Guest Post: Book Review of Madness by Marya Hornbacher

A few weeks back, we put out the call for reader reviews of Marya Hornbacher's new book, Madness: A Bipolar Life. Our first submission comes from Margarita Tartakovsky.

Madness: A Bipolar Life
Bipolar disorder is commonly misunderstood and often goes undiagnosed. While the average age of onset is 23, a person with bipolar can go years without receiving the correct diagnosis — on average, until age 40.* And around 70 percent of bipolar sufferers are misdiagnosed at least once.

In her beautifully written memoir, Marya Hornbacher also spends years misdiagnosed, using alcohol, drugs and self-mutilation to control her moods and silence the madness, which will "push you anywhere it wants."She delves into the depths of her struggles, documenting with precision the demons she faces every day, wavering between this madness and deep, oftentimes painful, depression.

The book opens with her suicide attempt. With images of water, drowning and blurred reality, Hornbacher lets the reader leap immediately into her shoes, to feel the devastating rollercoaster of emotions and the very confusion she experiences on and off throughout the book. It becomes difficult to distinguish what's real, imagined, exaggerated or merely a dream:

"I drop the phone and give in to the tide and feel myself begin to drown. Their mouths move underwater, their voices glubbing up, Is there a pulse? and metal doors clang shut and I swim through space, the siren wailing farther and farther away."

Time frequently becomes confused, another constant that runs through the book — Hornbacher loses chunks of time, unsure if it's been minutes, hours, months or "maybe yesterday or maybe last year." Following the suicide attempt, at the hospital, she writes:

"I come to and black out. I come to and black out. This lasts forever, or it takes less than a minute, a second, a millisecond; it takes so little time that it does not happen at all; after all how could I be conscious of losing consciousness."

When Hornbacher attempts suicide at 20 years old, she has no idea she is bipolar. No medical professional has ever mentioned it, even though there are several times when she tells therapists about her racing thoughts, manic moods, alcohol abuse and cutting, but no one picks up on it. In fact, she's put on Prozac, a medication that can send bipolar patients swiftly on the road to mania: "Prozac makes me utterly manic and numb — one of the reasons I slice my arm open in the first place is that I'm cooked to the gills on something utterly wrong for what I have."

Though Hornbacher won't accept her diagnosis for some time and doesn't devote herself completely to recovery until years later, not having an accurate diagnosis until she's 24 shatters her life, leading her to self-medicate, to battle her bipolar alone with drugs and alcohol to quell the moods, anxiety and pain that cloud her mind.

She has many encounters with therapists, some of whom are pivotal in her recovery and others who dismiss her obvious pleas for help ("his wise and considered opinion is that I'm a very angry little girl"), neglecting to listen to what roars with red flags.

In one session, after Hornbacher explains that she can't take the mood swings or anxiety, that her "life is a nightmare" and that she isn't sure if her medication is working, the psychiatrist responds with, "I think the Depakote's working. You'd be in much worse shape if it weren't. I'll see you next week."

Just as quickly, the same psychiatrist dismisses her drinking binges:

Hornbacher: "[My friends] keep telling me I'm an alcoholic…I'm drinking an awful lot. Not that I want to stop. I have, however, begun to notice the vast difference between the way I drink and the way everyone else drinks. And everyone else in my life drinks quite a lot."

Psychiatrist: "I don't think you have a problem."

Hornbacher also explores the stigma of mental illness, ever-present in our society. Like a caste system, there are acceptable types of mental illness and the crazy types of mental illness. While depression is viewed sympathetically, bipolar disorder and schizophrenia are shrouded in mystery with stereotypes of homeless people and criminals, running violently through the night. "Depression, that's one thing —lots of people have depression, and they're not crazy. Bipolar, schizophrenia — that's crazy. That's mental illness — the psychos, the nut cases, the incurably insane, the muttering bag ladies and bums, the freaks."

Along with the stigma, there's also a veil over therapy, oftentimes creating misconceptions about how mental illness is treated. During her various hospitalizations, Hornbacher describes her therapy sessions, the patients, the surroundings. As she starts to take her treatment seriously and focus on recovery, Hornbacher takes the reader through her daily regimen, which includes taking medication and supplements, documenting her moods in a journal, exercise and regular sleep.

Eventually, after years of confusion, anguish and blurred reality, Hornbacher is able to accept her diagnosis —"Managing mental illness is mostly about acceptance — of the things you can't do, and the things you must" — and herself —"I am who I am."

Hornbacher's book is painful and powerful, insightful and inspiring. She is brave and refuses to give up. It isn't easy, but it's possible; Hornbacher is an incredible example of that.

*As stated in Madness, which includes a resource section with statistics and information on bipolar disorder.

Margarita Tartakovsky is a freelance writer and editor. She holds an MS in Psychology from Texas A&M University, where she conducted research on disordered eating and body image and wrote for peer-reviewed psychology journals. She continues to explore these topics in her writing.