Opening
A name finally fixes the terror. In Chapters 31–35, Susannah Cahalan is diagnosed with anti-NMDA-receptor encephalitis, pivoting the story from frantic mystery to uncertain recovery. Breakthroughs—a song, a prayer, a video—glow against relapse and fear as the narrative begins stitching her lost self back together.
What Happens
Chapter 31: The Big Reveal
Dr. Russo tells Tom Cahalan the verdict from Dr. Dalmau: anti-NMDA-receptor encephalitis. Susannah’s immune system is attacking her brain, perfectly mirroring her arc from flu-like beginnings to paranoia, seizures, and catatonia. The diagnosis resolves The Diagnostic Mystery that has paralyzed the family, and Tom exhales—he doesn’t need to master the science to feel the relief.
The prognosis is murky: most recover with mild deficits, but some face disability or death. About half of cases are linked to an ovarian teratoma—“monster” cysts with hair, teeth, even bone—so the team discusses chemo and surgery. Susannah, drifting at the edge of the room, breaks down: “This is killing me.” Then hope: Dr. Souhel Najjar believes she can regain “up to 90 percent” of her former self. When a young doctor blithely mentions ovary removal in front of her, Tom erupts and ejects the students, embodying Love and Family Support as fierce protection of Susannah’s dignity.
Chapter 32: 90 Percent
A dermatologist rules out melanoma; an ultrasound finds no teratoma. The news cuts both ways: no tumor to remove means a slower, harder climb back. Najjar lays out a “three-pronged attack”: high-dose steroids to slash inflammation, plasmapheresis to filter out the antibodies, and IVIG to neutralize the rest. He also brings a gift the family craves—she can go home and continue treatment as an outpatient.
After 28 days, she leaves the hospital. Her parents, Tom and Rhona Nack, write a heartfelt thank-you to the nurses. The prescription list is daunting—antipsychotics, anti-seizure meds, anxiolytics—and the prognosis is only “fair.” In the car back to New Jersey with her boyfriend, Stephen, and Lindsey, a favorite karaoke track plays. Susannah starts to bop and robotically wave her arms—rigid, awkward, unmistakably her. It’s brief, but it’s real.
Chapter 33: Homecoming
Home feels alien, and Susannah later remembers none of it. She struggles with basic motor tasks, stuck and furious over a hoodie zipper until Lindsey quietly helps. The humiliation and dependency mark the wound of The Fragility of Identity and Loss of Self: even the simplest acts feel beyond her.
Paranoia surges. Spotting Stephen and Lindsey smoking on the patio, she becomes convinced he will leave her for her best friend. She whispers a panicked voicemail to her mother, begging her to intervene. Alarmed, Rhona calls a doctor, who recommends extra Ativan. The narrator clarifies that this backslide is paradoxically a sign of progress: recovery often runs in reverse, revisiting psychosis before clarity. When Jeff visits, he recoils at her vacant, zombie-like stare. Lindsey leaves in tears, unsure if her best friend will ever return.
Chapter 34: California Dreamin'
Readmitted for a week of plasmapheresis, Susannah endures a jugular catheter and the mechanical drain-and-reinfuse rhythm meant to strip her blood of antibodies. She shares a room with Debra, kind and terrified, awaiting biopsy results. When early-stage colon cancer is confirmed, Debra and the nurses pray, repeating, “God is good.” Susannah, unbidden, echoes, “God is good, Debra. God is good.” For a beat, empathy and clarity shine through the fog.
Back home again, Stephen drives her through familiar streets. He puts on a CD; “California Dreamin’” swells. As the chorus crests, Susannah belts along. Stephen glances over, stunned, then overjoyed. For him, this unforced duet is the first undeniable proof that she is still inside, reachable.
Chapter 35: The Videotape
The perspective snaps to the present. The author watches a hospital videotape of her “month of madness” and does not recognize herself. On-screen, her gown slips; her eyes blaze with “manic fear.” She writes, “That petrified person is as foreign to me as a stranger,” and she cannot imagine what it felt like to be her.
Here the theme of Memory and Unreliable Narration becomes explicit. The tape is hard evidence of an erased past, the record she needs to reconstruct this book and witness her own suffering. Watching her former self plead on the screen, she thinks, “Maybe I can help her,” reframing the memoir as rescue: the recovered narrator reaching back to the silenced patient.
Character Development
These chapters shift everyone from crisis mode to the grind of recovery, revealing character under pressure and the beginnings of repair.
- Susannah: Gains a name for her illness but remains fractured; her empathy (with Debra) and spontaneous singing flicker through psychosis and motor impairment. The author’s present-tense voice in Chapter 35 introduces a dual self—the lost patient and the reconstructing narrator.
- Tom: Moves from frantic father to fierce advocate, throwing out insensitive trainees and insisting on his daughter’s dignity.
- Stephen: Steadfast through weeks of disappearance, he finally receives tangible hope in their “California Dreamin’” duet.
- Dr. Souhel Najjar: Evolves from diagnostic savior to architect of recovery, mapping an aggressive, coherent plan and voicing measured optimism (“up to 90 percent”).
Themes & Symbols
The solved mystery redirects the narrative from “What is wrong?” to “How do we get her back?” Diagnosis relieves existential dread even as it reveals grueling odds. Recovery proves non-linear: Susannah must pass back through paranoia and disorganization before regaining control, underscoring the precariousness of identity and the labor of rebuilding it.
Symbols carry the emotional freight. The jugular catheter and plasmapheresis machine embody the invasive, mechanical nature of healing. The duet to “California Dreamin’” becomes a sonic landmark—evidence that memory and self can surface unprompted. The hospital videotape stands as objective memory, the artifact that allows the author to bridge the chasm between lived experience and narrative, turning erasure into testimony.
Key Quotes
“This is killing me.”
- Susannah’s raw declaration condenses terror, pain, and moral exhaustion into four words. It exposes the human cost beneath the clinical fix—an immune system turned traitor and a patient aware of her own vanishing.
“Up to 90 percent.”
- Najjar’s estimate quantifies hope without promising cure. The phrase becomes a talisman for the family: not a guarantee, but a target that organizes their courage and calibrates expectations.
“God is good, Debra. God is good.”
- In the shared hospital room, Susannah mirrors Debra’s prayer. The repetition signals a momentary reweaving of empathy, language, and social connection—proof that the self can still surface.
“That petrified person is as foreign to me as a stranger, and it’s impossible for me to imagine what it must have been like to be her.”
- The author confronts the fracture between the “video self” and the narrator. The line articulates the memoir’s central paradox: telling a story the mind cannot remember.
“Maybe I can help her.”
- This closing thought reframes the book as an act of rescue across time. The tape doesn’t just record the past; it summons the recovered self to speak for the silenced one.
Why This Matters and Section Significance
These chapters mark the book’s fulcrum. With diagnosis secured, the narrative turns from chaos to the painstaking work of recovery—uneven, humbling, and sustained by family advocacy. The “California Dreamin’” duet offers the first undeniable sign of return, while the relapse at home insists that progress zigzags. Introducing the hospital videotape is structurally crucial: it reveals how the author reconstructs her lost month and transforms a medical case into an exploration of memory, identity, and the power of storytelling to make a self whole again.