In 1998, Marya Hornbacher wrote Wasted: A Memoir of Anorexia and Bulimia, about an eating disorder so severe, she whittled herself down to 52 pounds and was given a week to live. The book stands out in its ability to dig inside the mind of someone with an eating disorder. Hornbacher, who was 23 when she wrote the book, hadn’t yet gotten distance from being sick, and that, combined with copious research, made Wasted a particularly unflinching look at anorexia and bulimia. (Too much so, I hear. Some have called Wasted a “triggering” book for anorexics, who can find it all a little too vivid, like a good description of a glass of whiskey might make an alcoholic want to drink.)

Now, a decade later, Hornbacher has written a follow-up: Madness: A Bipolar Life. The book picks up where Wasted leaves off, covering the last 10 years of Hornbacher’s life, when she discovers that her real problem all along has been bipolar disorder. Everything else—starving herself, drinking, cutting, throwing up—was just a means to control the roller coaster of her moods. As with her eating disorders, Hornbacher ignored the diagnosis for as long as possible, descending into an ugly hole of self-destruction.

Despite its subject matter, Madness is an entertaining read. Hornbacher clearly shows just how confused—or as she puts it, “fucking nuts”—a bipolar sufferer can be. In one scene, she leaves the house without clothes on, realizes it, goes in and puts on a dress. Them she realizes she hasn’t taken a shower, takes a shower, while still wearing the dress. Then she drives dripping wet to her husband’s office and acts so erratic that he has her psychiatrist escort her out of the building and eventually into a hospital. She is hospitalized several times a year. She rages, breaks things, doesn’t sleep, moves constantly around the country, and babbles on endlessly to people. This is in between more impressive feats such as writing a novel, pursuing her masters degree, and lecturing at universities.

But despite effectively demonstrating her instability, Hornbacher doesn’t give much insight into the inner workings of bipolar disorder. Most of the book is descriptions of insane-sounding wackiness. “I sing the Snoopy song, stand on my chair again, imitating Snoopy as vulture, plop down. ‘I never did like Peanuts much,’ I remark to the catatonic man across from me.” Or: “‘Can I get you anything besides water?’ the waiter asks. ‘No, we’ll just have water tonight!’ I shout at the top of my lungs, leaning forward and slamming the table, and then the incredible laugh explodes from my mouth and I tip over in the booth.”

While sometimes funny, this narrative style also leaves Hornbacher in danger of glossing over issues, and she does. She describes crazy rages against her first husband, Julian, but only explains that they occur as a “flipping of a switch”. She writes: “Julian and I are going along, having a perfectly lovely evening, and then it’s dark and I am screaming, standing in the middle of the room, turning over the glass-topped coffee table, ripping the bathroom sink off the wall ...” Okay, but is that because she is bipolar or because she is drunk (or both)? Could the fact that she drinks heavily during the evening be why the rages only happen at night and why she doesn’t remember them? She doesn’t say. Likewise, she gives no real reason why she finally decides to get treatment for alcoholism. One minute she is in the hospital, the next, “I’m sitting in a folding chair, looking around a crowded room. Someone is standing on a platform yelling, Hi! My name is Connie and I’m a drunk! ... Motherfucking Christ. I’m in rehab.” Poof! No more alcoholism.

The problem here may be that Hornbacher doesn’t remember much of her own life, which would make writing a memoir difficult. Still, there’s little attempt at addressing the reasons behind her actions. Or rather, the answer at any give minute to whatever Hornbacher is doing seems to be “I’m crazy.” The memory loss itself is explained as, “Madness strips you of memory and leaves you scrabbling around on the floor of your brain.” Yes, but why? Is it common for people to lose memory with bipolar disorder? Did she lose her memory because she’s on dozens of medications? Is it because she underwent electroshock treatment, which also erases memory? Instead of any insight into this, we get a string of unrelated descriptions of being in the hospital.

Hornbacher seems to believe that her illness is purely neurological, but she doesn’t use science or research to prove it. She was apparently neglected as a child—at least, she seems to be left alone all day at the age of four, where she sleeps until “they come home. I hear them open the door, and I fling on the lights and gallop through the house”. She’s bulimic at nine years old, getting drunk at 10, and sleeping around and doing hard drugs by high school. And while she implies that these things were all symptoms of being bipolar, they also point to a lack of parental involvement, which must offer some explanation into who Hornbacher is as an adult, if not the origins of her illnesses.

Between unreliability and unanswered questions, by the end of the book, we get the sense that Hornbacher is still very ill. Given that, it’s somewhat miraculous she managed to write this book at all. But we also get the sense that she doesn’t really know why she is ill and has little insight into the illness beyond the fact that she has to manage it regularly and take her meds. Unlike in Wasted, where the reader is left with clear insight into mental illness, in Madness, we’re left peering at the sound and static of mental illness from the outside. The trouble is that the static never clears enough to let us in.