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.
“Ultimately, it’s not about defining yourself as ‘defective,’ Mary,” he said. That was reassuring, since I’d been defining myself as defective all along. “It’s not about surrendering—it’s about claiming. It’s about figuring out how to live your life. Which is ultimately the goal for everyone, isn’t it?”
After this first meeting, I saw Dr. Pylko as often as I could and spent the rest of my time at home, trying to reconstruct the events that I’d been the center of. The faces of my kids tore at my heart. Noah and Lucy were both very sweet—they would bring me food in bed and check on me. They were so little. I didn’t want them to feel like they needed to take care of me. I told them that I loved them very much and that it was my job to take care of them—I would be well soon, so they didn’t have to worry. How could I not have protected them from this ugliness?
One day, I found Noah’s letter on my desktop:
Dear Mommy, I love you. I hope you feel better very soon. I’m going to take care of you. I love you because you do nice things for me. Love, Noah W.
Every morning when I woke up, I hoped that it was over—then I’d realize how far I had yet to go. Some days, the mania was so intense that trying to relax felt like running a marathon and being told to stop and meditate right at the finish line. My heart raced, my head was spinning, yet lifting my eyes or even a pencil required full concentration. I was supposed to sleep as much as possible, and I wanted to. I really tried (I remembered when I used to like sleeping), but because my head was in overdrive, I couldn’t completely shut down. Thinking about the headlines, about frightening my children, about putting our lives in full reverse (when for months, even years, I’d been convinced that we’d finally made it through the worst of it) made me feel like a fool. I’d worked hard to better my life. Now I was just seen as a spoiled psycho.
And then I informed the health team of something that they didn’t want to hear and absolutely did not support: Velvet Revolver was going to South America to promote Libertad, and I wanted to go.
There are too many reasons to list why it was a bad choice and why no one should’ve allowed me to make it. I went anyway. I shook all the way through Argentina, Chile, and Brazil, where VR was greeted by such a crowd of fans at the airport that we had a police motorcycle escort to the hotel. It was a spectacle; Christine described what the bikes were doing as “sling-shotting” from the front of our vans to the back, escorting us through intersections while stopping traffic. I had a sense of watching everyone and everything from very far away. If handcuffing myself to Scott was an option, I would have signed up and thrown out the key; if there was a BabyBjörn for adults that would have let me strap myself to him, I would have. The meds were starting to work, I knew I was coming down, but I feared that if he left I would fall apart again.
My doctors gave me a long list of rules to follow while in South America. I was to stay on the same time zone as L.A. I wasn’t allowed to go to the band’s shows. I couldn’t go out at night. I needed to take naps. I had to be consistent with my meds and avoid stress. I tried following doctors’ orders as much as possible, but staying on L.A. time was difficult—the band traveled throughout the continent, and South American fans are amazing. Passionate, involved, they stayed up late and often congregated in front of the hotel or greeted us in the lobbies. Paying attention to food, getting enough sleep—I kept losing track. Even naps were hard. I would tremble in bed and be afraid to close my eyes. Sometimes I needed Scott to crawl in bed and hold me.
I missed the majority of the shows. I’d watch the first song or two and then go backstage to Scott’s dressing room and rest. Lying in bed in beautiful hotels, I mouthed profanities at God for keeping me in lockdown when I should have been out and about seeing the countries. Mainly, I waited for the meds to kick in, as though I was in a holding pattern circling the planet waiting for clearance to land. Five minutes at a time, it happened. I wasn’t back to myself for weeks (actually, I’m still not back to myself, thank God), but as confounded as I was, I began to look forward to going home and putting it all back together.
THIRTEEN
october winds
California’s Santa Ana winds often begin in late September. They blow in from the ocean, with what at first feels like relief—but then, in some weird meteorological marriage with the winds off the Mojave Desert, they get hot. By the end of October, the Santa Anas have hijacked your serotonin. I struggle with this every year, much as people in the Northeast battle seasonal affective disorder and need to buy special lamps to get them through fall and winter. Even after Dr. Pylko stabilized me on my meds, I was still scared of October. It’s not a coincidence that so many of Scott’s setbacks had begun in October, from the beginning of the month when the breeze starts to blow, then to his birthday, then to Noah’s, and then to the holidays. Not everything can be fixed with pumpkin pie.
Addiction can reach out and grab you when you least expect it. One minute you’re drug free, the next minute you’re a player in your own drug deal. It’s as though you simultaneously lose control of your body, your carefully reconstructed mind, and, in all likelihood, your car, which for some reason decides to drive through neighborhoods you wouldn’t cruise through during a bright sunny day, let alone after dark.
One night, Scott came home hours past the kids’ bedtime; rather than give him the third degree, I went to our room and started getting ready for bed. He followed me there, leaned up against the wall, and said, “I have to tell you something, but I don’t want you to freak out.” Uh-oh, too late, I thought.
Driving home from the studio, he’d passed a metro bus station and watched a drug deal go down, he told me. Watching that deal basically blew the cobwebs off the coffin of the voice we both hoped had died. He bought the coke, did it in the car, got high, then drove around in despair. He came home to ask me for help. He promised that it was just this once and asked me not to worry.
This was a first. He’d never asked me for help after a relapse. It would’ve been nice if I could’ve responded in a patient, compassionate way—I knew about relapse, I knew that both of us were vulnerable to it, always. But I went ballistic. There had never been a “just once” before. All I could think about were the kids. “How could you do this to us?”
We had struggled so hard to put this behind us, we’d been given so much help, so many second chances. Noah and Lucy weren’t babies anymore, and even b
efore their uncle Michael died, I spent endless sleepless nights wondering how I’d tell them of their father’s death.
In the following weeks, if he called to say he was leaving the studio and on his way home, I would check the clock and start the countdown. God forbid he needed to stop for gas. I didn’t want to be this nervous, minute-counting person. I didn’t want to be responsible for clocking him from point A to point B. But I just couldn’t help it. My ability to trust him evaporated.
Scott had a dream from the time he was a little boy about making music and earning his living doing it. As rocky as the road was, he worked hard and made that dream true. He made a lot of money doing what he loves; for a while, I made a lot of money, too. Along with those resources and our very privileged life had come a team of people who arrived initially to help him, and help us. Scott had a payroll, and most of the people on it were more than happy to cast votes on our marriage. There were employees who used with Scott; there were employees who got drugs for him. Once again, I was back to the Trust No One place. The difference was, I was in treatment and on medicines that were working. I was determined that nobody was going to knock me over again. The simple truth is, a marriage doesn’t require a committee, a manager, a business manager, or a tour manager—it requires only the two adults who are in it. Maybe I should’ve been on his payroll as well. Maybe then my voice would’ve counted.
He promised this relapse was a one-time thing. I knew how difficult it was to make such a promise when you were deep in the middle; as I watched him struggle, it was clear to me that the one night drive-by wasn’t the end of it. He kept promising to drive directly home from the studio, but he was always late. Very late. I’d find him passed out in the pantry or outside on the deck. He rarely came to bed.
Fall to Pieces: A Memoir of Drugs, Rock 'N' Roll, and Mental Illness Page 23