A breathless, riveting novel about a young woman diagnosed with bipolar disorder who rejects the stability and approval found in a traditionally “normal” life for a career in stand-up comedy.

Maddy Banks is just like any other stressed-out freshman at NYU. Between schoolwork, exams, navigating life in the city, and a recent breakup, it’s normal to be feeling overwhelmed. It doesn’t help that she’s always felt like the odd one out in her picture-perfect Connecticut family. But Maddy’s latest low is devastatingly low, and she goes on an antidepressant. She begins to feel good, dazzling in fact, and she soon spirals high into a wild and terrifying mania that culminates in a diagnosis of bipolar disorder.

As she struggles to find her way in this new reality, navigating the complex effects bipolar has on her identity, her relationships, and her life dreams, Maddy will have to figure out how to manage being both too much and not enough.

With her signature “deep empathy and insight” (Booklist), Harvard-trained neuroscientist and New York Times bestselling author Lisa Genova has crafted another profoundly moving novel that makes complicated mental health issues accessible and human. More or Less Maddy is destined to become another classic like Still Alice.

This book is a raw and eye-opening exploration of a young woman’s battle with bipolar disorder. Lisa Genova does a deep dive into what it means to live with bipolar disorder, the challenges of treatment, and the impact the illness has on relationships. While I enjoyed the book, I wished we had gotten a more balanced look at Maddy’s life and experienced more of her successes than her failures.

The novel follows Maddy, an NYU freshman who is struggling with the typical pressures of college life. She just broke up with her boyfriend, and it hit her hard; school isn’t going great, and she can’t help but feel that she’s an outsider in her perfect family. All of this becomes too much for Maddy, leading to a pretty severe depressive episode, which leads to her doctor prescribing an antidepressant. The pills offer Maddy some relief, but eventually, Maddy experiences an unchecked manic episode that leads to her diagnosis of bipolar disorder.

The most uncomfortable part of the novel is Maddy’s struggle with her diagnosis and treatment. Like many people with bipolar disorder, she struggles with the idea of taking medication for the rest of her life. The scenes where she stops her meds and spirals into another episode are heartbreaking. The unpredictability of her illness is a central theme, and Genova does a remarkable job showing how it affects not only Maddy but also those around her – her family, her friends, and even strangers caught in the wake of her manic decisions.

One of the book’s biggest strengths is its realistic portrayal of mental illness. Genova does not sugarcoat the realities of bipolar disorder or glamorize Maddy’s manic highs. There’s a tendency in media to romanticize mania as an exhilarating, creative force, but the author avoids this trap.

Having dated someone with bipolar disorder who would unpredictably stop taking his medication, I found certain sections of the novel particularly triggering. The unpredictability of an unmedicated manic episode, the fear of not knowing what will happen next, is something Genova captures with haunting accuracy. For readers who have seen firsthand the chaos and fear that comes with untreated mania, Maddy’s journey can be triggering. The way she hides her struggles, the way she deceives herself into thinking she doesn’t need help, and the way her episodes escalate are all painfully real experiences.

While there are several things this novel gets right, one of my biggest issues with it was its pacing. While the first half of the book is riveting, there is a certain repetitiveness in the middle as Maddy cycles through multiple manic episodes. The pattern of going off her meds, spiraling, and facing the consequences happens multiple times, which, while realistic, starts to feel redundant. It would have been more satisfying to see more of Maddy’s life after she finds stability and her journey to success as a standup comic. The book spends so much time exploring the chaos of her illness that it shortchanges the moments of healing and growth. A deeper dive into how Maddy learns to manage her condition in the long term would have given the novel a more balanced feel.

Overall, this is a powerful, unflinching look at what it means to live with bipolar disorder. It’s not an easy read, especially for those who have personal experience with the illness, but it is an important one. It’s a story that lingers long after the final page, though I would have liked to see more of Maddy’s successes. Still, it ended on a hopeful note, which was nice for Maddy.

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