Opening
In these chapters, Susannah Cahalan steps out of crisis and into the long, uneven work of rebuilding a self. She starts to narrate her own story—assembling a timeline, relearning her craft, and testing who she is now—while confronting the aching gap between how she looks to others and how she feels inside.
What Happens
Chapter 41: Chronology
Susannah explains neuroplasticity—the brain’s ability to rewire—and marks her third hospital stay as her “true moment of awakening.” She begins a diary and, comparing it to her junior high journals, sees the same childlike preoccupations with surface issues like weight. This diary voice, a “budding Susannah,” feels like a separate self, highlighting The Fragility of Identity and Loss of Self.
With her father, Tom Cahalan, she tries to reconstruct a chronology of her illness—and realizes she remembers nothing after her hospital admission. The blank space becomes undeniable proof of profound amnesia, underscoring Memory and Unreliable Narration. Tom, who tends to bury the past, hands her his private journal. On its pages, his pain and devotion are unguarded; the gift itself becomes an act of Love and Family Support that mends their relationship.
Her mother, Rhona Nack, copes by minimizing the illness, creating distance. Over dinner, when Susannah struggles to retrieve a simple memory, Rhona breaks down and admits how afraid she was. Their shared vulnerability finally reconnects them.
Chapter 42: Infinite Jest
Four months after hospitalization, Susannah and Tom pack up her Hell’s Kitchen apartment. Losing her first real place feels like losing adulthood itself, and she moves back in with her mother. To reclaim control, she makes to-do lists, studies for the GRE, and attacks David Foster Wallace’s Infinite Jest—looking up every word yet failing to grasp the plot, a mirror of her fragmented cognition and slowly returning executive function.
She fixates on the 50 steroid-fueled pounds she has gained, calling herself a “roasted pig.” The body becomes a safer target than the terrifying possibility that her mind is permanently slowed—“slow, dour, unfunny, and stupid.” A run-in at a spin class with people from her old life sparks shame and confusion about who she is now.
Sorting old mail, she discovers her long-lost gold hematite ring. Its sudden reappearance glows like a promise—that what is lost might yet be found.
Chapter 43: NDMA
Prompted by her editor at the Post, Paul, to explain her illness, Susannah researches it for the first time. She learns the name—NMDA-receptor autoimmune encephalitis—and begins to stitch together the medical narrative of her “month of madness,” actively engaging with The Diagnostic Mystery. A New York Times Magazine case study helps her understand how her immune system attacked her brain.
The science leaves crucial questions unanswered, especially the trigger. She considers possibilities—a stranger’s sneeze, her birth-control patch, her cat’s autoimmune disease, something in the apartment—and accepts she may never know. Gratitude eclipses the uncertainty: she was at NYU at the right time, under doctors like Dr. Souhel Najjar. Had she fallen ill just three years earlier, before Dr. Dalmau named the disease, she likely would have been misdiagnosed, institutionalized, or dead.
Chapter 44: Partial Return
As at-home IVIG treatments continue, Susannah tiptoes back into her professional life. She plans to visit the office but panics and meets Paul outside instead. He is shocked by her changed appearance and slowed speech and quietly doubts whether she can report again. A colleague, Mackenzie, offers her a light assignment on “Facebook etiquette.” At first, she stalls—haunted by the pre-hospital writer’s block—then the words finally come.
Seeing her byline in the paper feels like redemption. The piece proves she can still do the job and reignites her desire to return. When she visits the newsroom a week later, the warm welcome makes her feel scrutinized and exposed—“violently, emotionally naked,” like a “lab rat.” She wonders whether the place that made her feel most herself will ever feel like home again.
Chapter 45: The Five W’s
Seven months after her breakdown, she returns to work full-time. Her desk sits untouched, a quiet assurance that her place was kept. Colleagues discreetly coach her through basics as she relearns her rhythms. Listening to old interviews, she hears a slurred, unfamiliar voice—her own from the illness. Convinced she’s “100 percent,” she tells her psychiatrist, who releases her—an outcome her family celebrates—even as Dr. Dalmau’s guidance lingers: full recovery takes years, and people often look normal long before they feel normal.
To reclaim her old image, she restyles her hair to cover her biopsy scar. Buoyed by confidence, she runs into an ex on the subway and reads pity in his eyes. Shame floods back—her “puffy” face, the weight, the sense of not being the woman he once knew. She ends the section doubting she’ll ever be at ease in her own skin, the gap between outer recovery and inner coherence yawning wide.
Character Development
Susannah’s arc shifts from survival to authorship: she starts to investigate, narrate, and test the boundaries of her restored life, even as anxiety about her mind and identity spikes.
- Susannah: Moves from passive patient to active agent—researching her disease, rebuilding trust with her parents, and publishing again. Her fixation on weight acts as a pressure valve for deeper fears about cognitive damage and selfhood.
- Tom: Reveals his private suffering through his journal and, by sharing it, deepens father-daughter trust despite his instinct to move on.
- Rhona: Drops denial, admits terror, and reconnects with her daughter through honesty and tears.
- Paul and colleagues: Serve as professional mirrors—supportive yet candid about the hurdles she faces—helping her measure progress in the space that once defined her.
Themes & Symbols
Identity fractures and reforms in layers. The “budding Susannah” voice, the spin-class shame, and the subway encounter with the ex dramatize a self in flux. External milestones—publishing, returning to work—do not erase the internal wobble. That dissonance drives the tension: becoming “functional” is not the same as becoming whole.
Memory’s holes force reconstruction. Building a timeline with Tom exposes the limits of recall and the reliance on others’ accounts and artifacts (diaries, recordings). The narrative becomes a collage, assembling a self from fragments gathered after the storm.
Family love becomes a scaffold. Vulnerability—Tom opening his journal, Rhona crying at dinner—turns private suffering into shared strength, giving Susannah the emotional footing to risk professional return.
Symbols crystallize the struggle:
- The “roasted pig” body: A concrete proxy for abstract dread; the body carries fear that the mind may never fully mend.
- The lucky ring: A talisman of return, suggesting lost parts of self can resurface.
- The byline: A visible token of competency and redemption—proof to others, and to herself, that she still belongs in the newsroom.
Key Quotes
“Budding Susannah”
- Naming the diary voice acknowledges a split self and tracks identity’s tentative regrowth. The phrase frames recovery as emergence, not restoration.
“Roasted pig”
- Her brutal self-image shifts attention from invisible cognitive fear to visible flesh, illustrating how body anxiety contains and expresses psychic terror.
“Violently, emotionally naked” … “a lab rat”
- Back in the newsroom, admiration feels like surveillance. The metaphors capture the alienation of being both welcomed and watched, and the stigma that shadows neurological illness.
“100 percent”
- Declaring full recovery wins release from psychiatric care, yet the certainty falters against Dr. Dalmau’s caution that feeling normal lags far behind appearing normal.
Her “true moment of awakening”
- This turning point reframes the story: from being observed to observing, from patient to narrator. Agency begins with noticing.
Why This Matters and Section Significance
This section marks the pivot from acute diagnosis to the ambiguous aftermath: the marathon of reintegration. Susannah learns that recovery is nonlinear—measured in to-do lists, scalpels hidden by hair, and a byline’s small miracle—and that “getting back” differs from “being back.” Family honesty steadies her, medical discovery saves her, and luck places her in the right hands. The lingering question—Who am I now?—becomes the engine of the chapters ahead, where outward competence must reconcile with the slow, private rebuilding of an inner life.