The novel’s depiction of Verity’s mental health journey is grounded in the clinical realities of Bipolar 1 disorder. Bipolar disorder exists on a spectrum: Bipolar 1 is defined by full manic episodes that are severe enough to require hospitalization or that include psychosis while Bipolar 2 involves a milder form of mania called hypomania paired with more prominent depressive episodes. Verity’s diagnosis is specifically Bipolar 1, which is consistent with her mental health crisis at Finley. The median age of onset for bipolar disorder is 25, though it often appears in the late teens, aligning with Verity’s diagnosis during her junior year of college. Her experience of feeling her skin is “on fire” and believing she must extinguish a sculpture to prevent a larger catastrophe reflects the delusions and hallucinations that can accompany a full manic episode with psychosis. This context is important for understanding that her behavior is a manifestation of a serious medical condition.

Verity’s experience as a Black woman with bipolar disorder also carries real-world significance. Research has consistently shown that Black people with bipolar disorder are much more likely than white people to receive a misdiagnosis of schizophrenia, a more severe diagnosis that carries different treatment expectations. A study of over 1,600 patients found that Black patients diagnosed with schizophrenia were significantly more likely to have overlooked mood disorder symptoms, suggesting widespread misdiagnosis of conditions like bipolar disorder (Gara, Michael A., et al. “A Naturalistic Study of Racial Disparities in Diagnoses at an Outpatient Behavioral Health Clinic.” Psychiatric Services, vol. 70, no. 2, 2019). These diagnostic errors are compounded by differences in symptom presentation: A 2023 meta-analysis of over 4,400 Bipolar 1 patients found that Black patients were less likely to report elevated mood, a hallmark bipolar symptom, but more likely to report insomnia and persecutory hallucinations, differences that can steer clinicians toward the wrong diagnosis. (Li, Kevin, et al. “Racial Differences in the Major Clinical Symptom Domains of Bipolar Disorder.” International Journal of Bipolar Disorders, vol. 11, no. 1, 2023). The consequences extend beyond the initial diagnosis. A review of treatment data found that no Black patients in one national sample received minimally adequate bipolar treatment in the prior year, compared to 17% of white patients, a gap driven by factors including a shortage of culturally competent providers and the underrepresentation of Black psychiatrists (Akinhanmi, Margaret O., et al. “Racial Disparities in Bipolar Disorder Treatment and Research: A Call to Action.” Bipolar Disorders, vol. 20, no. 6, 2018). These disparities make Verity’s accurate diagnosis and access to appropriate care a quietly significant detail in the novel.

Following her diagnosis, Verity’s path to stability involves medication and Dialectical Behavior Therapy (DBT). Unlike Cognitive Behavioral Therapy (CBT), which focuses primarily on identifying and restructuring negative thought patterns, DBT is built around four skill modules: core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These combine acceptance-oriented strategies (learning to sit with difficult feelings) with change-oriented ones (actively modifying emotional responses and communication patterns). Verity’s use of “opposite action” to combat depressive inertia is a classic DBT emotion regulation technique. Her journey illuminates the constant, active work required to manage Bipolar 1 while navigating a creative career, where the vigilance needed for stability can feel at odds with the spontaneous energy of inspiration.