One View of 'A Bipolar Life'

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By Rachel Beckman
Washington Post Staff Writer
Tuesday, April 8, 2008

For the more than 2 million people with bipolar disorder, life can be a constant struggle to manage the extreme swings in mood and energy. For the subset with a severe form of the disease called bipolar I, achieving that balance can be even more difficult. Marya Hornbacher's new from-the-trenches memoir, "Madness: A Bipolar Life," offers a disturbing glimpse into the mind of someone with that condition.

"Madness" finds Hornbacher alternately drunk, hospitalized, starving, compulsively shopping, screaming, crying, cutting and combinations thereof. She and her family decide together when it's necessary for her to stay in psychiatric wards to keep her safe. This happens every few months -- in 2006, she went inpatient, usually for about three weeks at a time, in January, July, September, October and November.

"That I have made it all this way without dying or killing myself or someone else is a miracle, or a joke," she writes in the book.

The Minneapolis-based writer takes six psychiatric medications daily -- costing about $300 a week -- and undergoes electroconvulsive therapy during major episodes.

"Madness" is Hornbacher's second memoir about mental illness. A decade ago, she wrote "Wasted," about her struggle with anorexia and bulimia. That book has been translated into 14 languages and nominated for a Pulitzer Prize. Although she started having "crazy spells," as she calls them, at age 4, she wasn't diagnosed with bipolar disorder until 1997, when she was 24.

We spoke by phone with Hornbacher while she was on book tour.

In the book, it seems that your bipolar gets worse after the diagnosis.

When I knew I was bipolar, I was still drinking myself to death and wreaking havoc on my relationships -- like a little tornado going through life. That was immaturity and fear. My own misperceptions. Me not wanting to be manic-depressive.

When did you get the condition under control?

I wouldn't say that there was any real stability until I was 28. That's when I got sober. If you're drinking, if you're using drugs, the meds won't work. The drinking and the substance abuse trigger everything to go haywire.

When I cleaned up, I had, honestly, a year of stability and then the bottom fell out. I spent two years in and out of psych wards.

What they finally sorted out was because I hadn't taken my meds for so long, and I had gone undiagnosed for so long, and I had been drinking so much, that I had addled my brain chemistry pretty substantially. It had to bottom out before it was time for me to take care of myself.

What are the most important things you do every day to manage your mental illness?

The most important thing -- above all else -- is to take my meds. The second is sleep. Without the sleep, the meds won't work, and without the meds, the brain won't work.

What's your average day like?

I keep a very regular schedule, which is not my style, but chemically it keeps the homeostasis in the brain going. I get up at the same time every day and take breaks at the same time. It's a rigid schedule.

I have what's called ultra-rapid-cycling bipolar, so my moods cycle many times a day.

I get up at 4, so I can be fantastic from 4 to 7 a.m. but by 2 p.m., I can be having suicidal thoughts. And at 6 p.m., I'm doing all right again. During a day like that, it's very difficult to sit at my desk and do my job.

What is your goal with "Madness?"

I want to show [people] that it's scary but it's not foreign. These people are people. Don't back away.

My great hope was to bring someone both inside the mind of someone with bipolar and inside the mind of a regular person with a mental illness.

Mood disorders are still just moods. All of us exist on a spectrum of mood and mind. One of the things that's so frightening is the knowledge that if it is a spectrum, then I can slip.

Why do we get so embarrassed when we see the man muttering to himself on the street? We don't want to be there, we don't want to be him.

What are the biggest misconceptions about people with mental illness?

The idea that this is about character, that it's not really an illness and it's a character flaw.

I'd invite all those people who believe that to an anatomy-of-the-brain class, and they can learn that it is a brain disease! It's not about being a bad person or committing sin.

It's really backwards and anti-modern to think that you should just be able to "pull yourself up by your bootstraps."

Now there's a caveat to that: As soon as you know you have bipolar, you better take your meds. Those are your bootstraps. ยท

Comments:beckmanr@washpost.com.


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