Book excerpt: Brain on Fire by Susannah Cahalan



AP Psychology/SpencerNew pERSPECTOVES ON mENTAL iLLNESSSUNDAY BOOK REVIEW‘Infectious Madness,’ by Harriet A. WashingtonBy?MEGHAN O’ROURKE DEC. 31, 2015One hundred and sixty odd years ago, Ignaz Semmelweis realized that physicians who didn’t wash their hands were carrying tiny germs from bedside to bedside and causing the childbed fever that killed many women. After doctors began washing their hands, fewer women died. The series of realizations in the 19th century that germs — bacteria and viruses — caused diseases like cholera and tuberculosis and influenza ushered in modern medicine. Mortality rates declined; children lived longer. Germ theory had a dramatic clarity to it. It pushed medicine away from holistic conceptions of illness as imbalance toward conceptions of illness as a specific entity. You get the germ, you fall sick, you take antibiotics or fight it off (or die). Ironically, though, the tidiness of this relationship helped obscure cases where germs may have less direct but still devastating effects — a complex reality we are now beginning to understand better.Indeed, a handful of researchers are wondering whether mental illnesses are really caused by our immune system’s response to powerful microbial infections. As Harriet A. Washington reports in her new book, “Infectious Madness: The Surprising Science of How We ‘Catch’ Mental Illness,” some researchers in the field believe microbes may be responsible not only for clear-cut diseases like typhoid and tuberculosis, but also for mental illnesses such as anorexia, obsessive-compulsive disorder and schizophrenia — but in a less tidy manner. As she reports, research has found that 10 to 20 percent of mental illnesses, including autism, are partly caused by pathogens.This new science, she excitedly claims, means we are on the verge of “a paradigm shift that replaces psychosocial factors with biological ones as the cause of mental illness.” (Washington is given to enthusiasm for her subject: If these infections can so far be said to cause only 10 to 20 percent of mental illnesses, is the shift as clear-cut as she says it is?)To introduce us to this new paradigm, Washington, who won a National Book Critics Circle Award for her 2007 book “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present,” weaves together profiles, medical history and recent research, including that of Susan Swedo at the National Institutes of Health and E. Fuller Torrey at the Stanley Medical Research Institute. She delves into the history of medical advances and Freudianism to explain why the idea of an infectious origin of schizophrenia seems so strange to us. Along the way, she lays out the research showing that infections may shape us in utero and in our youth by triggering immune reactions our na?ve immune system isn’t properly equipped to manage. (This can lead to out-of-control inflammation or autoimmune responses, in which the immune system attacks the body’s own tissue.)While the work reported on in “Infectious Madness” seems powerful and indeed paradigm-shifting, Washington often fails to tease apart the complexities and nuances of the complicated science she is outlining, limiting herself to a rather reductive point of view. At one point, for example, she details the idea some researchers have that pathogenic infections help shape societies and major historical events, because evolution has selected for us to distrust the infected. It’s here that she is on thinnest ice — failing to take seriously the role of other factors like economics, cultural pressures and local history.There are of course cases where we have long accepted that mental illness is caused by infection, as with paresis (in late-stage syphilis) and rabies. But Washington is trying to show that a host of other disorders are caused by it too. Among the most persuasive data she summarizes is evidence that obsessive-compulsive disorder, for example, can be triggered by strep throat practically overnight in a percentage of susceptible children. Take the story of Seth, who, until he had several bouts of sore throat, was “a quiet 10-year-old whose small rebellions rarely went beyond balking at bedtime.” One night after his illness, he refused to eat dinner and told his mother that his food might be poisoned. She woke to find he had been washing his hands raw in the sink — he had used nearly an entire bar of soap. An emergency room pediatrician diagnosed obsessive-compulsive disorder. As it happened, Susan Swedo at N.I.H. was Seth’s pediatrician. Swedo believes that strep throat can trigger O.C.D., Tourette’s and anorexia in the genetically predisposed by way of a condition she calls Pandas, or pediatric autoimmune neuropsychiatric disorders. In other words, the infection triggers an outsize immune response whose consequences manifest as, say, O.C.D. In one study, Swedo’s team studied a group of children whose “symptoms had been preceded by strep throat or similar infection.” They found that these children tended to have an antigen — a molecule that causes the body to make immune responses to it — making them vulnerable to rheumatic fever. In another study, when they gave immune-modulating interventions to 18 kids with O.C.D., 16 of the children, including Seth, improved.Also deeply intriguing, if less fully convincing, is Washington’s account of research being done on schizophrenia. E. Fuller Torrey, a psychiatrist, has been frustrated by the lack of answers about schizophrenia ever since his sister was given a diagnosis of the disease while he was a pre-med student at Princeton. At the time — in the Freudian heyday — doctors still believed that poor mothering caused schizophrenia, and they suggested “dysfunctional” family relationships as a cause. Torrey didn’t buy that. He came across facts that complicate the view of schizophrenia as purely psychological or just genetic. There is an element of seasonality to schizophrenia: Schizophrenics are about 5 to 8 percent more likely to be born in winter and early spring — not a huge upward tick, but one that is consistent across multiple studies in different countries. Schizophrenics also have elevated white blood cell counts, suggesting they may be fighting an infection, and they have gait disturbances, suggesting some change in their brains.Torrey also noticed reports that schizophrenia rates rose in the United States the same year cat ownership became popular, a fact that has led researchers to look into Toxoplasma gondii, a parasite that cats transmit to humans. It’s not harmful to everyone — though it appears to make those who harbor it more sexually aggressive — but a pregnant woman can pass it to her child in the womb, where it causes damage. Washington quotes from a study in the American Journal of Psychiatry that found that “children of mothers who contracted T. gondii while pregnant did suffer higher rates of schizophrenia than other children.” Another doctor, Hervé Perron, has identified a virus, HERV-W, that he believes is involved in schizophrenia; it turns out that “49 percent — nearly half — of people with schizophrenia harbor HERV-W, while only 4 percent of people without schizophrenia do,” Washington informs us. One theory is that viruses like the flu or infections like toxoplasmosis cause the body to “release” HERV-W viruses, overwhelming the immune system and causing inflammation in some people.While Washington’s interest in her material is enticing, she overstates her case and the evidence. In the later chapters, she digresses into conversion disorders, gun violence and ethnic conflict in South Sudan, reporting on research that high rates of infection correspond to increased levels of war and ethnic violence, which, as she puts it, “explains why some societies are more bellicose than others.” The result is a scattered and at times disappointingly limited exploration of the issues at hand. It’s interesting to think about the fact that anorexia may be triggered by a virus, but a girl’s desire to be thin is certainly also culturally and socially influenced. At many points “Infectious Madness,” in neglecting to take a nuanced view, undermines the reader’s confidence in the author’s ability to make discerning assessments. For example, Washington talks about neurasthenia as evidence that the flu causes mental symptoms, but neglects to mention how broad a diagnosis of neurasthenia once was, dependent on erroneous ideas about how the nervous system functioned.In her zeal to persuade us, Washington fails to unpack some of the obvious questions raised by the research she reports on. If she is correct, 51 percent of people with schizophrenia don’t have HERV-W. Is their schizophrenia triggered by another constellation of viruses? Or by a different mechanism altogether? Are we even defining “schizophrenia” correctly, as a single disease, or is it in fact a range of responses to different kinds of inflammation in the brain? Is some schizophrenia psychosocial in origin? What combination of genetics, environment and infection might we be talking about here? And if the abnormal response of schizophrenics to illness is itself abnormal, how do we conceptualize infection, pathology and health? What ethical and pragmatic implications are there at work?Nevertheless, Washington’s broader point that the body really does shape the mind is an important one. However much our health care system may excel at acute care and detailed surgeries, it’s not great at dealing with vague illnesses it does not yet understand. In particular, medicine seems particularly blind to its own limitations when it comes to its conception of the mind-body relationship. Medicine continues to put faith in a “reductionist anachronism of mind/body dualism,” Washington writes, quoting from the website of the DSM-IV, despite the recent triumph of realizing that depression is a physical disease. The more we learn about the brain and the immune system, the more the duality between psychiatry and “functional” or “organic” medical issues begins to look anachronistic. We need a new framework for understanding disease that is more complex. After all, we’ve realized that autoimmune diseases also stem from a complex interplay of genetics, environment and viruses that “pull the trigger.” In this new framework, it seems likely, we will come to understand there are multiple pathways to many diseases. Doing the research to understand more is crucial. But as Washington notes, this kind of research is often rejected because it involves radical new ways of conceptualizing disease. As it happens, the reflexive rejection of new paradigms of thought in medicine is termed the Semmelweis Reflex, because so many doctors initially rejected Semmelweis’s insights, leading to the unnecessary loss of many lives.INFECTIOUS MADNESSThe Surprising Science of How We “Catch” Mental IllnessBy Harriet A. Washington292 pp. Little, Brown & Company. $28.Meghan O’Rourke is writing a book about poorly understood chronic illnesses, including autoimmune disease and chronic fatigue syndrome.Catching MadnessCan we catch OCD, anorexia, or schizophrenia the way we can the flu?By Harriet Washington, published on November 3, 2015 - last reviewed on June 10, 2016Cats have been viral on the internet for years. The fractured grammar of LOLcats "I can has cheezburger?" is as ubiquitous as the animal itself. As far as domesticated animals go, cats are an oddly appropriate meme because they carry viruses that the world is only now fully recognizing. ?E. Fuller Torrey, a psychiatrist with the Stanley Medical Research Institute, has been studying the connection between cats, parasites, and mental illness. According to Torrey, a known parasite that can lead to madness is carried by the common household cat. In his book,?The Invisible Plague, he reveals that around 1808,?schizophrenia?was swiftly transformed from a rare to a relatively common disease. That same year, as cat ownership became popular in the United States, as well as in other parts of the world, U.S. schizophrenia rates rose sharply.This is no coincidence, Torrey contends. Cats transmit the one-celled parasite?Toxoplasma gondii?that causes the disease toxoplasmosis. It is already implicated in prenatal brain damage, abnormal head size, deafness, seizures, cerebral palsy, retinal damage, and mental retardation. Torrey and others think it does more: They argue that?T. gondii?infection causes schizophrenia.Illustration by John GallResearchers are unmasking the microbial roots of myriad illnesses; maladies as seemingly trivial as a sore throat can breed?anorexia, Tourette's,?obsessive-compulsive disorder, or schizophrenia. Researchers estimate that infectious organisms cause from 10 percent to 75 percent of serious mental disorders. Bacteria, viruses, fungi, and other infectious agents are responsible for many of the illnesses that we have long ascribed to?genetics. ?As for?T. gondii, Torrey and colleagues suspect that it causes subtle changes to an infected fetus that could lead to schizophrenia 20 years later. In 2008, Torrey and?Robert Yolken of Johns Hopkins published a study indicating that the peak age for becoming infected by?T. gondii,?between 18 and 35, coincides with the peak age for the first signs of schizophrenia. They also noted that in areas where felines are rare the prevalence rates of both toxoplasmosis and schizophrenia are low. By 2005, studies reported in journals like the?American Journal of Psychiatry?found that children of mothers who contracted?T. gondii?while pregnant had higher rates of schizophrenia in adulthood than did other children. But Torrey also found that, in fact, the most strongly positive schizophrenia correlations were not with?T. gondii?infections acquired in the womb, but with those that struck children and?teenagers.Torrey and Yolken argue that sandboxes are a possible culprit. "A likely mechanism for exposure to?T. gondii?in?childhood?is playing in the dirt of sandboxes contaminated with?T. gondii?oocysts," they write, explaining that each uncovered public sandbox studied is used as a litterbox by four to 24 cats. The cats shed?T. gondii?eggs and cysts that find their way onto the hands of children. The sandboxes provide convenient sites for research showing how urban areas where cats have a high rate of infection become areas where children's later schizophrenia rates are similarly elevated.article continues after advertisementCan You "Catch" OCD?Susan Swedo, the chief of pediatrics and developmental?neuroscience?at the National Institute of Mental?Health, has investigated Sydenham's chorea, a?psychiatric?disorder that can arise after exposure to a group A streptococcal, or GAS, infection, that results in symptoms such as a sore throat. Sydenham's, which mostly affects children ages 5 to 15, is characterized by rapid, involuntary, spasmodic movements, mostly of the face, feet, and hands. Chorea, from the Greek word for?dance, refers to these movements, which are often accompanied by muscle weakness as well as emotional and behavioral problems.Sydenham's is associated with rheumatic fever, which is caused by GAS that is untreated and is characterized by muscle aches, swollen and painful joints, skin rashes, and difficulty concentrating. As many as 30 percent of children who contract rheumatic fever develop Sydenham's. Although antibiotic use has rendered the fever rare in developed countries, it has recently made a comeback among the undertreated, such as inner-city children. Not only does Sydenham's follow streptococcal infections, but it is also seasonal, striking most frequently during the winter and early spring. In the U.S., it's most common in the northern states.Because Sydenham's is in essence a rare complication of a strep infection, Swedo wondered whether such infections were associated with other psychiatric symptoms—like OCD. She suspected that the group A streptococcal, or GAS, infections that cause strep throat might also cause a brace of childhood mental disorders—OCD,?Tourette's syndrome, anorexia, and other psychiatric conditions.She knew that for some children, psychiatric symptoms are the first harbingers of Sydenham's: The children become unusually restless, aggressive, or hyperemotional even before the physical symptoms of chorea appear. They also display frequent mood changes, uncontrollable crying, and behavioral regression. Similarly, in the most common childhood psychiatric syndrome, OCD, intrusive thoughts or impulses recur, and children seem powerless to abandon their compulsive behaviors. Often, affected children are seized by fears of harm coming to a family member or of intruders. They sometimes feel compelled to count silently, wash their hands over and over, organize items, or repeatedly check whether the door has been locked.Were the GAS infections really triggering mental disorders? "It was like a detective novel," Swedo recalls.Swedo set about finding children who had also suddenly acquired OCD symptoms or tic disorders shortly after a bout with strep throat or other GAS infection. As word spread about her investigation, dozens of parents from the District of Columbia, Virginia, Maryland, and even as far away as Illinois and Michigan made pilgrimages to NIMH.Swedo's?team?studied a group of 50 children with OCD, both with and without tics. All their symptoms had been preceded by strep throat or a similar infection. Tests found high levels of an antigen, a substance that stimulates an immune response against a pathogen, that suggested a genetic susceptibility to rheumatic fever and to Sydenham's chorea.In 1998, Swedo published the landmark paper that laid out her theory of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS, which appeared to afflict normally behaved children who fell into madness within days, sometimes overnight.PANDAS is a syndrome, which means that it encompasses a number of disorders—OCD, Tourette's, anorexia, and others—that share a cause. Swedo and other scientists estimate that PANDAS accounts for perhaps three of every 20 cases of such conditions: She cautioned researchers that PANDAS was not a default diagnosis and should be considered only in cases where the conventional model of illness did not explain a child's symptoms.One of the most distinctive features is rapid onset; in the case of PANDAS, symptoms arise a few days after infection, while Sydenham's lag six to nine months after exposure. PANDAS symptoms show a?gender?disparity, with boys more likely to have tics and girls more likely to have obsessive compulsiveness. Moreover, PANDAS children regress in ways that other Sydenham's, OCD, and Tourette's patients do not. PANDAS children suffer a rapid deterioration of fine motor control as shown by the loss of handwriting and drawing skills, whereas the loss is more gradual in Sydenham's. A picture drawn by a 16-year-old PANDAS sufferer looks like the work of a 6-year-old. This instant infantilism extends to other behaviors. Preteens resume?bed-wetting, and some find that they cannot stem the flow of their urine even during the daytime. They also begin to throw tantrums and refuse to speak and eat—though the latter is often triggered by an unshakable conviction that their food has been tainted or poisoned.Unpacking Tourette'sSwedo found that the body's response to an infection can go haywire in a young person when an inexperienced immune system generates vigorous "friendly fire" that ends by damaging the body's own tissues instead of wiping out the invaders. In the model proposed by Swedo, the antibodies that normally fight infection and then subside linger long enough to interfere with the functioning of the brain's basal ganglia, which are involved in coordination of movement.Because after an infection some children with PANDAS suffer from tics—including grunts, vocal utterances, and even curses—Swedo began to think they might suffer from a form of Tourette's syndrome as well.About 200,000 Americans have the most severe form of Tourette's, a neurological disorder usually diagnosed in children between 3 and 9 years old and characterized by repetitive, involuntary movements and shouts, eye blinks, grunts, vocalizations, even barking, that are collectively called tics. Some experience more complex motor tics that include facial grimacing, head twists, and shoulder shrugs. Tics are often more severe during periods of excitement or anxiety. As many as one in every 100 Americans now show mild symptoms.There are no blood, imaging, or lab tests for Tourette's; instead, diagnosis requires the presence of both motor and vocal tics for at least one year. Tourette's is chronic in 10 to 15 percent of affected people, but most children who are diagnosed weather the worst symptoms throughout their early teens; the tics gradually subside as they enter adulthood. This timing suggested a connection to PANDAS in Swedo's eyes, but more studies were necessary to prove the causal connection and to characterize the mechanism by which GAS causes mental disease. ?Swedo sought to discover whether giving treatment that fights GAS infections, such as filtering antibodies from the children's blood, would reliably alleviate the Tourette's symptoms.As she recruited more children with GAS-related experiences, the word spread through pediatricians' offices, support groups, and mommy blogs, resonating with many parents who felt that an insidious infection, not genetics or family tension, was behind their children's OCD, anorexia, or Tourette's.On one blog, a mother from Flint, Michigan, shared the?story of her daughter Lisa*, who went to bed an "outgoing, friendly, and spunky" 9-year-old and "woke up transformed" into a toddler, erupting in screams, tantrums, and whining at the slightest frustration. Lisa reverted to bed-wetting and baby talk and seemed tortured by a compulsion to repeatedly touch surfaces and door handles, crying, "Mommy, Mommy, help me. I can't stop doing this!'' Even her handwriting and drawing reverted to that of a 3-year-old. "It was as though she was possessed," Lisa's mother wrote.Lisa's overnight descent into illness seemed unnatural, and her mother was convinced that something physiological was afoot. While Lisa took medication and saw a behavioral therapist, her mother read about Swedo's studies. They drove to Maryland, where Lisa joined a study of 27 children with obsessive-compulsive disorder. The treatment involved filtering the offending antibodies from the children's blood. Swedo also used steroids, intravenous immunoglobulins, and plasma exchange to treat the underlying infections in carefully controlled clinical trials.As with most of the study's subjects, Lisa's symptoms abated. She was able to resist the compulsions almost immediately; and as her antibody levels fell, her verbal expression and handwriting returned to an age-appropriate level. Within a month, her speech returned to normal and her bubbly demeanor resurfaced. Of the 18 children diagnosed with and treated for PANDAS, all but two improved.This improvement is important because it helps bridge the gap between correlation and causation. The high antibodies to the infection are not merely associated with the mental-illness symptoms; as the antibodies are removed, the symptoms abate, which suggests a causal relationship between the madness and the antibodies, and therefore the infection.Another PANDAS illness that strikes mostly girls is anorexia. OCD and anorexia are related not only by their compulsive symptoms, but also by the fact that neurotransmitters malfunction in both. What's more, as in OCD and Tourette's, some cases of childhood anorexia are triggered or dramatically worsened by a GAS infection. In 2000, Swedo reported in the?Journal of Child and Adolescent?Psychopharmacology?that, when she tested four children who showed the clinical signs of PANDAS anorexia, the same antigens were elevated as in the other PANDAS disorders, indicating the telltale GAS infections.A Contested DiagnosisSome experts have expressed skepticism and questioned whether the connection is really causal, noting that the frequent sore throats characteristic of PANDAS cases are too common to constitute a distinguishing feature, especially because strep throat is never diagnosed in some children.Is PANDAS really distinct from garden-variety Tourette's and OCD? ?Critics point out that the discovery of PANDAS was made from case-finding among sick children who fit the general profile rather than from forward-looking studies of large numbers of children selected at random, and some wonder whether this method creates an illusion of causality.Some see the ubiquity of GAS infections as evidence against PANDAS: Strep throat and related infections are everywhere, but Tourette's and OCD are not. Does this mean that GAS infection is a cofactor, insufficient to cause disease on its own but exacerbating the damage from genetics,?stress,?trauma, or even poor?parenting? Or is GAS just a near-ubiquitous, innocent bystander? To those convinced of PANDAS's disease status, it is clear that not everyone infected with GAS becomes mentally ill, because many factors affect vulnerability. Genetics, immunological vigor, general state of health, and perhaps environmental insults may all determine who develops PANDAS and who is able to avoid antibody damage.But how do we determine whether the evidence that correlates infection with PANDAS rises to proof of causation? This question applies not only to PANDAS but to all the putative links between infection and mental states.Basic standards for proof of infectious-disease causation were laid in 1883 by the German bacteriologists Robert Koch and Friedrich Loeffler, whose criteria are called Koch's postulates. A suspected pathogen can be said to cause a disease only when:1) The germ is consistently associated with the disease.2) It can be isolated from the sick person and cultured.3) Inoculating an organism with the pathogen should cause symptoms of the disease to appear.Critics have invoked Koch's postulates to question the etiology of PANDAS and other madness caused by infection. But there are known limitations to the postulates: Some microbes that cause disease fail to fulfill them. Mary Mallon, or "Typhoid Mary," carried the fever without suffering signs or symptoms herself. This carrier scenario is so common in infectious disease, especially in viral diseases such as polio, herpes simplex, and hepatitis C, that it invalidates Koch's first postulate.?Koch's second postulate rests on shaky ground because some disease-causing micro-organisms, such as prions—infectious proteins that many think responsible for Creutzfeldt-Jakob disease—cannot be grown in culture.Koch himself knew that the third postulate was flawed: Ever since the establishment of germ theory, it's been known that not all organisms exposed to a pathogen will fall ill. Immunological resistance, genetics, and variations of general health can affect the outcome.?"Koch's postulates are obsolete," says Ian Lipkin, M.D., the director of the Center for Immunity and Infection at Columbia University. They "require that you grow something, put it in an animal model, and replicate disease. But there are agents that you can't cultivate in laboratories. You have infectious agents for which there is no animal model because you have to have a receptor for the virus," he explains. "Or, you have to be able to grow the bacterium: All these things are difficult. That's why we classify agents as possible, probable, and definitive evidence of disease."Hard-to-Swallow ProofsYet we often ignore science even when we have the evidence; the acceptance of PANDAS may be like the acceptance of?H. pylori.?Take Australian physicians Robin Warren and Barry Marshall. In 1982 they proved that?Helicobacter?pylori, a familiar bacterium living in our intestinal tract, accounts for 90 percent of stomach and duodenal ulcers, as well as other gastric diseases including stomach cancers. But if?H. pylori?was discovered to cause most ulcers in 1982, why did doctors continue to prescribe Tagamet and antacids until 1994? And why does the medical literature show that John Lykoudis, M.D., of Missolonghi, Greece, was curing ulcer patients with antibiotics as far back as 1958? A perusal of the NIH PubMed site for gastroenterology journals tracing ulcer treatment shows that during the century before Marshall and Warren's breakthrough, an infectious cause of ulcers had been "discovered" on at least 15 separate occasions—in 1892 in Italy, 1899 in Poland, the 1960s in Iran, among others.Without scientific publication or rigorous testing, the infection theory of ulcers was consigned to the forgotten annals. Lykoudis's notebooks detail a life blighted by professional frustration until his death in 1980, just two years before Warren and Marshall validated his life's work.The duo could prove the connection because they had access to tools unknown to Lykoudis, including the flexible fiber-optic endoscope developed in the late 1970s, which provided a safe technique to view the stomach and to collect specimens from the gastric mucosa of patients. Modern nutrient media and incubation techniques also allowed Warren and Marshall to grow the organisms in culture, as Koch dictates.In 1985, having satisfied Koch's postulates, Warren and Marshall published their findings that?H. pylori, not stress and spices, causes ulcers. But once again, the?H. pylori?hypothesis failed to change physicians' behavior. According to the Centers for Disease Control, most physicians knew of the?H. pylori?association, but half of primary care doctors did not test their ulcer patients for it; they kept doling out acid suppressors. Despite their superior tools and access to publication, Warren and Marshall were about to share Lykoudis's professional fate: studied indifference and obscurity.In the end, it took showmanship to get the medical world's attention. To illustrate his claim, Murray drank a beaker of?H. pylori?in culture in 1984, and within days he was nauseous and vomiting. An endoscopy revealed both?H. pylori?and gastritis, which Murray was able to banish with antibiotics. The fading of his symptoms in two weeks demonstrated, for at least the 15th time, that a microbe causes gastric woes and that antibiotics can cure them.The infectious cause of ulcers finally entered the medical canon when, in 1997, the CDC spearheaded a public-health campaign to spread the word that ulcers are a curable infection. In 2005 Marshall and Barry scored the ultimate validation: the Nobel Prize in Medicine or Physiology. ?Harriet Washington is the author of many books, including?Deadly Monopolies,?the?National Book Critics Circle Award-winner?Medical Apartheid, and?Infectious Madness.?She was an editor at?USA Today?and won fellowships at Harvard School of Public Health and Stanford University. She was also named a research fellow in medical?ethics?at Harvard.From the book?Infectious Madness?by Harriet A. Washington. Copyright ? 2015 by Harriet Washington. Reprinted by permission of Little, Brown and Company, New York, NY. All rights reserved.Book excerpt: Brain on Fire by Susannah CahalanOur book club pick of the month is a riveting memoir about a young woman’s terrifying experience with an undiagnosed illness. Is it possible Susannah has gone mad over the course of a single month?by?Laurie Grassi?Updated Dec 20, 2012?Brain on Fire by Susannah CahalanIn this excerpt from the New York Post journalist Susannah Cahalan’s riveting memoir, it quickly becomes clear how horribly awry her life is going?—?and how ill she’s becoming?—?as she reaches out to friends, desperately concerned about what is happening to her.I don’t remember how I got home after the interview or how I filled the hours in the wake of yet another professional debacle, but after still another sleepless night—it had now been over a week since I’d slept fully—I headed to the office. It was a gorgeous early March morning, the sun was out, and the temperature was a crisp thirty degrees. I had walked through Times Square twice a day for six months, but today, once I hit the rows of billboards at its center I was accosted by its garish colors. I tried to look away, to shield myself from shock waves of pigment, but I couldn’t. The bright blue wedge of an Eclipse gum sign emitted electric swirls of aqua and made the hair on the back of my neck stand up. I could feel the colors vibrating in my toes. There seemed to be something exquisite about that rush; it was simultaneously enervating and thrilling. But the thrill lasted only a moment when, to my left, the moving scroll of “Welcomes you to Times Square” caught my attention and made me want to retch in the middle of the street. M&M’s on an animated billboard to my left pirouetted before me, forging a massive migraine in my temples. Helpless in the face of this onslaught, I covered my eyes with mittenless hands, stumbling up Forty-Eighth Street as if I had just gotten off a death-defying roller coaster, until I hit the newsroom, where the lights still felt bright but less aggressive.“Angela, I have to tell you something strange,” I whispered, concerned that people might be listening in, thinking I was crazy. “I see bright colors. The colors hurt my eyes.”“What do you mean?” she asked, worry evident in her smile. Every day my behavior had been growing increasingly erratic. But it wasn’t until this morning that my ramblings had begun to frighten her.“Times Square. The colors, the billboards: they’re so bright. Brighter than I’ve ever seen them before.”“You must be really hung over.” She laughed nervously.“I didn’t drink. I think I’m losing my mind.”“If you’re really concerned, I think you should go back and see a doctor.”There’s something wrong with me. This is how a crazy person acts.Frustrated with my inability to communicate what was happening to me, I slammed my hands down on the keyboard. The computer glowed back at me, bright and angry. I looked at Angela to see if she saw it too, but she was busy with her e-mail.“I can’t do this!” I shouted.“Susannah, Susannah. Hey, what’s going on?” Angela asked, surprised by the outburst. I had never been histrionic, and now that everyone was staring?at me, I felt humiliated and on display, and hot tears streamed down my face and onto my blouse. “Why are you crying?”I shrugged off the question, too embarrassed to go into details I didn’t understand.“Do you want?to go out for a walk or something? Grab a coffee?”“No, no. I don’t know what’s wrong with me. I’m all fucked up. I’m crying for no reason,” I sobbed. As the crying spell took over my whole body, I became prisoner to it. The more I told myself?to stop, the more powerful the sensation became. What was causing these hysterics? I fixated on anything my mind could grasp, picking apart the minutiae of my life, anything that felt uncertain.?I’m bad at my job. Stephen doesn’t love me. I’m broke. I’m crazy. I’m stupid.?Many of my colleagues were now returning to the office, dressed in black from the reporter’s funeral, which I had not attended because I was too consumed by my own problems.?Was this the reason I was crying? I hardly knew the man. Was I crying for myself? Over the possibility that I might be next?Another reporter, who sat directly across from Angela, turned around. “Susannah, are you okay?”I hated the?attention. I shot her a derisive look, heavy with loathing. “Stop. It.”The tears continued down my face, but I was surprised to realize that instantly I was no longer sad. I was fine. Not fine. Happy. No, not happy, sublime, better than I had ever felt in my entire life. The tears kept coming, but now I was laughing. A pulse of warmth shot up my spine. I wanted to dance or sing, something, anything except sit here and wallow in imaginary misery. I ran to the bathroom to splash some water on my face. As the cold water flowed, the bathroom stalls suddenly looked alien to me. How was it that civilization had gotten so far but we still defecated in such close proximity to one another? I looked at the stalls and, hearing the flushing of toilets, I could not believe that I had ever used one before.When I got back to my desk, my emotions now relatively stable, I called Mackenzie, who had been so helpful with my snooping problem weeks?ago, and asked her to meet me downstairs. I wanted her opinion on what had just happened to me. When I found her behind the News Corp. building, I noticed that she too was wearing black and had just arrived from the reporter’s funeral. I suddenly felt ashamed for being so self-obsessed.“I’m so sorry to bother you when you’re suffering,” I said. “I know it’s really selfish of me to behave like this right now.”“Don’t worry about it. What’s going on?” she asked.“I just. I just. Do you ever not feel like yourself?”She laughed. “I hardly?ever feel like myself.”“But this is different. Something is really wrong. I’m seeing bright colors, crying uncontrollably. I can’t control myself,” I repeated, wiping away the remaining moisture from my swollen eyes. “Do you think I’m having a nervous breakdown? Do you think I’m going nuts?”“Look, Susannah, this isn’t something you can do yourself. You really need to just go see a doctor. I think you should write down all your symptoms, as if you were going to write up a story about it. Don’t leave anything out. As you know, even the smallest details can turn out to be the most important.”It was genius. I nearly ran away from her to go upstairs and start writing. But when I got to my desk, I wrote only the following:Insomnia / VisionThen?I began ?doodling, though I don’t ?remember scrawling out the drawing or what ?prompted it:People are desperate,?? They’ll do anything.“People?are? desperate, ?they’ll? do? anything,” ?I’d written. Abruptly I stopped writing and began to clear everything off my desk—all the water bottles, the half-empty coffee cups, and the old articles that I would never read again. I lugged armfuls of books that I’d been saving for reasons I could no longer remember to the floor’s Dumpster and discarded them all, as if they were evidence that I was a hoarder who had been unraveling for months. I suddenly felt in control of every part of my life. That buoyant happiness had returned. But even then I recognized it was a perilous happiness. I feared that if I didn’t express it and appreciate it, the emotion would blaze and burn away as quickly as it came.When I got back to my desk, I slammed my hands down on top of it.“Everything is going to be great!” I announced, ignoring Angela’s astonishment. I sauntered over to Paul’s desk, high on my brand-new, wonderfully simple theory on life.“Let’s go downstairs for a smoke!”As we took the elevator, Paul said, “You look much better.”“Thanks, Paul. I feel so much better. I feel like myself again, and I have so much to talk to you about.” We lit cigarettes. “You know, it’s finally dawned on me what is wrong. I want to do more stories. Better stories. Bigger stories. Not the feature bullshit. The real stuff. The real hard-hitting investigations.”“Well, that’s great,” Paul said, but he also looked concerned. “Are you okay? You’re talking a mile a minute.”“Sorry. I’m just so excited!”“I’m glad to hear you’re excited, you know, because some people had told?me that ?you’ve been upset at your desk and you’ve been so sick the past month.”“That’s over. I’ve seriously figured it out.”“Hey, have you talked to your mom recently?” Paul asked.“Yeah, a few days ago. Why?”“Just curious.”Paul was busy building a mental picture, ready to relate to Angela what he felt were the beginning signs of a breakdown. He had once seen another reporter whom he cared about fall apart. She began wearing bright, inappropriate makeup and acting strange, and she was later diagnosed with schizophrenia.After ten minutes of my ramblings, Paul headed back inside and called Angela. “Someone needs to call her mom or someone. This just isn’t right.”While Paul was upstairs talking to Angela, I stayed outside. If anyone looked at me then, they would have assumed that I was deep in thought or working out a story in my head—nothing out of the ordinary. But in fact I was far away. The pendulum had swung again, and now I felt wobbly and height-sick, that same feeling I’d had at the top of the mountain in Vermont, except without the terror. I floated above the crowd of News Corp. employees. I saw the top of my own head, so close that I could almost reach out and touch myself. I saw Liz, the Wiccan librarian, and felt my “self” reenter my grounded body.“Liz, Liz!” I shouted. “I need to talk to you!”She stopped. “Oh, hey, Susannah. How’s it going?”There was no time for pleasantries. “Liz, did you ever feel like you’re here but you’re not here?”“Sure, all the time,” she said.“No, no, you don’t?understand. I can see myself from above, like I’m floating above myself looking down,” I said, wringing my hands.“That’s normal,” she said.“No, no. Like you’re outside of yourself looking in.”“Sure, sure.”“Like you’re in your own world. Like you’re not in this world.”“I know what you’re saying. It’s probably just residue from the astral travel you experienced during the reading we did yesterday. I think I may have taken you to another realm. I apologize for that. Just try to relax and embrace it.”Meanwhile, Angela, worried about my erratic behavior, got permission from Paul to take me to the bar at a nearby Marriott hotel for a drink—and to tease some more information out of me about why I was acting so out of character. When I returned to the newsroom, Angela convinced me to gather my things and join her on a walk a few blocks north up Times ?Square to the hotel bar. We walked into the hotel’s main entranceway through revolving doors and stood beside a group of tourists waiting to take the transparent elevators to the eighth-floor bar, but the crowd bothered me. There were too many?people around. I couldn’t breathe.“Can we please take the escalator?” I begged Angela.“Of course.”The escalators, decorated on each side with dozens of glowing bulbs, only intensified my jitters. I tried to ignore the heart palpitations and the sweat forming on my brow. Angela stood a few steps above, looking concerned. I could feel the pressure of fear rise in my chest, and suddenly I was crying again.At the third floor, I had to get off the escalator to compose myself because I was sobbing so hard. Angela put her arm on my shoulder. In total, I had to get off the escalator three times to steady myself from sobbing during that eight-floor trip.Finally we reached the bar floor. The rugs, which looked as if they belonged in an avant-garde production of?Lawrence of Arabia,?swirled before me. The harder I stared, the more the abstract patterns merged. I tried to ignore it. The hundred-plus-seat bar, which looked down over Times Square, was almost completely empty, with only a few groups of businessmen dotting the chairs around the entranceway. When we walked?in, I was still bawling, and one group looked up from their cocktails and gawked at me, which made me feel worse and more pathetic. The tears kept coming, though I had no clue why. We positioned ourselves in the center of the room at seats with high chairs, far away from the other patrons. I didn’t know what I wanted, so Angela ordered a sauvignon blanc for me and an Anchor Steam for herself.“So what’s really going on?” she asked, taking a small sip of her amber-colored beer.“So many things. The job. I’m terrible?at it. Stephen, he doesn’t love me. Everything is falling apart. Nothing makes sense,” I said, holding the wineglass like a comforting habit but not drinking.“I understand. You’re young. You have this stressful job and a new boyfriend. It’s all up in the air. That’s scary. But is it really enough to make you feel this upset?”She was right. I had been thinking about all of that, but it was a struggle to make one detail fit well enough to solve the entire problem, like jamming together pieces from incongruent sets of puzzles.“There’s something else,” I agreed. “But I don’t know?what it is.”BOOKSBrain On FireMy Month Of Madnessby?SUSANNAH CAHALANBook SummarySusannah Cahalan was a healthy 24-year-old when she began to experience seizures, hallucinations and increasingly psychotic behavior. Her symptoms frightened family members and baffled a series of doctors until she was finally diagnosed with anti-NMDA receptor encephalitis, a rare autoimmune disease that can attack the brain. As one doctor put it, "her brain was on fire." Cahalan recounts her experience with the disease in?Brain on Fire.Note:?Book excerpts are provided by the publisher and may contain language some find offensive.Excerpt: Brain On FireCHAPTER 1BEDBUG BLUESMaybe it all began with a bug bite, from a bedbug that didn't exist.One morning, I'd woken up to find two red dots on the main purplish-blue vein running down my left arm. It was early 2009, and New York City was awash in bedbug scares: they infested offices, clothing stores, movie theaters, and park benches. Though I wasn't naturally a worrier, my dreams had been occupied for two nights straight by finger-long bedbugs. It was a reasonable concern, though after carefully scouring the apartment, I couldn't find a single bug or any evidence of their presence. Except those two bites. I even called in an exterminator to check out my apartment, an overworked Hispanic man who combed the whole place, lifting up my sofa bed and shining a flashlight into places I had never before thought to clean. He proclaimed my studio bug free. That seemed unlikely, so I asked for a follow-up appointment for him to spray. To his credit, he urged me to wait before shelling out an astronomical sum to do battle against what he seemed to think was an imaginary infestation. But I pressed him to do it, convinced that my apartment, my bed, my body had been overrun by bugs. He agreed to return and exterminate.Concerned as I was, I tried to conceal my growing unease from my coworkers. Understandably, no one wanted to be associated with a person with a bedbug problem. So at work the following day, I walked as nonchalantly as possible through the newsroom of the New York Post to my cubicle. I was careful to conceal my bites and tried to appear casual, normal. Not that "normal" means a lot at the Post.Though it's notoriously obsessed with what's new, the?Post?is nearly as old as the nation itself. Established by Alexander Hamilton in 1801, it is the longest continually run newspaper in the country. In its first century alone, the paper crusaded for the abolition movement and helped promote the creation of Central Park. Today the newsroom itself is cavernous yet airless, filled with rows of open cubicles and a glut of filing cabinets packed with decades of unused, forgotten documents. The walls are freckled with clocks that don't run, dead flowers hung upside down to dry, a picture of a monkey riding a border collie, and a big foam Six Flags finger, all memorabilia from reporters' assignments. The PCs are ancient, the copy machines the size of small ponies. A small utility closet that once served as a smoking room now holds supplies, and is marked by a weathered sign warning that the smoking room no longer exists, as if someone might accidentally wander in for a cigarette among the monitors and video equipment. This has been my eccentric little world for the past seven years, since I started here as a seventeen-year-old intern.Especially around deadline, the room buzzes with activity — keyboards clacking, editors yelling, reporters cackling — the perfect stereotype of a tabloid newsroom."Where's the fucking picture to go with this caption?""How is it that he didn't know she was a prostitute?""What color were the socks of the guy who jumped off the bridge?"It's like a bar without alcohol, filled with adrenaline-soaked news junkies. The cast of characters here is unique to the?Post: the brightest headline writers in the business, the hardened news-hounds hunting after exclusives, and type-A workaholics who possess the chameleon ability to either befriend or antagonize almost anyone. Still, on most days, the newsroom is subdued, as everyone silently combs through court documents, interviews sources, or reads newspapers. Often, like today, the newsroom is as quiet as a morgue.Heading toward my desk to start the day, I wove through the rows of cubicles marked by green Manhattan street signs: Liberty Street, Nassau Street, Pine Street, and William Street, throwbacks to a time when the?Post?was actually flanked by those downtown streets in its previous home at the South Street Seaport. My desk is at Pine Street. Amid the silence, I slid into my seat beside Angela, my closest friend at the paper, and gave her a tense smile. Trying not to let my question echo too loudly across the noiseless room, I asked, "You know anything about bedbug bites?"I often joked that if I ever had a daughter, I'd want her to be like Angela. In many ways, she is my newsroom hero. When I first met her, three years before, she was a soft-spoken, shy young woman from Queens, only a few years older than me. She had arrived at the?Post?from a small weekly paper and since then had matured under the pressure of a big-city tabloid into one of the?Post's most talented reporters, churning out reams of our best stories. Most late Friday nights, you'd find Angela writing four stories on split screens simultaneously. I couldn't help but look up to her. Now I really needed her advice.Hearing that dreaded word, bedbugs, Angela scooted her chair away from mine. "Don't tell me you have them," she said with an impish smile. I started to show her my arm, but before I could get into my tale of woe, my phone rang."You ready?" It was the new Sunday editor, Steve. He was just barely in his midthirties, yet he had already been named head editor of the Sunday paper, the section I worked for, and despite his friendliness, he intimidated me. Every Tuesday, each reporter had a pitch meeting to showcase some of his or her ideas for that Sunday's paper. At the sound of his voice, I realized with panic that I was completely unprepared for this week's meeting. Usually I had at least three coherent ideas to pitch; they weren't always great, but I always had something. Now I had nothing, not even enough to bluff my way through the next five minutes. How had I let that happen? This meeting was impossible to forget, a weekly ritual that we all fastidiously prepared for, even during days off.Bedbugs forgotten, I widened my eyes at Angela as I stood back up, gamely hoping it all would work out once I got to Steve's office.Nervously, I walked back down "Pine Street" and into Steve's office. I sat down next to Paul, the Sunday news editor and close friend who had mentored me since I was a sophomore in college, giving him a nod but avoiding direct eye contact. I readjusted my scratched-up wide-framed Annie Hall glasses, which a publicist friend once described as my own form of birth control because "no one will sleep with you with those on."We sat there in silence for a moment, as I tried to let myself be comforted by Paul's familiar, larger-than-life presence. With his shock of prematurely white hair and his propensity to toss the word fuck around like a preposition, he is the essence of a throwback newsman and a brilliant editor.He had given me a shot as a reporter during the summer of my sophomore year of college after a family friend introduced us. After a few years in which I worked as a runner, covering breaking news and feeding information to another reporter to write the piece, Paul offered me my first big assignment: an article on the debauchery at a New York University fraternity house. When I returned with a story and pictures of me playing beer pong, he was impressed with my chutzpah; even though the expose never ran, he assigned me more stories until I had been hired on full time in 2008. Now, as I sat in Steve's office wholly unprepared, I couldn't help but feel like a work in progress, not worthy of Paul's faith and respect.The silence deepened until I looked up. Steve and Paul were staring at me expectantly, so I just started talking, hoping something would come. "I saw this story on a blog ... ," I said, desperately plucking up wisps of half-formed ideas."That's really just not good enough," Steve interrupted. "You need to be bringing in better stuff than this. Okay? Please don't come in with nothing again." Paul nodded, his face blazing red. For the first time since I'd started working on my high school newspaper, journalism disagreed with me. I left the meeting furious at myself and bewildered by my own ineptitude."You okay?" Angela asked as I returned to my desk."Yeah, you know, I'm just bad at my job. No big deal," I joked grimly.She laughed, revealing a few charmingly crooked incisor teeth. "Oh, come on, Susannah. What happened? Don't take it seriously. You're a pro.""Thanks, Ang," I said, sipping my lukewarm coffee. "Things just aren't going my way."I brooded over the day's disasters that evening as I walked west from the News Corp. building on Sixth Avenue, through the tourist clusterfuck that is Times Square, toward my apartment in Hell's Kitchen. As if purposely living the cliche of a New York writer, I rented a cramped one-room studio, where I slept on a pullout sofa. The apartment, eerily quiet, overlooked the courtyard of several tenements, and I often awoke not to police sirens and grumbling garbage trucks but to the sound of a neighbor playing the accordion on his balcony.Still obsessed with my bites, despite the exterminator's assurance that I had nothing to worry about, I prepared for him to spray the place and spent that night discarding things that could be harboring bedbugs. Into the garbage went my beloved?Post?clips, hundreds of articles reminding me of how bizarre my job is: the victims and suspects, dangerous slums, prisons and hospitals, twelve-hour shifts spent shivering inside photographers' cars waiting to photograph — or "pop" — celebrities. I had always loved every minute of it. So why was I suddenly so terrible at it?As I shoved these treasures into the trash bags, I paused on a few headlines, among them the biggest story of my career to date: the time I managed to land an exclusive jailhouse interview with child kidnapper Michael Devlin. The national media were hot on the story, and I was only a senior at Washington University in St. Louis, yet Devlin spoke to me twice. But the story didn't end there. His lawyers went nuts after the article ran, launching a smear campaign against the Post and calling for a judicial gag order, while the local and national media began debating my methods on live TV and questioning the ethics of jailhouse interviews and tabloids in general. Paul fielded several tearful phone calls from me during that time, which bound us together, and in the end, both the paper and my editors stood by me. Though the experience had rattled me, it also whetted my appetite, and from then on, I became the resident "jailhouser." Devlin was eventually sentenced to three consecutive lifetimes in prison.Then there was the butt implant story, "Rear and Present Danger," a headline that still makes me laugh. I had to go undercover as a stripper looking for cheap butt enhancements from a woman who was illegally dispensing them out of a midtown hotel room. As I stood there with my pants around my ankles, I tried not to be insulted when she announced that she would need "a thousand dollars per cheek," twice the amount she charged the woman who had come forward to the Post.Journalism was thrilling; I had always loved living a reality that was more fabulist than fiction, though little did I know that my life was about to become so bizarre as to be worthy of coverage in my own beloved tabloid.Even though the memory made me smile, I added this clip to the growing trash pile — "where it belongs," I scoffed, despite the fact that those crazy stories had meant the world to me. Though it felt necessary at the moment, this callous throwing away of years' worth of work was completely out of character for me. I was a nostalgic pack rat, who held on to poems that I had written in fourth grade and twenty-some-odd diaries that dated back to junior high. Though there didn't seem to be much of a connection among my bedbug scare, my forgetfulness at work, and my sudden instinct to purge my files, what I didn't know then is that bug obsession can be a sign of psychosis. It's a little-known problem, since those suffering from parasitosis, or Ekbom syndrome, as it's called, are most likely to consult exterminators or dermatologists for their imaginary infestations instead of mental health professionals, and as a result they frequently go undiagnosed. My problem, it turns out, was far vaster than an itchy forearm and a forgotten meeting.After hours of packing everything away to ensure a bedbug-free zone, I still didn't feel any better. As I knelt by the black garbage bags, I was hit with a terrible ache in the pit of my stomach — that kind of free-floating dread that accompanies heartbreak or death. When I got to my feet, a sharp pain lanced my mind, like a white-hot flash of a migraine, though I had never suffered from one before. As I stumbled to the bathroom, my legs and body just wouldn't react, and I felt as if I were slogging through quicksand. I must be getting the flu, I thought.This might not have been the flu, though, the same way there may have been no bedbugs. But there likely was a pathogen of some sort that had invaded my body, a little germ that set everything in motion. Maybe it came from that businessman who had sneezed on me in the subway a few days before, releasing millions of virus particles onto the rest of us in that subway car? Or maybe it was in something I ate or something that slipped inside me through a tiny wound on my skin, maybe through one of those mysterious bug bites?There my mind goes again.The doctors don't actually know how it began for me. What's clear is that if that man had sneezed on you, you'd most likely just get a cold. For me, it flipped my universe upside down and very nearly sent me to an asylum for life.From?Brain On Fire?by Susannah Cahalan. Copyright 2012 by Susannah Cahalan. Excerpted by permission of Simon & Schuster, Inc, NY.AP Psychology/SpencerAutoimmune Encephalitis and Symptoms of MadnessA Young Reporter Chronicles Her 'Brain On Fire' NPR InterviewSusannah Cahalan is a reporter and book reviewer at the?New York Post.In 2009, Susannah Cahalan was a healthy 24-year-old reporter for the?New York Post, when she began to experience numbness, paranoia, sensitivity to light and erratic behavior. Grasping for an answer, Cahalan asked herself as it was happening, "Am I just bad at my job — is that why? Is the pressure of it getting to me? Is it a new relationship?"But Cahalan only got worse — she began to experience seizures, hallucinations, increasingly psychotic behavior and even catatonia. Her symptoms frightened family members and baffled a series of doctors.After a monthlong hospital stay and $1 million worth of blood tests and brain scans that proved inconclusive, Cahalan was seen by Dr. Souhel Najjar, who asked her to draw a clock on a piece of paper. "I drew a circle, and I drew the numbers 1 to 12 all on the right-hand side of the clock, so the left-hand side was blank, completely blank," she tells?Fresh Air's Dave Davies, "which showed him that I was experiencing left-side spatial neglect and, likely, the right side of my brain responsible for the left field of vision was inflamed."As Najjar put it to her parents, "her brain was on fire." This discovery led to her eventual diagnosis and treatment for anti-NMDA receptor encephalitis, a rare autoimmune disease that can attack the brain. Cahalan says that doctors think the illness may account for cases of "demonic possession" throughout history.Cahalan's new memoir is called?Brain on Fire: My Month of Madness.Brain On Fire ExcerptsMy Month of Madnessby?Susannah CahalanOn the moment when Cahalan lost her sanity"I don't remember anything from this experience. This was all told to me after the fact. [My boyfriend] Stephen heard guttural sounds coming from me. He thought maybe I was just angry because I hadn't slept for days, and he knew that it was really frustrating. And so he thought, 'Maybe she's just venting her frustration.' But the grunts were very unnatural sounding, so he turned and looked at me. And he saw that my eyes were wide open but completely unseeing, and at that point he tried to shake me and say, 'Are you OK, Sue? What's going on?' And at that point, my arms whipped out, and I had a grand mal seizure, and I was convulsing. And I bit my tongue so that blood and kind of a combination of blood and foam was coming out of my mouth. And he had the presence of mind — and I think this is incredible — to know that this was a seizure because I had never had a seizure before. And so he turned me on my side and he called 911. And [that's, for me] ... the difference between sanity and insanity ... that moment where kind of my memory goes dark."On some of the symptoms she exhibited at the hospital"I slurred my words. I drooled. I didn't have proper control over my swallowing ... I kept my arms out in unnatural poses. At one point, I was like the Bride of Frankenstein — I kept my arms out rigidly. I was slow. I could hardly walk, and when I did, I needed to be supported ... I started [acting] very psychotic. I believed that I could age people with my mind. If I looked at them, wrinkles would form, and if I looked away, they would suddenly, magically get younger. And I believed that my father had murdered my stepmother. I believed all these incredibly paranoid — a huge, extreme example of persecution complex. And then as the days went on, I stopped being as psychotic, and I started entering into a catatonic stage, which was characterized by just complete lack of emotion, inability to relate, or to read, or hardly to be able to speak."On being supported by her parents and boyfriend"Without them, I wouldn't be here right now, especially with my mom. She was a bulldog. I mean she would not take 'no' for an answer, especially in the beginning when they were saying it was alcohol withdrawal and partying. She refused to see that as an answer, and so she did her own research. She asked questions. At home, after a day at the hospital, she'd make a list of all the different terminology they used, and she'd look it up and, you know, not everyone is capable of doing that. ... I was so lucky to have someone there for me that could do that. ... If everyone could have someone like that, it would just be a better world."On the possible connection between her rare immune disease and cases of "demonic possession" throughout history"When you think about the symptoms — in my case alone, this grandiosity, this violence. In a lot of children, you see hypersexuality. Even my grunts and these guttural sounds that came from me sounded superhuman to someone who might be inclined to think that way. ... When you see videos of people — in fact, when I see videos of myself — demonic possession is not far from your mind. It wasn't far from Stephen's mind when he first saw that seizure. And I've talked to many people who've had this disease, and one woman I spoke to actually asked for a priest because she said, 'The devil is inside of me. I need it out.' A little girl was grunting — they had a monitor in her room — and she was grunting so unnaturally that her parents looked at each other and said, 'Is she, is she possessed?' They actually said that about a little girl. You can see throughout history why people would believe this.Susanna Cahalan’s Experience of Autoimmune Encephalitis (TED Talk)Under Attack: One Woman's Terrifying Battle With an Auto-Immune DiseaseWhen a young journalist suddenly began exhibiting signs of violence and psychosis, no one suspected that her body had actually turned on her brain.By Jennifer KahnIn April 2009, Susannah Cahalan, a 24-year-old reporter for the?New York Post, woke up strapped to a bed in a hospital room. She had no clear memory of the previous few weeks, though her medical records showed that she'd been psychotic and violent before lapsing into a profound catatonia. Her doctors had ordered a battery of blood tests and brain scans, but they revealed nothing. It took the brilliant neurologist Souhel Najjar, MD, to find the cause: Cahalan had a rare disease that caused her immune system to attack her brain. In her new book,?Brain on Fire, Cahalan chronicles her terrifying ordeal and the desperate search for a cure. We asked her to walk us through her journey.?Q:?Did you know you were sick before your hospital stay??A:?I knew something was wrong; I was constantly tired and I'd developed numbness on my left side. I'd also become paranoid that my boyfriend was cheating on me. I thought I was having a nervous breakdown. One psychiatrist told me I was bipolar. Then one day I walked through Times Square and the lights were painfully bright. I was experiencing photophobia, which preceded a massive seizure.?Q:?When Dr. Najjar came in, he asked you to draw a clock face on a piece of paper. How did that help him diagnose your condition??A:?When I drew the clock, I squeezed all the numbers into the right half of the circle. My brain wasn't "seeing" the left half, which was a sign that the right hemisphere of my brain was inflamed. My doctors already suspected that I had an autoimmune disease, but the test enabled Dr. Najjar to finally connect all the symptoms—paranoia, psychosis, increased heart rate, and numbness on my left side—into a single diagnosis.Q:?He concluded that you had anti-NMDA receptor encephalitis, a disease in which the immune system attacks proteins called NMDA receptors that lie on the surface of neurons. What do those receptors do??A:?NMDA receptors are concentrated in the areas that control learning and memory, higher functions like multitasking, and some of the more subtle aspects of personality. When the immune system makes antibodies that attack these receptors, people may have seizures and violent fits. They might act psychotic and paranoid, like I did, or become hypersexual and lewd. How you respond depends on the area of the brain that's most affected and the number of receptors damaged.?Q:?After you were treated and the renegade antibodies were flushed from your system, your recovery took months. Did you ever worry that you might never fully recover??A:?Definitely. At first I could barely walk. I'm a fast talker, but my speech was really slow for almost a year. And I was lucky. I was only the 217th person in the world to be treated for the disease, but many people who get it never recover—and about 13 percent of adults who do recover eventually relapse. So now if I'm sitting in the subway and the lights seem brighter, I'll think, "Am I seeing things?" Or if I'm feeling moody, I'll worry, "Could I be losing my mind again?"?Q:?As often happens with a rare illness, it took time to get the right diagnosis. Do you have any advice for people in a similar situation??A:?Get a second opinion. The first neurologist I saw just thought I was partying too much, and he stuck by that claim even after my family insisted that he was wrong.? ................
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