More or Less Maddy: A Novel

More or Less Maddy is a realistic fiction novel written by Lisa Genova and originally published in 2025. Genova has a PhD in neuroscience and is known for applying her medical and psychological knowledge to her fictional works, creating a blend of dramatic intrigue and informative reading. More or Less Maddy centers around a college-age woman who is diagnosed with bipolar I disorder and struggles with The Impossible Expectation of Normalcy, which she cannot and does not wish to fulfill. Maddy learns the power of Personal Challenges as a Source of Strength through a chosen career in comedy, and along the way discovers The Importance of Support in Managing Mental Illness. The novel was on the Indie Next List in 2025.

This guide uses the 2025 Simon & Schuster edition of the novel.

Content Warning: The source material and guide feature depictions of mental illness, suicidal ideation, self-harm, and substance use.

Plot Summary

The novel opens in a Vegas hotel room, where Maddy contemplates suicide, overwhelmed by feelings of shame and a lack of control over her bipolar disorder. Her life is a rollercoaster of extreme confidence (mania) followed by debilitating depression, and she often finds herself isolated and disconnected from reality. Although she successfully performed her Vegas comedy shows, Maddy knows she is still in the middle of mania and doesn’t know where to turn. The narrative then shifts to 18 months earlier, showing Maddy’s life at the end of her first year at New York University. Exhausted and struggling with her studies, she finds it difficult to rein in her emotions. Maddy’s relationship with her mother is strained, as Maddy resents being treated like a child. Maddy’s mother orders her to see a doctor, but the doctor downplays Maddy’s mental health, attributing her mental health symptoms to “normal” feelings of being young, or even PMS.

The story continues with Maddy’s experiences over the summer. While working at Starbucks, she begins to reconnect with her ex-best friend, Sofia, and to feel more grounded. Maddy’s complicated and toxic relationship with a boy called Adam continues to dominate her life, despite the pain it causes her. Maddy’s sister, Emily, visits Maddy at her NYU dorm and encourages her to meet new people, but Maddy feels disconnected from Emily and the world and suspects that something is wrong with her. She struggles to keep up with school, feeling drained and unmotivated. Her relationship with Adam feels empty, and she becomes increasingly anxious about her slipping grades. After visiting the Student Health Center, Maddy is prescribed antidepressants, which quickly make her feel unstoppable. Her mood and energy reach impossible heights as she excels in classes, dreams of writing for Taylor Swift, spends a fortune on designer clothes, and meets a comedian named Max who encourages her to try comedy.

Her behavior grows more erratic as she bombards her sister and Taylor Swift (via social media messages that go unanswered) with messages about her ambitions in the middle of the night. During Thanksgiving, Maddy appears to attempt to steal her mother’s car, threatening her with a knife and wrecking her brother’s car in the process. Her family witnesses this and takes her to a hospital. At first, she denies needing help and feels misunderstood by doctors. She is then transferred to a psychiatric facility, where a woman named Dr. Weaver diagnoses her with bipolar I disorder. Maddy and her mother are in shock, and Maddy realizes her life will look quite different from what she originally imagined.

After being hospitalized, Maddy begins lithium treatment, which leaves her exhausted, nauseated, and emotionally flat. Her mother removes anything dangerous from her room, and she’s forced to drop out for the semester. When Adam visits, he ends their relationship, and Maddy feels lost and betrayed. At Christmas, Maddy hides her self-harm wounds from her grandma (following her mother’s instructions) and tries to act “normal” around her family, as she knows that’s what they expect. Emily comforts Maddy and reveals that their father also had bipolar disorder, helping Maddy understand her mother’s fear.

For the rest of the term, Maddy isolates herself at home until she discovers six notebooks filled with comedy material, some of which is actually funny. She begins compiling a new notebook of her favorite lines. When her mother discovers fresh cuts on her arm, Dr. Weaver adjusts Maddy’s medication, adding quetiapine to counteract the depressive effects of lithium. Maddy gradually feels better and asks to move in with Emily in the city. After discussion, Dr. Weaver approves, believing independence will help her heal. Living with Emily and Emily’s fiancé, Maddy works at Starbucks and rebuilds her routine. Encouraged by a coworker named Simone, she decides to try stand‑up comedy. At her first open‑mic, she manages to get a couple of laughs, and finds the experience empowering.

Maddy starts spending most afternoons at Max’s apartment, developing her comedy while tolerating his dismissive and manipulative behavior. She performs several times a week and ignores his advice to stop berating men in her routines. At her first major show, Maddy wins over the crowd and assumes she’ll open for Max’s upcoming tour, but he later chooses another woman. Maddy is only crushed for a moment, because she then accepts an invitation to perform at a women’s comedy festival. Maddy lies to her family about her performances, turns her location off, and stops taking her medication, believing she no longer needs it. During Emily’s bachelorette trip to Nashville, Maddy abandons the party to go perform at a local club and then attempts to fly to Houston to meet Taylor Swift. She is detained at the Atlanta airport after trying to board a plane that she was late for, and she breaks a tooth in the process. She’s hospitalized again and flown home under her mother’s care.

Dr. Weaver adjusts Maddy’s medication and recommends that she stop performing. Back home, Maddy becomes numb and hopeless, feeling trapped by her illness and seemingly bleak future. In despair, she overdoses on pills in an attempt to end her life. Her grandmother finds her in time, and Maddy later wakes in the hospital to see Emily sleeping beside her, comforted that she’s not alone. After her hospitalization, Maddy begins to heal during the summer. She and Emily reconnect, and Maddy apologizes for missing her sister’s wedding. Emily forgives her and hopes Maddy can continue to find balance between her manic and depressed states. Maddy later opens up to her grandmother, who shares her own past struggles with thoughts of suicide and reassures Maddy that she will eventually find her own “door” to a better life. Slowly, Maddy accepts her diagnosis and begins to see a future beyond shame and fear.

Returning to NYU in the fall, Maddy resumes her studies and returns to comedy. She reveals her condition to Max, who reacts with indifference, which makes her more confident in herself. Maddy’s mother is sure she will relapse if she goes to Vegas, but Maddy insists on taking the opportunity. In Vegas, she performs successfully, but then Maddy’s behavior again becomes erratic. After her recovery, Maddy now performs comedy in Connecticut, even joking openly about her bipolar disorder, transforming pain into humor. Supported by her mother and sister, she finds purpose in her art and pride in her survival, and she comes to accept bipolar as part of her, but not all of her.