The Perfect Prescription

A musician explores the role music has played in treating his mental illness

I was about 14 when I first went crazy. Sitting in the bedroom of my parents' G.I. Bill house, a bolt of noxious energy exploded around me and the air turned grainy, like reality was suddenly an ugly, 16-mm film. Terrified, I saw the universe beyond my small room as endless and black, occupied only by a malign Presence. I screamed, batted my face with my hands, but the world wouldn't get right. The Presence was swallowing me. My mind separated from my body, what mental health professionals call a dissociative state. My parents quieted me with a Valium, but for weeks I lived in nauseous terror of reoccurrence — until a remedy appeared, presaged by no rational thought. The remedy was Electric Light Orchestra's "Ma-Ma-Ma Belle," a silly pop-rocker but with an essential difference — a huge, super-distorted guitar.

That guitar — with its rich, enveloping harmonics — was like an elemental ally. When I had those inevitable next episodes, I kept returning to that song, to the Guitar that halved the Presence's power and my fear. The graininess would clear, my heartbeat returned to normal. It was freakin' awesome.

A few years later, a similar episode occurred, this one at band rehearsal. This was the 1970s; nobody seemed to know jack about bipolar disorder, which is what I would be diagnosed with 30 hard years later. The bedroom panic had matured into the Terror, like the moment of panic one might feel before someone shoots you, but stretched out forever. It struck mid-song, in front of my band mates. Again, and with the same lack of thought, I found refuge in sound. I leaned my face into my Sunn amplifier, played hard and in a flood of distorted noise, the electric terror faded. Just a bit, but fade it did. A few years later, when debilitating depression joined my symptoms, I retaliated with Magazine's Secondhand Daylight and Siouxsie and the Banshees' The Scream. What matters: A lifelong means of dealing with the world had set in.

Twenty years later, despite hard work in therapy and a failed go at lithium, I suffered an epic, full-blown mental meltdown, a four-year lost weekend of compulsive suicide attempts, self-mutilation, manic acting-out, hospitalizations and paralyzing depressions. It was like the part of my brain that controls crazy, self-destructive impulses — what science calls the limbic system — had taken a permanent powder. The few times I was lucid I was pole-axed with shame over my behavior. My sole tether to reality was Jane Siberry's When I Was a Boy. It's not an exaggeration to say that Boy, along with very patient friends and my shrink, are responsible for my survival.

Another grinding decade of therapy, of enduring the side effects of many failed medications, and I finally met the right, very patient person, found the right meds. Mostly, I'm OK. But news of the release of The Soloist — the Jamie Foxx and Robert Downey Jr. movie about a journalist's relationship with Cleveland native Nathaniel Ayers, ex-Julliard cellist gone homeless schizophrenic — triggered two realizations: 1) That I cannot think of a single friend who struggled with mental illness where music did not play a crucial role. 2) That I'd have been history long ago were it not for music.

And so I'm wondering: What is madness? What is its connection to music? How did I know to "prescribe" myself this non-drug made of oscillations in the air without a single thought? Am I alone in all this?

More than 20 percent of the U.S. population suffers from a diagnosable mental disorder; that's about 57.7 million souls. In 2004, the most recent year of accounting by the National Institute of Mental Health, suicide claimed 32,439 of us. On average, we die 25 years younger than the general populace.

Musicians who are mentally ill — or "MI" because it's easier to type — and are out about their illness include DMX, Sinead O'Connor, Of Montreal's Kevin Barnes and Charley Pride. Suicide-wise, MI is hideously egalitarian: Ian Curtis and Elliott Smith, soul legend Donny Hathaway and blues-jazz shredder Danny Gatton all took their lives.

I have my own losses. There was Ellen, a great writer, music lover and manic-depressive. She bought into the old saw connecting madness and creation, went days without sleep while mixing psychotropic drugs to keep her tweaked. Three months ago, at the age of 41, her heart simply gave out. There was Mary (not her real name), a brilliant artist with whom I crafted a half-hour long song cycle about child abuse, who called one day because demons were crawling the walls and calmed down only when I played her some Brian Eno. And, unfortunately, others.

Dr. Robert Conley, adjunct professor of psychiatry at the University of Maryland, believes that although schizophrenia, depression and bipolar disorder are very different, at least some of the underlying causes are similar. Along with genetics and developmental factors, another thing these diseases have in common is lousy connectivity between the "middle brain" or limbic system, which controls emotions and memories, and the cortex, which deals with reasoning, planning and controlling moods. "In a sense, the limbic system kind of comes up with suggestions and the cortex is kind of editing and saying, 'Yeah, do that, don't do that,'" he explains.

As I understand it, this connectivity is vital to how we think and act, while people with MI brains "have somewhat fewer connections between the cortex and the rest of the brain," says Dr. Conley. "Or the connections are a little less efficient."

An example Conley likes: Show a person without depression a sad image. Her brain's neurons will fire normally until the cortex kicks in and essentially says "This is just a picture," and the mood passes. Not so much for the person with depression, as I understand it: The same image, the same nerve firing, but something goes flooey and the mood persists.

Now imagine when that compromised brain is confronted with a lost job or death. Then imagine that mixed with amped-out mania, and you have people such as Tiffany Lee Brown, Mike Doughty and, well, me.

Tiffany Lee Brown is a longtime fixture of the Portland, Oregon, underground, indie, performance and spoken-word scene, whose bands have included Black Orchid and Brainwarmer; she's now working on a 6,480-hour music "soundtrack" with Eric Hausmann called The Easter Island Project. Brooklynite Mike Doughty, meanwhile, enjoys a successful solo career highlighted by indie hits like "Looking at the World From the Bottom of a Well" after his time leading Soul Coughing.

What we share is music and bipolar disorder. Like some cruel joke of nature, bipolar's symptoms often first present during adolescence, at the same time kids are hormonally crazy anyway. And, yes, it probably has to do with a brain-connectivity problem — in this case, the way teen brains routinely "prune" away the brain cells of childhood. Brown had her first bipolar episode at 14; her first "balls-out, super-manic episode" at 17. Busy with music, a job, college, the school paper and the school play, Brown found herself "angry and depressed and hyper ... all at once," she says.

"What we in the bipolar business call a 'mixed-state episode.' It's like you're Dorothy being grabbed by the tornado and swooped up. It's kind of exciting — you might land in Oz, or you might just get dropped and land on your head."

And here's bipolar's dirty secret: Sometimes, mania feels awesome. "It's like the best drugs you've ever taken," says Brown. "Combined with the best sex you've ever had, combined with the best music you've ever played."

Doughty, who says his relationship with music has "always been essentially medicinal," has a more modulated view. "Sometimes I went into creative jags when I was manic," he writes in an e-mail. "But I rarely wrote anything worth keeping. It's kind of like being high in that what you write at the time seems really brilliant, but is really actually cruddy in the harsh light of day."

We all struggled with all these things for years. For Brown, it almost killed her. She was 24, enjoying a way-fun lifestyle of music-making, writing, tech support, clubbing and sleeping very seldom. Then she crashed. The world started to look like "that dark hellhole you always expected it was," she says. At a New Year's Eve party, close friends suddenly looked "revolting."

The next day, Brown meditated, listened to Dead Can Dance, and then she slit both wrists, the vertical incisions of the determined. Often, suicide really is a "cry for help." But for Brown, it was something more dangerous — a solution. "It was like, 'I don't have to be in pain all the time,'" she remembers.

If you do survive, you get to enjoy MI's big punchline: Getting better is hell. You might end up hospitalized, where "You don't do anything," according to Alan Sparhawk of slo-core favorites Low, speaking to The Onion in 2007, in reference to his hospitalization after a massive breakdown. "There were no lyrics scrawled in the cold hospital bathroom that later turned into ballads."

Inevitably, you're going to search for the right medication. This takes forever. For Doughty, it started 10 years ago with Prozac, which seemed a "miracle cure" before plunging him into mania; it turned out bipolars usually need a complimentary mood stabilizer and/or antipsychotic when taking with drugs like Prozac. Oh well.

Since not taking meds just led Doughty back to depression and "brutal obsessive thinking," he went back to trying out, mixing and adjusting the dosages of sundry meds and dealing with the god-awful side effects until he stabilized on his current cocktail.

Even if psychiatric medication is, in the words of New York psychcopharmacologist (and my doctor) Dr. Carlotta Schuster, in "the middle ages" of its development, I'll still stick with Seroquel (side effects include drowsiness, dry mouth, constipation), Klonopin (amnesia, hallucinations, hysteria) and Trileptal (somnolence, nausea, tremor), as opposed to suffering the alternative. When you're bipolar, there really isn't a choice; the same applies to schizophrenia, only more so.

For many people, schizophrenia is the scary mental illness. Schizophrenia is Norman Bates; it's whomever is killing people at the mall — forget the fact that the vast majority of sufferers hurt only themselves, if anyone at all. For an accurate view of the illness, Keven McAlester's 2005 documentary of the hard life of Roky Erickson, You're Gonna Miss Me, is essential.

Erickson's band, the 13th Floor Elevators, cranked out pioneering psychedelic-rock brilliance until Erickson was hospitalized at 21 for schizophrenia. Soldiering on solo, Erickson continued creating very strange delights until a consuming terror of being chased by aliens, among other delusions, stopped the music in the early 1980s. In the movie, we see Erickson change from the archetypical Dionysian rocker of the '60s, into the distracted, gray-haired man of today, his body paunchy, I assume, from antipsychotics. McAlester came to understand/accept the disease's hard laws. "There is no test for it, just a collection of symptoms that could be interpreted in multiple ways," he writes in an e-mail. "There is no medication for the disease, just for some of the symptoms."

McAlester has no time for the mad musical genius myth. He asks us to consider "Duke Ellington, Paul McCartney, Vladimir Horowitz. All studiously sane. [Frank] Sinatra, [Elvis] Costello, Stevie Wonder. Ditto. You have to go a bit down the list to get beyond the eccentric (James Brown) to the truly troubled (Roky, Nick Drake, Chet Baker).

"Meanwhile, go into any mental hospital," he continues. "How many geniuses do you run into walking those halls? The truth is that the intersection between madness and genius is no more common than the general intersection between humanity and genius; it's just a better story."

McAlester's film ends on a tentatively optimistic note; visit to witness Erickson resurgent, back on the count despite his illness. Still, why has Erickson, like Brian Wilson and jazz great Tom Harrell, prevailed when so many others have stalled?

Again, it's about brain connectivity. For schizophrenics, this is literally exhausting, making the fact of creating or enjoying music seem miraculous. I don't entirely understand the science Dr. Conley runs by me, but the gist is that the compromised brain has to interpret incorrect information from the limbic system — often manifest as hallucinations — and the infinite minutia of the real world. Even with something as simple as reading, the schizophrenic brain is "typically working 30 to 40 percent harder" than the non-schizophrenic brain. Conley stresses that this has "nothing to do with intelligence. It's really, truly just a physiologic difference."

Then there's that most basic existential thing, figuring out what's safe. What the schizophrenic person comes up with may not make sense to us; what matters is it works for them, as just moving from one room to another can be debilitatingly terrifying. For a person with a schizophrenic brain, change is the enemy of safe. It's why The Soloist's schizophrenic cellist prefers his poverty-stricken stretch of downtown L.A. over an assisted-living apartment. And, it's reasonable to guess, why Roky Erickson prefers staying in the home he grew up in. The better place just isn't, in their minds, the safer place.

But in many, perhaps most cases, music literally is. During our conversation, Dr. Conley and I talked about the schizophrenic's need for safety when we stumble onto an exciting possibility. "One of the good things about music," he says, "is as you learn things, it's the same and yet different at the same time. You can keep re-examining pieces, playing them over again, learning new things about them, but it's built on a substrate of a thing you know very well."

I think about being freaked out, about ELO, whose music I knew, and "Ma-Ma-Ma Belle," a song I didn't. And being wigged and working that out on an amp and guitar I knew. Then I recall a recent article reporting that music causes the brain to produce more dopamine, the body's own substance of pleasure. And finally, something else Doughty said about music, how it "just brings me into a soothing kind of focus."

So it helps you experience terrifying stuff and be safe all at once? "Yeah," says Conley. "You can explore those new things in a very safe way."

Later, in an e-mail correspondence, I run this notion past Petr Janata, a University of California-Davis associate professor in the psychology department and Center for Mind and Brain, focusing on the relationship between music, emotion and memory. "Music," he writes, "is free to impact some evolutionary deep networks [limbic system: anterior cingulate and amygdala], while the cortex can appraise the situation and render it safe, thereby giving it overall positive valence."

I choose to read this as validation. But it doesn't explain why music has helped me so much, while failing so spectacularly, so tragically with others — with Ellen, with all the other friends who struggled hard with MI in their own ways and lost, and how totally out there I've been at various junctures and still survived. For that, I think Brown has the ultimate answer. It's no good and it isn't fair but it sounds about right: "We're very lucky."

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