Episode 131: Welcome back to Real Health Radio. Today’s guest interview is with Marya Hornbacher.
Marya is an award-winning journalist and bestselling author. She is the recipient of a host of awards for her books, journalism, essays, and poetry. Shortlisted for the Pulitzer Prize for her first book, Marya has spent a prolific twenty-odd years writing and teaching across genres. She was recently honored with the Annie Dillard Award in Creative Nonfiction. Marya published her first book, Wasted: A Memoir of Anorexia and Bulimia in 1998, when she was twenty-three. What started as a crazy idea suggested by a writer friend became the classic book that has been published in sixteen languages, is taught in universities all over the world, and has, according to the thousands of letters Marya has received over the years, changed lives.
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Chris Sandel: Welcome to Episode 131 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/131.
Welcome to Real Health Radio, health advice that’s more than just about how you look. And here’s your host, Chris Sandel.
Hey, all. Welcome back to another episode of Real Health Radio. On the show this week, I’m sitting down with a guest, and my guest is Marya Hornbacher. Marya is an award-winning journalist, a bestselling author, and the recipient of a host of awards for her books, journalism, essays, and poetry. She was shortlisted for the Pulitzer Prize for her first book, Wasted, which she wrote when she was 22, and since then has spent a prolific 20-odd years writing and teaching across genres.
I first became aware of Marya about three years ago. Her first book, Wasted, is her memoir about her struggles with an eating disorder. Given what I do and my interest in the topic, I gave it a read, and honestly I was floored. I had to keep reminding myself that this was written by a 22-year-old because the writing was so raw and intense and skilful. I remember having this conversation with Kate Solo when she was on the podcast and we were chatting about the book. She remarked that just because you’ve gone through something, whether that be an eating disorder or overcoming addiction or climbing Mount Everest, doesn’t make you a writer. But Marya clearly is one, and it shines through in this book.
Wasted is an incredibly dark book, sharing the gory details of the destruction that she went through over the 10+ years that she struggled with an eating disorder. As we actually talk about in the conversation, the book has received some criticism because of the details that it goes into. As Marya mentions, she didn’t know that for some people struggling with an eating disorder, there is glamour in the destruction. When I read the book, I read about this hell of a place that I wouldn’t wish on anyone, but for someone in the depths of an eating disorder, it can be triggering to keep going or to restrict more.
The reason I’m going into these details is I’m always wary of who I recommend the book to. For people who’ve never had an eating disorder, go and read it. It is incredibly dark and gripping and a fantastic story. But for someone who has suffered with an eating disorder, it’s probably best to hold off until well into recovery.
There’s a point when talking with clients where, if they look back at old photos when they were their sickest or at their lowest weight, it’s triggering and they wish they could go back there. But at some point this changes. They look at those same photos and they start to see what everyone else saw. They see the struggle and the depths and they see past the stories that they’d been telling themselves and know what a hellhole that was.
I think the same thing about Wasted. At some point it is a good book for someone to read in recovery because the story becomes no longer tantalising. It’s just dark and agonising and somewhere that someone doesn’t want to go back to.
This may not be the same for everyone; there are undoubtedly people who are in the depths of their disorder and read Wasted and it is critical for them getting into recovery and helping them out of that place. But I am giving this long caveat because I don’t want to cause unnecessary harm.
Marya’s second memoir is Madness, and this is about her suffering with bipolar disorder and the 10-12 year period of her life when this was at its worst. Like Wasted, it is incredibly well written. When I had Chevy Rough on the podcast, we spoke about mental health issues, and it was really well received. It’s a topic that’s coming more into the public consciousness and we should be having more of a conversation about. So when I read Madness, which I did fairly recently, I decided to get in contact with Marya and invite her on the show.
The episode is us using her two memoirs as the basis for our conversation – eating disorders and bipolar. Because Marya is an award-winning writer and has such a gift in this area, we also talk about the writing process and tips for writers. I actually caught her on the first day of an intensive writing retreat that she’s doing for the next I think three months, so talking about the writing process was definitely front of mind.
With this long intro out of the way, here is my conversation with Marya Hornbacher.
Hey, Marya. Thanks for joining me on the show today. I’m really excited to finally have a chance to chat with you.
Marya Hornbacher: I’m very happy to be here. Thank you for having me.
Chris Sandel: It was probably three years ago that I first came across your work and read your first memoir, Wasted. Recently I’ve read Madness, which is your second memoir, and it picks up where Wasted finished off. I want to use both of those books as part of our conversation today. I would also really love to dig into your writing process as well, because you clearly have a gift with the written word. That’s a bit of an overview of what I want to go through.
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As a starting place, for any of the listeners who don’t know who you are, do you want to give a bit of background on yourself? We’re going to dig into this stuff in more detail, but do you want to just describe who you are and what you do?
Marya Hornbacher: Yeah, absolutely, thank you. It’s funny; I’ve written a lot about mental health, I’ve written about eating disorders, I’ve written about mental illness, but when you ask me ‘give an overview of yourself’, the first thing I say is I’m a writer and I’m a journalist.
My sense of myself has very little to do with eating disorders or mental health, but I’m certainly passionate about those topics. They’re areas I’ve written about extensively in both memoir and in opinion pieces and in novels and in other forms. But mostly what I do on a day to day basis is write books and spend time with people. That’s a little bit of a here and now overview.
But in my past, I really struggled with eating disorders for many years. I also have a diagnosis of bipolar. I consider it mental health recovery. Some people don’t care for the term ‘recovery’, but I like it. So I’ve been in recovery from mental illness for a long time as well. That kind of sums me up.
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Chris Sandel: Going into a little bit more detail on the eating disorder side, that’s your first book, Wasted. Are you able to give a bit more of an overview and a bit more detail about that and your experience?
Marya Hornbacher: Sure. I think anybody who’s gone through an eating disorder knows all too well, it’s a hellish experience for any of us and also for the people around us. My eating disorder started very early; I was about nine when I started delving into disordered eating and bulimic behaviour. As I got older, it transitioned into a mishmash of eating disorder behaviours.
I consider it in many ways addictive if not a strict addiction. I was very, very – the thinking and the emotional turmoil that goes along with any addiction and that certainly goes along with disordered eating. I was quite ill. I nearly died. All the usual. In some ways it’s a very familiar path to those of you, and to you certainly, who deal with that illness.
I started recovery when I was about 19 years old. I was hospitalised for the last time when I was 19 and was in the hospital for a long time, and that’s when I really started looking at the elements that went into creating this disorder and what the skills that I might possess, still, that would help me get out. That’s really when my recovery took off.
Chris Sandel: What were those elements? That sounds like it’s quite an interesting piece that people will want to hear – and I know everyone is different, but that seems like quite a significant part.
Marya Hornbacher: I think the elements that go into it are – it’s like we have different degrees of it for each of us. The pieces of the pie are different for each of us. I think for me, a lot of what went into developing the disorder was all the typical stuff. Perfectionism and ambition and a lack of sense of self, in a way. Also certainly there were family elements.
And I really feel that for me, and I think a lot of people, maybe increasingly – you would know more about that than I would about the current state of things – the cultural influences that we deal with are really profoundly derogatory to our mental health and to our sense of self and to our sense of body and to our sense of, in a way, hunger. I think it really damages us in some ways, and we have to find some ways to strengthen our inner sense of strength, our inner self, in order to combat some of those external cultural forces.
The elements that go into recovery for me were so many. I really take a strengths-based approach. When I started recovering from eating disorders, which was a very long time ago, first of all, people didn’t believe you could recover. They really flat out said – and I still hear this from people and it frustrates me – people say, “I know I’ll deal with this for the rest of my life,” which I think is largely garbage, because I don’t deal with it now, and I’m in the rest of my life. [laughs]
I also know a whole lot of people who don’t deal with the eating disorders and the disordered eating that they dealt with earlier in their lives. So I don’t think these are necessarily chronic disorders. I think these are things that we can move beyond.
For me, moving beyond it meant looking at what it was that I was actually hungry for. What were the elements that were missing in my life? For me, recovery was partly physical, partly spiritual, partly emotional. All of those were pieces that had to get put back in place in order for me to get my feet back on solid ground.
There’s the little stuff, like you have to learn how to eat. People I think disregard that that’s an important piece of recovery. You really do have to be able to learn how to comfortably and healthily feed your body. I think when we get caught up in the emotional aspect of it, we disregard the fact that the body is pretty important and we have to take better care of it.
When we get to the emotional elements of it, I think it’s getting to, what are the things I’m good at? What are the things I’m passionate about? What are the things I really love in my life? When you’re deeply in a disordered space, it’s hard to see what you’re passionate about and what you love. But those are the things that will help you get well.
When people say, “How did you want to get well?”, I kind of had to start with that negative theology and go, “I just didn’t want to be sick anymore. I didn’t want the disorder anymore.” So finding anything I could want to live for was really elementally important as well.
Chris Sandel: All of the different areas you’ve touched on there are things that I work on with clients. I think it was in an interview that I read where you said something to the effect that recovery in a sense is quite boring. It’s just like doing the things over and over again that you need to do. There’s not as many of the ‘aha’ moments that people think there are going to be; it’s just putting one foot in front of the other and doing it day after day. Which I think is pretty true for a lot of the work that I do.
Marya Hornbacher: Yeah. We’re expecting there to be one moment where suddenly – I think people often ask me, “When did you know you wanted to get well?” They’re expecting there to have been that lightning bolt that hit me and I was like, “Aha! Now I know I want to get well.” It really wasn’t that like that. Life isn’t that dramatic. I love the idea that it is, but it really is not.
Some of getting better is knowing that it isn’t all going to be highs and lows. There’s a lot of middle ground, and that middle path – there’s a lot of work in mindfulness and Buddhism that teaches us a lot about how to get through the day to day, the boring parts, the middle road, and some of those things can be really beautiful when we learn to see how much they heal us. Those ‘aha’ moments are great when they come, but they’re not the substance of how we get better, to my mind.
Chris Sandel: I would agree. I think because it takes so long, there are going to be a lot of moments where it’s just the daily grind and getting through it, where it’s just about putting in the time and doing the things.
Marya Hornbacher: Absolutely. It’s like training for a marathon in a lot of ways. Most of it’s not the marathon. Most of it is the training. The marathon is one day out of a year and the rest of the year, you’re just training, and that’s okay. That’s got to be okay.
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Chris Sandel: Then the book. How did that come to be? And when you first started writing it, was the intention for it to be a book, or was it some exercise in trying to piece together and make sense of what had happened?
Marya Hornbacher: That’s such a great question. It was not an exercise in trying to piece together what had happened. The original idea behind that book was it was never even going to be a memoir. It was going to be a feminist critique of pop culture and its influence on the way we understand our bodies.
The fact that it’s a memoir has very much to do with the publishing world. I was very young when I wrote it, so what they said over and over was, “Hey, tell us more of your story, tell us more of your story, tell us more of your story.” So gradually, and somewhat begrudgingly, I did that, for better and worse. I have very mixed feelings about that first memoir. I think it’s an okay book as a book, but it really occupies an odd part of my heart.
When I wrote it, I did not really know very much about memoir, for one thing. There was no memoir boom. There was no body of literature on eating disorders. It wasn’t a whole genre unto itself. None of that existed. And for that matter, it might help people to understand that the internet didn’t exist. The word ‘trigger’ was not part of the vocabulary. We didn’t know anything about pro-ana. Pro-ana didn’t exist yet. All of this came in the aftermath of the internet.
When I wrote that book, there was a lot I didn’t know that I really wish I had because I would’ve done it a little differently. But in writing it, I think it did help me in terms of piecing together how strongly I wanted to get better. As I went, I increasingly found that I wanted to get further and further away from the disorder. But also, I do know this: I get thousands of letters from people saying that it helped them see the disorder for what it is and helped them want to get better. That’s the good side.
Chris Sandel: And also referencing you saying there was no internet, it was a long time ago – for people who don’t know, this book was written I think 20 years ago. So it is a long time ago.
Marya Hornbacher: Twenty-one years ago, yep.
Chris Sandel: As you said, you were 23. I’m 36 now – God, I had to check. I’m 36.
Marya Hornbacher: Right. [laughs]
Chris Sandel: I won’t be held accountable for things that I’ve written when I was 23 because I would’ve thought very differently about the world. So I think to then hold you up to these modern standards when all of the world has changed in terms of our knowledge around the illness could be a little unfair.
Marya Hornbacher: I think it’s a little unsettling more than anything. I wish we had known how much we’d change in pop culture at that time. We had email. I was actually 22 when the book was written. That’s exactly half my life ago. I’m 44 now. There’s a real beauty in having gone a long way beyond that, but also, the fact is when you write a book, you set it down on paper, you are accountable for that. So I want to make sure that I remain mindful of the fact that those were my words and that was what I knew, and that’s all that I knew. [laughs]
Chris Sandel: What was the response like at the time? I know it’s kind of thought of as a cult classic now, but did it instantly do really well? Was it a slow burn? What was the reception?
Marya Hornbacher: The reception was pretty startling and pretty great. No one had ever talked about it before. I know that sounds crazy now because we talk about it all the time. But the whole purpose of that book was to get people to have a conversation about eating disorders and their role in, at that time, primarily women’s lives. That was by no means only, by no means restricted to women, but what we knew was that women were suffering pretty gravely in silence.
And now we know that it is not gender restricted, it is not racially restricted, it is not age restricted. It is absolutely indiscriminate in who is affected by disordered eating. But at the time we really needed to talk about it in the framework of what was going on with gender and pop culture. This was the second wave of feminism, so it was at the height of our awareness that people needed to be talking about women’s stories more. It was a moment in time.
But the response was that people were very, very happy finally to be talking about it, simply to have the elephant in the living room addressed. I don’t know if that’s a colloquialism that translates, but simply to be talking about what had been silenced.
Chris Sandel: It does.
Marya Hornbacher: Okay, good. It had been so hushed up for so long and so whitewashed and glamourised and glorified. The point of the book was to take some of that glamour away.
What we didn’t know – and I certainly didn’t know – was that people, when they are ill, find glamour in self-destruction. I wish we knew more about that today, even.
Chris Sandel: You said when you were writing it, they kept feeding back notes of “Tell us more about your story.” Did that mean that the intended audience shifted, or what you were trying to do with the book shifted in terms of stopping eating disorders or helping people with eating disorders?
Marya Hornbacher: I think my intended audience and the audience it ultimately had, that has changed over time. My intended audience was the general audience and also the loved ones of people with eating disorders. As anybody who reads the book knows, there’s nothing in it that someone with an eating disorder doesn’t already know.
What I underestimated was how many people would be glad to have their stories told. I didn’t realise how badly we as a community needed that story out there, and I’m very grateful for that, for the fact that people have told me, “You told my story.” My story, Marya, one person – who cares? But because it is the story of so many thousands of people, that I think became elementally important.
As I wrote, them telling me more and more, “Tell us more of your story,” I think that was partly a marketing ploy. I think the memoir boom was just about to happen. It was early in the memoir boom, and they really wanted a memoir. I really wanted a very academic little critique of feminism in the 1990’s. So we wanted different things.
Over time, I think I have come to terms with what it became and the fact that it, of course, is a memoir – enough such that I wrote another memoir. So memoir is not a form I don’t like, but it really did change my understanding of what the book was for. It stopped being an argument that I was making and it started being a story I was telling.
Chris Sandel: It’s interesting that you said that part of the intention was for a general audience, because when I think of a good documentary, I think of something that is engrossing and fascinating, even if you have no prior knowledge or interest in a topic that is covered. I definitely feel this way about your memoirs. Even if you don’t have an interest in eating disorders or you don’t have an interest in mental illness, they are definitely great books that are gripping and riveting to read and that people should check out. I know that’s a slight tangent, but it was just something I wanted to flag.
Marya Hornbacher: That’s great to hear. [laughs] That’s great to hear.
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Chris Sandel: I think it was the 15-year anniversary of the book, you included an afterword which seems a little bit at odds with how the book had originally ended. Do you want to describe this and what made you change your view or change your mind?
Marya Hornbacher: Yeah, absolutely. Time made me change my mind. Time and experience. The original book that came out in 1998 ended on such a note of ambiguity of “I don’t know if I’m ever going to get better. I don’t know how to get better.” It had all kinds of loose ends. One of the thing I really love about the book, if I can be said to love it, is the fact that it doesn’t try to tie it up. It doesn’t try to put it in a little bow and say, “And then I was struck by lightning and got better” because that doesn’t happen.
What I really wanted to do with that afterword was let people know two things: first of all, that full recovery is possible, and two, that it takes time and it takes effort. I wanted that to be reassuring to readers because the book in its original format is so dark and so uncertain – and that’s really reflective, of course, of where I was when I wrote it. By the time I wrote the afterword in 2014, I was well. Eating disorders weren’t on my mind anymore.
So when they contacted me and said, “Do you want to do anything for this 15-year anniversary?”, I said, “Absolutely. I want to say I was wrong. I want to say that that ambiguity, that darkness, is not a permanent condition.” One of the last quotes in the book is from Emily Dickinson about winter. It’s from ‘A formal feeling comes’. It talks about how cold things are after an eating disorder. And that’s not true. It was true at the time. It was, to the best of my knowledge, what was true.
But what’s true over time, if you do decide that you’re going to get past the disordered eating and you’re going to get past the illness, is it isn’t like that. You can go on with your life and you can have quite a beautiful life, free of the illness. I wanted people to know that and I wanted them to be reassured by that.
Chris Sandel: What was the response in terms of that? Because obviously there was some criticism in terms of the book that you talked about before. Did that help people in terms of reading that new afterword?
Marya Hornbacher: I don’t know. Mostly what I get from people in terms of mail, email, notes, messages, etc., is people saying that one way or the other, the book as a whole, with or without the afterword, helped them see what was going on in their lives.
What I have heard from people about the afterword is that it brought them up short after reading such a graphic account of the eating disorder. Hearing, then, that I am very adamant in the afterword that people do need to get well, that it’s something of a responsibility that we have – if we know we can, we have to – I think there’s such fatalism within the community of providers, sometimes, who help us. There’s such a sense of chronicity. What I wanted to break through with that afterword was that it may not be chronic. It doesn’t have to be chronic.
I think when people read that, it may give them a sense of “Oh, not only could I get well, I’ve kind of got to do that.” What I’ve heard from people is that that brings a sense of awareness to them that they may not have had.
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Chris Sandel: You’ve touched on some of this already, that things have definitely changed from when you were going through an eating disorder to now. What can you think of as being some of the biggest differences? This could be in terms of treatment, it could be in terms of what we understand, etc., for someone like yourself who was suffering with bulimia and anorexia in the ’80s and ’90s versus where things are now.
Marya Hornbacher: I think social media has really had a devastating effect on eating disorders and has increased them, exponentially increased our vulnerability to them and increased their incidence quite profoundly. Social media isn’t evil in itself, and I go on Facebook now and then myself, but I think the fact that we are so constantly hyperalert to how people see us, whether visually or personality-wise – we talked about a cult of personality in the ’80s and ’90s, and now that cult of personality is quite visual. We follow people on Instagram because of how they look. Well, who cares? To me that’s really bewildering, but I know that is very, very consuming to a lot of people.
I think we have become an almost entirely visual culture, and that is devastating to people who already have a vulnerability to being sensitive about how they look or who are self-conscious about how they look or who are body-conscious. And many, many, many, many people are body-conscious. I won’t say everyone, but certainly quite a lot of people struggle with that. So that has changed. Social media has changed us.
I wish I could say treatment has changed. I think to some extent, now there are providers who recognise that recovery is possible – but I still think that there is a really profound revolving door factor in treatment, and people are not encouraged to fully recover but are encouraged to think of their issue as chronic. When we are encouraged to think that it is chronic, that becomes a self-fulfilling prophecy. I wish treatment was more like, “You’re in, you’re here. Sort it out. Figure it out.” I wish we had better tools to help people do that figuring out in short-term intensive stays.
But the treatment that I see that really works is stuff like mindfulness-based stuff and things that have to do with getting people outside into nature. The types of treatment I see not working are the same treatments we had in the ’80s and ’90s, and they were just to feed us and send us on our merry way. And what’s changed? We’ve been fed, but we haven’t fundamentally changed as people, and that’s really where the change has to happen.
Chris Sandel: Yeah. From my work that I do with people, it’s very much marrying up those two things. The mindfulness piece, the yoga piece, the getting outside is great, but if someone’s not eating the food, then nothing’s going to happen. But at the same time, if someone’s eating the food but it’s just being forced upon them and they hate every moment of it and you’re not dealing with all of the things that brought this to the fore, then as soon as they get out, it will just go back. So it’s getting those two things to work in tandem.
Marya Hornbacher: Absolutely. So much of it has to do with integration of the body-mind stuff. We are not just bodies, we are not just minds. We are one whole organism, and the whole thing has to be dealt with in treatment.
Chris Sandel: Definitely. Do you see any positivity or hope in that changing in terms of your comments about it being seen as a chronic illness? Is there any glimmer of hope that you’re seeing in the treatment world?
Marya Hornbacher: I see some places – and they get really sniffed at by the mainstream world – that I think are doing really, really good work with 12-step approaches, with nature-based approaches. Like you were saying, the yoga, the pieces that – the more woo-woo it is, the more people I see getting better long term. I don’t mean like when we’re doing card readings or whatever, but I mean the more integrated we can be with the body-mind treatments, the better the outcomes. That’s what I see in both the research and in anecdotal evidence from people who’ve gone through programmes. The more clinically based it is, the more I see people tuning it out because they’ve already been through so much clinical work.
So I feel like some of the programmes have a lot to learn and some of the programmes that are a little bit woo-woo need better funding. I think we need to take risks of being a little bit woo-woo at the risk of not getting the kind of NIMH or federal grants that we would love. That becomes one of those fights between psychology and funders. That’s not super relevant, but I do think that the more we can support those programmes that are doing innovative work, the better.
Chris Sandel: Does it mean, from your comments there, that the places doing more of that integrative work are pretty much going to be the ones that are available to the people who have the money to pay it? They’re not going to be available through insurance to someone who otherwise couldn’t afford it?
Marya Hornbacher: With American insurance, basically treatment isn’t accessible at all anyway. Even clinically based or hospital-based programmes are hard to access. Treatment is very much horribly unavailable. We need more and more community-based programmes, and those will come from people who, in recovery, go back into the community and say, “This was my experience and this is how I got better.”
The clinically based programmes, at least in the US, when you have a capitalist-based system, it’s impossible to get coverage for very long. So you have those revolving doors. American insurance is very short-sighted, so they say, “Her vitals are up, his vitals are up, he’s eating now, so I guess he’s okay.” Out he goes again, relapses, comes right back in. It becomes incredibly costly. The long-term programmes, the ones that do the integrative work, are in the long run more cost effective.
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Chris Sandel: Let’s then chat about your second memoir, Madness. As I said at the start, it kind of picks up where Wasted left off. Are you able to give a bit of an overview of what this one is about?
Marya Hornbacher: Absolutely. It’s about bipolar disorder. Again, we only know what we know when we know it. That book came out in 2008. I’ve had several books since then, but I have a new book coming out now that reflects a lot of knowledge I’ve gained in the last 10 years. But that particular book deals with the really critical years of my bipolar disorder. I have bipolar type 1. When you say you have bipolar type 1, the doctor’s eyes widen and they go, “Oh golly.” But of course, it is really quite manageable over time and with the right support.
It deals with some pretty critical – it’s like a high speed chase of a book, and it picks up after the eating disorder treatments and when I was in my twenties and thirties. It covers the years of my twenties and thirties, when I was dealing with very severe mania and depressions, like you do with manic-depression. It also deals in the end with – as I was coming out of the darkest period of that illness, it begins to shed some light on how mental health recovery can be possible. And that’s what I’m getting at in my sixth book, which comes out next year.
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Chris Sandel: You referenced bipolar type 1. I imagine that many listeners will only have a vague idea of what bipolar is, so can you describe what that is and then the difference between bipolar type 1 and type 2?
Marya Hornbacher: Sure. Bipolar, for starters, is the common name for manic-depression. It’s characterised by swings between mania and depression with periods of what’s called euthymia in between, periods of stability and relative emotional equilibrium.
Type 1 is the type that has the manic breaks, the really severe – like I said, the high speed chase of mental health. The depressions are very, very severe, very dark, very deep. Bipolar type 2 – at least this is what the research shows right now, and that’s always changing – but bipolar type 2 doesn’t have full-blown manias. People go into what’s called hypomania. It’s a lower grade mania, but it can still be very damaging. What they deal with instead is a more chronic, pervasive, corrosive depression.
I think either one is a very hard hand of cards to be dealt, but that’s the distinction between bipolar 1 and 2.
Chris Sandel: In the book you describe the mania and the depressive states really well, but I guess it would be useful to give the audience a bit of a taste of that or a bit of a sense of it. When you’re in a manic state, what does it feel like? What’s going on?
Marya Hornbacher: When you’re in a manic state, at the very beginning it starts slow and it builds gradually. When you’re in a manic state, it can at first feel wonderful. It’s happier than happy. Everything in bipolar, it’s like the volume gets turned way up on it. It’s the same emotions but with the volume amped. Happy is incredibly happy. Excited is incredibly excited. You get very, very rapid in your thinking, in your speech. I’m already rapid in my speech, but that’s quite natural for me.
But you can, as the mania progresses, become grandiose. You can become incredibly impulsive. It can get very dangerous. People have a lot of car accidents. People buy a lot of stuff if they have the means to do so. People can become sexually extremely active. People struggle with self-harm when they’re dealing with bipolar mania. Those are the acting out – they’re called goal-seeking behaviours. That’s the acting out phase of mania.
And then at the far end of the spectrum, when it’s very, very severe and unchecked, people can become psychotic, become delusional – delusions of grandeur. If I’m having a delusion of grandeur, I’m not thinking my name is Marya; I’m thinking I’m the Queen of England. Religious delusions are quite common. It becomes a psychotic disorder at that point rather than simply strictly a mood disorder.
That whole arc from the very, very happy to very, very troubling and dangerous psychosis, all of that can be encompassed in the span of one mania. And typically it’s followed by a pretty hard crash.
Chris Sandel: Then the hard crash, what’s going on there? What’s it like?
Marya Hornbacher: It’s incredibly deep depression. The crash feels, literally – it’s like your body crashed into a wall. The depressions that follow manias are very, very deep, very, very – the word I want to use is heavy. It’s like there’s a horrible weight on you. It feels like your heart is breaking all the time, or some people go into a catatonic depression where you’re not feeling anything at all, you’re not talking, you’re not moving, you’re not doing anything. You’re just basically curled up in a ball. Those catatonic depressions are very dangerous.
Then those intermediary periods between depression and mania are also pretty dangerous as well. They can be called mixed episodes where you’re dealing with both the negative feeling and perception of a depression and the energetic out-of-controlness of a mania. Those mixed states are very, very dangerous.
People with bipolar have a very high rate of suicide, the highest of any of the psychiatric disorders. Between 15% and 20% of people with bipolar commit suicide. That’s horribly, horribly high, and the research is still out on why it’s so high. People are still working very, very hard to try to cut back on that very high rate.
Chris Sandel: I think you described it as like a car chase in the book. There is this intensity to your writing. There were moments where I was like, I’m going to have to put this down and have a break. I have never suffered with a mental illness, but the closest I can come to any similarities is having some bad experiences on drugs. I’ve had some wonderful experiences and I’ve also had some bad experiences.
But even with the bad experiences, I never lost a sense of self in terms of there was always a remembrance of “I’ve done something; this is going to end at some point. I just need to wait out this badness.” But I get the sense within the book that there isn’t that realisation. It just becomes the new reality. You don’t realise this is what’s happening. Is that correct?
Marya Hornbacher: That’s absolutely correct, and that’s really insightful too. I think one of the things to recognise about living with a mental health disorder like bipolar or depression or OCD or any of the severe disorders, schizophrenia, all of those – it isn’t going to end, to an extent. When you have a condition like this, we don’t now have a cure for mental illness. So when you’re in those extreme states, whether it’s psychosis or mania or depression, when you’re in that extremity, it feels very intense, it feels very extreme, and it also feels like there’s no endpoint.
The trick to recovery, if there’s any one trick, the real trick is to recognise ‘this will pass’. You have to have that tiny bit of insight to know, “Okay, right now I’m curled up on a bed and I can’t move and I can’t talk and I can’t cry, but this will pass.” Recognising that is very, very hard when you’re in that emotional state. It’s such an acute emotional state.
During those years when it was really, really severe, I would’ve loved to have been able to put my own life down and take a break. [laughs] That’s why, I’m sure, the book has that feeling to it. Oh gosh, I’m sure people reading it need to take a break.
And now in my life, in the aftermath of those very severe years, when I experience – whether it’s hypomania or depression or any of the things I still do experience, the real key is recognising – and when I can’t recognise it, asking someone else to tell me – this will pass. This has got to end.
00:43:24
Chris Sandel: Are there other misunderstandings that you think people have around mental illness or specifically bipolar? This can be either people who actually have those conditions and you’re like “I really wish people would know this” or it can be more the general public, where you’re like “I wish people know this.”
Marya Hornbacher: Absolutely. I think on both counts, there are a lot of things I wish people were more aware of when it comes to bipolar and mental illness in general. First of all, it’s not a death sentence. I think again, that perception of chronicity and permanence is really damaging because it leads people who have the disorders to believe, “I’ve just been diagnosed with bipolar or schizophrenia or whatever; that’s it. I’m done.” And that’s not even kind of true. But that certainly is the widespread perception: that if you have a severe mental illness, that’s what you have now and that’s your life.
In fact, going back to what I said right when we started talking, that’s not actually a primary or persistent or even very frequent part of my self-perception. Yes, I have bipolar, but for me now, after all this time, it is like having diabetes. I do what I need to do to take care of it, and when it flares up, it flares up and I take care of it again. That doesn’t make dealing with it pleasant, but it does mean that I get to go on with my life. I’m a professor, I’m a journalist, I write books. I go on.
One of the things that I also wish people would recognise is that they can do more for themselves in terms of recovery than the doctors are telling us. The doctors, who I love dearly and respect and admire, don’t know very much about mental illness at this point. They don’t know about where it comes from, they don’t know why it happens very much. They know a little bit about the brain elements of it. But what they don’t know very much about is what we can do to do better in our own lives. That’s something we have to resource on our own.
So there has to be a lot more active engagement by those of us who have the disorder in terms of figuring out what works for us, and that is where recovery comes into play.
Chris Sandel: Is that part of your reason for writing the book? I know you obviously only touch on that very much towards the end, but to try and give people a better understanding with bipolar and some of the remedies or the things that could be helping them out that aren’t normally recommended or isn’t going to be coming necessarily for their doctor?
Marya Hornbacher: That’s what I’m doing with my new book. The new book is called We’ve Been Healing All Along: Stories from the Road to Mental Health. I’ve interviewed about 1,500 people now, and most of them have mental illness themselves. The reason I went about this book was to find out, if I’m doing so much better than I was ever told I would, somebody else is probably doing so much better than anybody told them they would. I’m not the only one doing fine.
And indeed, I’m not the only one doing fine. What I’ve been discovering is how all these people individually, quite independently of each other and quite independently of the field of mental health, are finding ways to make their lives work, with or without a mental illness. That’s why I’m doing this next book.
The reason I wrote Madness was because there was and is such misperception around what bipolar actually is. People see you as this wild-eyed, cart-pushing person who can’t get their life together and who is just difficult. I wanted to break some of that stigma down by telling a story.
But the next book is more about some of those strategies for getting your life back on track.
Chris Sandel: At the back of Madness, you share some stats about bipolar, which were both illuminating and worrying. My copy of Madness was published in 2009, so it’s nearly 10 years old. The figures may have shifted somewhat, but my sense is probably not that much.
Marya Hornbacher: Not that much.
Chris Sandel: One of the stats that jumped out was that the average age of onset for bipolar is 23, but the average age for a correct diagnosis is 40. This is an incredibly long time. What is the reason it takes so long, if you know?
Marya Hornbacher: Yeah, I do. There are two primary reasons. The first is that psychiatric diagnosis is directed primarily by the DSM (Diagnostic and Statistical Manual of Disorders), which is really a malfunctional document. All it does, really, is tell people what your diagnostic code is. It doesn’t tell people anything about what caused your disorder; it doesn’t tell people anything about how to treat your disorder. It just tells them what your number is on a chart.
When you go into a psychiatrist and say, “Here are my symptoms,” you’re more likely to go in when you’re feeling awful, and you will be diagnosed with depression. You’re not likely to go in when you’re feeling grandiose or feeling really fantastic or buying lots of clothes or whatever the things are when you’re having those more positive or at least less destructive symptoms of bipolar.
So bipolar is hard to diagnose because we usually are diagnosed with depression first. Also, many people with bipolar have co-occurring disorders like eating disorders or drug and alcohol addiction. The rate of drug and alcohol addiction is very, very high in bipolar, and that’s both genetic and characterological in origin. You may get seen for your alcohol addiction when you’re 17, but they’re going to treat you for your alcohol addiction and not necessarily know that you have bipolar.
There’s lots and lots of misleading factors. There’s lots and lots of mis-diagnostic cues. There’s lots of missed cues. There’s lots of hints that are there that people don’t see. And then there’s the simple fact that psychiatry is very bound up in a very diagnostic procedure, also.
00:50:00
Chris Sandel: As well as that, at the end of the book you also list a breakdown of the costs of your medication and supplements and therapy and psychiatric visits and hospital stays. The cost of this stuff is not cheap, and a fair amount of it is out of pocket and not covered by insurance. Reading this list also made me think part of the reason people aren’t (A) getting better but (B) also getting the diagnosis they need is they just aren’t able to afford to go to the places to get diagnosed adequately.
Marya Hornbacher: That’s absolutely true. The fact of it is that – I’m reading a lot right now on what’s more effective in terms of treatment, and the most effective treatment, we don’t know. We don’t know whether the meds are more effective than psychotherapy. But it doesn’t look like they are substantially more effective. A lot of people need both, and both the medications and psychotherapy are expensive. It depends on what country you’re in, it depends on what kind of coverage you have, of course, but the best approach does cost money.
The one thing I would say about that is that many of those stats in the back of the book – the stats about the field haven’t changed. I, however, am on vastly fewer medications. I need a whole lot less therapy. I need a lot less care than I used to. So the costs for me personally have gone way, way, way down as I have gotten better at doing things in my own life to keep myself well.
Actually, some of the most effective things for bipolar, depression, schizophrenia, anything like that, the severe mental illnesses, a lot of the things that are most effective are free, like sleeping. [laughs] Sleeping is number one on my list of meds. Food, another one way high on the list of meds. It’s not free, but it’s certainly not as expensive as say lithium. Some of the techniques that we can use to keep ourselves well really are lifestyle-based, and that’s a hopeful thing.
Chris Sandel: Is that part of what is coming out in this new book? It’s almost like an afterword for Madness, in the same way as you did a very brief afterword for Wasted, but you’re now doing a whole book as an afterword for Madness?
Marya Hornbacher: It is and it isn’t. It’s not a memoir. I’ve been doing the research on it for about five years now. The research base is much different than it was for either of the memoirs. I’ve been interviewing neuroscientists and psychiatrists and people with mental illness themselves and people who work in the fields and people who research. It’s a really different kind of book.
But what it does do is take a look at what we really know about the brain and what we can really do on the ground, here and now in our day to day lives. It talks a lot about the conflicts in the field. There are a lot of conflicts in the field between psychiatry and neuroscience, between neuroscience and behavioural health providers. I mean, you’re very aware of some of those controversies that exist right now.
Part of what that book does is talk about, okay, here are the controversies, and here’s the bottom line for those of us who deal with mental illness on a day to day basis.
00:53:39
Chris Sandel: It has been 10 years since the book was written, and I think towards the end of the book it was at a stage where often in the summertime, you would be having moments of mania, and then in the wintertime, you were having more tendency towards depression. It seems like that was a pretty yearly thing. Is that where you’re at now, or it’s more spaced out? How is your mental health?
Marya Hornbacher: My mental health is great. I haven’t had a hospitalisation since 2007, so since a year before the book came out. In the book, there are 14 hospitalisations or something crazy like that. But I haven’t been hospitalised in many, many years, and part of that is simply getting better at managing it, and part of it is I’m not on medication, some of which I really didn’t need to be on. Part of it is that I’m on the right doses, everything like that.
There are a lot of pieces that go into recovery, but I haven’t been hospitalised in a long time. I don’t really deal with extreme manias anymore. I still deal with some low grade depression, and that is more than anything corrosive. It’s annoying. It’s like there’s this dog yapping and nipping at your heels. And it’s annoying, but you just deal with the dog. You just go, “Well, the dog’s back.”
Actually, William Styron, in that beautiful memoir Darkness Visible, called depression ‘the black dog’. He’d say he was having a visit from the black dog. That really is how it is. When depression comes, it’s present, and you just do what you need to do to take care of it. When mania or hypomania, as I experience it now, comes, I don’t use my credit cards. [laughs] I don’t have credit cards, I don’t shop, I don’t do anything impulsive. I recognise it.
A lot of managing mental illness comes from experimenting over time with what works. What you really need is the insight to say, “Oh, this is happening. Now, how can I make this better?” instead of saying, “Oh, this is happening. I’m going to ride this high till I crash.” That’s a very big difference in terms of outcome.
00:56:05
Chris Sandel: I would like to shift focus a little bit. At the very beginning you described yourself as a writer and a journalist, and that’s what you do, so I would love to chat a little bit about your writing process. We’ve talked about your two memoirs; how do you go about putting a memoir together? I know that’s a very broad question, but we can start there and drill down from there.
Marya Hornbacher: Sure. The two I have written were written in very different ways. The process was very different.
With Wasted, I wrote almost from the beginning to the end. It’s a very chronological structure. It’s a traditional memoir in that it goes from Point A to Point C with B in between. With Madness, because it’s so reflective of the fragmentation that one experiences mentally with mental illness, the structure is very fragmented. I wrote Madness in fits and starts. I’d write a scene here and a scene there and a passage there and a passage here. When I realised I’d written everything I had to say about it, I laid all these things out on a very long table and shuffled them around until they had the logic of the book that you see.
So totally different processes, but the writing itself has to do with – and now this is me with my writing teacher hat on – the writing has to do with recognising that you are dealing with a very focused period of time. A memoir is not an autobiography. An autobiography is comprehensive. It details everything and assumes everything is important. A memoir is a very, very focused piece of work. It’s a genre that deals only with the subject matter.
I have one eating disorder memoir, one mental health memoir, and I don’t have an autobiography out, nor do I need one, because most of my life is really, really dull. We don’t need to be comprehensive about my life. I had a couple of things that I knew a lot about, so I wrote memoirs about those things.
When you are writing a memoir, when one is writing a memoir, you have to remember that not everything is relevant. In fact, almost nothing is relevant. Only those things that contribute to that particular story get to stay. That’s really the thing to be aware of.
Chris Sandel: That’s probably the part that makes Madness – and I’m referencing Madness just because I’m remembering it better now because I read it most recently – so intense, because you really concentrated all of the timeline into only the bits that are about that part. You kind of get the impression that that’s what it’s like all the time because there isn’t any of the dullness there. I think that adds to the intensity of it, which is obviously what you’re trying to get across as part of a memoir like that.
Marya Hornbacher: Sure. That’s very true. A memoir is very distilled. When people read my memoirs, I always get such a giggle when they say, “I feel like I know you so well.” I’m like, oh my gosh, you don’t know almost anything about me. I am honoured on the one hand by people saying “I feel like I know you so well,” because what they know is a personality or a style. But what they don’t know is I look ridiculous in the morning and I wear blue pyjamas and I wander around the house and talk to my dogs when no one is home. We all have very, very ordinary lives in many ways, and I think there’s a real beauty to that.
Maybe someday I’ll write a book about all the ordinariness in my life, and it will be my favourite book. It will be my very favourite book of my own. [laughs]
Chris Sandel: In terms of getting down everything that happened and remembering this, how much of this is coming from memory versus how much of it is being filled in by family and friends and ex-partners and all of that?
Marya Hornbacher: People go about it differently, but I come from a journalistic background, so my instinct is to go right to the sources. I had years and years and years of journals and notebooks and records and emails and letters and all of these sources that I could go to, to find out exactly, to the best of their ability and my recollection. I could go right to the source. I interviewed my parents for I don’t even know how many hours for both of those books. Probably 30-40 hours apiece. I interviewed ex-partners, many, many friends, siblings, relatives, teachers, bosses. All of those people have been incredibly instrumental in helping me remember accurately.
The other thing I have done in both cases is have the book go through a series of readers after the drafts were done for fact-checking, just like you would an article. That’s why I have always felt pretty strongly that when you’re writing memoir, you don’t have to do it just ‘to the best of your recollection’. You can really get down there and find out what happened.
Chris Sandel: The way that you describe things, the tension and the drama and the illustrative nature of the words and the phrases you use – when I was reading Madness, it was no surprise when you then talk about the fact that you write poetry and you took poetry classes. How do you feel poetry has helped you as a writer, even if you’re writing prose instead of poetry?
Marya Hornbacher: Oh, I love poetry so much. In fact, that’s mostly what I read. I mostly read poetry and essays. I think poetry teaches me a lot about the economy of language, so there’s not a lot of wasted words when I’m writing, or I try to cut them in the editing process. Poetry is so imagistically profound. There’s so much image, there’s so much metaphor, there’s so much beautiful language, and there’s such good choices made.
When you’re writing a poem, there’s no wasting of words. You don’t have time. And when you’re reading poetry, I think that makes you more instinctively aware of which words belong, which don’t, which images are strongest and which are weak, what has the best ring in terms of the music of the language that you’re using.
When I’m teaching, I have all of my students read poetry, regardless of what I’m teaching. Well, maybe not when I’m teaching journalism, but when I’m teaching nonfiction or fiction or poetry, I always have people read the poetry for the language and for the economy of it.
Chris Sandel: Is there other advice you would want to share with writers, or one thing you wish you’d known earlier in your career that you know now?
Marya Hornbacher: Yeah. You don’t have to reinvent the wheel. The thing that I recommend for most people is that if you want to write a novel, read a lot of novels. If you want to write a memoir, read a lot of memoirs. Read a variety of memoirs. Read a lot of memoirs that have nothing to do with your topic. If you want to write a novel in fragments, read lots of fragmented novels.
You don’t have to start from the ground up, because what will happen – and this happens a lot with new writers – is they write things that have been written before. We all have an ear for what we think things should sound like, and that’s what we hear first. You have to dig below that to get to your own voice, to what’s really original. To do that, you have to read what’s already been done, and then you’ll find out what’s new and what’s original to you as a writer.
Chris Sandel: You said before your life is pretty boring outside of what was written in the memoirs. Do you have another memoir in you? Is there another part of your life that you feel is an interesting story that hasn’t been covered? I know this sounds like an absurd questions; you’ve already written two, and most people don’t write two memoirs. But I’m just wondering.
Marya Hornbacher: [laughs] A lot of memoirists write like five memoirs. Memoir is a form, and when you get used to writing in that form, it becomes pretty effective for you. I’m certainly not the first memoirist to do it twice.
But no, probably not another memoir. I’m working on right now something that will come out after this book on mental health and recovery, a collection of essays. That’s not a memoir. It’s a really different format, it’s a really different structure. But it is first person, so there is more story to tell. But I don’t have another memoir, to the best of my knowledge at this time. On the other hand, I’m only 44, which I know sounds really old when you’re 22, but I’ve got another half a life to go here. So I wouldn’t put it past me. But I think probably I have changed my approach enough that my next books will be journalism, essay, and novel. And maybe one of these days I’ll do a collection of poetry.
01:05:43
Chris Sandel: When I was reading through Madness, and also it was touched on in Wasted, thinking about a memoir on alcoholism. I know you touched on it in both of those books, that if you really focused on that particular topic, it felt like there could probably be another memoir in there.
Marya Hornbacher: Oh, probably. But I feel like there are some brilliant memoirs on alcoholism. I don’t know that I have anything to add to those. I think the ones that have been done are really beautiful.
Chris Sandel: How was it for you, becoming sober, and how do you compare that to an eating disorder? Or is it blurrier because they were intertwined?
Marya Hornbacher: It’s a great question. The one thing I can point to in terms of getting my mental health back that I did was get sober. That helped. The meds? Meh, some of them help, some of them don’t. The yoga? Sure, it helps most of the time. But what really makes the fundamental physiological difference for me in terms of managing my bipolar is staying sober.
That’s really important, because so many people with bipolar and with schizophrenia and with depression and with the other mental health disorders, so many of us deal with substance abuse, it’s not even funny. It is really literally like pouring gasoline on a fire. So if you want to stay sick, keep doing it. If you want to get better, you might want to stop. That’s something I always do want to let people know. That makes a fundamental difference to the brain. Just very, very basic biology and chemistry.
Getting sober was initially really, really hard. In that way it was very much like the eating disorder initially. It was very, very hard. And then it was just run-of-the-mill. After a period of time, you just get used to not drinking in the same way you get used to eating when it’s time to eat.
You have to remember, I think, that it’s a return to your body’s natural state. It is not your body’s natural state to binge and purge. It is not your body’s natural state to starve. None of those are where your body likes to be. In the same way, your body doesn’t really like to be drunk. So when you return your body to homeostasis, when you return your body to baseline, it’s really grateful, and it works a lot better for you, and your brain works a lot better.
Both the eating disorder and the alcohol, once those were eliminated from my life, everything got a lot easier. [laughs] It just got a lot easier after that.
Chris Sandel: I think that’s a good place to finish up with this. Marya, thank you so much for coming on the show and for chatting with me. I’m a huge fan of your work, and it was a pleasure to be able to speak with you.
Marya Hornbacher: Oh, thank you. It was wonderful to speak with you as well.
Chris Sandel: Before you go, if people want to know more about you, where should they head? You can put website; if you do social media, tell them that, and then different books that you want to point them towards. I’ll put all of this in the show notes.
Marya Hornbacher: Oh, wonderful. Absolutely, yes. Go to my website or go to my Facebook page. I have an author page. I also have a personal page. I friend everybody. I’d love to connect with folks. It’s maryahornbacher.com, and on Facebook and Twitter I’m just Marya Hornbacher.
Chris Sandel: Perfect. Thank you again for your time, Marya. It has been an absolute pleasure.
Marya Hornbacher: It’s been a delight. Thanks so much, Chris.
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