Back to Reality

Summary

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Podcast Summary: Snap Judgment – "Back to Reality"

Date: December 9, 2025
Host: Snap Judgment (with PRX)
Featured Guest: Susanna Cahalan

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Main Theme / Purpose

This episode, titled "Back to Reality," is a powerful, cinematic retelling of journalist Susanna Cahalan’s descent into–and recovery from–a rare and serious neurological illness. Mixing raw personal narrative with immersive beats, the story delves into what happens when someone’s grip on reality slips away, the challenges of piecing a life back together, and the line between madness and self.

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Key Discussion Points & Insights

1. The Fracturing of Reality (00:46–03:28)

• The episode opens in an environment of confusion and delusion:

  • Susanna wakes up in a hospital, restrained, with little memory of how she arrived.
  • Describes physical sensations (itchy head, smell of chemicals) and her growing panic.
  • Sees a “flight risk” hospital band and realizes cameras are trained on her at all times.

  Quote:

  • “All I knew is that I wanted to get out any way that I could.” — Susanna (02:11)

2. Delusions and Lost Time (03:34–05:44)

• While reviewing hospital footage, Susanna recounts vivid delusions:

  • Incidents of paranoia, believing herself to be on the news and under threat from her father.
  • Admits to not remembering key events, recollects her emotions as desperate, bored, angry, and confused.

  Quote:

  • “I believe that my dad had actually killed my stepmother and he was going to hurt me.” — Susanna (04:40)

  • Reflects on the persistence of the “unpleasant...very deranged” parts of herself during her psychosis.

3. Before the Breakdown: Life in New York (05:44–07:41)

• Paints her pre-illness life: energetic, stressful, and exciting as a young tabloid reporter.

• Recalls wildly shifting emotions, from intense joy to weeping under her desk.

• Describes a social faux pas with John Walsh that made her realize something was amiss.

  Quote:

  • “My world was so exciting, so stressful, so new, that it took me longer to figure out that something was happening inside of me.” — Susanna (05:44)

4. The Unraveling (07:41–08:29)

• Details the night her boyfriend, Steven, witnessed her become unresponsive.

• Attempted to flee, believing she was being kidnapped, leading to a seizure at NYU.

• From this point, considers herself “an entirely unreliable narrator.”

5. Diagnosis & Hospital Experience (08:29–10:37)

• Introduction of Dr. Suhail Najjar, who administers tests and discerns cognitive impairments (clock-drawing test reveals right-brain neglect).

• Diagnosis: Anti-NMDA receptor autoimmune encephalitis.

• Relief at having a definable, treatable illness after extensive tests showed nothing.

  Quote:

  • “My immune system was attacking my brain. Two weeks into my hospitalization ... everything kept coming back normal. And now we had an answer.” — Susanna (10:02)

6. Recovery and the Challenge of Normalcy (10:37–12:09)

• Undergoes treatments: steroids, plasma exchange, IVIG.

• Released from hospital in April—struggles to read, write, or walk alone.

• Describes the fear and uncertainty: “I had no idea if this was the beginning of the recovery, or if this was the end of recovery.” (10:56)

• Small victories, like walking to get coffee, feel monumental and terrifying.

  Quote:

  • “It’s very destabilizing to have a task that is so mundane suddenly be this big challenge.” — Susanna (11:45)

• Reflections from her mother challenge her perception of recovery (12:09).

7. Reintegration, the Return to Work, and Changed Perceptions (12:09–13:59)

• Attends a wedding, feeling “back,” but friends see her as “robotic.”

• Gradual return to work at the New York Post, starting with easy assignments.

• Eventually writes about her illness; this helps other patients and brings a sense of purpose.

• Ongoing difficulty reconciling self-perception with how others view her.

  Quote:

  • “Everyone described me entirely different. They described me as robotic ... Susannah’s lost her spark.” — Susanna (12:31)

8. Living With Uncertainty and Lasting Change (13:59–16:35)

• Moves in with Steven; faces a 20% relapse risk and hypervigilance about her health.

• Physical reminders: weight gain, a scar from her brain biopsy.

• Candid with Steven about whether she’s changed; his hesitation signals that maybe she has.

  Quote:

  • “Do you think I’m different than I was before? ... He paused for much longer than I would have liked.” (15:06)

• Moments of doubt about what is real: spots something in her peripheral vision, unsure if it’s a hallucination, but is relieved when it turns out to be a real water bug and not a delusion.

  Quote:

  • “I breathed a sigh of relief and I thought, it’s real. It’s real.” — Susanna (16:35)

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Notable Quotes & Memorable Moments

• “There are parts of me, unpleasant parts of myself, very deranged parts of myself, paranoid parts. Those parts were part of me.” (05:22)
• “I started to undergo steroids. I went through plasma exchange, and then I went through an IVIG treatment.” (10:29)
• “So I would kind of push myself to do things that scared me. And I remember walking to town on my own to get a coffee. And that was a very big deal.” (11:26)
• “Probably the biggest story I was able to do at that time was to write about my autoimmune encephalitis. ... Some people got diagnosed, which was amazing.” (13:38)

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Important Timestamps

• 00:46: Episode premise; “Back to Reality.”
• 01:31: Susanna’s first hospital memories.
• 03:28: Recognition of “flight risk” status.
• 04:22: Hallucinations of being “on the news.”
• 05:44: Life before illness.
• 07:41: Unresponsive episode; first seizure.
• 08:29: Meeting Dr. Najjar and diagnostic breakthrough.
• 10:02: Final diagnosis: anti-NMDA receptor encephalitis.
• 11:26: Post-hospital recovery challenges.
• 12:31: Wedding scene, disconnect between internal and external perceptions.
• 13:08: Return to the newsroom.
• 15:06: Steven’s pause about whether Susanna has changed.
• 16:35: Relief at confirming reality with the water bug moment.

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Episode Tone & Style

The storytelling is raw, cinematic, and reflective. It fuses disjointed, vivid memories with a beat-driven background, capturing the chaos and fear of a brain under siege—but also moments of hope, humor, and resilience. Susanna’s voice is candid and self-aware, never shying from her struggles or vulnerabilities.

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Closing Notes

This episode is a moving dive into the journey of reconstructing identity after the mind turns against itself. Susanna Cahalan’s account provides insight into the blurry boundaries between illness and self, the arduous road of recovery, and the lasting impact of psychological trauma—balanced by moments of triumph and humanity.

For those impacted by unusual psychiatric symptoms or medical mysteries, her story is both a caution and a beacon of hope.

(For further exploration of Susanna’s story, listeners are directed to her memoir, “Brain on Fire,” and an upcoming episode of WHYY’s The Pulse.)

Transcript

[A]

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Snappers. Today we have an episode about a whole different type of returning. We're calling it Back to Reality. Now for today's story, I want you to imagine that scene in your favorite thriller. The one where the hero wakes up and has no idea where they are or how they got there, who their friends are. And all sorts of bizarre memories keep popping up. What if that scene was real? And what if that character was you? How would you start to put your world back together? Writer Susanna Cahalan. She found out. Snap judgment.

[B]

What do you, like, remember from that time?

[C]

It was dark. I couldn't really make out if there were other people in the room, but I could hear the sounds of footsteps. I smelled something chemical. I saw a curtain, a green curtain. It was on all sides of me, around me. I also remember this sensation that my head was itchy. I remember that there was a camera, two cameras trained on me.

I couldn't really remember what had brought me there. It was like a blankness that came before.

All I knew is that I wanted to get out any way that I could.

I couldn't get my arms to move because they were restrained. I could not get out of my bed. There was someone sitting there beside the bed who was observing me but not saying anything.

And I said the words, help me. She said, don't do that.

And I said, where am I? And she said, the hospital. You better calm down.

At some point. I said, it hurts.

She unhooked me and I was able to lift my arms to my head where I felt rows of wires, these snakes of wires. I can still feel them, honestly. And I plucked one off.

And I could smell that chemical smell. And I lowered it to eye level.

[A]

And.

[C]

And at that point I saw something on my wrist. Seemed to be a band, like a plastic orange band that said flight Risk.

I had a camera in the room monitoring me all the time.

[B]

I was hoping we could look at some of those videos.

[C]

Sure.

[B]

If that's okay with you.

[C]

Yeah, yeah, of course.

[B]

I Just kind of wanted you to, like, talk about what you're seeing and what's happening. In the video.

[C]

I'm in the advanced monitoring unit. There are three other patients in that room. You can hear the hustle and bustle of doctors and nurses around. I keep hiding my face, turning away. I hit the call button for help. And a nurse comes in over the intercom and. And asks me what's going on, essentially. And I say, it's okay. And I'm repeatedly kind of touching my face, freaked out. At some point, I hand my phone over. I say, I can't have this on me to the nurse, and I tell her, I'm on the news.

[A]

I'm on the news.

[C]

And I remember this vividly. I had seen myself on a top of the hour news program. It was a delusion that had followed me from I outside the hospital. I believe that my dad had actually killed my stepmother and he was going to hurt me.

I later learned that I had a phone on me the whole time, and it looked like I was talking to the phone, but my phone was not charged during that time. So I don't remember who I thought was on the other line, but there was no one on the other line.

[B]

Like, what do you think was in your head?

[C]

It's very hard for me to access that time. I think I was pretty desperate and bored. I think that there were times when I was really angry, when I was really confused.

[B]

Does the person who was thinking those things. Do you feel like that person kind of still exists somewhere?

[C]

Yeah, I was still there. There are parts of me, unpleasant parts of myself, very deranged parts of myself, paranoid parts. Those parts were part of me. And even the content of my delusions and my psychosis, they came from me.

Before I was hospitalized. I was 24 years old, and I had just started dating a musician. And I was living on my own in New York City in an apartment in Hell's Kitchen. I was working as a tabloid reporter. I investigated a mysterious smell in South Street Seaport. I went undercover as a stripper to get illegal butt injections. I never knew what each day would bring. My world was so exciting, so stressful, so new, that it took me longer to figure out that something was happening inside of me.

My emotions swung wildly. One moment I'd be, I mean, most excited and happy I'd ever felt in my life. And then the next moment, I would actually be under my desk crying.

The final interview that I did was with John Walsh from America's Most Wanted. And I was there to interview him about drug smuggling, submarines. And I just found the whole situation hilarious. And it wasn't. It wasn't a funny interview. But I started laughing very inappropriately. The publicist said to me, it's time for John to go. I said, oh, I'll walk you out. And then I just kept repeating, I'm a huge fan. Huge fan. I'm a huge fan. It was such a misstep. And I knew it. And I was devastated, but also just unhinged.

That night, back in my apartment in Hell's Kitchen with Stephen, my boyfriend, he had cooked dinner. We sat down and the last thing I remember was watching a show. And Steven later told me that he awoke to the sound of me grinding my teeth. And he looked over at me and my eyes were wide open but completely unseeing.

And he tried to wake me up, but I wouldn't respond.

So we went and saw a neurologist who then ordered up an eeg. And in the car ride, on the way to get the eeg, I actually felt that they were kidnapping me. And I tried to jump out of the moving vehicle. Steven actually grabbed me. And eventually they stopped the car and had to put on the child locks.

Once we got to nyu, I had a seizure in the waiting area. From this point on, I am an entirely unreliable narrator. I do have memories from this time, some of them murky, some of them extremely vivid. Like the one where I woke up strapped to the hospital bed.

One morning. My mom was there and my dad was there, and this man walks in the door. He's middle aged, he has a thick mustache. He immediately started talking to my parents in a way that no one had. I mean, he really looked at them in the eye, face to face with them, asking them all sorts of questions, handwriting the answers. This was a doctor named Suhail Najjar.

So after this very involved interview with my parents, he switches gears to me. And at one point, he actually just got a piece of paper and a pencil and he asked me to draw a clock. It took me several times to draw a circle properly. And then I started to write the numbers. When I was finished, Dr. Najjar looked down on the page and he really had to restrain himself. He was, I mean, beaming. He saw that I had written all the numbers from 1 to 12 smushed together on the right side with basically nothing on the left hand side.

The drawing showed that I had neglect on the right hand side of my brain, which is responsible for the left field of vision. There was something going on in the right hand side of my brain. And Dr. Najjar suspected that that there was inflammation. And ultimately I tested positive for a newly discovered disease called anti NMDA receptor autoimmune encephalitis.

My immune system was attacking my brain. Two weeks into my hospitalization, I had seen every specialist you can imagine. They administered every test you can imagine. And everything kept coming back normal. And now we had an answer. And this was a huge deal because this was something definable. And not only that, there was a treatment.

I started to undergo steroids. I went through plasma exchange, and then I went through an IVIG treatment.

I was released from the hospital in April. I was still severely impaired. I couldn't read, I couldn't write. You know, I could barely walk on my own. My feelings weren't that robust. But underneath it all was a lot of fear about kind of what would happen next. I had no idea if this was the beginning of the recovery or if this was the end of recovery. By June, I was keeping a journal. I always kept journals. I actually have still have the journal. And it's very sweet in a way, to look back. It's like today was a nice day. The weather was very warm. I was still there. I was still in there. I just couldn't get it out. So I would kind of push myself to do things that scared me. And I remember walking to town on my own to get a coffee.

And that was a very big deal. There are other people there, and there's music playing and there's conversations, and the lighting is weird. What am I going to order? How am I going to pay? It's very disturbing, actually, and very destabilizing to have a task that is so mundane suddenly be this big challenge.

I went fine. I got my cup of coffee.

My psychiatrist would ask me, like, what percentage do you feel back to yourself? And I would almost always say 95%. And my mom would have to say, oh, no. I would say, she's more like 80.

I went to a wedding. I got this, like, bright pink dress, and I wore this dress. And I felt great. I was, like, drinking champagne. I was still on a lot of medication. I shouldn't have done any of this. But I did. Wore, like, high heels. And I danced all night. I felt really good about the whole thing. How I looked, how I acted, my experience. I felt back.

It was only later that I talked to people there and everyone described me entirely different. They described me as robotic. I had a perma smile. They all felt bad for me. One woman went up to my mom. And she said to my mom, oh, it's so sad. Susannah's lost her spark.

Probably about three months after the wedding, I reached out to the Post and said, I'm ready to come back. They, like, didn't touch my desk during, like, seven months being gone.

[B]

And so you just started, like, working again.

[C]

They would give me very easy articles, like, the Hottest Bartender in New York City. I have recordings of myself from that time because I recorded my interviews, and my speech patterns were very slow. I had a little bit of a kind of lisp. So I still didn't sound like myself. But I kind of maybe just like, willfully ignored that and just felt like, okay, here I am again.

As I felt more confident and my editors felt more confident in me, started to take on kind of bigger stories. And, you know, probably the biggest story I was able to do at that time was to write about my autoimmune encephalitis. I was overwhelmed with the amount of emails that I got from that story through that story. Some people got diagnosed, which was amazing.

I'm starting to feel like myself again, but I'm still living with my mom, and that's hard. I wanted to be an adult again, and part of that was living on my own. So I brought this up in a conversation with my boyfriend, Steven, and I was kind of like, well, would you want to maybe live together? He was like, I assumed that's what we would be doing. So we moved in together.

I'm doing well, but there's a 20% relapse rate, so this could happen again at any time. And I started to have really vivid dreams during that time, and, in fact, started talking in my sleep. So while you're walking to work, you're feeling like, is that light too bright? Am I experiencing photophobia again? I mean, you really start to doubt yourself.

I looked different, too. Not only had I gained some weight from the amount of steroids I was on, but I also had a big scar on my head from the brain biopsy. Oftentimes I'd be touching it. If I looked in the mirror, all of a sudden I'd see the scar. And so the one person who I really trust as an objective witness to a lot of this is Stephen. And so I asked him one day, do you think I'm different than I was before? And I remember that he paused for much longer than I would have liked.

He said, no, I don't think you're different. But that did.

Kind of poke at something in me that I did suspect that maybe I wasn't completely back or I'd have been changed.

So I'm living in Jersey City with Steven and we're watching TV and there's like movement on my peripheral vision. Is this real? Am I seeing things? And I asked Stephen, did you see that? And he said see what? And I said nothing very quickly because I didn't really trust myself.

Then suddenly Steven lunged toward me and I heard this loud smack. This happened in like a matter of a second.

Stephen had actually lunged past me to grab his shoe and used it to kill like a huge 2 inch long water bug that was on the floor. This was the thing I had seen.

I breathed a sigh of relief and I thought it's real. It's real.

[A]

Big. Thanks to Susanna Cahalan for sharing her story at the snap. Susanna tells the full tale of her descent into madness and her rise out in the international best selling memoir Brain on Fire. She's written a new book called the Acid Queen about the reality bending world of psychedelics and snappers. If you can't get enough of her adventures in the backwaters of the human brain, then I want to clue you into something special because our friends at the Pulse be continuing Susannah's story this coming week as she investigates one of the most famous psychological experiments of all time and discovered something incredible. You can catch that on next episode of WHYY's the Pulse, available on the NPR podcast feed. The music was from the Blue Dot sessions. You can check out a full list on our show Notes the engineering was by Bowen Wong. The story was edited by Nancy Lopez, was produced by Justin Kraymond.

Now if you missed even a moment, know an entire world of Snap storytelling awaits and you can listen to it all on podcast platforms everywhere right this moment. Take you to In San Francisco, Snap Judgment's orbiting Hall of Justice. Snap is brought to you with the uber producer, Mr. Mark Ristage. No SNAP Studios content may be used for training, testing or developing machine learning or AI systems without prior written permission. On Team snap, the union representative, producers, artists, editors and engineers are members of the national association of Broadcast Employees and Technicians, Communications Workers of America, AFL CIL Local 51. Now there's Nancy Lopez, Pat Mercedi, Miller, Anna Sussman, Renzo Gorio, John Facil, Shayna Shealy, Teo Da Cotta, Flo Wiley, Bo Walsh, Marissa Dodge, Regina Bediaco and this is not the news. No way is this the news. In fact, you could not be as far away from the news as this is. But this is PRX.