So I’ve just finished the audiobook for Susannah Cahalan’s memoir, Brain on Fire. The audiobook was narrated by Heather Henderson, who did an amazing job especially with interpreting some of Susannah’s speech patterns as she progressed through her harrowing brush with insanity and catatonia brought on by her rare autoimmune encephalitis. I was deeply affected by this book, although I can’t exactly say that I enjoyed it in the sense that the entire time I was listening, I felt a rising sense of alarm and anxiety, unable to separate myself from my innate fears as a parent, that something like this could happen to anyone’s child, to my child! Nevertheless, I found it a fascinating and well-written book, and certainly, a story that needs to be told. Spoilers abound below.
Like Perry, I have a few concerns about the movie, insofar as it may be a challenge for the screenwriters to adapt it in such a way as to make the movie interesting to laypeople. I have found in my veterinary practice that many of my clients aren’t always all that interested in the pathogenesis of their pets’ diseases… all they really care about is the outcome. Perry stated that “I don’t really see a movie here that would appeal to a wide audience, and I’m surprised if the book did. It is so full of medical jargon and science mixed with ordinary family dynamics, that an hour of House would have been enough to tell the story.” I can’t help but share those concerns, but I have to admit, I’m just the opposite.
Although Susannah (to my ears) did a good job explaining the pathogenesis, or underlying physiological basis for the disease, and while that same explanation may have been either overwhelming or just uninteresting to some readers, I actually wanted a more in-depth review. I spent about 2 1/2 hours last evening intently watching neurology Grand Rounds presentations by and for neurologists to get a deeper medical perspective as well as an update on where they were as of 2013/2014 compared to where they were at the time the book was written. I learned that while the disease was relatively unknown at the time of Susannah’s diagnosis, at least the higher echelon of neurology groups are now actively looking for NMDA Receptor Autoimmune Encephalitis both in adult and pediatric medicine, and have in fact identified and characterized several other types of neuron receptor autoantibodies… anti-NMDA attacks mostly young women, anti-VGKC mostly older men, etc. Interestingly, both of the medical presentations I watched on YouTube showed a picture of the Brain on Fire book cover, and one neurologist said that Brain on Fire was now the most-often-cited book by interns and 1st year residents in neurology as “the book that sparked their interest” in neurology specialization.
As of 2014, the pediatric neurology group that I watched has had success treating cases of sudden onset of these types of neurological behaviors with immunosuppressive therapies even before the results of the auto-antibody tests are known (it often takes several weeks to get the results back) and in their group, although about 8 out of 20 of the patients eventually returned negative for anti-NMDA receptor antibodies in their cerebrospinal fluid, most responded similarly with a high percentage returning to normal or near-normal after the same treatment as those patients who did have the anti-NMDAR antibodies, which suggests that there may be a number of various neuron receptors susceptible to autoimmune attacks that simply haven’t been identified yet. So while an autoimmune process can’t account for every case, it is likely that many cases in both adults and children do masquerade as schizophrenia in adults, autism in children, etc. and therefore go undiagnosed and untreated, devastating lives permanently. One hopes that if nothing else, a movie about it will continue to raise awareness in the medical community, leading to not only more successful outcomes if and when it is looked-for and treated, but also to more research funding, etc.
Moving on to some other challenges I see for the screen adaptation: it may be difficult to film at least the early stages of the encephalitis without the lead character coming off as unlikable. In the book, the first person account in the narrative explains how in retrospect, Susannah is ashamed of how off-putting the crazy behavior was, and she therefore comes off as a likeable person. However, in a movie it may be difficult to establish a rapport with the character of Susannah because she quickly became so full of paranoia, so rude, nonsensical, and combative… just generally behaving in ways that are basically unacceptable in likeable people!
On the other hand, there are a lot of opportunities here for some creative cinematography as the film attempts to convey Susannah’s version of reality. Some of the encephalitis manifestations, such as her temporal lobe seizures, resulted in hallucination and strange distortions of reality, with paintings and wall displays coming alive or pulsating, out-of-body experiences, people’s faces rapidly aging and then regressing to childhood before her eyes, etc. I am really interested in how they will explore these aspects, and some of her other more paranoid delusions, on film.
I wonder if Richard Armitage, set to portray Susannah’s father, will meet with the real Tom Cahalan? Or with Susannah Cahalan? True, I admit I listened to the book with an image of RA in the back of my mind, so my admiration for Tom Cahalan might be a bit biased. Nevertheless, the man impressed me greatly. Although the book didn’t go very in-depth about his character, it did give some clues as to the type of man Tom Cahalan is. It seems that he is both a spiritual man, unafraid to sink to his knees and pray for his daughter’s return, but also a practical and down-to-earth man, willing to clean his daughter’s apartment alongside his wife when they found it to be a huge mess with trash strewn everywhere and permeated with rotting food smells. Tom was fiercely protective of daughter- (shades of Proctor?)- and there were times when his “Big Man” persona, his forceful personality, emerged. Occasionally, his temper got away from him: in one scene, he intimidated a taxi driver who told the family to get out of the car because Susannah was behaving wildly and claiming to be kidnapped; there is another scene when a group of interns and medical students arrived to gawk at Susannah and speak about her condition as if she weren’t in the room. Even after she was on the road to recovery, he had to restrain his fury and get ahold of himself when he observed women at the nail parlor whispering and pointing at his daughter, who was dazed and drooling on one of her first solo outings after her hospitalization.
I think that Richard Armitage will have no problem doing justice to the role of Tom Cahalan. He has no problem playing a forceful character, but he is equally adept at drawing on his inner sensitivity and there are many nuances, and much angst, to be found for any father in this situation. Tom Cahalan is undoubtedly a dedicated father, and my heart hurt for him as he went about his faithful caretaking… showing up every day, even if it meant he had to stay out in the hallway. Forgiving hurtful manifestations of Susannah’s psychosis- delusions of hers that had him as a kidnapper, a murderer, or as an imposter turning into other people in order to perpetrate a cruel hoax. He would prepare and bring home-cooked meals to tempt her to eat, help her to write thank you notes when she became fixated on it but unable to write them herself. And above all, I admired his ability to stay focused, at least in Susannah’s presence, on the positives… he was really her rock. It will be interesting to watch the dynamics between Susannah’s parents, who had to put aside their differences and dislike for one another in order to be there for their daughter.
Another interesting dynamic to explore for Richard was Tom Cahalan’s relationship with Susannah’s boyfriend, Stephen. Her dad’s initial impression of Stephen as a “place holder” boyfriend, decent but probably not “the one”… growing into an abiding respect for the younger man when he, too, continued to show up day after day, lending his calming influence and continuing to love Susannah, and to believe she was still “in there somewhere” as the encephalitis ravaged her brain. What a guy! Not sure if she is still with Stephen, but I think I would be. A guy like that doesn’t come along every day!
So all in all, I’m really excited about this movie, and I hope that they are able to do the story justice. It has the potential to be very heartwarming as it covers the family dynamic and the love story between Susannah and her boyfriend, and the bigger implications of the discovery of a disease like this, when one considers how many victims throughout history likely underwent exorcism, died or were placed in asylums, are staggering.