The Case for the Biopsychosocial Model for Depression

This article is an excerpt from the Shortform summary of "Brain On Fire" by Susannah Cahalan. Shortform has the world's best summaries of books you should be reading.

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What does severe paranoia signal? Are there paranoia causes beyond mental illness?

Severe paranoia is a recurring symptom in Brain on Fire. Susannah had paranoid thoughts about her family, her nurses, and her boyfriend.

Read more about the severe paranoia exhibited by Susannah Cahalan.

Signs of Severe Paranoia

Susannah refuses to go to Dr. Bailey’s for her EEG. Finally, Stephen convinces her to go. On the way to the doctor’s fancy office in New York City, Susannah has a hallucination: Allen is speaking without moving his lips. She thinks he says, “You’re a slut and Stephen should know.” 

Enraged, she tries to throw herself out of the moving car. Her severe paranoia causes her to behave recklessly.

Stephen tells her that her behavior is not okay. She notices that he’s using a new tone of voice and obeys him. After settling down, she goes into panic mode again and flings herself against the locked car door. Finally, she falls asleep on Stephen’s shoulder.

When she wakes up, she insists on being fed. They stop at a diner, where Susannah pushes her way past the long line and shouts, “Get me coffee and an egg sandwich!”

“To go,” Stephen quietly tells the man behind the counter. 

Sandwich and coffee in hand, Susannah saunters out of the diner, feeling powerful for making things happen. She then throws the food on the floor of the car, saying she’s not hungry anymore. 

At Dr. Bailey’s, Susannah undergoes a rigorous EEG. The technician tells Susannah nothing is wrong with her—it’s in her head, just like those stressed-out Wall Street bankers. Susannah laughs bitterly, because now she knows the truth: her family has set up this EEG to punish her for her bad behavior. Her severe paranoia causes her to suspect her family’s motivations.

A Fast Downward Slide

Allen and Susannah’s mom agree to let Susannah return to Manhattan under her father and stepmother’s care. All goes well at first, but as Susannah and her dad head for the subway, Susannah’s severe paranoia returns. She starts screaming on the street, and her father has to push her into a cab to get her to his home in Brooklyn. “They’re kidnapping me!” Susannah yells at the cabbie. She tells her dad she’s calling the police. She’s convinced she isn’t safe in his care.

Exhausted by the time they get to her dad’s place, Susannah just sits on the couch and stares as her dad and stepmom, Giselle, prepare her favorite meal, pasta. When they set it before her, though, Susannah has another hallucination; the tomato sauce is too bright. The basil pulsates. The cheese glistens. Susannah refuses to eat. After dinner, she has another hallucination like the one she had in the car with Allen. She thinks she hears Giselle saying, “You’re a spoiled brat,” even though Giselle’s lips don’t move.

Susannah has other hallucinations that night. A painting comes alive. A bust of Lincoln follows her with its eyes. Her childhood dollhouse is haunted. Her father is beating Giselle.

Convinced her father is going to kill her, Susannah is desperate to get out because of her severe paranoia. She runs to the front door of the brownstone and bangs her fists against the door, screaming, “Let me out! Help!” 

She hears her father run downstairs, and she scoots into the bathroom, locking herself in. She’s about to jump out the window when she spots a statue of Buddha on the bathroom counter. It convinces her that everything will be all right, and she smiles. 

It takes Susannah’s dad an hour to coax her out of the bathroom. When Susannah falls asleep in his lap, he calls Susannah’s mom; they both agree she must be admitted to a hospital. However, both insist that she not be put in a psych ward.

Allen and Susannah’s mom drive in from New Jersey the next morning to take Susannah to Dr. Bailey’s, where they ask him to draw up admittance papers. He refuses, insisting that her EEG was normal, along with her MRI, exam, and bloodwork. He repeats that Susannah drinks too much and refuses their request.

Her mom won’t buy it. Under pressure, Bailey gives in and secures Susannah a room at NYU, on a floor that has 24-hour EEG monitoring.

Severe Paranoia: Signs of Susannah’s Brain on Fire

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Like what you just read? Read the rest of the world's best summary of Susannah Cahalan's "Brain On Fire" at Shortform .

Here's what you'll find in our full Brain On Fire summary :

  • How a high-functioning reporter became virtually disabled within a matter of weeks
  • How the author Cahalan recovered through a lengthy process and pieced together what happened to her
  • How Cahalan's sickness reveals the many failures of the US healthcare system

Rina Shah

An avid reader for as long as she can remember, Rina’s love for books began with The Boxcar Children. Her penchant for always having a book nearby has never faded, though her reading tastes have since evolved. Rina reads around 100 books every year, with a fairly even split between fiction and non-fiction. Her favorite genres are memoirs, public health, and locked room mysteries. As an attorney, Rina can’t help analyzing and deconstructing arguments in any book she reads.

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