Harvard-trained neuroscientist Lisa Genova debuted as a novelist with Still Alice (2007), about a woman who is diagnosed with early-onset Alzheimer's disease. Genova's later novels Left Neglected, Love Anthony, Inside the O'Briens, and Every Note Played feature characters with hemi-spatial neglect, autism, Huntington's disease, and ALS, respectively. Her sixth novel, More or Less Maddy, follows a young woman with bipolar disorder. As ever, Genova brings both an expert understanding of the neuroscience and a masterful eye for compelling characters in an emotionally textured narrative. Maddy's story is completely absorbing; it may keep readers up all night.

Maddy Banks has had a privileged upbringing in suburban Connecticut. There were some tough times in her early childhood, and her father is a shadowy figure. But since her mother, Amy, remarried, it's been easy: dinners at the country club, a popular boyfriend, a highly successful older sister, and an easygoing jock of an older brother. In high school, "each day was laid out for her like a matching outfit on a bed, when both her inner and outer worlds felt organized, predictable, happy, and light. Life was handed to her like a potted succulent, small and tidy and requiring little effort to maintain." But the transition to college has not been smooth: "She remembers herself then... and it's as if she was a different girl in another lifetime. She can't pinpoint exactly how, but she doesn't feel like she used to feel."

Her first year at NYU is a shock: "The impossible-to-keep-up-with workload, living with a roommate who drove her crazy, having no clue what to major in, still not finding her passion or her tribe, losing [her boyfriend] Adam. Twice." In her sophomore year, Maddy's diagnosed at the student health center with depression. The antidepressants she's prescribed help to set off her first manic episode, a big splashy event that results in her first stay in a mental hospital. Maddy and her family--who are loving, if not always graceful with the challenges they face--are in for a roller coaster.

In her more stable moments, and especially during the hypomania that often precedes full mania, Maddy develops an interest in stand-up comedy. Along with her love for Taylor Swift--and delusions about their friendship, with a budding business and creative relationship--Maddy's passion for comedy becomes a trigger for her mother: getting excited about comedy, Amy Banks believes, means a manic episode is imminent. But while Maddy does not in fact have a personal relationship with Taylor Swift, she does have a gift and a passion for comedy. In Amy's country-club world, this is not a reasonable life path. But Maddy wants it to be. It is one of the tricks of bipolar disorder that "real" excitements can be mistaken for illness, making it difficult for Maddy to pursue her legitimate dreams.

Maddy, her family, and readers learn about bipolar disorder together, with accompanying denial, anger, grief, the ups and downs of sorting out medications and side effects, and relapses. It is heartrending to see Maddy's anguished efforts to come to terms with her disorder and to dissect what is real and healthy from what is delusion. Readers are privy to her self-talk: "It's okay to feel disappointed and sad."; "It's okay to be happy."; "It's okay to be giddy." It is one of the greatest gifts of fiction to allow readers into experiences that are not their own, to find empathy. Genova's descriptions of Maddy's episodes are evocative, clear, and relatable: "Before her hypomania ripened to rotten, there was a delicious sweetness to her thoughts and life. She had a massive amount of unearned confidence in her ability to do anything that struck her fancy. She made big dick energy look flaccid by comparison."

Secondary characters are equally convincing and essential. Amy is capable of actions that frustrate Maddy (and readers), but she also genuinely wants the best for her child. Maddy's sister, Emily, is almost too perfect--life comes easily for her, and it's the life of their mother--but she is goodhearted, and that seems to be the life she truly wants. Maddy's high school boyfriend, Adam, is one example of the gradual realization that things are not always as they appear. He had the right markers--basketball star, handsome, popular--but readers, and Emily, see some red flags in his treatment of Maddy, who goes on to make other exemplary friends and meet other objectionable characters along her rocky path.

It is an important element of Maddy's development that she chooses to embrace her own unique self--her sense of humor, her interests, her differences--rather than follow the cookie-cutter plan laid out by her upbringing. "When Maddy was growing up, being normal was always the unquestioned goal.... Normal was her default, unexamined way of life. It meant fitting in, blending with the colors, sounds, and shapes around her." All young people are out to find themselves; Maddy must live her own version of that. She is not defined by her disease, but is rather a complex young woman navigating the expected tumult of coming-of-age with added complications. Her story is affecting, harrowing, beautiful, and enlightening, as well as a great pleasure to read. --Julia Kastner  

Lisa Genova (photo: Greg Mentzer)

Lisa Genova--who's been hailed as the Oliver Sacks of fiction and the Michael Crichton of brain science--is the author of Still Alice (adapted into an Oscar-winning film starring Julianne Moore), Left Neglected, and Remember: The Science of Memory and the Art of Forgetting, among others. Genova holds a degree in biopsychology from Bates College and a Ph.D. in neuroscience from Harvard University. Her sixth novel, More or Less Maddy (Gallery/Scout Press, January 14, 2025), features a young woman coming to terms with bipolar disorder.

Why bipolar?

I'm excited to talk about the distinction between a mental illness and a neurological condition. There's a stigma attached to the idea of mental illness. I can't trust you, you're crazy, you're dangerous--all of that gets piled on immediately. We would never refer to ALS, autism, or Alzheimer's as a mental illness. And yet depression, schizophrenia, bipolar--those are also neurological conditions. To distinguish them as mental illness seems to add an unnecessary burden on these folks that this is somehow their fault.

My neuroscience background is my unique lens on fiction and it's why I write, because these topics are so daunting and overwhelming, and fiction is such a lovely place to help people empathize. I picked bipolar disorder because I had a sense it was everywhere.

Every time I said my next novel was going to be about bipolar disorder, it got the same reaction: a mix of gasps, whispers, and applause. That's never happened with any other topic I've announced. People started DM-ing me on social media: I have a mother, I have a brother, I have a dad. Not necessarily offering to talk to me, although a lot of people did, but others were just thanking me already for this book I hadn't written yet. I felt an enormous sense of responsibility and opportunity to contribute something meaningful.

Your website identifies you as an "empathy warrior." Is that what drove you to fiction?

My grandmother had Alzheimer's. I was 28 when she got the diagnosis. I had a Ph.D. in neuroscience. Alzheimer's was not my area of expertise, but I had the vocabulary. I dove into the research, I read on how the disease was managed from a clinical perspective, but what was missing was, what does it feel like to have this? And how to feel comfortable with her Alzheimer's. I had a tremendous amount of sympathy for her, and for us, but I did not know how to be with her. If she started talking to plastic baby dolls, I left the room. I let my aunts take over. I felt heartbroken, frustrated, scared, and embarrassed. I felt sympathy, but sympathy actually drives disconnection. Keeps us emotionally separate. I didn't know how to get to empathy. I didn't have the understanding or the maturity to just be with her and imagine what it's like to be her in a room, not recognizing it as her home. Everything I'd been reading about Alzheimer's was from the outside looking in. The scientists, caregivers, and social workers have valuable points of view, but none of them were the perspective of the person who's living it. Fiction is where you get a chance to walk in someone else's shoes, find that human connection, that shared emotional experience. That was the beginning. When Still Alice worked, and I got feedback about how much it helped, there was so much appreciation--I just knew. I love doing this, and now I feel the value in it. I'm going to keep going.

How did you create Maddy?

I begin all my stories by reading as much as I can. I read lots of memoirs and textbooks, and then I go out and talk to people. For this book I sought out the authors of some of those textbooks. I talked to the guy who runs the bipolar treatment center at Mass General. I found a psychiatrist at McLean Hospital. I spoke with psychiatrists from all over. If you have diabetes, there's a single protocol, no matter where you live in the world. With bipolar that is not the case. You go to 10 doctors, you're going to get 10 different prescriptions. I'm always trying to tell the truth under imagined circumstances, but one thing I'm very cognizant of is my books are known for being informed. They're researched, and they're going to be used as a blueprint. They're used in medical schools, in OT, PT, speech pathology. I wanted to get the best practices right. My experts are always the people who live with it and their families. I spent a lot of time talking with lots of people. It's an ongoing conversation, it's in-depth and really intimate, and I'm grateful that people trust me with their stories.

Bipolar begins young. I wanted Maddy to be a woman. I wanted to consider the expectations of her to live a normal life as a woman, and the limitations that imposes. If this starts just as you're launching a life, how disrupting and confusing would that be? I wanted her to be a college student, with all those expectations and pressures. In making her a comedian, I wanted her to choose something that was outside the stability of the expected life. Comedy I liked because it's very public; she'd be in front of people. Comedians sort of live the bipolar experience. If you're killing it, that's the highest high. You're connecting, everybody gets you, there's a human bond. If you're bombing, it's the lowest of lows. It's a death. Weirdly, that swing is a nice metaphor for what it could feel like to be bipolar. I'm a big comedy fan, so this gave me a lovely excuse. Comedians who are great at what they do, it's because they're speaking truth. They're tapping into a vulnerability in the human condition. If I could write my character's comedy and that progression toward having something meaningful to say about accepting herself with bipolar, that would be really cool. It was terrifying, too, because I'd never written comedy. I did take a standup comedy writing class and I did a five-minute set.

Did you discover a new calling?

Oh no. Ohhhh, no. Not going to quit my day job.

Do you consider yourself an activist author?

That's what the "empathy warrior" is about. It's about humanizing, destigmatizing. These books are an opportunity. If I see someone with dementia, or who might be manic, my reflexive response isn't, I need to get away from that. My response becomes more, I'm not afraid of you. How can I help?

I advocate for resources for care and for research. In the author's note of this book I send people to the International Bipolar Foundation for more education, and to donate money if they'd like. I've raised millions of dollars for Alzheimer's care and research. And we're 15 years out from Still Alice, so I stay as an activist, advocate, empathy warrior. I want my books to be a reason for people to learn more, to contribute, to offer help. --Julia Kastner