Opening
In these chapters, Susannah Cahalan free-falls from mounting paranoia into full-blown psychosis as her family scrambles to keep her safe. Her mother Rhona Nack, father Tom Cahalan, boyfriend Stephen, and even her doctor Dr. Saul Bailey face the terrifying puzzle of symptoms that blur the line between psychiatric and neurological. A misdiagnosis delays help—until a seizure in a hospital lobby propels Susannah into monitored care and the “lost month” where her memory vanishes.
What Happens
Chapter 11: KEPPRA
Susannah becomes convinced her new anti-seizure medication, Keppra, is poisoning her. She swallows a pill only to appease Rhona, then tries to purge it, recoiling from the one remedy that might steady her. In a rare, lucid night, she watches her mother sleep and feels a flicker of tenderness before insomnia swallows her again. At Tom’s urging, she starts a Word document journal. The entries zigzag between her love for her job at the Post, her need for routine, and a desperate attempt to anchor a self that keeps slipping.
Her paranoia spikes. She proclaims a series of “epiphanies”: first Stephen is the problem, then her job, then New York City. In mid-rant, she crumples into her second grand mal seizure, convulsing on the floor and biting her stepfather’s finger when he reaches to help. Rhona calls Dr. Bailey, who orders an EEG. When Stephen visits, a crowded restaurant overwhelms her; at a quieter bar she cannot eat, then blurts “I love you” for the first time. New, subtler seizures—lip-smacking, blank stares—flicker across her face. Later, her diary reads like a coded message from another mind, frighteningly opaque.
Chapter 12: THE RUSE
Susannah refuses to go to the EEG. Stephen coaxes her into the car “for your mom,” but during the drive she hears her stepfather call her a “slut” without moving his lips. She lunges for the door of the moving car. Stephen grabs her shirt and her stepfather slams on the child locks. The restraint only fuels her terror.
At Dr. Bailey’s office, reality warps. The waiting room feels hostile; a Miró print seems to grin at her. The EEG technician brushes her off, suggesting stress—“all in her head.” The comment detonates her paranoia. Convinced the visit is a punishment, she decides the entire appointment is an elaborate ruse staged by her family and laughs as she confronts her horrified mother.
Chapter 13: BUDDHA
Longing for normalcy, Susannah insists on her own apartment but begrudgingly agrees to spend a night at Tom’s Brooklyn brownstone. When Tom and his girlfriend, Giselle, arrive at Susannah’s filthy place, they start cleaning while she watches, oddly proud of the squalor. She refuses to leave. Tom physically ushers her into a cab; she screams that she is being kidnapped, and Tom snaps at the driver not to stop.
At home, the delusions deepen. Susannah thinks she hears Giselle call her a “spoiled brat.” Imagined pounding from upstairs convinces her Tom is beating Giselle because of her. She says something so vicious it makes Tom cry for the first time in her life. Certain her father will kill her, she barricades herself in the bathroom and considers leaping from a second-story window—until a small smiling Buddha figurine on the counter calms her enough to stand down.
Chapter 14: SEARCH AND SEIZURE
At dawn, Rhona and Allen arrive to pick Susannah up. She bolts outside, shouting that Tom imprisoned her. Tom and Rhona have already agreed she needs hospitalization, but want to avoid a psychiatric ward if possible. Back at Dr. Bailey’s office, he stunningly misreads the case, waving off seizures, paranoia, and hallucinations as “classic signs of alcohol withdrawal,” and tells her to “knock off the partying.”
Rhona refuses. Armed with a symptom list, she demands immediate admission. Dr. Bailey finally secures a bed in the epilepsy monitoring unit at NYU Langone. While they wait in admitting, Susannah slams into another grand mal seizure. From this moment, her memory all but disappears. The reliable narrator of herself—the “I” she recognizes—drops out, and the story enters her lost month.
Chapter 15: THE CAPGRAS DELUSION
Susannah is admitted to the advanced monitoring unit on the epilepsy floor: four beds, round-the-clock video, wires everywhere. She fights the technician placing electrodes; the cameras will later become crucial to reconstructing what she cannot remember. In the fluorescent glare, her paranoia worsens. She screams at her father and accuses him of being an imposter.
A neurologist notes she is “labile” and “tangential.” Her belief that Tom has been replaced by a double is identified as Capgras syndrome—an injury-driven misfire where facial recognition and emotional response no longer connect, so a loved one looks right but feels wrong. That night, sure the nurses are spying and mocking her, she rips out a clump of electrodes—and hair—and bolts for the hallway, only to be caught. Her long hospital siege begins.
Character Development
As seizures multiply and psychosis tightens its grip, Susannah’s recognizable personality shreds. Around her, family and partner step into roles that simultaneously protect her and strain them to the breaking point.
- Susannah Cahalan: From anxious and confused to paranoid and violent, she loses the thread of her identity and then her memory altogether. Short, eerie bursts of tenderness and insight—watching her mother sleep, declaring love to Stephen—flash within a storm of delusions.
- Rhona Nack: The uncompromising advocate. She confronts dismissive clinicians, catalogs symptoms, and forces the issue of hospitalization, keeping Susannah on the medical track that will ultimately save her.
- Tom Cahalan: Loving but pushed to force. He cleans, restrains, absorbs cruelty that makes him cry, and still refuses to abandon his daughter, even as she calls him a double bent on harm.
- Stephen: Steady and lifesaving. He talks Susannah into appointments, catches her as she tries to leap from a moving car, and stays close even as she becomes a stranger.
Themes & Symbols
The fragility of self crystallizes as Susannah’s Word-doc diary becomes a breadcrumb trail from an unraveling mind. In these pages, the need for routine and work collides with frantic “epiphanies,” exposing the collapse mapped in The Fragility of Identity and Loss of Self. When her memory stops at the hospital admission, the book’s perspective shifts, foregrounding Memory and Unreliable Narration: the narrative must be rebuilt from video, charts, and others’ recollections because Susannah’s “I” cannot witness herself.
Dismissal and delay drive The Diagnostic Mystery: a tech’s shrug and a physician’s wrong call (“alcohol withdrawal”) hide a neurological firestorm in psychiatric disguise. Against that failure stands Love and Family Support, the only constant that pushes Susannah into the right ward at the right time. Finally, the naming of Capgras syndrome embodies The Mind-Body Connection: a brain-circuit glitch produces a delusion so convincing it rewrites who a father is, while a small Buddha figurine momentarily soothes a mind in revolt.
Key Quotes
“All in her head.”
A throwaway judgment from the EEG technician becomes gasoline on Susannah’s paranoia and a case study in diagnostic bias. It shows how psychiatric labels can eclipse neurological red flags, delaying proper care.
“Classic signs of alcohol withdrawal.”
Dr. Bailey’s confident misdiagnosis distorts the clinical picture at the worst moment. The line captures the peril of fitting complex symptoms into a familiar, convenient box.
“Knock off the partying.”
Flippant and reductive, this admonition reduces seizures and psychosis to lifestyle. It sharpens the contrast between casual dismissal and Rhona’s urgent, accurate advocacy.
“I love you.”
Uttered to Stephen in a quiet bar as she struggles to eat, the line feels like a flare from the self that’s fading. It underscores how affection can surface even as identity unravels.
“A ruse.”
By naming the appointment an elaborate setup, Susannah reveals persecutory logic that reinterprets care as threat. The word encapsulates how psychosis hijacks meaning and trust.
Why This Matters and Section Significance
This stretch marks the nadir of Susannah’s descent and the pivot toward answers. The lobby seizure turns an outpatient spiral into an inpatient investigation, placing her under continuous monitoring that will eventually expose the true cause of her illness. With Susannah’s memory gone, the memoir’s engine shifts from first-person recall to reconstructed reporting, welding emotional urgency to medical sleuthing. Family persistence against professional skepticism keeps her on the path to a diagnosis, while Capgras and the AMU footage frame the mystery the rest of the book must solve.