In a brief list, Kaysen considers the etiology behind her mental illness (the word “etiology” is a term used in both medicine and mythology to describe the cause, set of causes, or manner of causation of a disease or condition, or a particular societal ritual, tradition, or behavior). Susanna posits that she is, among many things, perhaps on a perilous journey from which she will learn much when she returns—that is, if she ever does return. Alternately, she supposes that she may be possessed by God, the Devil, or a minor demon; that she is actually a witch or bewitched; that she is bad and in need of isolation and punishment; that she is ill and must be treated by purging and leeches, electroshock therapy, a hysterectomy, or a sedative; that she is a victim of society’s tolerance for deviant behavior; or that she is, after all, just sane in an insane world.
The dual medical and mythological implications of the older Susanna Kaysen’s consideration of her own “etiology” are vast and inextricably intertwined. The story of Susanna’s illness is one of the major “mythologies” of her life, and as she attempts to get to the bottom of why her illness befell her, what impact it had on her life, and what it revealed about her in the end, she considers again whether she was, at the time of her institutionalization, “sane in an insane world,” or truly insane, and stranded helplessly in the world of the sane.