It's hard to imagine a more harrowing life, psychologically speaking, than that which author Marya Hornbacher, 34, has lived. Before finally being diagnosed with bipolar disorder at 24, she suffered through life-threatening anorexia and bulimia (described in her best-selling book Wasted), self-mutilation, drugs, alcohol and numbing sex. With a proper diagnosis and treatment came self-knowledge and a remarkably stable life. Her new courageous book, Madness: A Bipolar Life (Houghton Mifflin) delves fearlessly into the experience of severe mental illness, in the tradition of An Unquiet Mind and The Center Cannot Hold. TIME reporter Andrea Sachs reached Hornbacher at her home in Minneapolis.
TIME: At what age did you first find yourself having emotional problems?
MARYA HORNBACHER: My parents say that even as a very, very little kid, the way that I acted was dramatically different from other little kids. My own awareness that something was wrong with me was also very, very early. I was aware that I was pretty wild, that I couldn't calm myself, that I had dramatic shifts in moods and thought patterns. I always felt a little crazy. As I got older, I started having real problems in school. I was getting in trouble a lot. I was developing an eating disorder and some substance abuse problems. It's a lifetime of feeling like you're out of control, which is very much the nature of a mood disorder like bipolar.
How old were you when you started developing an eating disorder?
I was nine when the eating disorder sort of took hold. It started with bulimia. I spent a lot of time alone, and a lot of that time was spent really feeling like my emotions were ruling my life, like I couldn't control my thoughts. What I discovered with the bulimia and later the anorexia was that it did provide something of a homemade mood stabilizer. It allowed me a few minutes, a few hours of feeling like I was able to calm my thoughts. My thoughts were entirely focused on food.
So you were bingeing, and then you were purging?
Then the anorexia took hold. That became very severe, right?
Yes. When I was about 15, it sort of started transitioning from primarily bulimia to primarily anorexia.
Your weight went dangerously low, to 52 lbs.
Yes, at the end.
That's impossible! How did you stay alive?
One really wonders. One thing that I didn't realize at the time, that I became aware of later, is that bulimia is just as dangerous. A low weight isn't the only thing that kills you. Eating disorders in any form are incredibly dangerous, and have a high fatality rate. Very few people fully recover. It does a lot of damage to the body. So being 52 lbs. is a little surreal. Now I'm at a totally healthy weight and I'm more than twice that. I can't picture myself half my own size.
You got into cutting yourself as well?
I did, later on. I did it a few times when I was in my early teens, and it didn't really catch. It was when the bipolar really set in, as an adult form of the disorder. There's childhood and early onset bipolar, but it transitions in your early adulthood into something a little bit different, and extremely severe. It was at that time that my impulse control just went out the window. Impulse control when you're manic just disappears. One of the ways that manifested in my life was in cutting, and not being able to stop cutting.
On top of that, you developed a drinking problem. What age was that at?
I started drinking when I was ten. There's a scene in the book where I talk about discovering the booze in the cupboard underneath the stove... It, too, functioned very briefly as a mood stabilizer... It elevated my mood, and just made me feel like I was flying. Instead of feeling like I was going up and down and up and down, there were no more crashes. For a few hours at a time, I wasn't terrified, I wasn't anxious I was just high as a kite. Of course, like any other alcoholic, the reasons you do it at first become irrelevant, because then, you're just drinking because you're an alcoholic. When you try to stop drinking, as I did many, many times many years later, you realize it's not about anything. It's a function of a kind of desperation and addiction.
How old were you when you first saw a therapist?
I guess I was about 12 when my parents first had me go see a psychiatrist. At the time, they were concerned with my grades and my behavior in school, which was disastrous. School counselors, teachers, my family, really thought it was just that I was an out-of-control kid. In my mind, I knew I was crazy, and I couldn't stop. When I was at school, I would just lose my mind and go into rages, or have little crying fits and lock myself in my room at home.
At the beginning of the book, you describe life-threatening episodes of severely cutting yourself. Was it a suicide attempt?
It was what you'd call an accidental suicide attempt. Many suicides are accidental. There's a death wish, but it's fairly vague. It's different than actually trying to die. In that case, I was so manic that I was unaware that there would be consequences. That's one of the things about manic impulsivity you can't associate your acts with the consequences. You think that when you're spending thousands of dollars, you will not go broke. You think that when you're driving 100 miles an hour, you're going a perfectly reasonable rate. You think that when you jump out of the window, you can, in fact, fly. In that case, my impulse was just I wonder if I could hit my artery? A few seconds later, I realized indeed I could hit my artery, and was about to die. You know, if I had wanted to die, I would have lain down and died. But I had no interest in dying. What I wanted to see was if I could hit my artery. So, of course, I was trying to get to the phone, trying to call 911. And thank God, they got there in time. I'm very grateful to the powers that be that someone was able to get there in time.
You went through hospitalizations, and different therapists. How did you finally find out that you were bipolar?
It took quite a long time. There was much less knowledge in the '80s and '90s, when I was developing my bipolar, before it became extreme. I went through therapist after therapist, and finally it was when I had just gotten married for the first time, my behavior was just totally out of control. I was aware that it wasn't reasonable anymore.
I looked up a psychiatrist in the phone book. I like his name. His name was Dr. Beedle. So I gave him a call, got an appointment and went in. I happened to be fairly manic at the time. And he was very funny. He just let me talk and talk and talk and talk and talk, until he finally said to me, "Has anyone ever mentioned the word 'mania' to you?" And I'm like, "Well, I've heard the word. What are you talking about?" He got me to describe the mood swings, which had never really been discussed before in all of my previous therapy and psychiatry. People had always focused on the eating disorder. It's understandable it was a very severe eating disorder. It's not like you can blame them for being concerned. The association usually made with eating disorders is that you have depression. That is an unfortunate thing, because there are great many people with bipolar disorder who are misdiagnosed with depression, as I was, and then put on medication that makes them manic. So when I met this doctor, and he diagnosed me, it was a very strange moment. Simultaneously, he described, this is what bipolar is, and asked, "Does this sound familiar?" And boy did it sound familiar! It sounded like my entire life.
What do you do now to keep on track?
I take my meds. Number one, two, three, four and five is that I take my medication.
Do you still have problems with your bipolar disorder, or do you feel as though it's completely under control?
Oh, Lord, yes. It's a day-to-day thing. I have a type of bipolar that swings up and down all day long. There are significant mood swings within a day, within a week, within a month. I go through at least four major episodes a year. That's really the definition of bipolar rapid cycle. But I have ultra-rapid, so I have tiny little episodes all day long. So the management of it makes it entirely possible for me to live at a highly functional level, to have great relationships, to have a wonderful marriage, to do my work very effectively, most of the time. And then there are the times when I can't.
If you could be ordinary, without bipolar disorder, would you choose that?
Oh, yeah. (Laughs.) I absolutely would. I think many people with a chronic illness would prefer not to have their chronic illness, simply because it's high maintenance. With a mental illness, it's confusing. It's disorienting. It's profoundly psychologically affecting. It affects your identity. It affects your feeling about who you get to be in society, because there is an enormous stigma attached to it. I don't think anyone would choose to be associated with something that many people see as helpless, hopeless, freakish. However, the flip side of that is having this illness has really forced me to become extremely responsible. It also really forces me to be very, very conscious of other people. It may have given me, not some super-special empathy, but a certain amount of empathy. It isn't hard for me to imagine other people in trouble. I'm not real judgmental because of it, I think. And like any big challenge in a life, it strengthens you. I think I've gotten a little toughened up because of it.