Brain on Fire – Review

Anti-NMDA Receptor Encephalitis. That’s quite a mouthful. And a rather scary one, as the Charlize Theron-produced, Gerard Barrett-directed film Brain on Fire sets out to prove. One of the rarer and lesser known diseases of the brain, the condition mainly affects young women, and one of such survivors is at the centre of the action: Susannah Cahalan has got it all: the pretty twenty-something New Yorker comes from a well-off background, has a cute musician boyfriend, and works as a young reporter for a large New York newspaper. Things look perfect – when suddenly, without rhyme or reason, Cahalan starts hearing and imagining things, acting unpredictably. Misdiagnosed by baffled GPs and clinicians, Cahalan rapidly descends into what looks like epilepsy, schizophrenia and psychosis, finally entering a catatonic state. And then Dr House appears, connects the dots, prescribes the medicine, and saves the day. Happy end.

No doubt, the fact that this story is based on reality, makes it noteworthy. Cahalan went through this ordeal in 2009 and wrote her memoir in 2012, two years after the daughter of a friend of mine had been diagnosed with the same disease on the 1st of December 2010. For S___, Cahalan’s memoir came too late, so to speak, but luckily she had had the fortune of being seen by doctors who were aware of Anti-NMDAR Encephalitis even at that early stage. The road up to this diagnosis had been tough – and I remember the overwhelming feelings of horror, helplessness, worry and frustration that even I as a bystander felt when reading my friend’s regular updates about S___’s worrying condition. And nothing I have seen in BoF mirrors that existential fear, or the rollercoaster journey veering between hope and despair that I witnessed when my friend’s family went through the same ordeal.

BoF the film is told in a straight-forward way, essentially recording the time-line of events from on-set to recovery. Avoiding all aesthetic gimmicks, the film chooses to cast a quasi-documentary eye on the plot. That may be a good idea in terms of respecting the RL authority and sensibilities of the story, but it results in a major flaw: The story becomes an impersonal case-study and neglects to make the audience properly identify with or feel for the protagonist. The unexciting linear storytelling fails to provide highs and lows; instead, it flatlines into an endless observation of misery which only receives a denouement at its happy end.

Just before disaster strikes… Scene from Brain on Fire

It doesn’t help that the main characters appear as stereotypes – the bouncy young journalist. The divorced parents – housewife mother, ex-banker dad. The slightly hapless boyfriend – an artist. The aloofly-condescending doctors. And *one* “demi-God dressed in white”. While the family unit lacks in depth and definition, it strangely appears as if only the lesser secondary characters have been given a little bit more human contradiction – a tough-nut work-mate who actually shows emotion when faced with the unresponsive friend in hospital; the hard-hitting newsman boss who shows a lot of understanding rather than fire his unreliable cub reporter; the junior doctor in hospital who is not convinced of the diagnosis and brings in the eventual “saviour” of the piece. But for the audience to “connect” with the story, there is not enough emotional depth conveyed by the main characters in the film – a pity as a medical drama usually provides such in spades.

This could have been achieved by giving BoF a richer narration from a post-event point-of-view. After all, with the main protagonist out of action for most of the film, we never get her view as the disease is happening to her. A commentary from the POV of Cahalan – or more believably: from her father, who is shown as the only passionate advocate for his sick child – would have helped the viewer to understand the despair and the frustration of the situation. Daddy Cahalan shows *some* spirit at least (even though I found some of his ire directed at the poor boyfriend after Susannah’s first episode rather misspent), raising his voice, demanding more effort and insisting on alternatives to the psychiatric diagnoses.

Caring daddy mode for Armitage in Brain on Fire

Richard Armitage as Tom Cahalan is well-cast and ably conveys the passionate protectiveness of a parent. Although the movie does not go into detail over the supposed difficult relationship between him and his daughter (which was mentioned off-set), Armitage fills the (limited) scope that this role provides – as a caring, worried father who is prepared to push on his daughter’s behalf. Mummy Cahalan comes off slightly less well – providing the opposite to her vehement ex-husband by being calm, reconciling and almost dispassionate throughout. If that was what the script wanted, then Carrie Ann Moss played it well. As a couple, the two actors were certainly well matched, and ably carry the plot. Which is just as well because Chloe Grace Moretz did not fully convince me in her role. She was good once she had to act catatonia – although that sounds much like a back-handed comment. But her ever-present pout otherwise looked inappropriate for a supposedly independent woman in her mid-twenties, and in her talking scenes, I often felt that she was overacting.

Overall, this medical drama looks more like documentary on the search for a good doctor, than a film about the search for a diagnosis. Of course, the knight in shining armour turns up in the end, just in time, to save Cahalan before the disease can leave lasting effects. How he manages to connect the dots, we are not shown. Maybe it’s too difficult for a lay audience to understand.

But showing the mere mechanics of a progressing illness and the wondrous diagnosis at the end is also not enough to provide proper insight into the human drama connected with such an ordeal. For me, the material just doesn’t lend itself to a feature film as it lacks the suspenseful up and down of a story. Illness as a mystery element can be intriguing – but not if the main character inspires too little emotional understanding and investment from the audience despite an hour and a half of hallucinating and spasming. It all could have been done in half the time – only that that would’ve deprived those of us, who are firm believers in watching any Armitage plot, of some nice new headcanons: daddy!Armitage, DIY!Armitage. fierce-protection-mode!Armitage is always a joy to watch, after all.

PS: Like Cahalan, S___ made a full recovery in a relatively short time. She is now married and has a two-year-old daughter. My friend went on to establish the first German self-help organisation for families dealing with Anti-NMDAR-Encephalitis. She celebrates every 1st of December.


39 thoughts on “Brain on Fire – Review

  1. Of the unreleased movies we’ve been waiting (forever) for, this was the one that interested me the least. I TRIED to read the book… meh. Just meh.

    Thanks for sloughing through it for us.


  2. That’s one way to get me to watch this! LOL now i need to watch this tonight as i want to read what you wrote 🙂 hopefully i won’t be tempted to fast forward 😉


    • Go ahead and fast forward through Moretz’s over-acting. Just imagine the pout and big eyes, and you have it. Looking forward to hearing what you think.


  3. Thanks for the review. I actually found the book really interesting. But then I like reading real life disease exploration. Too bad the movie doesn’t pull it off. I’ll probably patiently wait until it makes its appearance on Netflix.
    Good to hear your friend’s daughter is ok — it must have been really scary.


    • S___’s period of undiagnosed illness was absolutely scary. Things seemed to deteriorate so quickly, and I remember my friend being completely distraught, yet stubbornly clinging to hope. It was just absolutely incomprehensible how a perfectly fine, young girl moved from normal to completely undone within a week. It must have been unbearable for her parents.


  4. I watched it (finally) just yesterday, and I agree with much of what you’ve said. Nevertheless I was affected more emotionally than I think the script would otherwise have evoked, simply for having so recently been through a terrifying few weeks when my own central nervous system went rogue. Armitage-as-Dad was pretty endearing, too. The movie could have been so much more powerful. And agreed- I thought Chloe did really well as she entered the catatonic phase. But she wasn’t a particularly sympathetic character the rest of the time.

    Liked by 1 person

    • I can only imagine how much more haunting this film is for someone who has her own experience with an intangible illness. While I enjoy a good medical drama, I tend to only watch those in small doses. Anything more and I get paranoid.
      But as you said – the film unfortunately fell flat and did not really make enough impact to leave a lasting impression. I’m sure that Cahalan is a nicer, more symathetic character than she comes across in this film.
      BTW – good to hear from you. I hope you are doing well!?

      Liked by 1 person

  5. I’m glad your friend’s daughter is well!

    My review was similar, and I think particularly important the points that the decision to eschew an actual POV was disastrous and that CGM was miscast here. One problem with the movie is that a lot of the characters’ behavior sort of only makes sense if you have read the book and know something about the actual people. I found Tom Cahalan convincing because the book reveals he’s a particular kind of East Coast elite, entitled guy that you run into all the time in airports and Armitage inhabited that really well. So the way he treated his daughter’s BR totally made sense to me (whether or not it was unfair).

    Another problem is that it can be really hard to convey abstract information narratively / dramatically (this is why almost all of the films about Martin Luther are so disastrous — how do you tell a compelling story about a theological / legal point without descending into stereotype or parable?). If I think about the films about science that I think are really great (Apollo 13 being a good example), they are all structured around the science and the personal narratives, while important for sympathy, are secondary to that. The real mystery / thing that keeps you watching in Apollo 13 is “how do we re-engineer this spacecraft from remote to get these guys home?” The triumph ends up being about science and only secondarily about the achievements of Lovell et al., although we of course get plenty of them. But Cahalan’s book is only somewhat about the science (even if it explains it in more detail than the film); it’s really about her experiences — and the film seems to have decided to magnify that approach, saying almost nothing about the science. The main point of the film is we’re supposed to identify with her and learn to recognize the symptoms of this disease, and I think the failures in the script wouldn’t be so troubling if it weren’t so difficult to get past her overacting / non-acting. If she were a great actress we would watch with awe as she presented us, subtly, with the troubling progression of the disease. In fact one reason it was so hard to diagnose was that it didn’t present itself as totally obvious. But nothing doing: everything about CGM’s acting is completely obvious.

    One thing that I found interesting about the film was the way that the father’s role was pushed into the foreground. The book says that Susannah had always been closer to her mother, particularly after her parents’ divorce, but that the disease revived and deepened her relationship with her father. Still, it’s clear from the book that her mother was more emotionally involved than the film suggested. There’s a lot of unexplored territory in that book that I put down to a potential sentiment on the part of the writer: my family relationships are not the easiest, but they all showed up and went above and beyond the call of duty when I was sick; I want to write about this life-changing experience; I don’t want to do it in ways that hurt or expose the vulnerabilities of my family members. Unfortunately great narratives live from exposure of that kind of thing and it must be difficult to do that with living family members. I wonder if the director / script people decided that emphasizing the “heroic father” thing would just be more convincing on the screen? Culturally, we are so willing to blame the mother for everything, and that must have played into this particular version of the story as well.

    Liked by 1 person

    • I must re-read your review now that I have written mine. Even though I read it when it first appeared, I stayed away from it until now so that I could come up with my own verdict. Mind you, I did of course remember the gist of your review – the miscasting of CGM one of it.
      Even without having read the book, I can totally see how reading it would have filled in many of the gaps in the movie. Interesting re. Tom Cahalan and his status. Yes, that does explain his aggressive assertiveness and protectiveness over his daughter’s diagnosis. In the context of the film only, I did not think that RA overacted that; in fact I fully believe that anger and aggression are typical ways of reacting in a situation where someone’s daughter’s life is threatened. But your reference actually makes it even more understandable, and adds a different spin on it – as in Tom is not so much volatile as entitled. But as you said – it’s problematic if a film relies on the expectation that the audience is already familiar with the characters.
      So true, it is always hard to make a film about an abstract discovery – rather than a human interest story. To me it looked as if they tried to make BoF a human interest story rather than a story about a medical discovery – except there wasn’t that much human interest in there, by virtue of making the protagonist not particularly interesting. She came across as a naive, slightly bratty girl, privileged and protected, entitled in her own way. That kind of character would rile me from the beginning, I have to admit. In any case, through the course of watching the film, I kept wondering “yeah, ok, so where is the interest in this, where is the part of the story that sets this apart from everything else?”. Perhaps unfairly, I kept comparing the film to an episode of ‘Dr House’ – which is infinitely more interesting. I wondered why, seeing that both the neurological drama in the TV and the film are focussed on rare diseases that are eventually diagnosed correctly for a happy ending. The answer is that the TV show keeps the audience entranced with the human interest story of an unpredictable, difficult main character who is convincingly portrayed by a fantastic actor. Maybe CGM had little to work from to begin with. But it didn’t help that the role required more subtlety than she was evidently able to apply to it. (She is, however, still very young, so maybe that will develop over time. But that was one of the things that surprised me right from the announcement of the project – why cast an 18-yo in the role of a 24-yo? At that young an age, every year matters. But that’s probably an ageist argument.)
      Interesting to hear that in the book the mother was more emotionally involved. That did not come across in the film at all. In fact, I occasionally thought to myself that she was behaving incredibly calm for a mother whose daughter seems on the verge of losing her mind. Not that everybody has to scream and shout all the time, but Mother Cahalan (I can’t even remember her name – that says a lot already) was so zen about everything, it could’ve been mistaken for being dim. In hindsight it made me wonder whether that was deliberate so that the difference between the two ex-partners were obvious, kind of underscoring/highlighting the fact that they were divorcees?
      If the script writers wanted to emphasise one parent over the other, I really dislike that approach in theory. (In practice I am delighted to see Armitage in enhanced daddy-mode, of course.) Sure, there is the ever-present trope of “mother’s love is stronger than anything”, but that is complemented by the “father will protect his family at all costs” trope. No need to apply ‘positive action’ to the father… How does the book play this? Does Cahalan give the impression her dad had more tenacity when it came to insisting on an alternative diagnosis for his daughter?


      • –ageism: I’ve had this discussion before about LLL. If a 17 year old actor could convincingly play a 65 year old, that would be one thing; it’s my contention that most can’t. I think more significant than the fact that she’s so young, though, is that she hasn’t had the kind of experiences that someone like Cahalan would have had at 24. If you haven’t been to college or worked in an office setting, you don’t really know how professionals interact with each other or what appropriate office behavior is or how to mimic it, and more importantly, you don’t know that you don’t know it. That could have been overcome with research, of course, but I don’t think that was what CGM was focused on.

        –entitlement: I think SC is quite entitled, if her book is any indication. She comes from a wealthy social segment; even if she emphasizes that her parents didn’t support her financially, she still grew up with the expectation that the world would bend to her will and the cultural capital that facilitates that. She takes for granted that the world should find her story interesting even though she doesn’t tell it in a very interesting or reflective way. It was stunning to me that in more than a hundred pages of narrative about complicated and expensive medical treatment, she never once refers to what it must have cost, or the miracle that somehow her employer didn’t terminate her health insurance once she became unable to work. TC reminds me very much of the man under authority in Matthew 8: I say to this one come, and he comes. They both very much have this attitude that they are owed a solution to her medical problems and quickly.

        –re: parental involvement: there’s a rhetorical problem in that SC doesn’t remember most of what she’s describing and the main record of it comes from her father’s notebooks. So it’s not surprising that that perspective would come to the forefront. Maybe she felt she didn’t need to talk so much about her mother, but it seems to be a very typical post-divorce scenario: father moves out, sees less of children, mother is there every day and doing the core support, and this persisted after SC became an adult, until her illness. The book makes her father mostly responsible for the aggressive search for a diagnosis, but/and I am sure her source material did as well. However, she lived with her mother all the way through her recuperation, a significant chunk of the book that the film mostly omits.


        • Glad you are confirming what I thought about the 18 yo being cast as a 24 yo. To me, CGM came across as a high school girl all through the film even though you cannot necessarily discern a 18 yo from a 22 yo just be looks alone. And yet, she looked more like an intern at work, and an aggravated teenager at home.
          It is very telling that SC never once reflects on the costs of her treatment. Mind you, I did read an interview with her (in the Guardian) in which she did state that she realised she was privileged, and in which the final cost of her treatment was mentioned (a whopping $1m) – maybe she has learnt how to *appear* less entitled…
          It is exactly because SC cannot describe her ordeal from her own memory, that I felt a voice over by Tom would’ve made sense. He was there all of the time, and he could’ve added some suspense to the story. The way SC’s mother gets short shrift in the film, is really annoying.


  6. I agree with your review completely. I didn’t hate the movie, but it was not emotionally engaged by it either. The cutie pie pouting was annoying, because it seemed to be exaggerated by close-ups. If I could stand to watch it again, I would count them. But, don’t think I can do that.


  7. Very interesting discussion! For me it raised the question of whether the person who gets sick in a medical drama should be a sympathetic character. Let’s say that she is an annoying, bratty girl. Does this make it a more interesting movie, because we are forced to reckon with our inevitable reaction of reduced sympathy–or does it make it a lesser movie because we are denied the pleasure of sympathizing (or empathizing) with the good person who “deserves” to be cured? I also think the mother issue is important. Carrie Ann Moss seems to be regarded by casting directors as an emotionally cool type–so I suspect that a deliberate contrast was set up between the passionate parent and the detached one. Why the filmmakers would want to do this, I don’t know. Maybe they thought that Daddy should be the sympathetic focus?
    At any rate–DILF. I’ll have to remember that one.

    Liked by 1 person

    • You’ll have to see the film, but I don’t think it’s a matter of sympathizing / not sympathizing with Cahalan — CGM’s acting makes it difficult to do either. There are plenty of unsympathetic protagonists for whom an audience comes to have sympathy — either because of the script or the skill of the actor — but this portrayal of SC doesn’t really fall into that realm. I had more sympathy for Cahalan after reading the book (although I did not find her a likable narrator) than I did after seeing the film.


  8. Well, saw it and not all that much left to say which hasn’t been said already. It’s not a particularly engaging film tbh, at most TV film material (which i have to say make me grind my teeth as by comparison Urban is really a masterpiece almost and million time more engaging… the unfair outcomes in this entertainment business! :-((()
    I give them credit for wanting to bring attention to the disease but honestly i’ve seen more rigorous documentaries on TV which are much more useful and engaging and effective in spreading the word. I suspect anyone who has dealt with neurological problems would say the complexity of the problems is immense as are diagnosis. There is just sooo much about the brain we don’t know or understand. It slightly irritates me that this makes doctors seems incompetent as a majority body and then somebody comes in, does one test and bang, miracle solution. Medicine, especially neurology is nothing like that i suspect. As you say between intrigue and linearity and oversimplification this just isn’t a particularly captivating watch. And yes it needed somebody more experienced in the lead role, just because these kind of extreme things are so hard to portray even by more mature actors.
    I didn’t feel the imbalance between the 2 parents to such a degree. Yes, we see the father spending a few more nights in hospital and we probably shouldn’t have .. but other hand in practice who knows how people are able to take time off in these circumstances and so on. She did go and live with her mother at first and i can’t really blame her for going and asking for his support.. why should she carry the burden alone?
    And yes, maybe he is used to a more authority position so he gets more vocal at times. But i didn’t feel that necessary in their encounters with the doctors there was that imbalance. He is louder but she is almost more stubborn and determined. There is that scene towards the end where they are on the corridor and she is actually the one who is clear on never ever giving up when he is in a much more confused state.
    Yes they have very different personalities, but i’d say both strong minded and it does comes across that despite their different lives they do come together as a united front where their daughter is concerned, hardly surprising after all. Given how young and vulnerable and unable to deal with even daily life (including before the first signs show) i don’t think it’s against the vibe to make her father somewhat over-protective.

    Given how little time they get on screen (and i have to admit it was less than even i expected) it’s to be commended for both RA and CAM that they managed to create personalities at all. Same for the boyfriend. The office colleagues and boss fair somewhat better and also, given size they do quite well i think.
    The gifs tbh allow us to indulge a bit more in what are otherwise but brief seconds or glances (except for 2 scenes with the doctors).
    I could however empathize with the frustration and worry in watching somebody you car about and know deteriorate that rapidly. If the film is effective in transmitting that i cannot say, i do because i’ve felt that panic.

    I hope there will be more scientific documentaries out there which will do more to publicize the illness and help doctors diagnose it faster and patients and friends and so on become better and pinning down the symptoms.
    As to what interests us – given how little air time he had i think it’s quite amazing he managed to build a clear character, even a bit of volatility into it, he’s not just shouty, he’s the fix your problems but reprimand you and tell you what to do kind of dad, he’s likable at times but also vulnerable. I’ve not watched all his roles but i’d say well done on filling the dad figure very very convincingly and very differently. In Urban he becomes also a sort of father figure, but they couldn’t be more different! There is some of this in LLL at times but only very slim shreds and he’s created a very very different father figure there yet again. It’s pleasing to me that even in this barely there material he’s now so mature and experienced and ready and able to shape characters that he can do so much in virtually no time and with no prep and hardly anything to work with.

    Given the mere minutes and the stuff we’re likely to get in Pilgrimage i can now honestly say i am looking forward to Berlin Station 2 and i never thought i’d say that.. i’m just desperate to see him on screen longer to see him act … hoping against hope there will be more scope for that in S2, fingers, toes crossed. Sheesh!! Somebody give this man some material for goodness sake! He’s like this fully stocked cabinet of spices and ingredients and all people want him to make with it is sausages and mash! I want a 7 course meal with flavours to blow my mind, i’m starving for it!

    Liked by 1 person

    • I love this comment, Hari – you are saying all the right things, and really, this should’ve been a blog post on your blog. Particularly your conclusion – the fully stocked spice cabinet that is never able to deploy because all that is required is bangers and mash. Spot on, I say – I want roles with more meat for RA. And as you said – it looks as if BS is the only such opportunity at the moment, by virtue of being a multi-episode vehicle. I am slightly concerned that it will pan out like season 1, though, just because Hector de Jean looks as if he is on the show for all of the season, too. Nothing against Rhys Ifans, but Hector definitely stole the show last season. Now I want to see Daniel come into his own and continue where he left off at the end.

      Liked by 1 person

  9. Guylty I’m glad your friend’s daughter is ok, what a frightening thing to go through for all concerned.
    Thanks to everyone for the interesting comments. I’m afraid that I didn’t make it to the end of the film for two reasons, firstly the film link I was watching broke down around the 30 minute mark and all I got from then on was volume without picture and secondly by half an hour in I was beginning to loose the will to live anyway and I’m not sure I would have made it to the end without being bored into catatonia myself, no offense intended to anyone who watched and liked it.


  10. Gesehen habe ich es noch nicht, bin aber sehr gespannt. Auch wenn mich beim lesen gerade das Gefühl überkommen hat er macht das Beste aus einer eher einfach gestrickten Vorlage?


    • Genau so isses. Er muss mal wieder mit Material arbeiten, dass nicht wirklich optimal ist. Kann er zwar gut, aber leider bleibt die Tatsache den Zuschauern auch nicht verborgen…


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