Susannah Cahalan

Quick Facts

• Role: Protagonist, narrator, and author of the memoir Brain on Fire
• Age/Context: Twenty-four-year-old reporter at the New York Post in New York City
• First Appearance: Early chapters as a healthy, ambitious journalist; the first grand mal seizure in Chapter 8 becomes the clear break
• Key Relationships: Stephen, Tom Cahalan, Rhona Nack, Dr. Souhel Najjar

Who They Are

At her core, Susannah Cahalan embodies the collision between identity and biology. A hard-driving young reporter whose self-worth is rooted in her intellect and independence, she’s abruptly thrust into a body and mind she can’t trust. Her memoir’s power lies in that dual vantage point: the fragmented “lost month” lived from inside psychosis and the sober reconstruction afterward—journalist and subject converging to investigate herself. Her story illuminates the precariousness of personhood through the lens of the The Mind-Body Connection and the uneasy dance between memory and truth in Memory and Unreliable Narration.

Personality & Traits

Susannah’s personality doesn’t just shift—it disintegrates and reforms. Before the illness, her drive and skepticism ground her; during it, paranoia and regression replace judgment. The memoir tracks how traits forged in the newsroom become tools for survival in recovery, even as her altered body complicates the return of her old self.

• Ambitious and hardworking: A newsroom lifer who started at the Post as a teenager; she thrives on its “adrenaline-soaked” pace and measures herself by productivity.

• Confident and social: Outgoing and talkative, she builds a bright, independent life and a new romance with Stephen, at ease in the city’s energy.

• Independent to a fault: Living alone and priding herself on self-sufficiency, her later dependence on others becomes both humiliating and transformative.

• Rational and skeptical: Fact-driven instincts make her own delusions feel alien, heightening the terror as logic erodes.

• Paranoid and delusional: She suspects plots everywhere, even mistaking her father for an imposter (Capgras syndrome), and reads menace into ordinary events.

• Erratic and volatile: Emotions whip from euphoria to rage; she lashes out physically, tries to flee the hospital, and distrusts those trying to help.

• Childlike and dependent: Language and executive function collapse; she can’t read or write and requires constant care for basic tasks.

• Catatonic: At her nadir, she becomes nearly unresponsive, limbs rigid, face fixed in a “frozen, vacant, idiotic grin.”

• Body as battleground: Visibly transformed—“outrageously skinny,” pale, eyes glazed—then steroid-bloated with a “moon-shaped” face and a five-inch biopsy scar. The external changes mirror her internal estrangement from herself.

Character Journey

Susannah’s arc is a plunge into disintegration and a painstaking climb back, a living case study of The Fragility of Identity and Loss of Self. The descent begins almost imperceptibly—bedbug fears, lapses at work, sensory distortions, and spiraling jealousy—traced in the Chapter 1-5 Summary. Her first grand mal seizure snaps the thread to her previous life, inaugurating a month where the “old Susannah” disappears into paranoia, violence, and, finally, catatonia. That month exists for her only as a dossier: hospital footage, notes, and interviews she later assembles to reconstruct a self she couldn’t inhabit in real time. The clock-drawing test provides the pivot, confirming inflammation in the brain’s right hemisphere and reframing her crisis as neurological rather than “purely psychiatric.” Treatment initiates a second, quieter battle—the long, humbling work of rehabilitation, the shame of dependence, the fear her spark won’t return. Writing—first an article, then the book—becomes not just record-keeping but identity reclamation, a journalist’s craft retooled to reassemble a person.

Key Relationships

Love is not background in Susannah’s story—it is her safety net, her translator, and often her only reliable witness, crystallizing the memoir’s emphasis on Love and Family Support.

• Stephen: Her boyfriend becomes her steady anchor and “Susannah whisperer,” witnessing the first seizure and weathering accusations and volatility without retreat. His daily presence in the hospital affirms the continuity of the “real Susannah,” resisting the illness’s attempt to erase her and deepening their bond into shared survival.

• Tom Cahalan: Once a bit distant, her father transforms into a relentless advocate—physically imposing at the hospital and emotionally immovable in his insistence on answers. The crisis forges intimacy out of terror; his watchfulness and stubbornness become a bulwark against institutional dismissal.

• Rhona Nack: Her mother channels anxiety into meticulous documentation and pushback against easy psychiatric labels. Though their relationship strains during recovery—Susannah resents dependence—Rhona’s doggedness secures care and, ultimately, becomes a template for Susannah’s own investigative persistence.

• Dr. Souhel Najjar: A listener first and diagnostician second, he resists reductive explanations and uses the simple clock test to locate the problem in her brain. His blend of compassion and rigor models medicine at its best and marks the narrative’s hinge from chaos to clarity.

Defining Moments

Susannah’s transformation is punctuated by scenes that reframe her illness—from inexplicable behavior to neurological crisis, from victimhood to authorship.

• The first seizure (Chapter 8): Violent tonic-clonic convulsions—arms thrashing, eyes rolling back, foam at the mouth—obliterate denial. Why it matters: It anchors her condition in the body, pushing doctors and family beyond psychiatric explanations and signaling the end of her pre-illness self-conception.

• The paranoid night at her father’s (Chapter 13): Convinced Tom has killed his wife, she barricades herself in the bathroom, trapped in a nightmare logic. Why it matters: It reveals the totalizing power of delusion and the heartbreak of mistrust within intimate relationships.

• The clock test (Chapter 26): Asked to draw a clock, she crams all the numbers onto the right side of a lopsided circle. Why it matters: The asymmetry exposes right-hemisphere dysfunction, reorienting treatment toward autoimmune encephalitis and away from misdiagnosis.

• Writing “Month of Madness” (Chapter 46): Back at work, she’s tasked with telling the story she can’t remember. Why it matters: Turning investigation on herself converts shame into meaning, restoring her professional identity and giving narrative shape to trauma.

Essential Quotes

Because of the nature of my illness, and its effect on my brain, I remember only flashes of actual events, and brief but vivid hallucinations... What is left, then, is a journalist’s inquiry into that deepest part of the self—personality, memory, identity—in an attempt to pick up and understand the pieces left behind. (Author's Note)

This frames the memoir’s method: when memory collapses, reportage takes over. Susannah’s vocation supplies both the tools and the ethic to reconstitute a coherent self from fragments.

This moment, my first serious blackout, marked the line between sanity and insanity. Though I would have moments of lucidity over the coming weeks, I would never again be the same person. This was the start of the dark period of my illness, as I began an existence in purgatory between the real world and a cloudy, fictitious realm made up of hallucinations and paranoia. (Chapter 8)

The seizure inaugurates a liminal state—neither wholly present nor entirely gone. The language of “purgatory” captures both torment and the possibility of eventual passage out.

We are, in the end, a sum of our parts, and when the body fails, all the virtues we hold dear go with it. (Chapter 9)

This stark claim fuses identity to biology, dismantling romantic ideas of willpower. It underscores the book’s insistence that moral qualities—confidence, reason—can vanish when the brain misfires.

"I can’t get my ideas from my head out." (Chapter 30)

Simple and devastating, this line makes cognitive impairment intimate and tangible. It also reverses the journalist’s craft—normally an effortless pipeline from observation to words—into a blocked channel.

Who am I? Am I a person who cowers in fear at the back of a spin class, avoiding everyone’s gaze? This uncertainty about who I am, this confusion over where I truly was in the time line of my illness and recovery, was ultimately the deeper source of the shame. A part of my soul believed that I would never be myself, the carefree, confident Susannah, again. (Chapter 42)

Recovery introduces a subtler agony: self-doubt. The fear that the illness has rewritten her permanently becomes its own obstacle, and confronting that fear marks real progress toward wholeness.