Fall to Pieces: A Memoir of Drugs, Rock 'N' Roll, and Mental Illness (25 page)

You know the way an animal looks when it’s cornered—a mouse cornered by a cat, a little dog bullied by a big dog? Their eyes widen, their shoulders come up around their heads, and they freeze their bodies so tight that every muscle twitches in protest? That was me. I share a birthday with Salvador Dalí, and my clock was beginning to melt.

After the gate
and door were locked behind me, I sat on the couch in the main room and tried to pull myself together. I think the nurse took pity on me after I told her what happened, so she let me use the pay phone to call my mom. It was five in the morning when she picked up. Thank God she’s a light sleeper. Through my tears, I told her how scared I was and that I needed her to get me out. “Mom, they put me in a cage.”

I gave her the main office phone number, and she told me she would figure something out. Waiting to hear from her again felt like
an eternity. I called her back about twenty minutes later, and she broke the bad news—I was stuck there until the next doctors’ shift began at nine
A.M
.

I could no longer handle the goings-on in the main room. A man who kept unbandaging and examining his bleeding foot and an old guy wearing a hospital gown with his ass out and a catheter dangling at his knees was just too much. I went into my room and sat on the bed. I was so run down, nothing would’ve made me happier than sleep. But I was afraid that if I slept I would lose control of the situation. Which is kind of funny, because how much control can you have when you’re locked in a cage and you’re not holding the key?

At nine the next morning, the troops arrived: my dad, my brother, my aunt. And a psychiatrist I’d never seen before. Not Dr. Pylko. “I want Dr. Pylko,” I said. “Scott said I would have Dr. Pylko.” I thought about digging in, but it became clear to me that this doctor was the one who would get me out of there.

With my family around me, we finally talked him into releasing the seventy-two-hour hold, which he did only on the condition that I take a sedative and someone stay with me at home until I could see Pylko. My dad said he’d do it and that there would be no time I was alone or unmonitored.

Thankfully, we’d gone outside to sit at a picnic table while the doctor looked at my chart. I looked at the fence surrounding me and above me and felt like I’d been admitted to a bird atrium. For liability reasons alone, it was a major struggle to inch my way out the door. Finally, I was released into the custody of my family, who promised to keep me settled and make sure I showed up for my appointment with Dr. Pylko. We crammed into the front seat of my dad’s truck and started the thirty-minute drive back home.

I’m sure Dad and Johnny were wondering whether or not they’d made the right choice, springing me from the funny farm. I’d like to know who coined the term
funny farm
. True, you are treated like an animal, so I get the farm bit—but where’s the funny?

When we got home, we all fell on the couch. Now that I no longer had to play normal, my head dropped the flag and I started racing again. What anyone said or did at that point, I have no memory of. My sister Julie and her now-husband Ian came back to the house to help out. The sedative slowed down my body, but it had no effect on my mind at all. I tried sleeping but got nowhere, so I just laid in my room staring at the wall. My dad, brother, and aunt left after it was obvious that Julie and Ian had it covered, and I wasn’t going to go bananas again.

When Scott finally came in, I surfaced. “You had me locked up,” I said.

“I know,” he said. “And you had me locked up once, too. You knew it was for the best that time, and so was this. You need to give in to the medication now, Mary—I’ll stay with you. Tomorrow, we’ll go see Pylko.”

I was as far down into a black hole as I’d ever gone. As I finally fell into something like sleep, I wondered if anybody existed who could truly dig me out.

On April Fools’ Day 2001
, Scott went with me to my first appointment with Dr. Pylko. I couldn’t see myself from the outside. I wasn’t able to sit still, I needed Scott’s hand to hold me down, and I was scared. I didn’t want to go anywhere without him. I needed him to explain to the doctor how I was acting, why I was acting like that
what was wrong with me. I couldn’t remember half of what I’d done (I couldn’t believe half of what I heard), and I could not make any connection between my body and my mind. It seemed as though each part of me was making its own decision about what it wanted to do without asking my permission.

Many other doctors, therapists, and addiction specialists had passed through Scott’s and my life—at rehabs, in family groups, in hospitals. On some basic level, even through my fog, I felt that I could trust Dr. Pylko. If all I’d wanted was a quick diagnosis and a prescription for painkillers, it wouldn’t have mattered to me if a doctor was good at his job. But I’d come to the end of some kind of road and instinctively sensed that competence mattered a lot. Dr. Pylko seemed tall to me that day (of course, I felt very small), with graying hair and beard, rimless glasses, eyes that held no criticism. Not an “egghead”—more like the cool science teacher you wish you’d had. Hanging on to Scott as though he had custody of the lone oxygen tank, I struggled to focus on Dr. Pylko’s calm voice and what it was saying. I knew my life depended on it, and I knew my children’s did as well.

He gave me a test called the Young Mania Rating Scale (YMRS). It’s not named after young maniacs—it’s a clinical questionnaire. The doctor asks the questions, the patient answers. Eleven questions, asking me about things like “flight of ideas” (I had many of them) and “incoherent communication” (I had a lot of that, too) and “disruptive-aggressive behavior” (check). The highest rating is sixty, the lowest is zero. Anything between zero and twelve is considered in the normal range of response; between twelve and twenty is hypomania—elevated manic state, but still functional. Anything above twenty is mania. I scored a thirty-one. God knows what I would’ve scored the day before.

“That’s serious, Mary,” said Dr. Pylko. “In almost any circumstance, it would require hospitalization.”

And then slowly, he began to help me unravel the mystery of what had gotten me into so much trouble. I would like to explain it myself, as I’ve attempted to do in earlier chapters of the book, but at the point at which we met, I wasn’t taking notes or reading books on my own various disorders—I didn’t know what they were. I knew about addiction, and Bernie had worked with me endlessly about the issues that Scott and I had together. But this was different.

“That day I first met you,” Dr. Pylko tells me now, “you were what we call ‘floridly psychotic’—manic, but somehow composed, despite a lot of psychotic symptoms. You wanted relief from the symptoms, but you didn’t want to be drugged into unconsciousness—you were fighting for clarity, not surrendering. You had suffered inordinate stress that year, and for years before that, and what happened to you was a culmination of an accumulation.”

Humans are rhythmic beings, like animals, he tells me. Our bodies and brains are calibrated for certain activities at certain times (like, say, sleep once it’s dark, and nutrition once we’re hungry). But there is very little that is rhythmic or organized about our contemporary lives. There was nothing rhythmic about my life that first day. “Loss, grief, the houses, being on the road, swinging back and forth between a picture of a life and the actual realities of your life,” he says. “And finally you broke.

“An easy way to think about bipolar disorder is to consider allergies,” he told me.

“Allergies are a disorder of the immune system, misidentifying antigens as toxic and then attacking them—it’s not the pollen that makes us sick, it’s our body’s reaction to pollen. Bipolar disorder
is cellular, but it can become a kind of allergic reaction to stimulus. In disorganized thinking, you perceive yourself as attacked, so you react—but that may not be what’s going on at all. In a downswing, you feel worthless, hopeless, and at the end of possibilities, in spite of all the objective truth of everything good you see around you—children, home, material comfort. You can’t make it carry any emotional weight. In an upswing, you feel bulletproof, smart, tireless, and brilliant—you work long hours, you don’t sleep, your mind races. You had all of this, and the side effects, too: substance abuse, compromised judgment about decisions. You were spinning in ways that literally threw you off center.”

The meds for depression went to the wrong part of my brain, which is why they only made things worse. And then, when I abruptly stopped taking them, that made the worse even worse. Like speeding in a car, which is risky, and speeding on an icy road, which is even riskier. If I’d gotten a correct diagnosis—or, to be honest, if I’d paid attention when the possibility of bipolar disorder was mentioned years before—I might’ve avoided both the bonfire inside my head and the one in my driveway. No way to know.

This is information
from Dr. Pylko about the genetic component of bipolar disorder, which, before I understood it, scared the hell out of me in terms of my future and the future of our children. It’s what explained Bernie’s remark about being “front-loaded” for addiction:

The Human Genome Project has identified more than thirty thousand genes that code for all kinds of behaviors, and no one gene codes for only one thing. There is no single “addiction” gene per se, there is no single mental illness gene, any more than there is one
“artistic” gene, or a gene that makes it easier for some people to balance their checking accounts or obey the speed limit. But there are genes that show distinct strengths and weaknesses. Some genes code for multiple uses: a genetic predisposition to substance addiction might also carry with it a genetic predisposition to creativity, or athleticism, or perfect pitch. But if that person is never exposed to baseball or music, or heroin or cocaine, that aspect of that gene set may never turn on. The child of a diabetic will not automatically become diabetic, but might inherit a vulnerability. Genes are not destiny, they are information, and when we have the information, we can usually (to the best of our abilities and resources) make our choices accordingly. But often, we don’t have the information. Just as often, the information isn’t enough. It’s the difference between having a shopping list of items and having a recipe to put them together. As much as we’ve learned about the brain, we’ve learned that we are just beginners.

I was caught in what Dr. Pylko called a “perfect storm” of vulnerability: a genetic predisposition to addiction, a great deal of emotional disorder and trauma in my young years, the early drug-and-alcohol experimentation that tripped me right into addiction, and the ongoing daily craziness of our lives. That doesn’t mean that the life of a model or a rock star is automatically wired for disaster—it simply means that if all the ingredients are there, the odds for disaster go up. He also told me that there was ongoing research into genes that might code for resilience—that just as I might be predisposed or vulnerable to bad things, I could also be predisposed for good ones. Creativity, maybe. My love for music. My sense of humor. Maybe that was all genetic, too.

I asked him why it was only the depression that the other doctors kept seeing, and that I kept feeling, when this other half of me
existed and nobody really seemed to have pegged it correctly. “With some manic episodes, people don’t remember, or they’re not reliable witnesses about their own behavior,” Dr. Pylko said. He told us of a patient some years ago who bought three cars in a day. The man was wealthy, so his big buys didn’t seem extreme or manic to him; in fact, he had to be reminded that he’d done that. I’d been having intermittent manic episodes for years—for example, much of the chemical charge I got from the drug-run years was from the risk, the edge of it. That was as much about mania as it was about addiction: the chronic sleeplessness, the constant arranging/rearranging, and, of course, the trip to Palm Springs.

Yes, he said, there were drug therapies for bipolar disorder, and we’d begin trying them, but I couldn’t just grab the meds and run—I had to have a plan. Talk therapy was going to be a part of it; trying to make my life consistent would be another part. And I had to take my health seriously. Bipolar patients have a significantly higher risk of cardiovascular and respiratory disease, cerebrovascular (stroke) and endocrine (diabetes) disorders as well. This isn’t just self-indulgent neurosis we’re talking about—it’s about my wanting to be around when my children have children. I had to get going on that plan immediately.

In addition to the meds and the talk therapy, he said, there were “side” prescriptions: common-sense stuff. “If you want to have optimal stability, you’ve got to have an optimal life,” he said. Regular bedtime, regular wake time, nutrition that works, a routine that keeps all the machinery in working order. Is this how normal people lived? What would I have to give up? Staying up all night, evidently. Vodka-water with a slice of lime, probably. Drama, maybe. Did I have to be bored, or boring, in order to be well?

“Even in ‘normal’ life,” he said, “ambition or circumstances can work against the stability prescription. I don’t sleep eight hours—I barely get six, and nutrition goes to hell for days at a time. Then I oversleep on weekends, and we pay a price for that, too, especially as we age. I eat on the run; the cell phone’s always at me. But once you become aware of what it costs you, you’ll start to make small adjustments. It won’t feel like giving things up; it’ll feel like taking your life back into your own hands. In the meantime, the meds will help you get the calm and focus that you need to make these changes. It’ll take time, but I believe you can do it.”

It wouldn’t all be roses, he cautioned me. Addiction recovery, or accepting a diagnosis of a mental disorder, both often require what he called “the mourning of the healthy self.” I thought I was this person, it turns out I’m that person. The sorrow of that can be a relapse trigger in addiction recovery, and it can kick off depression again as well. It’s humbling. Ultimately, in order to take care of myself, I had to accept my life. If I didn’t, I’d stay sick. It wouldn’t be as simple as that, of course—figuring out the right treatment and strategy for me might take years. I might be fighting for it for the rest of my life.