The Story of The Book "Madness: Bipolar Life" by Maria Hornbacher

The book I chose to read was “Madness: a bipolar life” by Marya Hornbacher. The book tells the story from Marya’s point of view of what it is like for her to live with bipolar disorder, anorexia and bulimia, substance abuse, and self-mutilation. Marya grew up with rapid cycling mood swings since the age of six, however, it was not until the age of twenty-four that she was diagnosed with Type I Bipolar Disorder. Before Marya was officially diagnosed with bipolar disorder, she was recovering from a long-time struggle with anorexia, bulimia, and self-mutilation.

Marya developed an eating disorder at the age of nine because the binging and purging helped to control her racing thoughts. At one point, she was down to a dangerously low weight of 52 pounds and needed to be hospitalized. One of Marya’s previous doctors prescribed her Prozac, an antidepressant, to treat the eating disorder. Unfortunately, the antidepressant that was prescribed was the wrong medication for Marya’s undiagnosed bipolar disorder because it caused her to act more manic than euthymic.

Marya self-medicated with alcohol to stabilize her mood when she experienced manic episodes and ultimately turned into an alcoholic. Marya finally saw a doctor by the name of Dr. Beedle who diagnosed her with bipolar disorder at the age of 24 and prescribed her a mood stabilizer, Depakote. Marya’s insurance didn’t cover Dr. Beedle so she started seeing Dr. Lentz as a psychiatrist instead. Marya continued to struggle with alcoholism and Dr. Lentz explained that her alcohol use will essentially make the medications ineffective, which will not treat the illness she has.

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Throughout the years, Marya struggled with managing her medications and drinking alcohol, which turned into mismanaging her disease, landing her in the psychiatric unit multiple times. With the help of her family and her doctor, Marya finally became sober and was able to manage her medications as well as her disease.

A major theme that was seen throughout the book was the lack of coping mechanisms. Unfortunately, many patients with mental health disorders, such as bipolar disorder, lack the basic coping mechanisms that patients without mental health disorders have. Marya lacked basic coping mechanisms when it came to managing her bipolar disorder. Instead of having healthy coping mechanisms, such as meditating or exercising, Marya relied heavily on drinking alcohol because she believed it helped to stabilize her mood. She began drinking early in life and transitioned from binge drinker to full-blown alcoholic quickly. Women with bipolar disorder have a greater risk of having alcoholism than the rest of the population (Snow, Smith, & Branham, 2008). When it comes to alcohol and substance use in relation to bipolar disorder, there are two hypotheses: persons with bipolar disorder choose to use alcohol or other substances as a way to manage their symptoms. It is also believed that the symptoms of manic episodes, recklessness, risky behavior, and poor judgment, lead to alcohol and substance use (Stalman, Canham, Mahmood, King, & O’Rourke, 2017). Marya continued to drink alcohol not because she wanted to, but because she had to. Marya believed it helped “numb her mind” and “keep the crazies away”.

Throughout the book, we see that Marya struggled with poor judgment and risky behavior. Not only did Marya consume more alcohol than those around her, but she also acted promiscuously and engaged in sex during manic states. She engaged in one-night stands and meaningless sex with many different men. When she was having sex with these men, Marya felt absent, lonely, and uninterested. A study done by Meade et. al (2011) showed the effects on patients with bipolar disorder and their sexual activity. There showed to be an increase in a person’s sexual activity during manic episodes.

Manic symptoms include feelings of euphoria, increased energy, grandiosity, hypersexuality, impulsivity, and poor judgment. Risky behavior is associated with going on spending sprees, gambling, promiscuous sex, alcohol use, and substance use (Meade, Fitzmaurice, Sanchez, Griffin, McDonald & Weiss, 2011). Marya engaged in risky behavior by going on shopping sprees, partying every night, having sex with random guys, and drinking copious amounts of alcohol. She was aware that she needed to stop consuming alcohol for her medication to be effective, it just took multiple hospitalizations and reaching rock bottom to understand that her medications are more effective without alcohol in her system. Persons with bipolar disorder and substance abuse report having more inpatient psychiatric hospitalizations due to a lack of medication compliance (Stalman, Canham, Mahmood, King, & O’Rourke, 2017).

Marya also struggled with an eating disorder for the majority of her life because she felt as though “it purged all her fears, the paranoia, and the racing thoughts”. The eating disorder gave her comfort and acted as a temporary mood stabilizer. It’s estimated that 3.7% of women struggle with anorexia nervosa and 4.2% of women struggle with bulimia at some point in their lifetime (American Psychiatric Association Workgroup on Eating Disorders, 2006).

Patients with mental disorders, such as bipolar disorder, are considered to be a vulnerable population. This is because persons with mental disorders experience numerous risk factors that lead to premature mortality, discrimination, and social exclusion (World Health Organization, 2012). Not only are they vulnerable because of the inability to cope with their illness, but they are vulnerable because of the way the general population discriminates against them.

References:

1. Meade, C.S., Garrett, F.M., Sanchez, A.K., Griffin, M.L., McDonald, L.J., & Weiss, R.D. (2011). The relationship of manic episodes and drug abuse to sexual risk behavior in patients with co-occurring bipolar and substance use disorders: a 15-month prospective analysis. AIDS Behavior. 15(8), 1829-1833.
2. Snow, D., Smith, T., & Branham, S. (2008). Women with bipolar disorder who use alcohol and other drugs. Journal of Addictions Nursing, 19(2), 55-4.
3. Stalman, M.N., Canham, S.L., Mahmood, A., King, D., O’Rourke, N. (2017). Aspects of control and substance use among middle-aged and older adults with bipolar disorder. International Journal of Mental Health Nursing, 27(2), 833-840.
4. Wolfe, B.E. (2008). Issues of Body Weight and eating behavior in psychiatric and mental health nursing practice. Journal of the American Psychiatric Nurses Association, 13(6), 343-344.
5. World Health Organization (2012). Risks to mental health: an overview of vulnerabilities and risk factors.