Excerpt from The Great Pretender by Susannah Cahalan, plus links to reviews, author biography & more

I spent four years after my diagnosis collecting facts about my disease, about ages of onset, and about new advances in infusion treatments—a kind of armor to defend against the lonely irrationality of it all. I am proof of our advancement. Still, I am stalked by the everpresent threat that psychosis will return. Writing this now, halfway through my pregnancy with twins, I can't forget the ways my body can (and has) failed me. As traumatic as being diagnosed with melanoma was in my late teens, it did not feel like the disease touched a part of my soul the same way that my experience with psychosis did. Psychosis is the scariest thing that has ever happened to me. It was neurological, "organic," but it came from me, from inside who I am, making it far scarier than any other "physical" illness. It rocked my sense of self, my way of seeing the world, my comfort in my own skin, and shook the foundations of who I am. No amount of fact- gathering could arm me against this truth: We are all hanging on by a very thin thread, and some of us won't survive our fall.

I published Brain on Fire to help raise awareness of my condition and in the aftermath was invited to lecture widely at medical schools and neurological conferences, spreading the word about my disease like a missionary, determined to make sure no others were left undiagnosed. At one point, I had the chance to address a large crowd of psychiatrists inside a functioning psychiatric hospital. It was located in a renovated army barracks, but it felt light, white, and modern. Like a real hospital, I remember thinking. (When I had packed for the trip I made sure to bring my most adult, sophisticated, not crazy ensemble, a simple black- and- turquoise Ann Taylor shift dress paired with a crisp black blazer.)

After my presentation that day, a psychiatrist introduced himself to our group of presenters, speaking in soft but urgent tones about one of his patients. He had diagnosed a young woman with schizophrenia, but in his words, "It just didn't feel right." In fact, she reminded him of me. The woman was of a similar age, had a similar diagnosis, and exhibited similar symptoms. But she also appeared similar to the sea of others with serious mental illness who were being treated alongside her. The question was, How do we know the difference? How to decide who will respond to the intervention I received—the infusions that helped stop my body from fighting itself—versus psychiatric treatments? The group of doctors discussed next steps, the blood tests, lumbar punctures, and MRI scans that might offer an alternative diagnosis for this young woman. Later, as we walked through one of the hospital's units, passing a group therapy meeting, I couldn't help wondering, Is she in there?

I learned after my talk that the young woman had indeed tested positive for autoimmune encephalitis, the same disease I'd had. But because she had remained misdiagnosed for two years, unlike the single month I had spent in the hospital, she would probably never regain the cognitive abilities that she had lost. She could no longer care for herself in even the most basic ways and despite her successful diagnosis, she now would, one doctor told me, operate as a permanent child.


I had thought I was done examining my own story after I published my memoir. But once you've come face‑to‑face with real madness and returned, once you've found yourself to be a bridge between the two worlds, you can never turn your back again. I couldn't shake the thought of the words TRANSFER TO PSYCH in my own medical records. What happened to this young woman almost happened to me. It was like seeing my reflection through the looking glass. She was my could- have- been, my mirror image.

How are we—my mirror images and I—any different from the millions of people with serious mental illness? How could we be so easily misdiagnosed? What does mental illness mean, anyway, and why would one affliction be more "real" than another? These questions have haunted me ever since my memoir was released, when the stories of people's battles within the medical system first landed in my inbox. Some write hoping to have my disease. Anything, some say, except mental illness.

Excerpted from The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness. Copyright © 2019 by Susannah Cahalan, LLC. Reprinted with permission of Grand Central Publishing. All rights reserved.