When Brilliance & Madness Collide is a personal account of Ruth Manning, PhD, who has struggled with bipolar I disorder for the majority of her adult life. Her career path has had a myriad of twists and turns, from serving as founder and CEO of a biotech DNA sequence analysis software company, to working at a US national laboratory, to teaching mathematics as a university professor. These professional successes are interspersed with many hypomanic and manic episodes, over a dozen severe manic psychotic episodes requiring psychiatric hospitalizations, and the personal tragedies of long-time friendships and family keepsakes forever lost to the chaos of a manic or hypomanic state.

 

This book is partially a memoir and partially a journey inside her mind during a manic psychotic episode that occurred in 2018. Notably, this was the most severe episode of mania and psychosis that she had experienced since 1995. During this period, Ruth went five days without food or sleep, which is very dangerous for a 67-year-old diabetic and led to twenty pounds of unintentional weight loss. She experienced numerous hallucinations, psychoses, and tangential connections that nearly resulted in a house fire, which she later chronicled in multiple notebooks while still hypomanic and recovering in a psychiatric hospital.

 

Her story is separated into six parts that are recounted chronologically—with Parts III, IV, and V reflecting her hypomanic (nonhospitalized), manic (nonhospitalized), and manic-hypomanic (hospitalized) states, respectively. The book also includes some of the clinical documentation of her psychiatric hospitalization, providing an objective measure of her progress and recovery each day. Throughout the book, Ruth frequently refers to her mental wellness using Meemaw1 (normal), Meemaw2 (hypomanic), and Meemaw3 (manic) descriptors, though the exact lines between each state may blur or may exist concurrently. She defines this concurrency as ontological simultaneity. It is perhaps most evident in Part II of her book, where it can be difficult to see where some of her more subtle delusions and experiences blend with her Meemaw1 state.

 

When she enters manic and hypomanic states, Ruth will often gain religious undertones that drive her actions, thoughts, and hallucinations. This is true to her being, just as much as her desire to help others or give away personal possessions is ingrained. As one reads through the middle and later sections of this book, those undertones will become more pronounced—subtly at first, then unmistakable. Reading this book provides a journey into the mind of a person with type I bipolar disorder, with each tangential connection and hallucination described in detail. 

 

The descriptors she uses for her mental wellness are well known to me, as I grew up seeing them firsthand. As one of her two children, we spent every other day at a different parent’s house and needed to track what weekend of the month it was to know which bus to ride. Travel plans with Mom were always restricted unless another adult who knew her well was also in tow. Since this was all we knew as children, we adapted to this level of responsibility as if it was a normal state of affairs. That plan worked well for about a decade until a particularly severe psychotic episode and hospitalization in 1995 jarred us into the reality of how far her mental health disorder could go.

 

The mere fact that we were changing houses every day was what clued our dad into Mom’s severe psychosis in 1995, leading to early intervention and hospitalization. There’s something to be said about having two children arrive in tears, having just said goodbye forever to their mom, thinking it was actually the end of the world and that she needed to go to Omaha, Nebraska to preach the gospel. That was quite the awakening into adulthood. Having also witnessed Mom’s psychosis in 2018 (with many episodes in between), and in my current role as an emergency physician caring for patients with mental health emergencies, I understand why a psychiatrist in the 1980s had told Mom that her bipolar disorder was “the second worst case he had ever seen.” 

 

But just as well as I have seen her at her least emotionally stable states, that is not my mom. Most of the time, we trust her to watch our kids unattended. She never used illicit drugs, and she always made a point of keeping stable housing despite her career swaps and later reliance on disability services. Mom is kind, dedicated, and driven; but compassion is her strongest quality by far. This trait escalates considerably when she enters a manic or hypomanic state, to the point where she has given away many cherished family keepsakes, her car, and even one of her companies.

 

 Even without manic features, Mom’s empathy shines through. She will go the extra mile to help others, particularly those who are in unstable and disadvantaged positions. Over the years, we've had people stay at our house for months on end while they seek to get their bearings, such as a family who immigrated to be near their son and who only spoke Filipino and Spanish when they first arrived in the US. Her work to elevate disadvantaged and minority students also exemplifies this well. Growing up in her house—despite the occasional psychotic setbacks—helping others from underserved walks of life was the norm, not the exception.

 

Ruth Manning’s journey has been an emotional rollercoaster. Her book is written to exemplify how success, failure, mania, and psychosis can occur in tandem. It is written to show the perspective of a person who must constantly be mindful of her mental wellness and must bounce back from each inevitable setback. It is written to let others with mental health disorders know that they are not alone and that they can still live a successful life despite their challenges and struggles. To their friends, family members, and loved ones, it is written to provide context and let them experience what it's like to be in a psychotic state happening outside of their control.

 

Mom, thank you for sharing your life’s story. I’m proud of you.

 

Love,

—John Manning, MD