Two Friends, One Diagnosis: This Is a Love Story
When Kat Alexander started looping through cycles of mania, it was her best friend, Mara Altman, who came to the rescue.
Halfway through Kat Alexander’s fourth cycle of IVF, her best friend, the journalist Mara Altman (who has written for The Persistent), got a call from Kat’s fiancé, Dave. He needed help getting Kat out of the house to a medical appointment.
“I didn’t understand why he needed help,” says Mara. But when Mara arrived at Kat’s California home, it became clear. She kept taking off her clothes, darting from room to room, and saying she was the John Oliver of computer programming.
Kat was experiencing a manic episode.
Over the following months, it would become a lot worse and ultimately result in a diagnosis of bipolar disorder. Sometimes she seemed lucid; other times, it was hard for people around Kat to understand what was happening to her.
At one point, Kat claimed she was starting a “billion-dollar business” to help domestic violence victims recover. She took one such person to a high-end hotel and showered her with gifts. Kat blew through her savings, spending thousands of dollars on luxury items like purses, activewear, silk scarves and leather wallets. She believed she was a “conduit for money, it was meant to flow through me and out to others,” she explained later on. Needless to say, she isolated herself from friends and her fiancé in the process.
Kat disappeared, reappeared, rammed her car repeatedly into a parked car outside an Airbnb she had been staying in, and sent Mara—who had been her closest friend since just after college—expletive-laden messages telling her to check her privilege, explaining that Mara and their other friends must work to earn Kat’s friendship back.
There were many hospitalizations. Sometimes the police brought Kat in. Sometimes it was Dave. The visits lasted about three days—enough time for her to stabilize on antipsychotics, after which she’d be allowed out. Once released, the mania would ramp right back up. The looping cycle would continue despite Kat being prescribed medications.
Finally, after one extended hospital visit and about 10 months of depression, Kat took off to Playa del Carmen, a tourist town in Yucatan, Mexico, to attend an ex-boyfriend’s wedding. She found various reasons not to return home to California until two weeks after the wedding, Kat disappeared altogether.
At this point, Mara and Dave called the U.S. Consulate and began scouring social media. It was social media that provided clues: “Someone said they thought they saw her alone and disheveled, with her suitcase,” explains Mara. ”Another person said she’d tried to attack him on the street.” Eventually, Mara was sent a video of Kat on a street in Playa del Carmen, directing traffic, flashing people in a small tank top and wearing bikini bottoms.
And that’s when Mara—not Dave, who Kat, in her psychosis, regarded as “dangerous”—got on a plane to attempt a rescue.
Two years on, with Kat now in a more stable place and back home living with Dave, Mara and Kat have released an audiobook “Episodes: The True Story of Two Friends & One Diagnosis.”
The narrative flips back and forth between their perspectives as they tell their story—Mara talking about watching her friend become overwhelmed by her mania; Kat explaining how she rationalized her actions to herself. Snippets of audio recorded in the moment and messages Kat recorded for Mara during her most manic moments are layered in. The result is an extraordinarily compelling story of female friendship and healing.
It also offers insight into how profoundly mental illness can quickly grind life, progress, family, career to a halt—Kat had been developing a wellness program for the San Diego Unified School District when all this happened.
In an interview with The Persistent, Kat and Mara explain why they created "Episodes," what they hope their listeners will get out of it—and why, ultimately, their tale is a love story.
The conversation has been edited for length and clarity.
Mara, you’re a writer, which is usually a very solitary job. Tell us about the process of writing this script together.
Mara: There's no way I would ever write about it without Kat. I don't think it would be a full piece without her voice and without her perspective. It just makes it so powerful to hear both perspectives together, contrasting on the same moment and seeing it so vastly different. It's less common to hear the perspective of the person who went through it than that of the bystander.
Kat: It made it not othering.
Mara: One of my biggest fears was that it would be exploitational, or that having Kat relive all that happened would be in some way traumatizing. So we had really long talks about it, me bringing up all my fears about going into it together, and Kat really taking the time to think through whether it was something she wanted to do or not.
Kat: What was really helpful, especially dropping into the very difficult memories—like when I was in an altered state and manic in Mexico—was that Mara would sweet me up with some avocado toast and I would be in the fetal position, literally dropping into that part of my brain that normally I couldn't access, and she would be vigorously typing.
It was very cathartic. I very much could not have written this story without her. Not only did she offer a reliable narrator, but we are modeling what it looks like to have a healthy, loving friendship,
Kat, at the beginning of the story, you tell your listeners that you want them to see that you’re “more than the worst things that have happened to me.” Did the writing process help to cement that for you?
Kat: In the middle of writing I found the answer to the question I had a decade ago: How do you not be reduced to the worst thing that happened to you? The answer is, you write it with your best friend, you ground it in a friendship and love and laughter and adventures and nerdiness and coming of age.
I am not reduced to the worst thing that happened to me because this reliable narrator friend is a Care Bear, staring at me the whole time. And that is the way through. This is a love story. And who doesn't love a love story?
There’s a lot about bipolar that most people don’t really understand and in their effort to understand, they simplify. This leads to a lot of myths around it, like “once you get the medication right, everything is fine.” Have you encountered much of this?
Kat: You could do all the right things, and you can still experience the manic episode.
The way our brains are wired is that we want to believe that one plus one is two. There's a thing called the Just World Hypothesis, which says that our brain will jump to the conclusion that makes it a “just world.” That is where victim blaming comes from—“What was she wearing?” “What were you doing?”
Mara: Dave and I triangulate sometimes, because even the stress of the U.S. presidential election and this project coming out created a moment of hypomania for Kat just a few weeks ago: Kat could not see it, and I was starting to freak out, and I think there were moments when she thought I was overreacting a little bit. It's hard: you're like, “my friend is really happy, and I'm worried.” She's like, “I'm doing all these things! I'm being productive! Why aren't you happy for me?”
Sometimes I do worry that I'm overreacting. But is it better to overreact than not to react? You have this really delicate balance.
Kat: I got so defensive because I felt good. It wasn’t like I was sleeping 14 hours a night and on the couch, and on TikTok all day. I was showered! I was out of the house! What do you mean I'm sick? But we've gone from that attitude four years ago, to now, when my mantra is: Don't get defensive, get curious.
Mara, when you look at Kat now, what do you admire about her?
Mara: I’m amazed by all this extra stuff that Kat has to worry about. She has to take her drugs, and some of the drugs that she has taken in the past, the pill itself is so big that it makes her nauseous. Just stuff that you don't think about that someone has to deal with. You would not know, just seeing Kat in the grocery store, all the things she has to do to take care of herself.
Kat lost friends as a result of her bipolar disorder, but Mara—you kept showing up. Was there ever a point at which you thought, I'm close to my line now?
Mara: There was no line really. My brain, for whatever reason, separated out her illness from who I saw her as, and it really felt like something I had to rid her of or save her from.
I didn't take anything she did really personally. I was very naive about what a mental illness does, and what kind of havoc it wreaks.
What do you both want people to take away from this story?
Mara: For me, the big headline is, we have a mental health crisis. This story makes it really tangible: this is what it looks like for one person; here’s how the ripples go out to affect family, friends and community. We'd like it to de-stigmatize mental illness.
Kat: My mother was 19 and in college when she was date raped. Three weeks later, she's in an inpatient psychiatric ward and given a bipolar diagnosis.
She only disclosed this to me in my 30s when she was at a mental hospital. What did she name me? She named me Katharine. The name Katharine means pure. I was her pure daughter. I was her second chance.
And that's what Mara’s giving me.
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