Marianne's Reviews > More or Less Maddy

More Or Less Maddy is the sixth novel by award-winning, best-selling American neurosurgeon and author, Lisa Genova. Always a happy person, Madison Baker puts her deep depression during her first year at NYU down to the overwhelming pressure of schoolwork, the breakup with her boyfriend of four years, an annoying dorm roommate, and her difficulty making new friends. She does admit that the break up put her in a negative mindset: “She wanted to feel bad, as if she were honoring the death of their relationship, and the depth of her mourning needed to match the significance of their love.”

Over the summer break, Adam convinces her to hook up again, she’s working at Starbucks with the girl who used to be her best friend, Sophia, and she’s happy enough. But back at NYU, unlike Adam and Sophia, she still hasn’t settled on a major that will lead to a decent career. Meeting assignment deadlines, even going to classes, is exhausting and she spends more time in bed than ever before. Her grades suffer, and she starts cutting.

A visit to the student health clinic to get a medical extension on her assignment results in a diagnosis of depression, and a prescription for an SSRI. Very soon, Maddy has boundless energy, feels enervated about everything, and needs no sleep. Grandiose ideas that include writing for her idol, Taylor Swift, and becoming a comedian. Expected future wealth means she can spend big on things to enhance her image. She doesn’t know it, but Maddy is having her first manic episode.

Maddy’s lucky she has a wealthy step-father and a devoted family who see that she gets the best care, but the bipolar diagnosis is a shock. Medication, a stay in a private mental hospital: “Maddy stares into her expressionless brown eyes in the mirror and can’t see the normal Maddy she used to be. That girl is gone.” And the mania is prevented, but “She’s empty, a recycled cardboard cutout of a human, alive but also dead. She’s depressed with no signs of relief.”

There’s also the stigma attached to a mental condition and “Her diagnosis has changed the way her mother sees her, or rather doesn’t.” Amy Baker seems to only see potential problems that will trigger the next manic episode. Meanwhile, part of Maddy “feels dead, like a zombie or a robot or an actor in the world’s most boring play… Maddy imagines her own meds holding her together, an after-school crafting project of string, glue, and staples.” She wonders, too, if the side-effects aren’t worse than the illness?

The peek Genova gives us of the personal perspective of someone deep in a manic episode is wholly convincing and especially revelatory. It’s easy to see that during hypomania/mania, any insight that Maddy might have into her thought processes and mental stability disappears, replaced by delusions of grandeur. The initial denial is also understandable, such that a patient begins to doubt the diagnosis, and stops taking their medications to check if they’re right. Many patients probably wish they could access “hypomania, that glittery on-ramp to mania’s superhighway” at will.

As always, Genova’s professional expertise shines through on every page. Informative, moving and hopeful.
This unbiased review is from an uncorrected proof copy provided by NetGalley and Allen & Unwin.