Set Fire to the Brain

“I know what kind of crazy I am, and this isn’t that kind of crazy,” Will tells Hannibal. “This could be seizures. This could be a tumor. A blood clot.” After nine episodes of worsening symptoms—from headaches and sleepwalking to blackouts and hallucinations—“Buffet Froid” finally provides the audience (if not Will) with a medical diagnosis: anti-NMDA receptor encephalitis. 

The Will Graham of Thomas Harris’ Red Dragon did not suffer from encephalitis. Bryan Fuller confirmed in 2013 that that particular detail came from the real-life experience of FBI Special Agent John Douglas, who is widely credited with pioneering the field of criminal profiling. (Douglas is also the inspiration for Jonathan Groff’s character on Mindhunter, Holden Ford.)

Not unlike Will, the relentless pursuit of violent offenders took a physical and emotional toll on Douglas. “I started telling the assistant director, ‘I can’t take it. I can’t keep up with it; I’m taking cases home every day,’” Douglas recounts in a 2015 profile. “He said, ‘You know how it goes. You have to keep up until you drop,’ and I said, ‘I’m about there.’” Will has a similarly unhelpful conversation with Jack in “Rôti.” 

J: You look like hell, Will.

W: I feel like hell. Actually, no, I feel fluid, like I’m spilling. Must have come down with something. I hope it’s not contagious.

J: Look, this work that we do, it will compromise your immune system, if you allow it. You’ve got to keep things in perspective. You’ve got to keep yourself in perspective. 

W: Myself is a little hazy at the moment.

J: You’ve got to start taking better care of yourself.

W: Build my resistance?

J: You just can’t take it all in. You’ve got to let go of as much of it as you can. You’ve just got to let go.

W: It’s hard to shake off something that’s already under your skin.

Douglas did drop in November 1983 while in Seattle tracking the Green River Killer. His colleagues found him comatose in his hotel room two days after he collapsed and had suffered multiple seizures. With a temperature of 107 degrees, the right side of his brain had split and started to bleed. Doctors diagnosed him with viral encephalitis, predicting he would most likely either die or remain in a vegatative state. Douglas survived, coming out of his coma a week later and returning to work in May 1984 after a month in the hospital and five months of rehabilitation. 

Douglas had infectious encephalitis, however; Will is diagnosed with autoimmune encephalitis. Both result in an acute inflammation of the brain, making their symptoms similar: fever, headaches, disorientation, hallucinations, memory loss. But infectious encephalitis is caused by a viral infection. Autoimmune encephalitis, on the other hand, is a disease that occurs when a person’s own immune system attacks the brain. Anti-NMDAR encephalitis is a specific type of autoimmune encephalitis in which antibodies target the synaptic proteins that control the brain’s electrical impulses—impulses that are critical for cognitive functions such as judgement and memory as well as autonomic bodily functions like breathing, heart rate, and blood pressure.

“The symptoms are only going to get worse,” Dr. Sutcliffe tells Hannibal in “Buffet Froid.” And that is certainly what happens. In “Rôti,” Will hallucinates Abel Gideon as Garret Jacob Hobbs, suffers a “mild” seizure, and collapses with a 105-degree fever. In “Relevés,” Will hallucinates killing Abigail before another seizure sends him into a dissociative fugue. One minute he is with Abigail at the Hobbs cabin in Minnesota, the next he is on an airplane in Virginia, alone. In “Savoureux,” Will wakes from a nightmare to find himself covered in dried mud—evidence of another dissociative fugue. After coughing up a severed ear, he calls Hannibal. “I don’t remember going to bed last night,” Will says. “Maybe I got up to let the dogs out, and then I—”

Anti-NMDAR encephalitis is hard to diagnose, as Alana tells Hannibal and Jack in “Savoureux.” According to this 2011 article, studies have shown that brain MRIs come back normal in half of all cases. And symptoms such as agitation and delusions frequently lead to a psychiatric misdiagnosis. But, contrary to what Alana says, tumors are a common sign. The tumors just do not manifest in the brain and thus do not appear in a neurological scan. A 2011 clinical study of anti-NMDAR encephalitis found that about half of patients over 18 years old had an underlying tumor, most often a teratoma. (A teratoma is a rare kind of tumor that contains several types of tissue and typically forms in the testicles, ovaries, or tailbone.) According to the Anti-NMDA Receptor Encephalitis Foundation, tumors associated with the disease most often include neural tissue and NMDA receptors. The body’s immune system produces antibodies to attack the receptors present in the tumor, and those antibodies eventually make their way to the brain to attack similar receptors found there. Cue brain on fire. 

The nature of autoimmune encephalitis—and particularly anti-NMDAR encephalitis—feels particularly symbolic when it comes to Will. Perhaps that is why the show deviates from the character’s real-life inspiration to give its criminal profiler this specific type of encephalitis. Will is not suffering from a neurological condition brought on by a viral infection. He is the source of his sickness. We never learn of doctors finding a physical tumor they might associate with Will’s disease, but he sure has a metaphorical one. It is what a phantom Elliot Buddish saw inside Will in “Coquilles.” His darkness. The ease with which his empathy disorder allows him to envision himself a murderer. The way killing someone makes him feel good. After Garret Jacob Hobbs, that aberration within Will grows. His immune system makes antibodies to fight it off, but ends up only targeting Will’s brain. For unlike other anti-NMDAR encephalitis cases, Will’s is a tumor that cannot be removed.

If we are to connect Will’s illness to his empathy disorder, then presumably he has been susceptible to autoimmune encephalitis for his entire professional life. In that case, Hannibal does not “infect” him. We see Will take aspirin to manage headaches—a common early symptom—as early as “Aperitif,” before the pair’s initial meeting. Hannibal does, however, stoke the fire and “let [Will] burn,” as Sutcliffe puts it. Not only does he gaslight Will about his condition and withhold medical treatment but we also learn in “Yakimono” that Hannibal uses light therapy on Will without his knowledge or consent to induce seizures and create blackouts. “I was under his influence,” Will confesses to Miriam Lass.

Hannibal implies to Sutcliffe that he chose not to disclose Will’s encephalitis out of professional curiosity. “It is so rare to be able to study the psychological effect of this type of malady on a person’s mind,” he muses. “Imagination is an interesting accelerant for a fever.” Sutcliffe joins Hannibal in the conspiracy, lying to Will about his test results for the rare opportunity to study the disease’s neurological effects. But is this really Hannibal’s primary motivation? Perhaps. I am more inclined to believe, however, that another and maybe likelier impetus is his personal fascination with the prospect of Dark Will. An unstable Will might “cultivate” the “urges [he] kept down for so long” and “become someone other than [himself],” as Hannibal says in “Savoureux.” 

Gaslighting and medical abuse aside, Hannibal relies on a familiar strategy to facilitate that dark becoming: persuade Will to kill someone. In “Rôti,” his chosen target is Dr. Abel Gideon, the person who so rudely took Hannibal’s identity as the Chesapeake Ripper. After coaxing Will out of a comatose state, Hannibal feigns concern for Alana. Gideon is still at large, he says; she might be in danger. (Hannibal, of course, told Gideon where to find Alana just moments earlier.) Then Hannibal not so subtly leaves Will alone in his dining room with a loaded gun and car keys on the table. Will takes the bait and goes after Gideon to save Alana, just as Hannibal hoped he would. 

This set-up, however, feels different from the way Hannibal orchestrates Will’s deadly confrontation with Hobbs in “Aperitif” or even the way he similarly moves Bedelia, Abigail, and Miriam to harm others. And it comes down to Will’s acute encephalitis and Hannibal’s abuse of their doctor-patient relationship. Rather than persuade a lucid Will to commit murder, he uses a sick Will as the means to achieve his own ends. First, as a tool to hurt the person who wronged him—Gideon—and then as a scapegoat for his own crimes.

For this reason, I cannot watch the final three episodes of season one without thinking of The Cabinet of Dr. Caligari (Robert Wiene, 1920). Much like Hannibal, Caligari is a fantastical, psychological thriller about madness, obsession, and the abuses of authority. The titular character is the director of an asylum masquerading as a carnie, eventually accused by the story’s protagonist of using his somnambulist patient, Cesare, to murder those who affront him. (Somnambulism is a fancy word for sleepwalking.) And the similarities between Hannibal and Caligari do not stop there. For a thorough comparison of the two, I highly recommend this 2014 post by meejaleibling. The author perfectly explains the significance of Caligari to German and film history, as well as provides thoughtful insights about how the film and series speak to one another on the subjects of genre, narrative, character, aesthetic, and theme.

Hannibal may not turn Will into a “zombie-like instrument” for murder in the same way that Caligari does Cesare, as meejaleibling points out, but both texts use the story of a psychiatrist taking advantage of his sick patient to tap into potent fears about psychological violation and moral corruption. In the 2014 article “Hannibal’s Feminist Take on Horror,” writer Sady Doyle describes the “biggest scare” of the first season thusly:

The biggest scare of the first sea­son wasn’t a gory corpse dis­play — though we got lots of those — but the rev­e­la­tion that Will had encephali­tis, and Han­ni­bal was pre­vent­ing him from get­ting treat­ment. The pri­mal fear here isn’t axe-mur­der, it’s aban­don­ment; all the blood in the world can’t scare us more pro­found­ly than the idea that the peo­ple who care about us may be fak­ing it.

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