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Book Review   |    
Paul Plasky
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.11.1354
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by Marya Hornbacker; New York, Houghton Mifflin Company, 2008, 299 pages, $25

Dr. Plasky is medical director at the University of Massachusetts Memorial Hospital, Worcester.

In Madness, Marya Hornbacker has written a first-person account of her struggle with bipolar disorder from her childhood through her late twenties. Using the for>m of a streaming monologue, all in the present tense, she has produced a chaotic and titillating portrait of rapid cycling, self-harm, and alcohol abuse. The tone of her book is set in her introductory chapter, a graphic description of a cutting episode with blood spurting around the room, with italics and exclamation marks going on for pages.

She experiences it all here: mania and isolation, sadness and delusions, fighting and sex. There is lots of intense drinking, impulsive travel, and grandiose start-overs, all related with a sense of urgency and immediacy. However, it seems at times that nothing is learned and little is gained. Episodes blend into each other; people come and go. It makes for wild reading, but it is uncertain whether it contributes to our knowledge about a terrible, life-threatening illness. Describing a fire is not the same as understanding it.

Underneath all this, of course, there is a keen mind that knows how to write a compelling sentence. Hornbacker makes good use of her book by offering several helpful informational appendices and an excellent bibliography citing the more readable guides to bipolar disorder. Also to her credit, she is positive about treatment and medication, and she tries to normalize the experience of electroconvulsive therapy, a task that cannot be done too often. Oddly enough, she has written about some of this same material before in her previous best-selling memoir, Wasted, which describes her earlier struggle with an eating disorder. She demonstrates that like many patients with bipolar disorder, she was misdiagnosed and improperly treated.

Who is the likely audience for this book? Given the age of the author during these events, the older adolescent may readily relate to it. However, it is not a book to give to your patients who are trying to come to terms with a new diagnosis of bipolar disorder; it simply has too much drama. Medical students may find it useful as an introduction to the field because it is fast reading and leaves a strong impression. Of course, the benchmark book in this area is Kay Jamison's An Unquiet Mind, a masterwork of balance, insight, and information, and this should be any reader's first choice for a first-hand account of bipolar disorder.

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