Brain on Fire


Based on a memoir by New York Post journalist Susannah Cahalan, this Netflix original depicts the author's struggles as she combats a mysterious illness.  

The film follows her ordeal as she and those closest to her try to cope with a range of distressing symptoms including personality changes, challenging behaviours and seizures leading to a psychiatric diagnosis (apparently more than one).

Ignoring the fact that seizures would normally indicate neurological problems, the evil and apparently ignorant doctors of New York where Cahalan is employed at a major newspaper, decide that Susannah is suffering from a mental illness - schizophrenia, bipolar disorder, or multiple personality disorder. (The film also implies that a possible diagnosis might be psychotic episode even though this is not a diagnosis, but a description of what is happening, without elaborating on a cause. Psychotic episodes can be caused by a range of things including drugs or physiological problems - but I digress.)

After months of seeking help and trying to find an explanation for her distressing symptoms, Cahalan's condition worsens and she eventually wakes up cuffed to a hospital bed, one unruly interaction away from being confined to the dustbin of the psych ward.

Where the hell is Hugh Laurie when you need him?

Enter tall, dark and sensitive Dr Souhel Najjar determined to rescue the now-catatonic Susannah from the clutches of the psychiatrists.

A resident has persuaded the brilliant neurologist to temporarily vacate the groves of academe to help provide a physiological cause for Cahalan's symptoms which he duly does, using a drawing test to diagnose right hemisphere problems. (Notably, the resident prefaces her introduction to the patient with the description "right-handed" - hang on! sounds like she already knows what she has.)

Apparently "no psychiatric patient would draw the clock in such a way" - which begs the question of how the hell he would know - maybe someone with schizophrenia might like to test out the aesthetics of a squashed and single hemispheric clock face just for fun and to stymie brilliant neurologists.

In her review of Cahalan's memoir, Aida Emerarian argues that the book disappointingly underlines existing hierarchies between physical and mental illness: "an even greater relief, in Cahalan's case, is that her suffering turned out to have a clearly physiological cause. Physical illness is neutral, easily comprehensible, and is not seen as connected with the thinking, feeling self in the way that mental illness is. There is a frightening hierarchy implied in part of a note that Cahalan's father taped to a wall on the epilepsy ward: "Susannah is a wonderful young woman who deserved your hard work." The overwhelming feeling, while Cahalan was ill, was one of shame. She hid her condition from colleagues until she could explain it, and even then she felt she had to prove her return to "normality".

"A physiological explanation is the pot of gold everyone is searching for, from health providers to drug companies; finding it makes everything easier, and frequently more lucrative. Why embark on the uncertain business of talking therapy, for example, when you can prescribe some pills? Stories like Cahalan's provide a wild hope – Najjar was engulfed with requests for help after she wrote about her case – and it is true that there is a growing group of autoimmune diseases being discovered that directly affect the brain, and must be chased as aggressively as possible." Aida Edermerian in The Guardian

The film portrays Cahalan's parents as people who would far rather their daughter have a serious neurological condition than a possible mental illness. They are adamant that they don't want Susannah in a psych ward (every parent's worst nightmare? ) the underlying implication being that mental illness tips us over into "otherness" overwhelming our social and personal selves, "decreating"us in its own image, beyond hope and help.

At the end of the film, a voiceover tells us that misdiagnosis of mental illness is more common that we think and if only all those poor people languishing in psych wards with a diagnosis of schizophrenia could get their own Dr Najjar to rescue them, we would all be a lot happier.

This is not just unrealistic, it paints a picture of mental illness as a lot scarier, a lot less knowable and far less ordinary than it actually is.  It leaves us with with the sense that people with schizophrenia or other serious mental illness are the unfortunate ones left behind after everyone else has escaped the stigma of a psychiatric diagnosis. 

Brain on Fire does nothing to end this stigma and unhelpfully underlines and increases the distinction between physiological and non-physiological illness, undoing much of the work advocates have done to try to end stigma. 

Wouldn't it be better for popular culture to throw its considerable weight behind stories that can help destigmatise mental illness and help us create a society where psych wards are not looked upon as hell-holes or dustbins for the socially risible, but therapeutic communities for engagement, empathy and healing? 

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