I first met Marya Hornbacher ten years ago, while she was in the middle of touring to promote her first memoir, Wasted. In her early 20s, she came across as a whirlwind of energy, eagerly talking about her future projects over a string of vodka martinis. It's only now, reading her new book, Madness, that I realize she was in a highly manic phase of the bipolar condition she had just been diagnosed with, exacerbated by alcoholism—this new memoir mercilessly depicts the downward spiral that followed and the process of building herself back up again. "It seems to me I could have turned things around before I hit bottom," she reflects, sitting at the end of a long table in a Houghton Mifflin conference room. "But I told myself, 'I don't think that's for me. That's just another diagnosis.' I thought that it I could just plow through, it would never really be true. I would never really have to deal with being a 'crazy person.' And I had to really crash and burn with the alcohol before the bipolar was going to get attention... [otherwise,] it's like having two mental illnesses going at the same time."

In our 1998 interview, she had spoken at length about the damage she had done to her body through her eating disorder, and I comment that it seemed at the time that she was trying to get all her writing done because she thought she didn't have much time left. "I was expecting that on a lot of levels," she agrees; either she would die, or her fear of going totally crazy would come true. "I turned 30 [a few years ago] and was absolutely stunned—how the hell did that happen? It never got through my head that everything was going to work out... It's more amazing to me that I haven't hurt anybody else." Ten years on, "it's a very simple life: Work. Family. Friends. That's it."

In the decade between her memoirs, skepticism has grown about the authenticity of the genre, or at least of some of the people working in it, and Hornbacher anticipates more questions this time around about how much of the book is real, especially given that she admits to a "scattershot" memory due to her condition and its treatment. "But everyone writing a memoir is writing with some compromised memory," she observes. "Your life is never a narrative." Still, she did the journalistic research to fill in her mental gaps, and stands confidently by her account. "What kind of person is going to put out a book where I'm this nuts?" she asks rhetorically. "I have no reason to lie."

Because Madness discusses recurring hospitalizations for manic episodes in April, I ask about her decision to tour this month, and she says that her spring flare-ups are usually mild compared to those in February. The main thing, she says, is making sure that she gets enough sleep; even one redeye flight can be enough to disrupt her cycle. "Then I feel like I'm wearing very high heels on ice," she says. "Lights and sounds become more piercing." Staying grounded through contact with friends and family helps, and her husband accompanies her on this first leg of the tour. "It's like the care and feeding of a small child," she says of her condition. "It's truculent, it's stubborn, and it doesn't follow logic. But you have to care for it all the time."

"When I wasn't managing it at all," she adds, "I also wasn't managing my work." Thus the long gap between Wasted and her novel, The Center of Winter. "I must have produced 2,000 pages of absolute trash," she says of the first five years of writing. "My agent has been like a second mom. She just stuck with me... She didn't know I was bipolar. She didn't know I was alcoholic." The constant constructive feedback paid off, and once Hornbacher was sober and on medication, she says she was able to produce the novel in nine months. Now, she recognizes, "I can't write well unless I'm sane." And she plans to push ahead: "The book I'm working on now is going to be much harder than anything I've ever done before," she says. "I can take risks professionally and creatively now I couldn't before."