In 1998, at age twenty-four, Marya Hornbacher published the Pulitzer Prize–nominated, best-selling Wasted: A Memoir of Anorexia and Bulimia. Now, still a young woman, Hornbacher tells the story that until recently she had no idea was hers to tell: that of her life with Type I ultra-rapid-cycle bipolar disorder, the most severe form of bipolar disease.
In Madness, Hornbacher relates that bipolar can spawn eating disorders, substance abuse, promiscuity, and self-mutilation, and that for too long these symptoms have masked, for many of the three million people in America with bipolar, their underlying illness. Hornbacher’s fiercely self-aware portrait of bipolar, starting as early as age four, will surely powerfully change the current debate over whether bipolar can begin in childhood. At the center of this brave and heart-stopping memoir is the story of how her undiagnosed disease began to take over her life, spawning manic sprees and devastating crashes.
1. Marya Hornbacher has given a nontraditional structure to her book; instead of chapters, she uses parts and sections marked by dates and locations. How does this choice contribute to or detract from your reading experience? How else does the author use structure and format in the book in an attempt to convey the experience of living with bipolar?
2. Even as a child, Marya displays signs of being troubled. How is her behavior different from other, “normal” children? How is it similar? What do the other children see that the adults can’t, or won’t?
3. Marya’s mother periodically emerges in the memoir as a caretaker, for both her husband and her daughter. How does her care of young Marya differ from that of a “normal” child? How do you feel about the kind of care and understanding the Hornbachers exhibit toward their daughter? Does Marya’s presentation of her relationship with her parents in her childhood and adolescence differ from the way she describes their relationship in her adult years?
4. In the juvenile psychiatric ward, Marya’s fellow patients are “under eighteen, the dregs of the system,” including a twelve-year-old car thief, a rapist, a sociopath, two cutters, and a violent mute. Does seeing the world through the eyes of someone like Marya change what you previously thought of such “problem children”? What about the ways you may have regarded adult criminals? Use examples from the book to explain why your opinion has or has not changed.
5. Throughout the book, Marya struggles with a fear of failure, driven to prove she’s not a “fuckup.” To whom is she trying to prove this? Where does this fear originate, and what does it really mean to Marya?
6. After struggling for so long without treatment, you might expect that Marya would be relieved to learn that she has an actual disease. But instead of being relieved that there is, in fact, something medically wrong with her, Marya casually takes in and then rejects the information—she can’t seem to accept it. Why does she react this way to Dr. Beedle’s bipolar diagnosis?
7. On page 45, Marya writes, “Finally I have grasped that I cannot feed my mind and starve my body to death.” Beyond the immediate reference to her eating disorder, how else does this realization affect how Marya deals with her bipolar? Identify other ways in which she explores the mind-body connection throughout the memoir.
8. When her bipolar goes into remission, Marya throws herself into her new “normal” life—she fills her time with friends, parties, caring for the house, a new job, a new marriage, and dozens of goals for the future. How is this kind of mania different from her actual manic episodes? How is it similar? Analyze and compare her motivations, actions, and the results.
9. Marya has several relationships over the course of the memoir, some of them with men who are also mentally ill. How does her involvement with Jeff, who is clinically depressed, differ from that with her other boyfriends, like Crazy Sean? Why does she fall in love with Jeff? What ultimately makes their unlikely relationship work?
10. How does Marya’s realization that life is just a series of banal tasks, causes and effects, that keep the madness away devolve into another manic episode? What are some of the triggers for her bipolar throughout the book?
11. Marya describes the visitors who come to Unit 47 to see their loved ones as wanting the patients to “snap out of it” or “stop feeling sorry for themselves,” as though their illness were a weakness or a willful choice. Yet Marya also says that her recovery is fueled by her refusal to die and by her decision to accept her illness, to live with it in order to have the life she wants (page 217). Do you think, based on the material given, that “mind over matter” can play a role in disorders such as bipolar and depression? How does Marya rely on this maxim, both positively and negatively, throughout the book?
12. Marya struggles to think of her illness as “just like diabetes.” What does this really mean for her, and how does it affect how she copes (or doesn’t) with her bipolar? Compare and contrast diabetes and bipolar in terms of the illnesses themselves, how they affect patients, how they are treated, and how patients respond to treatment. Do you agree with Marya’s comparison? Why or why not?
13. Despite the control her madness retains over her, how does Marya begin to identify the onset of her manic or depressive episodes? How does she eventually learn to gauge when she needs to be hospitalized or when she needs intervention of some kind?
14. Throughout Madness, Marya refers to herself as a failure, a fuckup, a slob, a freak, useless, fat, stupid, and other such hurtful labels. How does Marya’s view of herself and her life reflect Americans’ general opinion of mentally ill people? By what rule does she measure herself? How much of her self-esteem problem is due to her mental illness, and how much of it is due to her being an American woman? Have you also suffered from or observed this kind of self-disparagement in your life? Discuss the possible origins of low self-esteem and how Madness may shine light on this universal problem.
15. A pervasive theme in this book is the idea of a normal life. What does Marya think a normal life is, and what does it represent to her? How do you feel about her perspective? Do you harbor similar feelings? Why or why not? Where do you think such feelings come from?