• Even still, I readily admit that I’m an unreliable source. No matter how much research I’ve done, the consciousness that defines me as a person wasn’t present then. Plus, I’m biased. It’s my life, and so at the core of this story is the old problem of journalism, made a hundredfold messier.
• There is a dull foreboding in the pit of my stomach. That, I recognize. My thoughts translate only slowly into language, as if emerging from a pot of molasses. Word by word the questions come: where am I? why does my scalp itch? where is everyone? Then the world around me comes gradually into view, beginning as a pinhole, its diameter steadily expanding. Objects emerge from the murk & sharpen into focus. After a moment I recognize them: TV, curtain, bed.
• On my wrist is an orange plastic band. I squint, unable to focus on the words, but after a few seconds, the block letters sharpen: FLIGHT RISK.
• I have felt that odd whirr of wings in the head. (VIRGINIA WOOLF)
• Maybe it all began with a bug bite, from a bedbug that didn’t exist.
• Though it’s notoriously obsessed with what’s new, the Post is nearly as old as the nation itself. Established by Alexander Hamilton in 1801, it is the longest continually run newspaper in the country. In its first century alone, the paper crusaded for the abolition movement and helped promote the creation of Central Park. Today the newsroom itself is cavernous yet airless, filled with rows of open cubicles and a glut of filing cabinets packed with decades of unused, forgotten documents. The walls are freckled with clocks that don’t run, dead flowers hung upside down to dry, a picture of a monkey riding a border collie, and a big foam Six Flags finger, all memorabilia from reporters’ assignments. The PCs are ancient, the copy machines the size of small ponies. A small utility closet that once served as a smoking room now holds supplies, and is marked by a weathered sign warning that the smoking room no longer exists, as if someone might accidentally wander in for a cigarette among the monitors and video equipment. This has been my eccentric little world for the past seven years, since I started here as a seventeen-year-old intern.
• “What color were the socks of the guy who jumped off the bridge?”
• We sat there in silence for a moment, as I tried to let myself be comforted by Paul’s familiar, larger-than-life presence. With his shock of prematurely white hair and his propensity to toss the word fuck around like a preposition, he is the essence of a throwback newsman and a brilliant editor.
• ...I said, desperately plucking up wisps of half-formed ideas.
• She laughed, revealing a few charmingly crooked incisor teeth.
• I brooded over the day’s disasters that evening as I walked west from the News Corp. building on Sixth Avenue, through the tourist clusterfuck that is Times Square, toward my apartment in Hell’s Kitchen. As if purposely living the cliché of a New York writer, I rented a cramped one-room studio, where I slept on a pullout sofa. The apartment, eerily quiet, overlooked the courtyard of several tenements, and I often awoke not to police sirens and grumbling garbage trucks but to the sound of a neighbor playing the accordion on his balcony.
• Though it felt necessary at the moment, this callous throwing away of years’ worth of work was completely out of character for me. I was a nostalgic pack rat, who held on to poems that I had written in fourth grade and twenty-some-odd diaries that dated back to junior high. Though there didn’t seem to be much of a connection among my bedbug scare, my forgetfulness at work, and my sudden instinct to purge my files, what I didn’t know then is that bug obsession can be a sign of psychosis. It’s a little-known problem, since those suffering from parasitosis, or Ekbom syndrome, as it’s called, are most likely to consult exterminators or dermatologists for their imaginary infestations instead of mental health professionals, and as a result they frequently go undiagnosed.
• As I knelt by the black garbage bags, I was hit with a terrible ache in the pit of my stomach—that kind of free-floating dread that accompanies heartbreak or death. When I got to my feet, a sharp pain lanced my mind, like a white-hot flash of a migraine, though I had never suffered from one before. As I stumbled to the bathroom, my legs and body just wouldn’t react, and I felt as if I were slogging through quicksand.
• Clinking our bottles of Sierra Nevada, we bonded over our shared dislike for shorts and our passion for Dylan’s Nashville Skyline. Stephen was alluring in that languid, stay-out-all-night kind of way: a musician with long, unkempt hair, a skinny smoker’s frame, and an encyclopedic knowledge of music. But his eyes, trusting and honest, have always been his most attractive trait. Those eyes, with nothing to hide, made me feel as if I had dated him forever.
• A stranger stared back from my reflection; my hair was wild and my face distorted and unfamiliar.
• I had lost two hours. It felt like five minutes. Moments later, the migraine returned, as did the nausea. It was then that I first noticed my left hand felt funny, like an extreme case of pins and needles. I clenched and unclenched my hand, trying to stop the tingling, but it got worse. I raced to the dresser to put away his things so that he wouldn’t notice my pilfering, trying to ignore the uncomfortable tingling sensation. Soon though, my left hand went completely numb.
• It was like I was possessed.
• When I got to my desk, I noticed that the numbness in my left hand had returned—or maybe it had never left?—and had moved down the left side of my body to my toes. This was perplexing...
• To keep calm, I fixated on the strangest and most colorful of the paintings—a distorted, abstract human face outlined in black with bright patches of primary colors, red pupils, yellow eyes, blue chin, and a black nose like an arrow. It had a lipless smile and a deranged look in its eyes. This painting would stick in my mind, materializing again several more times in the coming months. Its unsettling, inhuman distortion sometimes soothed me, sometimes antagonized me, sometimes goaded me during my darkest hours. It turned out to be a 1978 Miró titled Carota, or carrot in Italian.
• Dr. Saul Bailey was a grandfatherly-looking man. He introduced himself, extending his left hand, which was soft but strong. In my own, smaller one it felt meaty, significant. He spoke quickly.
• ...feeling uncomfortably exposed in just the hospital gown.
• Unpleasant as they can be, MRIs are largely unremarkable. But something about this visit, especially that innocent exchange with the tech, stayed with me long after the appointment, much like the Carota picture. Over time, the tech’s mild flirtations teemed with a strange malevolence created entirely by my churning brain.
• It was a relief to have a word for what plagued me.
• ...we met at a local Irish pub, sitting in the dining area underneath a low-hanging antique chandelier that let off little tufts of light.
• Stephen, Sheila, and Roy made small talk as I sat there, mute. I had met Sheila and Roy only a few times and hated to imagine what kind of impression I was making, but I couldn’t rouse myself to join the conversation. They must think I have no personality.
• The background music swelled... I felt the pulse of the crowd... The breath of the man and woman behind me flared hotly on my neck. I couldn’t focus on the music.
• “I used to try to forget about you,” Randy “the Ram,” a washed-up pro wrestler played by a haggard Mickey Rourke, says to his daughter.3 “I used to try to pretend that you didn’t exist, but I can’t. You’re my little girl. And now I’m an old broken-down piece of meat and I’m alone. And I deserve to be all alone. I just don’t want you to hate me.” Hot, wet tears ran down my cheeks. Embarrassed, I tried to control the heaving in my chest, but the exertion made me feel worse. Without saying a word to my father, I ran from my seat to the theater’s bathroom, where I hid in a locked stall and allowed myself to weep until the feeling passed. After a moment, I collected myself and headed out to wash my hands and face, ignoring the concerned rubbernecking of the middle-aged blond at a nearby sink. When she left, I stared at my image in the mirror.
• Insecurity is part of the job, I told myself. Reporters exist in a state of constant self-doubt...
• That afternoon we borrowed my mom’s black Subaru and drove four hours north to Arlington, Vermont. It was a perfect weekend: Saturday and Sunday mornings we went to a quaint local restaurant called Up For Breakfast, shopped at outlet malls, and hit the slopes—or, rather, Stephen snowboarded as I read Great Expectations in the lodge. On Sunday a snowstorm hit, so we were happily forced to stay another day...
• Safe at the bottom a few minutes later, though, I recognized that this panic had been far more critical than just a fear of heights. Still, I said nothing further about it to Stephen.
• I was still having trouble sleeping, but now instead of nervous, I felt nostalgic. I riffled through old clothes and discovered I finally fit into pants that I’d only been able to pull up to my midthigh since sophomore year in high school. I must be doing something right, I thought gleefully. I would soon learn firsthand that this kind of illness often ebbs and flows, leaving the sufferer convinced that the worst is over, even when it’s only retreating for a moment before pouncing again.
• She smelled of incense and patchouli and had drooping, trustworthy, puppy eyes. There was something attractive about her energy, and despite my innate skepticism of witchcraft and religion overall, I found myself wanting to believe.
• Waves of calm coursed through my system as I concentrated on her words. I had needed someone to tell me that I was going to be okay, that these odd setbacks were just blips on the radar of my life. In retrospect, Liz may not have been the right person to go to for this kind of reassurance.
• The pages were breathing visibly, inhaling and exhaling all around me. My perspective had narrowed, as if I were looking down the hallway through a viewfinder. The fluorescent lights flickered, and the walls tightened claustrophobically around me. As the walls caved in, the ceiling stretched sky-high until I felt as if I were in a cathedral. I put my hand to my chest to quell my racing heart and told myself to breathe. I wasn’t frightened; it felt more like the sterile rush of looking down from the window of a hundred-story skyscraper, knowing you won’t fall.
• He still had the makeup on from his Fox News interview, and it had melted a bit under the bright lights of the studio.
• It was a gorgeous early March morning, the sun was out, and the temperature was a crisp thirty degrees. I had walked through Times Square twice a day for six months, but today, once I hit the rows of billboards at its center I was accosted by its garish colors. I tried to look away, to shield myself from shock waves of pigment, but I couldn’t. The bright blue wedge of an Eclipse gum sign emitted electric swirls of aqua and made the hair on the back of my neck stand up. I could feel the colors vibrating in my toes. There seemed to be something exquisite about that rush; it was simultaneously enervating and thrilling. But the thrill lasted only a moment when, to my left, the moving scroll of “Welcomes you to Times Square” caught my attention and made me want to retch in the middle of the street. M&M’s on an animated billboard to my left pirouetted before me, forging a massive migraine in my temples. Helpless in the face of this onslaught, I covered my eyes with mittenless hands, stumbling up Forty-Eighth Street as if I had just gotten off a death-defying roller coaster, until I hit the newsroom, where the lights still felt bright but less aggressive.
• “Angela, I have to tell you something strange,” I whispered, concerned that people might be listening in, thinking I was crazy. “I see bright colors. The colors hurt my eyes.”
• As the crying spell took over my whole body, I became prisoner to it. The more I told myself to stop, the more powerful the sensation became. What was causing these hysterics? I fixated on anything my mind could grasp, picking apart the minutiae of my life, anything that felt uncertain.
• The tears continued down my face, but I was surprised to realize that instantly I was no longer sad. I was fine. Not fine. Happy. No, not happy, sublime, better than I had ever felt in my entire life. The tears kept coming, but now I was laughing. A pulse of warmth shot up my spine. I wanted to dance or sing, something, anything except sit here and wallow in imaginary misery. I ran to the bathroom to splash some water on my face. As the cold water flowed, the bathroom stalls suddenly looked alien to me. How was it that civilization had gotten so far but we still defecated in such close proximity to one another? I looked at the stalls and, hearing the flushing of toilets, I could not believe that I had ever used one before.
• I lugged armfuls of books that I’d been saving for reasons I could no longer remember to the floor’s Dumpster and discarded them all, as if they were evidence that I was a hoarder who had been unraveling for months. I suddenly felt in control of every part of my life. That buoyant happiness had returned. But even then I recognized it was a perilous happiness. I feared that if I didn’t express it and appreciate it, the emotion would blaze and burn away as quickly as it came.
• “Everything is going to be great!” I announced, ignoring Angela’s astonishment. I sauntered over to Paul’s desk, high on my brand-new, wonderfully simple theory on life.
• I stayed outside. If anyone looked at me then, they would have assumed that I was deep in thought or working out a story in my head—nothing out of the ordinary. But in fact I was far away. The pendulum had swung again, and now I felt wobbly and height-sick, that same feeling I’d had at the top of the mountain in Vermont, except without the terror. I floated above the crowd of News Corp. employees. I saw the top of my own head, so close that I could almost reach out and touch myself. I saw Liz, the Wiccan librarian, and felt my “self” reenter my grounded body.
• There was no time for pleasantries. “Liz, did you ever feel like you’re here but you’re not here?” ... “No, no, you don’t understand. I can see myself from above, like I’m floating above myself looking down,” I said, wringing my hands... “Like you’re in your own world. Like you’re not in this world.”
• I had been thinking about all of that, but it was a struggle to make one detail fit well enough to solve the entire problem, like jamming together pieces from incongruent sets of puzzles. “There’s something else,” I agreed. “But I don’t know what it is.”
• I stood up and paced. My thoughts were running wild from guilt to love to repulsion and then back again. I couldn’t keep them straight, so I moved my body to quiet my mind. Most of all, I didn’t want him to see me in this state.
• ...while having to physically restrain myself from pacing around the apartment. __I couldn’t stay with one thought; my mind was flooded with different desires, but especially the urge to escape. __
• “I feel like my heart is beating out of my chest.”
• I laughed right before everything went hazy.
• When he suggested I try to relax, I turned to face him, staring past him like I was possessed. My arms suddenly whipped straight out in front of me, like a mummy, as my eyes rolled back and my body stiffened. I was gasping for air. My body continued to stiffen as I inhaled repeatedly, with no exhale. Blood and foam began to spurt out of my mouth through clenched teeth. Terrified, Stephen stifled a panicked cry and for a second he stared, frozen, at my shaking body. Finally, he jumped into action—though he’d never seen a seizure before, he knew what to do. He laid me down, moving my head to the side so that I wouldn’t choke, and raced for his phone to dial 911.
• This moment, my first serious blackout, marked the line between sanity and insanity. Though I would have moments of lucidity over the coming weeks, I would never again be the same person. This was the start of the dark period of my illness, as I began an existence in purgatory between the real world and a cloudy, fictitious realm made up of hallucinations and paranoia. From this point on, I would increasingly be forced to rely on outside sources to piece together this “lost time.”
• Everything that had been happening to me in recent weeks was part of a larger, fiercer battle taking place at the most basic level inside my brain.
• The healthy brain is a symphony of 100 billion neurons, the actions of each individual brain cell harmonizing into a whole that enables thoughts, movements, memories, or even just a sneeze. But it takes only one dissonant instrument to mar the cohesion of a symphony. When neurons begin to play nonstop, out of tune, and all at once because of disease, trauma, tumor, lack of sleep, or even alcohol withdrawal, the cacophonous result can be a seizure.
• ...the symptoms from this type of seizure can range from a “Christmas morning” feeling of euphoria to sexual arousal to religious experiences.67 Often people report feeling déjà vu and its opposite, something called jamais vu, when everything seems unfamiliar, such as my feeling of alienation in the office bathroom; seeing halos of light or viewing the world as if it is bizarrely out of proportion (known as the Alice in Wonderland effect), which is what was happening while I was on my way to interview John Walsh; and experiencing photophobia, an extreme sensitivity to light, like my visions in Times Square. These are all common symptoms or precedents of temporal lobe seizures.
• A small subset of those with temporal lobe epilepsy—about 5 to 6 percent—report an out-of-body experience, a feeling described as being removed from your body and able to look at yourself, usually from above. There I am on a gurney. There I am being loaded into the ambulance as Stephen holds my hands. There I am entering a hospital. Here I am. Floating above the scene, looking down. I am calm. There is no fear.
• I hadn’t felt like myself for weeks, but the real damage to my personality was only now bubbling to the surface. Looking back at this time, I see that I’d begun to surrender to the disease, allowing all the aspects of my personality that I value—patience, kindness, and courteousness—to evaporate. I was a slave to the machinations of my aberrant brain. We are, in the end, a sum of our parts, and when the body fails, all the virtues we hold dear go with it. I am not dead yet.
• ...my voice mellowing as I returned, almost instantly, to my old self. Manic episodes can fade away as quickly as they arise.
• Allen’s brother was schizophrenic, and as a result Allen had turned inward, maintaining only a few important friendships and living primarily in his own world. He was animated with his closest loved ones, gesticulating wildly with his hands and laughing a contagious guffaw; with outsiders, he could be quiet and aloof, to the point of seeming rude. But his warmth and calm, not to mention his experience with mental illness, would prove invaluable over the coming weeks.
• Seconds later, the normally muted green of the couch grew noxiously garish. Then the room seemed to pulsate and breathe, like the office hallway.
• “No great mind has ever existed without a touch of madness,” Aristotle said.
• I spent the night in a state of ecstasy: I had a name for what plagued me, and those two words, which fell off the tongue so sweetly, meant everything. I didn’t even want to be “cured.” I now belonged to an exclusive club of creatives.
• As I made my case through my strange, jumpy logic, she jotted down her impressions on two pages of wide-ruled paper: “Said she had bipolar disorder. Hard to conclude,” she wrote. “Everything is very vivid. Started in last few days. Can’t concentrate. Easily distracted. Total insomnia but not tired, not eating. Has grand ideas. No hallucinations. No paranoid delusions. Always impulsive.” Dr. Levin asked if I had any history of feeling this way and wrote, “She’s had hypomanic attacks her whole life. Always has high energy. But has negative thoughts. She was never suicidal.”
• The Keppra must be causing my insomnia, forgetfulness, anxiety, hostility, moodiness, numbness, loss of appetite. It didn’t matter that I had been on the drug for only twenty-four hours. It was all the Keppra. An Internet search proved it. These were all side effects of that toxic drug.
• Even during this time when I hardly recognize myself, there are still shadows of the real Susannah, a person who cares what her family and friends think, who doesn’t want to cause them pain.
• Wisely, gently, my father suggested that I write down all my racing thoughts. So that’s what I did for the next few days: “My father suggested writing in a journal, which is definitely helping me. He told me to get a puzzle and that was smart because he too thinks in puzzles (the way things fit together).”
• Some of the statements are incoherent messes, but others are strangely illuminating, providing deep access to areas of my life that I’d never before examined. I wrote about my passion for journalism...
• As I wrote these lines and others, I felt that I was piecing together, word by word, what was wrong with me. But my thoughts were tangled in my mind like necklaces knotted together in a jewelry box. Just when I thought I had untwisted one, I would realize it was connected to a rat’s nest of others. Now, years later, these Word documents haunt me more than any unreliable memory. Maybe it’s true what Thomas Moore said: “It is only through mystery and madness that the soul is revealed.”
• Stephen grabbed my hand and walked me out of the restaurant into the freedom of the frigid air. Now I could breathe again. Stephen drove me to nearby Madison, to a dingy bar called Poor Herbie’s where there was no wait. The waitress, a woman in her midsixties with frizzy bleached blond hair and gray roots, stood at the table with her left hand on her hip, waiting for our orders. I just stared at the menu.
• When the food came, I could focus only on the greasy french dressing congealing on Stephen’s corned beef sandwich. I looked down at my own sandwich despairingly; nothing could convince me to put it to my lips.
• As we walked to the car, two conflicting urges struck me: I needed either to break up with Stephen here and now or profess my love to him for the first time. It could go either way; both impulses were equally intense.
• Sometimes I would trail off midsentence, staring off into space for several minutes before continuing my conversation. During these moments, the paranoid aggression receded into a childlike state. These times were the most unnerving for everyone, since I’d been pigheadedly self-sufficient, even as a toddler. We didn’t know it then, but these too were complex partials, the more subtle types of seizures that create those repetitive mouth movements and that foggy consciousness. I was getting worse by the day, by the hour even, but no one knew what to do.
• Reading these entries now is like peering into a stranger’s stream of consciousness. I don’t recognize the person on the other end of the screen as me. Though she urgently attempts to communicate some deep, dark part of herself in her writing, she remains incomprehensible even to myself.
• “Susannah,” Stephen said in a level tone, a timbre I had never before heard from him. “That is not okay.”
• When I walked into the office, something felt different about the place, odd, alien. I felt like Gonzo walking into the casino after he had dropped mescaline in Fear and Loathing in Las Vegas. Nothing was as it seemed, and everything dripped with apocalyptic meaning. The other waiting patients were caricatures, subhuman; the glass window that separated the receptionist from us seemed utterly barbaric; the Miró was smiling down at me again with that twisted, unnatural grin. We waited. It could have been minutes or several hours, I have no idea. Time didn’t exist here.
• When she closed the door behind her, I smiled. That smile turned into a laugh, a belly laugh dripping with bitterness and resentment. It all made sense. This was all a ruse, set up to punish me for my bad behavior and tell me that I’m suddenly cured. Why would they try to trick me? Why would they arrange something this elaborate? She wasn’t a nurse. She was a hired actor.
• "...Well, it didn’t work. I’m too smart for your tricks.”

My mom’s mouth fell open in horror, but my paranoia read it as nothing more than mock-surprise.

• They set the long harvest table and brought over a heaping, pulsating dish of reds, greens, and yellows—tomato, basil, cheese, and penne—in a blue Le Creuset pot. Pancetta glistened unnaturally in the blood-red tomato sauce.
• The words hung in the air around me, like pockets of smoke. I didn’t see her mouth move.
• Beyond that, I can’t remember much at all of that night, which might be my body’s way of trying to preserve some self-respect. No one wants to think of herself as a monster. My father doesn’t remember what happened either, although it’s more likely that he has consciously chosen to forget. I do know that I said something terrible to him—something so awful that it made my father cry, the first time I had ever seen him cry in my life. But instead of generating sympathy, this just added to my twisted need for power.
• Yes, I could probably have made the jump. But then I caught sight of a small Buddha that Giselle kept on the bathroom counter. It smiled at me. I smiled back. Everything would be all right.
• Unlike before, there are now no glimmers of the reliable “I,” the Susannah I had been for the previous twenty-four years. Though I had been gradually losing more and more of myself over the past few weeks, the break between my consciousness and my physical body was now finally fully complete. In essence, I was gone. I wish I could understand my behaviors and motivations during this time, but there was no rational consciousness operating, nothing I could access anymore, then or now. This was the beginning of my lost month of madness.
• Which is more puzzling, the existence of suffering or its frequent absence? (Franz Wright)
• Because I was still in the midst of what seemed to be psychosis, many tests were impossible to conduct.
• Immediately she noticed that I was “labile,” meaning prone to mood swings, and “tangential,” meaning that I skipped from topic to topic without clear transitions.
• Dr. Russo allowed me to ramble on for a few minutes before redirecting me. “Can you tell me a little about how you felt before you came to the hospital?” “I felt like I disappeared.”
• Siegel was charismatic and approachable. After the neurological exam, he extended his hand to my mother and said, “We will figure this out. Susannah will be fine.” My mother clung to these words like a life raft and nicknamed the doctor “Bugsy”—her own doctor gangster.
• I can’t hear their voices anymore. Her skin is so smooth. I stare at the doctor’s cheekbones and pretty olive skin. I stare harder, harder, harder still. Her face swirls before me. Strand by stand her hair turns gray. Wrinkles, first just around her eyes, and then around her mouth and across her cheeks, now line her entire face. Her cheeks sink in, and her teeth turn yellow. Her eyes begin to droop, and her lips lose their shape. The striking young doctor ages right before my eyes. I turn away and look at Stephen, who stares back at me. Stephen’s stubble morphs from brown into a muted gray; his hair turns white like snow. He looks like his father. Out of the corner of my eye, I watch the doctor. Now she is growing more radiant with each passing second. All the wrinkles on her face smooth out, her eyes grow pert and oblong, her cheeks gain baby fat, and her hair turns a deep chestnut brown. She’s thirty, twenty, thirteen. I have a gift. I can age people with my mind. This is who I am. And they cannot take this away from me. I am powerful. Stronger than I have ever been in my life.
• The term schizoaffective disorder was introduced in 1933 in a much-quoted paper, “The Schizoaffective Psychoses”: “Like a bolt from the blue, full-blown delusions suddenly shatter the poise of a fully rational mind . . . and flare up without premonitory signs. . ."
• Alone, I could not fight this battle.
• If she were a computer, he thought, we would have to restart her hard drive.
• My dad slid a fresh pair of nonskid, moss-colored socks over my feet and helped me off the bed. He noticed I had no electrodes on my head, but as it turned out this was just because I had removed them again during another overnight escape attempt, and the staff hadn’t yet been able to replace them.
• Whatever I suffered from seemed to ebb and flow, minute to minute, hour to hour.
• Most of the time I stared off into space, without any visible display of emotion, my psychosis now completely replaced by passivity. Still, these remote spells were sometimes punctuated by a few passionate pleas for help. In my few seemingly lucid moments (which are, like the rest of this time, still foggy or entirely blank in my own recollection), my dad felt as if some primal part of me was reaching out to him as I repeated over and over, “I’m dying in here. This place is killing me. Please let me leave.” These invocations deeply pained my father. He desperately wanted me out of this soul-sucking situation, but he knew there was no other option than to stay.
• ...inside the hospital it was as if time didn’t exist. Stephen likened the atmosphere to Atlantic City, with beeping blood pressure monitors instead of slot machines and sad, sick patients instead of sad, sick gamblers. Like a casino, there were no clocks or calendars. It was a stabilized, static environment; the only thing that punctuated the time was the endless activity of the nurses and doctors. From what my family could tell, I had developed an affection for two of the nurses: Edward and Adeline. Nurse Edward, a burly guy with a warm smile, was the only man on a floor of all female nurses, and because of this, he was often mistaken for a doctor. He took it in stride, maintaining an extraordinarily cheery disposition, and joked with me about the Yankees and the New York Post, his favorite newspaper. By contrast, Nurse Adeline, a middle-aged Filipino woman, was tigerishly efficient, a straight shooter who offered a healthy dose of discipline. Apparently she had a calming effect on me.
• Still, certain little things brought me joy: I looked forward to the slow, rickety walks that allowed me to skip the daily shots required to prevent blood clots in bedridden patients. Beyond that, I had two other obsessions, apples and cleanliness. Whenever anybody asked me what I wanted, my answer was always the same: “Apples.” I expressed a constant desire for them, so everyone who visited brought apples: green ones, red ones, tart ones, sweet ones. I devoured them all. I don’t know what prompted this fixation; perhaps some metaphorical urge to “have an apple a day, and keep the doctor away.” Or maybe the urge was more basic: apples contain flavonoids, which are known to have anti-inflammatory and antioxidant effects on the body. Was my body communicating something that my mind—and my doctors—didn’t yet understand?
• I also insisted on having my clothes changed and cleaned every day. My mother believed this was a subconscious yearning to rid my body of the sickness, whatever it was.
• ...my slurring of words had worsened so considerably that it was as if my tongue was five sizes too big for my mouth. This scared her more than the hallucinations, the paranoia, and the escape attempts: this was measurable, consistent change, but in decidedly the wrong direction. My tongue twisted when I spoke; I drooled and, when I was tired, let my tongue hang out of the side of my mouth like an overheated dog; I spoke in garbled sentences; I coughed when I drank liquids, which required that I drink water out of a cup that dispensed only a tablespoon of liquid at a time; I also stopped speaking in full sentences, moving from unintelligible ramblings to monosyllables and sometimes just grunts. “Can you repeat after me?” Dr. Russo, the neurologist, asked. “Ca, ca, ca.” But the hard sounds of the c’s coming from my mouth were so softened that the consonant became unrecognizable, more like “dtha, dtha, dtha.”
• To return to the analogy of the Christmas lights, even if just one area goes out, many different connections may be altered. It’s often difficult to locate one area and make a causal connection to basic functions or behavior. Just like everything else in the brain, it’s complicated. Or, as author William F. Allman put it in Apprentices of Wonder: Inside the Neural Network Revolution, “The brain is a monstrous, beautiful mess.”
• She couldn’t tell what was real and what had been engineered by my tortured mind. Allen agreed that it was likely the latter...
• In other words, a catatonic patient cannot sense his or her body in space, and therefore cannot appropriately adjust. The result is that a person sits very still in awkward, atypical, unnatural poses. Catatonia is more akin to the results of a botched lobotomy than a persistent vegetative state because the person is technically still active. There are behaviors of a sort, as bizarre, nonresponsive, and inappropriate as they may be.
• “She’s still in there,” Stephen said. “I can see her. She’s still there. I know it.”
• “My . . . heart . . . hurtssssssss . . .,” I said, holding my chest and squirming on the cold hospital floor. “I . . . can’t . . . breeeeathe.”
• Sometimes when I seemed to be doing better, the original psychosis would return. This frightened everyone.
• A few minutes later, Dr. Najjar strode into my private room, 1276, his voice booming. H__e had a measured gait and a slight slope to his back that made his head fall a few inches in front of his body, most likely due to the hours he spent hunched over a microscope. His thick mustache was worn at the tips from his habit of twisting and pulling at it when he was deep in thought.__
• His Syrian accent hopped rhythmically, sticking on and accentuating the hard consonants, often turning t’s into d’s. When he got excited, he dropped prepositions and combined words, as if his speech could not keep up with his thoughts.
• One of the remarkable things about Dr. Najjar was his very personal, heartfelt bedside manner. He had an intense sympathy for the weak and powerless, which, as he told me later, came from his own experiences as a little boy growing up in Damascus, Syria.
• Finally, he sat down on the bed near me. He turned to my parents and said, “Her brain is on fire.” He took my small hands into his large ones and leaned down to my eye level. “I’m going to do everything I can for you. I promise I will always be there for you.”
• The OR was the embodiment of medicine on an industrial scale, a sterile place with doors snaking into dozens of operating theaters. Gone were the landscape paintings and soothing music; this was where the serious surgeries happened.
• After some spotty and tangential answers, I finally said, “I can’t get my ideas from my head out.” She nodded: this was a typical response for people suffering from aphasia, a language impairment related to brain injury. I also had something called dysarthria, a motor speech impairment caused by a weakness in the muscles of the face, throat, or vocal cords.
• Her next stage of questions assessed attention, processing speed, and working memory, which she compared to a computer’s random access memory (RAM), as in, “How many programs you can have open all at once—how many things you can keep in your head at once and spit back out.”
• With my head in his arms, he could smell the glue on my hair. “We’re going to get you out of here.”
• His voice bounced around the hospital room.
• My mom’s house in Summit looked particularly striking that spring day, my homecoming. The front lawn was lush with fresh green grass, white azaleas, and the blooms of pinkish-purple rhododendrons and yellow daffodils. The sun beamed down on the aged oak trees that shaded the maroon door at the entranceway to the stone-front colonial. It was gorgeous, but no one could tell if I even noticed. I certainly don’t remember it. I just stared ahead, making that constant chewing motion with my mouth as Allen swerved into the driveway of the place I had called home most of my young adult life.
• As if on cue, Stephen and I together belted out the chorus, “California dreamin’ on such a winter’s day!” For a moment, Stephen took his eyes off the road and glanced at me in astonishment and joy. Finally, here was the confirmation he had been waiting for all these weeks: I was still in there.
• Fear of this sort is not something we typically capture in photographs or videos of ourselves. But there I am, staring into the camera as if I’m looking death in the face. I have never seen myself so unhinged and unguarded before, and it frightens me. The raw panic makes me uncomfortable, but the thing that truly unsettles me is the realization that emotions I once felt so profoundly, so viscerally, have now completely vanished. 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. Without this electronic evidence, I could never have imagined myself capable of such madness and misery.
• "What did it feel like to be a different person?” people ask.
• The transformation was extreme, as though a hummingbird had turned into a sloth.
• For me, it was an equally powerful encounter. He had always been my kid brother, but now he had become a man overnight, complete with stubble and broad shoulders. He looked at me with such a devastating mixture of surprise and sympathy that I almost fell to my knees. It wasn’t until I saw the look on his face that I realized how sick I still was. Perhaps it was the closeness between us as siblings that brought this realization to the fore, or maybe it was because I had always considered myself an older custodian to baby James, and now the roles were clearly reversed.
• It was amazing how powerless I felt at that moment, especially compared to the superhuman control I had enjoyed during the height of my psychosis.
• He had shaved his beard and cut his shaggy, cheekbone-length hair into a dapper, slicked-back 1940s hairstyle. He looked even more handsome than usual. As I watched him enter the car, I was suddenly filled with an aching feeling of gratitude that I had found such a selfless, devoted person. It’s not as if I hadn’t known that all along; it was just that at that very moment, I couldn’t contain the deep love I had for him, not only for staying with me, but also for providing me with security and meaning at a very difficult time in my life. I had asked him many times why he stayed, and he always said the same thing: “Because I love you, and I wanted to, and I knew you were in there.” No matter how damaged I had been, he had loved me enough to still see me somewhere inside.
• Though recovery is clearly a relative process (you need to know where you’re coming from to see how far you’ve gone)...
• Later she would tell me that the way I presented to people did not match up with what seemed to be going on internally. There was a serious disconnect, and I may have actually been more present than I appeared. I felt this divide too. Often, like at the party and the wedding just a few weeks before, I felt as if my “self” was trying to communicate with the outside world but couldn’t break past the broken intermediary, my body.
• Now her stylized, R&B-tinged vocals wafted through the summer night.
• The brain is radically resilient; it can create new neurons and make new connections through cortical remapping, a process called neurogenesis. Our minds have the incredible capacity to both alter the strength of connections among neurons, essentially rewiring them, and create entirely new pathways. (It makes a computer, which cannot create new hardware when its system crashes, seem fixed and helpless.) This amazing malleability is called neuroplasticity. Like daffodils in the early days of spring, my neurons were resprouting receptors as the winter of the illness ebbed.
• Yet, there are surprising similarities between this diary and the journals I kept during junior high school. In each, there’s a stunning lack of insight and curiosity about myself. In place of deep thought, there are dozens of passages dedicated to my body (weight gain in the recovery piece and lack of breasts in the junior high journal) and silly, petty issues of the day (hating hospital food versus fighting with frenemies). I sympathize with this vulnerable, budding Susannah, as I do that preteen version of myself, but she is still not entirely me, as I am now.
• “To move forward, you have to leave the past behind.”
• At one point in the conversation the only sound James could hear on the other line were deep gulps of air meant to mask the sounds of heavy sobs.
• “To move forward, you have to leave the past behind.” Though I wasn’t ready to do that myself, I could, at least for his sake, follow his motto when it related to him. My strong Irish protector was, at the heart of it all, a big softie, and his love for me, something that during our roughest times I had questioned, was immeasurable. “All I knew was that she was alive, and her spirit was intact. We had more hospital stays for treatments, doctor visits, and lots of medications to deal with, but my baby was on the way home,” the journal ends.
• ...we now met for dinner regularly, which was a vast improvement over the once-every–six months relationship we had had before. Sometimes, now, over a meal, we lock eyes and begin speaking in some sort of secret code, which could be described as an otherworldly connection, inadvertently freezing out everyone else at the table. I never realized how rude we often were until Giselle later brought it up. “I don’t think you guys are aware of it,” she confided, “but sometimes it’s hard for people around you to feel included.”
• We didn’t mean to exclude others. My dad and I had gone off to war, fought in the trenches, and against all odds had come out of it alive and intact. There are few other experiences that can bring two people closer than staring death in the face.
• Just for a brief moment, I could picture the rows of booths in the diner and a blurry man behind the countertop handing me coffee. This recovered image taunted me with the echoes of all the other moments I had forgotten and would never get back. And then it was gone.
• The reality was that I was no longer capable of living on my own.
• The steroids also made my face moon-shaped and chipmunk-like, to the point where I hardly recognized myself in the mirror. I had begun to fear that I would never lose the weight and would be forever confined to this foreign body. The problem was much more superficial—but easier to grapple with—than my real worries about being trapped in my broken mind. I know now that I focused on my body because I didn’t want to face the cognitive issues, which were much more complex and upsetting than mere numbers on a scale. When I worried about being fat forever, marred in the eyes of those closest to me, I was actually worried about who I was going to be: Will I be as slow, dour, unfunny, and stupid as I now felt for the rest of my life? Will I ever again regain that spark that defines who I am?
• Who am I? Am I a person who cowers in fear at the back of a spin class, avoiding everyone’s gaze? This uncertainty about who I am, this confusion over where I truly was in the time line of my illness and recovery, was ultimately the deeper source of the shame. A part of my soul believed that I would never be myself, the carefree, confident Susannah, again.
• Inside, there was my long-lost gold hematite ring. My lucky ring. Sometimes, just when we need them, life wraps metaphors up in little bows for us. When you think all is lost, the things you need the most return unexpectedly.
• It felt strange but also comforting to hear a voice from before my illness: my life was now divided into “pre” and “post” in a way it had never been before.
• “It’s been a crazy couple of months, to say the least. I now know what it’s like to go mad.”
• Buoyed by this new ability to explain, I began to research the disease in earnest and became obsessed with understanding how our bodies are capable of such underhanded betrayal. I found, to my frustration, that there’s more we don’t know about the disease than we do know.
• Studies seem to point to all autoimmune diseases in general as being about two-thirds environmental, one-third genetic.
• The sentiment was kind, but it just made me feel more self-conscious. Was it that obvious that I was uncomfortable? There seemed to be no buffer between what I was feeling and how I appeared. I suddenly felt violently, emotionally naked in front of all these coworkers and friends. I felt like a lab rat, innards exposed, waiting for the impending dissection. The thought jolted me: Would I ever again feel comfortable in this newsroom that basically raised me?
• Patients may be able to return to work, function in society, or even live on their own, but they feel that they have more difficulty doing the things that had once come organically, leaving them essentially still far away from the person they were before the illness.
• As I replayed the encounter while I waited on the platform, I caught sight of myself in the oncoming train and noticed how frizzy my curled hair looked, how puffy my face was, and how chubby my frame had become. Would I ever feel comfortable in my own skin again? Or would this self-doubt follow me around forever?
• “He’s talking about my brain,” I whispered, although I didn’t understand then what these slides portrayed. All I knew was that a very intimate part of myself was on display in front of a hundred strangers. How many people can say that they’ve allowed others to literally see inside their heads? I touched my biopsy scar as Dr. Najjar continued to talk about my brain tissue.
• It was thrilling, if somewhat frightening and dizzying, to think of sharing those confusing months with the world.
• But it was irresistible: Now I had the opportunity to uncover that lost time and prove to myself that I could understand what had happened inside my body.
• Evil. To the untrained eye, anti-NMDA-receptor autoimmune encephalitis can certainly appear malevolent. Afflicted sons and daughters suddenly became possessed, demonic, like creatures out of our most appalling nightmares. Imagine a young girl who, after several days of full-bodied convulsions that sent her flying into the air and off her bed—and after speaking in a strange, deep baritone—contorted her body and crab-walked down the staircase, hissing like a snake and spewing blood. This chilling scene is, of course, from the unedited version of the blockbuster film The Exorcist, and though fictionalized, it depicts many of the same behaviors that children suffering from anti-NMDA-receptor autoimmune encephalitis do.
• In 2009, a thirteen-year-old girl from Tennessee displayed a “range of emotions and symptoms that varied by the hour, at times mirroring schizophrenia, and, at other times, autism or cerebral palsy.”54 She lashed out violently and would bite her tongue and mouth. She once insisted on crab-walking across the hospital floor. She also spoke in a bizarre, Cajun-inflected accent, according to the Chattanooga Times Free Press, which detailed her experience with anti-NMDA-receptor autoimmune encephalitis and subsequent recovery.
• Dr. Najjar, for one, is taking the link between autoimmune diseases and mental illnesses one step further: through his cutting-edge research, he posits that some forms of schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression are actually caused by inflammatory conditions in the brain.
• In the spring of 2009, I was the 217th person ever to be diagnosed with anti-NMDA-receptor autoimmune encephalitis. Just a year later, that figure had doubled. Now the number is in the thousands. Yet Dr. Bailey, considered one of the best neurologists in the country, had never heard of it. When we live in a time when the rate of misdiagnoses in the United States has shown no improvement since the 1930s, the lesson here is that it’s important to always get a second opinion.
• While he may be an excellent doctor in many respects, Dr. Bailey is also, in some ways, a perfect example of what is wrong with medicine. I was just a number to him (and if he saw thirty-five patients a day, as he told me, that means I was one of a very large number). He is a by-product of a defective system that forces neurologists to spend five minutes with X number of patients a day to maintain their bottom line. It’s a bad system. Dr. Bailey is not the exception to the rule. He is the rule.
• I had enough distance from my own madness to view it as a hypothetical. But watching myself on screen, up close and personal, obliterated that journalistic distance. The girl in the video is a reminder about how fragile our hold on sanity and health is and how much we are at the utter whim of our Brutus bodies, which will inevitably, one day, turn on us for good. I am a prisoner, as we all are. And with that realization comes an aching sense of vulnerability.
• Like any other major trauma, this disease bursts you wide open, and after surviving so much, you’re finally prepared to give back and willing to help anyone else who may be going through similar upheavals. But being so exposed, like a gushing wound, leaves you unprotected from the elements.
• I live with that constant refrain—not of self-pity but the real question of why my body decided to turn on itself. Then again, why does this happen to anyone?
• All the people I spoke to had lost themselves. And not everyone had found herself again. Some would never be as smart or funny or animated as before the illness.
• Like these people, I knew exactly what it was like to be caught in the prism of your own fractured psyche.
• This eureka moment happened quietly, more than a year after my diagnosis...
• ...there was no longer a chasm between the person I was inside and what people around me saw. I felt in control and at ease; I no longer struggled for the right words, didn’t have to push myself to make small talk, and had reclaimed my old sense of humor.
• I know that this new Susannah is a lot like the old Susannah. There are changes, but it’s more like a step to the left than an overhaul of my being. I talk fast again, can do my job with ease, feel comfortable in my own skin, and recognize myself in pictures. However, when I look at photographs taken of me “post,” versus pictures of me “pre,” there is something altered, something lost—or gained, I can’t tell—when I look into my eyes.
• But recognizing myself in pictures, of course, does not signify a full return; I’m different than I was before. When I try to pinpoint all the subtle ways that I have changed, my hand instinctively sneaks up to that raw, bumpy bald spot on the front of my scalp that will never grow hair again. It is my permanent reminder that no matter how “normal” I feel, I will never be the same person that I was before.
• I live with this fear. It does not control me or hinder my resolve, but I do live with it. The friends and relatives I interviewed would never have used the term skittish to describe me, but every now and then, when I’m on the subway and the colors seem brighter than normal, I think, Is it the lighting, or am I going crazy again?
• Those closest to me had undoubtedly changed as I did, if not even more so. Stephen, who was once always so laid back, had become a worrier, especially when it came to me. “Do you have your phone? How long will you be gone? Call me the minute you leave,” he would often repeat, calling and texting me over and over if I went just a few minutes without answering my phone.
• For a long time after the hospital, Stephen saw me as a piece of fine and fragile china that could easily break, and he continued as my protector against the cracks and fissures of the real world. Though I’m eternally grateful for this, sometimes it became exasperating when he couldn’t give up that role. How could you blame him? But I did. Accepting this type of nannying was completely outside my personality, normally so self-reliant and obtusely independent. So, perversely, I would battle him, staying out late without calling and pushing his buttons about his constant check-ins. It was only when I started acting like an adult that Stephen started to treat me like one, and slowly we became equals again, evolving into a healthy relationship so different from the caregiver-patient relationship that had been formed under the harsh lights of the hospital room. But of course he still worries, and I doubt this will ever change. His thoughts often return to that night at my Hell’s Kitchen apartment, where my eyes rolled back in my head and my body stiffened, and both of our lives changed forever.
• People never change, they say. I remember when I was entering sixth grade and the guidance counselor called us into her office to talk about the transition from elementary school to middle school. She asked me to pick an emoticon out of a list of about fifty to describe how I felt on the first day of school. I picked “ecstatic,” the one with the wide-mouthed, full laugh. The counselor was surprised by my pick; this apparently was not a common choice. I had been ecstatic then, but would I pick ecstatic now? Or have I lost that spark after all? Is there a sliver of me that did not recover from the fire?
• The impostor EEG nurse, the sea of paparazzi surrounding my father at the top of the news hour, the insult silently hurled at me by my stepfather. These absurd memories persist, while others that are real and documented fall through the fingers of my mind like water. If all I remember are hallucinations, how can I rely on my own mind? To this day, I struggle with distinguishing fact from fiction.
• ...logically, I understood he would never say such things. Yet why did I continue to believe my own bizarre memory over a lifetime of proof? And why did these specific memories remain intact? If I didn’t have a mental illness, how did these hallucinations come about?
• Though subjects on a placebo could also be tricked by the illusion, those on ketamine sooner and more intensely believed that the rubber hand was their own. The experiment showed that the ketamine injections, for whatever reason, helped break down the subjects’ sense of reality, making things that would ordinarily seem impossible to a rational mind, like having the ability to age someone with your mind, suddenly seem possible.
• In the same vein, it is precisely because these hallucinations are self-generated that they are so believable and vividly remembered, explained psychology professor Dr. Philip Harvey. It’s called the generation effect:63 “Because those hallucinations were self-generated,” Dr. Harvey told me, “you were better able to remember them.”
• The amygdala, an almond-shaped structure situated atop the hippocampus, located at the sides of the head above the ears in the temporal lobes, is a structure intimately involved in emotion and memory, helping to choose which memories should be kept and which should be discarded, based on which events have traumatized or excited us.64 The hippocampus tags the memory with context (the hospital room and the purple lady, for example), and the amygdala provides the emotion (fear, excitement, and pain). When the amygdala stamps the experience with high emotional value, it’s more likely to be preserved, a process called encoding, and eventually made into a memory, called consolidation. The hippocampus and amygdala help encode and consolidate the experience, or make it into a memory that can be retrieved later.65 When any part of this elaborate system is compromised, the memory may not be formed.
• A team of New York–based neuroscientists in 2000 demonstrated this assumption in lab rats by testing to see if memories are constantly altered each time we recall them.67 The team uncovered another step in the memory process, called reconsolidation: when a memory is recalled, it’s essentially remade, allowing new (and sometimes wrong) information to filter in. This is normally useful because we need to be able to update our past experiences to reflect present information, but it sometimes creates devious inaccuracies.
• “Our brains make little stories,” explained Dr. Chris Morrison, the neuropsychologist who had tested me at the hospital, when I interviewed her in December 2010. “It’s possible that when you rehearse things so many times, you start to internalize and believe that you were there. You integrate fragments, scenes of things that you could not truly remember.”
• Similarly, a retrieval mechanism is triggered in the brain when we see something recognizable. Smells or images will instantly transport us back in time, unlocking forgotten memories.
• I couldn’t believe how vividly it came rushing back to me. What else had I forgotten? What else would come back, knocking me off balance and reminding me how tenuous my grip on reality was? Almost every day, something reemerges. It can be something insignificant, like the moss-colored socks at the hospital, or a simple word, like the time in the drugstore when I saw a box of Colace, the stool softener I had taken at the hospital, and the memories of Nurse Adeline came rushing in with it. During these moments, I can’t help but think that the other Susannah is calling out to me as if to say, I may be gone, but I’m not forgotten. Like the girl in the video: “Please.” But with every memory I recapture, I know there are hundreds, thousands even, that I cannot conjure up. No matter how many doctors I speak with, no matter how many interviews I conduct or how many notebooks I scavenge, there will be many experiences, bits of my life that have vanished.
• Or maybe on some level, I can remember. I like to believe what Friedrich Nietzsche said: “The existence of forgetting has never been proved: we only know that some things do not come to our mind when we want them to.” Maybe it’s not gone but is somewhere in the recesses of my mind, waiting for the proper cues to be called back up. So far that hasn’t happened, which just makes me wonder: What else have I lost along the way? And is it actually lost or just hidden?
• Before I know it, we’re embracing. The scent of her body is like Purell. Images flood through my mind’s eye: my father feeding me oatmeal, my mom wringing her hands and looking nervously out of the window, Stephen arriving with that leather briefcase. I should be crying, but I smile instead. The purple lady kisses me softly on the cheek.