Podcast Summary: Snap Judgment – "Back to Reality"

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

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.

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)

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)

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.

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.

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.)