This revealing conversation explores the making of ‘Four Pills’ — a comedy special about bipolar disorder that blends dark humor with emotional truth.
Actor, writer, director, and acclaimed stand-up comic Cameron Esposito has never been one to shy away from hard truths. But in Four Pills — a new comedy special written and directed by Esposito, now streaming on Dropout.tv — vulnerability reaches a whole new level.
With signature wit and unflinching honesty, the 43-year-old comic recounts the series of events that led to rehab, a bipolar disorder diagnosis, and the path toward meaningful support. The result is a deeply personal, darkly funny, and refreshingly stigma-busting hour of comedy.
Esposito’s two-decade career spans stand-up specials, albums, acclaimed podcasting, and television and film. Known for the culture-shifting Rape Jokes, the semi-autobiographical series Take My Wife, and the best-selling memoir Save Yourself, the comic has consistently used the stage to explore gender, queerness, faith, and identity. And since going public with their diagnosis a few years ago, bipolar disorder has become a central part of that conversation, too.
In this candid interview with bpHope, Esposito reflects on the journey to diagnosis, how symptoms are managed today, and why being open about mental health — especially while in the public eye — can be a lifeline for others. From navigating medication concerns to leaning on a strong support system, the insights shared here are both relatable and revelatory.
Editor’s note: This interview has been edited for length and clarity.
Four Pills feels so different from a traditional stand-up special — not just in how it’s artistically shot, but in how deeply it conveys the emotional reality of living with bipolar disorder. What inspired you to tell your story this way, and what were you hoping viewers would take away from the experience?
Cameron Esposito: The biggest thing was creating an experimental understanding of mental health and mental illness. Even when we do talk about it, it rarely reflects the actual experience. We talk about things like cancer, breaking a leg, or having a child — these major, life-altering medical events — but we don’t really talk about what it feels like to live with mental illness. I wanted the special to offer people a glimpse into that experience. And also — I just wanted to make cool art.
You’ve spoken openly about mania. Can you share a bit about what depression looks like for you — and how that side of bipolar 2 disorder shows up in your life?
CE: People are on a spectrum in what they experience. For me, depression feels like a short-term crash, maybe a few days of wanting to be on the couch. I don’t get stuck there for months, but so many people struggle with it long-term.
What’s been most helpful for you in managing bipolar symptoms? Do you have a go-to set of tools or routines that help keep you steady?
CE: I’m under the care of a psychiatrist, I attend a support group, and I see a therapist — which is very helpful to me. On top of that, I try to stay pretty physically active. I tend to do okay these days.
Having a solid support system can make a big difference when managing bipolar disorder. What helps you stay grounded and in check — especially when it comes to recognizing how you’re feeling or the choices you’re making?
CE: For me, I need to sometimes check how I’m feeling, like the behaviors and choices I’m making. And having people that can bring some joy and balance into my life, so I’m not off on my own trying to supply that.
In Four Pills, you share what led to your bipolar diagnosis at age 40. Was hearing the words “bipolar disorder” a surprise — or did it help things click into place? Do you remember any questions your psychiatrist asked that stood out?
CE: I had read about some of the symptoms going into my evaluation, as was suggested by the rehab facility I stayed at directly prior, so I wasn’t surprised. The questions centered on behaviors like having large mood swings, too many ideas, too much energy, and no need to sleep. My experience with all those symptoms is the basis for what became Four Pills.
There can be a lot of fear around seeking a diagnosis. What would you say to someone who suspects they might have bipolar or a mood disorder but hasn’t been evaluated?
CE: Getting evaluated is important. For me, it was extremely helpful in my understanding of myself, and honestly, a relief. If you’re off-kilter, you don’t know you’re off-kilter. If your friends or family are pointing something out to you, they may be able to see something you can’t see — and it’s also important to maintain those relationships.
You’ve shared that you reached out to other artists with bipolar disorder when you were first figuring things out. What did those conversations mean to you, and how has it helped to have that kind of support from peers who understand?
CE: I have lots of artists in my life who are open about their mental health, some who are really close friends. We’re lucky to be able to express this side of ourselves in our working lives and support one another as we try to stay in the game and healthy.
Despite growing awareness, stigma around bipolar disorder and other mental health conditions still lingers. Why do you think that is?
CE: I haven’t experienced negative reactions because of my field, local environment, and family, but there are many folks who do. It’s a shame to have positive steps toward acknowledgment and treatment, yet still be greeted with suspicion and derision.
In Four Pills, you mention that you’re not the performer you once were — that life feels different since your diagnosis. How has getting diagnosed changed your relationship to stand-up and the pace you used to keep?
CE: I need to sleep more than I did in the past; I get tired occasionally and I’m a little less driven as an artist. I also don’t “need” to do stand-up the way I once did — I’m more relaxed, and enjoy intimacy and consistency off stage. Now, I get to choose to do stand-up and other work, instead of pursuing it from a place of unbalanced energy.