic, carefully enunciated tone people used; they were talking down to me, as if I were a toddler or a very old person. It was demoralizing, but I couldn’t really blame them. No one had a clue about what was going on inside my mind.

  My mother, however, was proud to see me enjoying myself—that is, until another wedding guest broke into her quiet admiration.

  “I’m so sorry to hear what happened to Susannah,” the woman said, hugging her. My mother does not like to be touched by strangers.

  “Thank you,” she said, trying to keep an eye on me.

  “It’s so sad. She’s so different. She’s just completely lost her spark.” At that, my mom tore her eyes from the dance floor and shot the woman a look. There had been many moments of insensitivity, but this was among the worst. “I mean,” the woman continued, “do you think she’ll ever get back to her old self again?”

  My mom smoothed out her dress, also pink, and shouldered past the woman, saying through clenched teeth, “She’s doing very well.”

  CHAPTER 39

  WITHIN NORMAL LIMITS

  Although I had already made substantial leaps in my recuperation, nonetheless for many months to come my days would revolve around the candy-colored med
ications that I had to take six times daily. Each week, my mother spent an hour portioning out my pills into a dispenser that was the size of a shoebox top. Often it took her several tries to get the proportions right because the doses were complicated and always changing. The pillbox was divided into yellow, pink, blue, and green slots and had seven columns for each day of the week and four rows: morning, midafternoon, late afternoon, and bedtime. I was tethered to this pill dispenser.

  My reliance on these pills meant I couldn’t be independent, and so I loathed them. Not only were they symbols of my infantile status in my mother’s home, but the pills also made me sleepy and slow. Sometimes I would just “forget” to take them (an incredibly dangerous thing to do). Because I wasn’t wily enough to throw out the medication, I often left the evidence in the dispenser, which tipped off my mother, prompting her to reprimand me as she would a child. In many ways, during that recovery period at my mother’s home, I associated the pills—and the fights they engendered—with her. In a practical sense, I needed her to portion out the pills because it was far too complicated a task for me at the time. In a more emotional sense, though, I began to feel that she, like the pills, embodied my contemptible dependence. I can admit now that I was sometimes cruel to her.

  “How was your day?” she would ask me after she returned home from a long day at the district’s attorney’s office.

  “Fine,” I would say coldly, without elaborating.

  “What did you do all day?”

  “Not much.”

  “How are you feeling?”

  “Fine.”

  I cringe when I recall these interactions, since my mom and I had always been inseparable, and I can only imagine how much it must have hurt her. I realize that I was still holding tightly on to an amorphous grudge against her for reasons that seem so meritless now. Though the hospital was a blur, residual anger from that time remained somewhere in my subconscious. Somehow I had convinced myself that she hadn’t spent enough time with me in the hospital, though this was neither fair nor true. On some level, her suffering, which she had buried so deeply, had begun to drain out of her unconsciously and onto me. The worst part was that the struggle didn’t end once the hospital stay was over; now she had to live with this hostile stranger, her own daughter, who had once been one of her closest friends. But instead of sympathizing with her pain, which certainly matched and may have even surpassed my own, I took her suffering as an affront—a sign that she could not handle how flawed the sickness had made me.

 

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