Susannah Cahalan got her start in journalism in the summer after junior year, when she got an internship at the New York Post, and worked her way up from grabbing coffee and making photocopies to a general assignment reporter.
One day in early 2009, Cahalan woke up in a strange hospital room, strapped to her bed, under guard, and unable to move or speak. Her medical records from a month-long hospital stay showed psychosis, violence, and dangerous instability. Her New York Times bestselling memoir Brain on Fire chronicles the swift path of her illness and the lucky, last-minute intervention led by one of the few doctors capable of saving her life. As time passed and she moved inexplicably from violence to catatonia, $1-million worth of blood tests and brain scans revealed nothing. The exhausted doctors were ready to commit her to the psychiatric ward, in effect condemning her to a lifetime of institutions, or death, until Dr. Souhel Najjar joined her team. He asked her to draw a simple sketch of a clock, which became key to diagnosing her with a newly discovered autoimmune disease in which her body was attacking her brain.
Also in 2009, Cahalan was the recipient of the Silurian Award of Excellence for the article “My Mysterious Lost Month of Madness,” on which Brain on Fire is based. Her work has also been featured in The New York Times, Scientific American, Psychology Today, and Focus, and she still works for the New York Post, now as their books editor.
As a huge fan of Brain on Fire, I emailed Cahalan requesting an interview, and we spoke on the phone shortly afterward.
When did you decide that writing was something that you wanted to pursue?
Probably for as long as I can remember. You know, those are the classes I enjoyed most. I kept journals when I was really a little kid, I still have them.
So how did you go about getting that internship at the Post?
I was editor of my high school newspaper, and I knew I wanted some kind of real world experience. I was always a fan of the Post, since I was a little kid, and my mom’s friend worked for the Times and her husband worked for the Post. They were hiring interns, and they agreed to hire me on. For about two summers, I got coffee for people and handed out mail. I didn’t do any writing for those first two years.
What sort of things have you learned during your time at the Post that helped you to write Brain on Fire?
It definitely taught me how to interview people. It taught me how to be diligent and deadline oriented, because when you’re writing a full-length book, it’s an entirely different story than writing an article and keeping yourself to deadlines is very important. And being self-motivated, that’s a really big part of my job. When I came on as a full-time writer here, I worked for the Sunday paper, where you had to pitch and write and report your own stories. In other parts of the paper there are things called rewrites, who write the piece, and then there are runners, who report the piece. On Sunday you do rewrite and runner, so it taught me how to do both, and how to allocate time. It did two things: it made me a little less fearful, because I got put in a lot of very uncomfortable and strange and foreign and exciting and over my head experiences, and prepared me for that, and it also completely removed any ego I had about writing. (Laughs). Because they beat it out of you here.
So before you decided to write this book, what sort of pieces were you working on?
I was general assignment, so it was really different from week to week, from crime to celebrities to local quirky. I was doing a lot of quirky, local New York news stories.
And were they mostly short-form?
Yeah. There would be times when I would write a two-page spread, which is about 1,600 words, but that was less common than 8 inches, which is about 250 words.
So why did you decide to write a piece, and then later an entire book, about such an intimate part of your life?
The reason I wrote it was actually because my editor found it interesting and assigned it to me. I think on some level I wanted it to happen, and I thought, “This would be a book.” I wasn’t necessarily actively saying that, but then a friend of mine came with me on rounds that my doctor was doing, and she said, “This is really fascinating”, and told my editor about it, and then he said “I would love for you to write about it, and you have three days to put it together,” which was very intimidating.
What made you decide to turn it into a book?
Well, the response was so resounding. Just hundreds of emails poured in. I saw that people were interested in the story and that it was helping people. So I decided that I had to write it as a book-length piece. I’ve always wanted to write a book, and it kind of landed in my lap.
What was the writing process like for you when you were working on the book?
It was really rough. (Laughs). If you take on a project it can just be so overwhelming, you have to take it down piece by piece so the way that I did it is I broke it up. I started by handwriting my own memories, so I could differentiate them from later false memories. On some level I knew that that was going to happen, and then I got my medical records and I got a dry-erase board calendar, and I began filling in all the pieces of objective facts in that calendar. It was kind of like building a case. And then from there, I interviewed my doctor, and my boyfriend, and my parents, and my friends and started to get the story. And I didn’t start really writing until probably six months in.
Then how long did it take you to write, do you think?
Six months. It was very fast, comparatively speaking. I have two years for my next book, and I don’t even think that’s enough (laughs).
What was the research process like for a book that was so personal to you?
Well, you know, it wasn’t that personal to me, because a lot of it wasn’t my own memory. So it was actually like researching someone else, and more of a straightforward piece of non-fiction than a memoir. The third part [her recovery] was more personal, but the second part [her stay in the hospital], was pretty much blank, so it felt like I was researching someone else.
How were you able to interview people about yourself?
It was very difficult. I tried to maintain distance, but it’s impossible when you’re sitting across from your father, asking your father about yourself. It’s too bizarre, it’s too strange, there’s too much there to really get objective facts. So I did struggle with the idea of whether I was really getting the real story, because I’m in my own way.
Once your book was done, I mean, as done as you thought it was going to be, how did you go about getting it published?
I actually had a book deal before I started writing it. With non-fiction books, that’s typically how it goes. Fiction is a different story, but non-fiction usually sells based on a proposal. So you write about 50 pages of chapter summaries and a few chapters, and kind of who the audience is going to be. From there you get a book deal and then you start writing. So that was my process.
And in writing the proposal and trying to get it signed on, were you rejected by anyone?
Oh yeah, oh yeah, definitely. Without a doubt. I was very lucky to get my acquiring editor, and she was very passionate about it. But I heard things like “No one wants to hear about a rare disease,” you know, “This is too rare and too specific to get a wide general audience.” I heard “The science is too complicated.” I heard a lot of those things.
And how did you cope with the rejection?
It was happening so fast and when Simon & Schuster came and said yes, I kind of forgot about it. But it was really hard. It was very painful because my agent forwarded me all the rejection emails, and it was hard to see, for sure.
So, it became a number one New York Times bestseller, as you know. How did you go about promoting the book once it was published?
Well luckily I had a very wonderful publicist who arranged a lot of great media: TV and print and radio, and I think that probably the biggest thing was radio, for me. NPR, in particular. And I got lucky with that. I think that started the interest, and [the book] did relatively well. But then it had a second life when it came out in paperback and nobody really knows why.
I know a lot of writers, myself included, who feel like they can write, but they can’t go out and self-promote, and get things done. Do you have any tips for how to go about doing that?
Unfortunately it’s part of the job, especially in journalism. So the way that I look at it is when I am doing these things and I feel outside of my comfort zone, I put on my reporter hat, and I feel like I’m the reporter me. I am not doing it for me, I am doing it because I’m doing a story. Because you know, there are so many things you would do when you’re a journalist that would never do as a normal person. People you would talk to, things you would say, questions you would ask, people you would approach. So you have to take that same kind of approach to how you present yourself and who you meet and how you get your foot in the door.
Do you have any advice for aspiring writers?
Two pieces of advice. One is that the only way you get better at writing is by doing it every day. Some people have different processes, but I think that even if you’re writing just a little bit every day, it’s important. It’s a muscle, you know? Another thing is if you’re working on a book and you’re really having trouble and you need some guiding voice, there’s a wonderful book called the Modern Library Writer’s Workshop by Stephen Koch, the head of writing at Columbia. I give that book to every one of my writer friends because it’s comforting but also gets you motivated. He has a chapter called “ Shitty First Drafts,” and it’s exactly what you need when you’re writing and you need this kindred spirit watching over you.
What are you working on now? Are you interested in writing more books, or are you going to stick with your pieces at the Post?
I’ve sold another proposal about a study that took place in the 1970s [the Rosenhan experiment], where a group of volunteers from many different walks of life—housewives and artists and architects, and a professor, some psychologists—volunteered to go undercover at psychiatric hospitals across the country to basically see what’s going on in these hospitals. They all went in pretending to hear a voice that said “empty” or “hollow”, and based on that very limited symptom, they were all diagnosed with schizophrenia. And it became a case of when they were diagnosed with schizophrenia and they were in these hospitals, it became a problem of how do you get out? How do you prove your sanity once you’re deemed insane? And that study had major influence on psychiatry in general and led to a whole host of changes in the ‘80s mainly. Anyway, I’m revisiting that study. The names of the people involved have never been revealed, but I’ve gotten their names and have been able to talk to a few of them. So it’s a way in to talk about psychiatry in general, but also through a very cool, fascinating, thriller-like story.
So is that the kind of story that you’re interested in writing about now, mental health and illness and stuff like that?
Very much. I don’t think that you can go through something that I went through and not have an interest in mental health.
Do you plan on continuing to write books and long-form pieces?
I would love to. That would be awesome. That would be my goal, I would say, to be able to continue. It’s a horrible process, but it’s a very worthwhile one, and it’s painful, but you forget how hard it is, and you want to do it again. So right now, I want to do it again.
Jeri Knopp is a freelance journalist currently finishing up her Master of Journalism degree at the University of British Columbia. Her work, primarily focused on travel, gender politics, and mental health, has appeared in the Georgia Straight, the Thunderbird, and Ocsplora, and is influenced by her expat upbringing, which took her all over the world. When she isn’t writing, Jeri spends her spare time trying to keep up with the ever-expanding corpus of great literature, sneaking a few romance novels in between. She also loves hiking, baking, and promptly devouring everything she’s baked.