Opening
In these closing chapters, Susannah Cahalan interrogates her memories, tests them against science, and rebuilds a coherent self out of missing time. As she traces the line between hallucination and history, she finds anchoring symbols and returns to the hospital that once terrified her, transforming fear into connection and closure.
What Happens
Chapter 51: FLIGHT RISK?
After her illness, Susannah wrestles with memories that feel more vivid than reality—paparazzi tailing her father, an impostor EEG tech, even her stepfather Allen calling her a “slut.” She knows these scenes are false, yet they carry the emotional weight of truth. That tension propels her deep into the terrain of Memory and Unreliable Narration and the shattering uncertainty of not being able to trust her own mind, underscoring The Fragility of Identity and Loss of Self.
She studies how hallucinations form and persist. Research on ketamine—an NMDA-receptor blocker like the dysfunction at the core of her disease—shows healthy people losing their grip on reality and becoming susceptible to illusions. She learns that hallucinations arise from failed “self-monitoring,” when the brain misattributes internal thoughts to the outside world. The “generation effect” makes self-created material easier to remember, while the amygdala and hippocampus stamp emotionally charged experiences into lasting memory—even if those experiences are false.
Her most stubborn false memory is an orange “FLIGHT RISK” wristband. She, her family, and her friends all recall it clearly, but nurses and EEG footage later show no such band—only a likely yellow “FALL RISK” tag. Through memory reconsolidation—the alteration of memories with each recall—and “social contagion,” a fiction can become shared reality. Susannah wonders if she invented the “FLIGHT RISK” band and then passed it to those she loves, a chilling testament to how convincingly memory can lie.
Chapter 52: MADAME X
Susannah speaks with her neuropsychologist, who explains that brains “make little stories,” weaving fragments into a coherent narrative that may not be factual. That principle snaps into focus when a friend brings her to Egan’s pub. At first, nothing registers. Then a chandelier unlocks a cascade: she was there with Stephen right before she got sick; she ordered fish and chips—now viscerally repulsive to her. The moment exposes how precarious her reality feels, yet it also proves that the “other Susannah” can still reach her through sensory cues.
Unpacking an old box, she finds a postcard of John Singer Sargent’s Madame X, with a receipt from the Metropolitan Museum of Art dated February 17, 2009—days before her collapse. She has no memory of the visit. The woman in the painting strikes her as “haughty and sick, as if too arrogant to admit that she is deathly ill,” a figure who unnervingly mirrors her own posture before diagnosis. The image exerts a magnetic pull, a bridge to a self she can no longer access.
Reflecting on forgetting, she invokes Nietzsche: perhaps memories aren’t gone, just inaccessible. She hangs Madame X in her writing room as a talisman of her “lost month,” a reminder that the person who lived through the illness exists—if hidden—waiting for the right key to turn the lock.
Chapter 53: THE PURPLE LADY
Nearly two years after discharge, Susannah returns to the NYU epilepsy unit. She thinks of her parents’ and Stephen’s daily trek to this place, a living proof of Love and Family Support. She initially lands on the wrong floor; when she finds the right wing, a smell of alcohol swabs and musk instantly transports her back.
She spots “the purple lady,” the Jamaican nurse who haunted her paranoid delusions and anchored the book’s opening scene. The nurse doesn’t recognize the healthy woman in front of her—until Susannah introduces herself. “You look all better,” the nurse says, eyes wide, voice warm. They embrace.
That hug remakes the hospital: from a site of terror into a room of human connection. Instead of restraints and panic, Susannah now recalls her father feeding her, her mother’s vigil, Stephen’s steady presence. The circle closes not with tears but with a smile—acceptance, gratitude, and peace replace fear.
Character Development
In these chapters, Susannah shifts from patient to investigator, using science, interviews, and artifacts to rebuild her past and claim authorship of her story. She accepts uncertainty without surrendering agency and reframes her most frightening memories through connection and evidence.
- Tests her own memories against research on NMDA receptors, self-monitoring, and reconsolidation
- Confronts a painful false memory with her mother, choosing repair over suspicion
- Discovers triggered recall (Egan’s chandelier) and learns to invite, not fear, such returns
- Adopts Madame X as a tool for integrating her “lost” self into her present
- Revisits the hospital and transforms the “purple lady” from a symbol of fear to one of care and closure
Themes & Symbols
Susannah’s dismantling of the “FLIGHT RISK” wristband turns the memoir inside out: the story we read is itself a reconstruction, stitched together from journals, videos, medical records, and a mind that once misfired. The text embraces the instability of memory rather than hiding it, inviting readers to see narrative as an ongoing act of reconsolidation.
Her identity fractures and then recomposes around tangible anchors—places, smells, images—that let the “other Susannah” break the surface. Love steadies this process. Family and caregivers fill in the gaps her brain cannot, and their presence helps convert scenes of terror into scenes of care.
Symbols:
- The “FLIGHT RISK” band: the seduction and spread of a compelling falsehood
- Madame X: an artifact of the erased month and a mirror of sick-yet-poised selfhood
- The purple lady: fear transformed into compassion; trauma rewritten as connection
Key Quotes
“You look all better.”
- The nurse’s greeting turns a figure of paranoia into a witness to recovery. Recognition replaces restraint, completing the book’s movement from emergency to empathy.
“How tenuous my grip on reality was.”
- Susannah names the instability at the center of her memoir. The line frames her project: to narrate responsibly while acknowledging the limits of recall.
The brain “make[s] little stories.”
- Her neuropsychologist’s phrase encapsulates confabulation as an adaptive function. Narrative fills gaps; the challenge is to keep those stories honest by testing them against evidence.
“Haughty and sick, as if too arrogant to admit that she is deathly ill.”
- Susannah’s description of Madame X doubles as a portrait of her pre-diagnosis self—composed exterior, hidden catastrophe—making the painting an “objective correlative” for her lost month.
Memories aren’t gone; they’re “just hidden.”
- This idea undergirds her use of cues—smell, light, art—to surface what illness submerged. It reframes forgetting as inaccessibility, not annihilation.
“FLIGHT RISK.”
- The two-word inscription epitomizes a sticky, emotionally charged error that feels truer than truth, illustrating generation effect, reconsolidation, and social contagion.
Why This Matters and Section Significance
These chapters resolve the arc by shifting from the crisis of The Diagnostic Mystery to the ethics and psychology of remembering. Susannah doesn’t just survive; she authors. By integrating studies on ketamine, self-monitoring, reconsolidation, and the generation effect, she bridges reportage and reflection—an embodiment of The Mind-Body Connection.
The structure closes a narrative circle: the book opens with restraint and terror under the “purple lady’s” watch and ends with an embrace on the same unit. That return converts the hospital from site of violation to site of care, proving recovery not as erasure of the past but as its reframing. The memoir’s final lesson is durable and humane: even when memory falters, meaning can be rebuilt—through science, artifacts, and love.