Getting the last laugh

Hey there, time traveller!
This article was published 08/03/2025 (580 days ago), so information in it may no longer be current.

Often described as the Oliver Sacks of fiction, Lisa Genova has a PhD in neuroscience from Harvard and draws from her clinical work to fashion scenarios that make for readable, compelling novels.

Genova’s holistic approach — placing the patient in their natural environment, living their life both in and out of the medical system — brings understanding to the reader that serious illness affects everyone.

Her first novel, Still Alice, was a bestseller that beautifully and tragically exposes the toll of early onset dementia. It was made into a successful film starring Julianne Moore.

In her latest novel More or Less Maddy, Genova brings us another story of a well-rounded woman, this time one at the very beginning of her adult journey.

The titular Maddy is a young freshman, similar to millions of other young women, with many of the typical emotional stressors the transition from teen to adult years bring to bear in their world — in Maddy’s case, New York City in the new millenium.

To put it plainly, mentally ill people don’t necessarily deal with worse problems than other people. It’s their ability to cope and cultivate resilience towards everyday challenges that is sometimes compromised by a Gordian knot of individual factors which can include genetics, early environment, brain chemistry and trauma.

One day young Maddy — living her good life juggling school, boys, a perfect sister and a slightly smothering mom — begins to act strangely. She messes up to the point of ending up in the psych ward — and not for the last time.

So begins a journey of self discovery both abetted and sometimes hampered by the medical system and her annoying but caring family. Maddy asks as we all do in our salad days: Who am I, really? What can I offer the world?

One night Maddy attends a comedy show and realizes that as a creative outlet, standup might be a good fit. One of the reasons standup is attractive to dysregulated folks, and Maddy seems to catch on to this, is the constant, rapid validation a comedy set can provide.

While actors have to wait for the curtain call, a good comic can get a dopamine hit from a big laugh every few seconds. Entry at an open-mic level is a low bar.

After meeting a psychiatrist, Maddy is diagnosed Bipolar type 1, a form of manic depression. Episodically dysregulated, unpredictable and prone to wild, impulsive behaviour, Maddy is both freed and confined by the diagnosis and the various medications prescribed to help her cope with life.

During her first manic episode, Maddy grandiosely writes a one-hour Netflix special; her family, meanwhile, considers her plan to do comedy another delusion. Young people whose goals don’t ally with their families will strongly relate.

The material Maddy/Genova creates is genuinely funny, and the presentation of the standup both authentic and impressive.

So, Maddy rides a teeter totter. A splitting occurs. Instead of being just Maddy, an artificial baseline is created which she and others now apply to measure her actions.

Is she More Maddy (manic) or Less Maddy (depressed)? Will she find an integrated way of being, and will she metaphorically and literally have the last laugh?

It’s worth the ticket price to go on this ride of discovery.

Very highly recommended.

Lara Rae is an oversharer who is both a veteran of standup comedy and a long-standing pyschiatric outpatient diagnosed with Bipolar 1 and borderline personality disorder (although never at the same time).