If you invite your college graduate daughter over for dinner and it ends with her screaming about how your fiancé is trying to kidnap her, you might automatically assume she’s crazy. That she has some sort of psychiatric disorder like schizophrenia and your only option is to truck her off to the nearest psychiatric hospital and hope for the best.
Brain on Fire, a movie based on Susannah Cahalan’s story, takes you into her mind, allowing you to hear the voices she did and see the distortions from her point of view.
For the young New York City journalist, things took a strange turn. From being perfectly healthy, she began to slip into what seemed an awful lot like psychosis. She was told that she was partying too much despite drinking very little, was misdiagnosed with bipolar disorder, and it took her regressing into a fully catatonic state for things to grow clearer.
The film, unfortunately, is lackluster and lacked a lot of context. It moved too fast, in that Susannah was given no background as a character, but too fast in that it started out with symptoms.
The story progressed in a way that made even first person hallucination effects slow and boring. What draws the viewer to the film is the sense of mystery.
One may, for example, spent the entire hour and a half absolutely convinced she has schizophrenia, torn between giving up and googling on their phone and just sticking to it and waiting things out.
Brain on Fire is intriguing, not only in the illness it depicts, but the acting which, for the most part is commendable, especially considering the strange set of symptoms.
It took a countless amount of doctors to finally come to the conclusion that she had a rare auto-immune called anti-NMDA receptor encephalitis. Brownie points if you’re actually familiar with that term, because most people aren’t, including many professionals in the field.
What is anti-NMDA receptor encephalitis?
In layman’s terms, what was happening to Cahalan was that her brain’s anti-bodies were attacking it’s proteins. In this case, the protein is called N-methyl-D-asparate, or NMDA.
It’s a serious but newly identified illness, meaning that it’s a stroke of luck she was diagnosed in time. Her brain, in a doctor’s words, was on fire.
Symptoms of this illness are pretty violent and escalate in a short period of time. At first glance, it’s so easy to diagnose as a mental illness as a result of hallucinations, delusions, an agitation along with mood swings.
For example, she was convinced she had bug bites, ones that she showed to doctors and friends, only to hear that there was nothing there.
However, it’s the seizures, numbness, and ‘flu-like symptoms’ that one develops that throw doctors off.
Typical to the illness, the sufferer develops a movement disorder within 10-20 days of contracting the disease, finding themselves barely able to blink. Once the illness has progressed to this stage, the sufferer develops problems with temperature, blood pressure, and heart rate as well.
All the disease needs to be diagnosed is an NDMA receptor anti-body test. The illness can be found in the spinal fluid, as well as by extracting an analysing brain matter, which was the method used in the film.
Can anti-NMDA receptor encephalitis be treated?
Thankfully, this disease, especially if recognised early on, is treatable. A main focus is immunotherapy through intravenous immunoglobulin, or plasma exchange which is often utilised.
The mortality rate of this illness sits at a rather low 4%, however, it often is triggered by a tumour, which could change the chances of a patient’s recovery. 75% of patients have a full recovery, Cahalan included, but the remaining 25% may be left disabled.
However, research by Oxford Academic suggests that 8 of 9 people who have recovered do show cognitive issues 23-69 months following their recovery.
(Written by Keiran Mehra)