She burned with shame in the harsh light of the barren room, reality spilling around her like coins spattering from a slot machine jackpot. She had been here for hours now, lying on a bed without springs, looking through blinds without cords. She had handed over her belt and her shoes, along with her pens and pencils and her hairbrush. Her open door left her exposed to anyone walking by.
Her eyes ached from a day of sobbing, yet when she looked around, tears flooded them all over again. Was this really happening? she wondered. Is this really me?
Her husband, Bob, had already put up with so much. A wife who committed suicide would merely add a final crushing chapter to the past four years of heartbreak. During that time she had emptied their bank accounts, borrowed tens of thousands of dollars, and maxed every credit card. When she had thought her life couldn't get more degrading, she had gathered jewelry and hocked it for a few hundred dollars. She had lied about it all-where she had been, what she had done, the amount of money she had lost, now reaching into the hundreds of thousands of dollars. She had confessed and relapsed so many times that her promises rang as empty as the family's bank accounts. And for what? To sit mesmerized before a flashing, jangling machine, punching a button over and over, praying for a jackpot that wouldn't come.
That was the incomprehensible part. It was all so out of character, so out of the blue. It was as if a demon had seized control of her mind and was pulling levers to destroy her for sport. Before, she had been a trial lawyer at a well-known Chicago firm, a decent and generous mother and wife who was approaching 50 years old. She and her husband had built the kind of storybook North Shore life that made places like Winnetka so desirable. She was a churchgoer and a soccer mom who lived her life according to a strong moral code. Willpower. Fortitude. That's how life was lived. For proof, she needed merely to look to her father-who had quit smoking cold turkey after 43 years.
Now everything she thought about herself had changed. She had become a liar, living a double life, behaving in just the sort of repulsive way that had once been so easy to judge. And no matter what she tried, how low she had sunk, she couldn't stop. Why? The answer, she thought, was obvious. She, Barbara Hermansen, was simply a bad person. She looked in the mirror. A hollow-eyed woman in an open-back hospital gown and gray booties stared back.
She could see why they were treating her like a crazy person. She looked crazy.
As she lay back on the thin mattress-under suicide watch in the psychiatric care unit at Evanston Northwestern Hospital-she felt the hot tears of her shame come once more. And once again, for the thousandth time, the millionth, her mind spun like the pull of a slot, trying to land on the answer to a bigger mystery than any dealer's hole card: What has happened to me?
Ten years earlier, long before thoughts of suicide, before she had felt possessed by a demon, Barbara Hermansen's biggest worry, her only real worry, was the worms. Not actual worms. But little nerve tremors that wriggled and spiraled up and down her legs every time she lay down to go to sleep.
Night after night she would lie in wait, hoping against hope that they would spare her. But within an hour, they would arrive, creeping under her skin like creatures in a B horror flick, making her shift and thrash in bed, until finally she would rip back the covers and storm downstairs. She would lie on the floor or ride an exercise bike until she was exhausted. Finally, around 5 a.m., the worms would go away-at least for the night-and she would lapse into a couple of hours of sodden sleep, sentenced to another groggy morning hunched dead-eyed over coffee. She tried not to complain. How could you, with a life so richly blessed?
Born in a small town in Nebraska, Barbara had been an excellent student and a championship swimmer before coming to Chicago to teach and ultimately earn a law degree at Northwestern University. She had joined one of the city's top firms, Schiff Hardin & Waite, where she eventually became a partner. In 1990, she married another Schiff Hardin lawyer, Bob Wilcox-a product of Harvard and the law school at the University of California at Berkeley-and they moved to Winnetka. With their two children, Ben and Katie, the family now lived in a graceful old colonial that had been owned by Bob's parents.
So she felt fortunate. But she also felt tortured by her sleeplessness. "It was so hard getting up in the mornings," she recalls. "I would wake up and my first thought would be, When can I get back to sleep?"
Desperate to find what was wrong, she sought answers from the Center for Sleep Disorders at Loyola University Medical Center. There, in 1996, a neurologist named Thomas Freedom finally put a name to her misery: Barbara was suffering from a neurological malady called restless leg syndrome. The condition, which is said to affect up to 12 million Americans, usually appears at night, and in aggravated cases makes it almost impossible for the sufferer to sit or lie in one position for more than 30 seconds or so. Movement alleviates the symptoms, but also creates the most debilitating consequence: severe insomnia.
Dr. Freedom told her that a class of drugs initially manufactured to treat Parkinson's disease had recently shown great promise. Dopamine agonists, as the drugs are called, promote the presence in the brain of a natural body chemical called dopamine, which in turn calms muscle movement-hence its effectiveness against the "worms" of restless leg syndrome. Dopamine also influences feelings of pleasure and reward. Dr. Freedom explained that the side effects of the drugs were few when they occurred at all-nausea and lightheadedness in some people, dry mouth, hallucinations, involuntary movement, and sudden sleepiness in others. But with Barbara's initially low dose-.05 of a milligram a day-the doctor said he doubted she would have problems.
The revelation thrilled her. Could a little pill really cure a problem that had tormented her for so many years?
Of the three most popular dopamine agonists, Mirapex, Requip, and Permax, Dr. Freedom wrote a prescription for Permax, a medication made by Eli Lilly and distributed by Valeant Pharmaceuticals. That night Barbara swallowed the pill, then crawled under the covers about midnight. When she woke up and looked at the clock it was 3 a.m. "Three hours might not sound like a lot," she says. "To me, it was a miracle." As Bob slumbered, blissfully unaware of the breakthrough, she burst into tears.
|The first night she took Permax (above), one of a class of drugs known as dopamine agonists, Barbara Hermansen was able to sleep from midnight until 3 a.m. "Three hours might not sound like a lot," she says. "To me, it was a miracle."|
The drug changed her life. Where once she dreaded going to bed, she now awoke refreshed. "Before, I functioned, but I always felt a little foggy," she says. "Being able to sleep helped me focus." Namely, she was able to think clearly and to reflect on her priorities, including what she wanted to do with her newfound vigor. She surprised herself with the answer. She didn't want to work in a law office anymore. She wanted to spend more time with her children. With Ben already a blond beanpole and Katie blossoming into a young woman, they were growing up way too fast. "I realized that I had gotten on this treadmill where I was simply putting one foot in front of the other," Barbara says. "Once I started sleeping at night, I knew that I was neglecting the one thing I loved the most: my children."
Some acquaintances found her timing odd. "They'd say, ‘You want to quit now?'" she recalls. To Barbara, it made perfect sense. What better time to recommit to her family than the very moment when she could devote herself to it with all her energy and passion?
She left Schiff Hardin in June 1997, having spent 15 years with the firm. She saw Bob off to work in the mornings and greeted him when he came home. She joined her church board, taught Sunday school, volunteered as a Cub Scout den leader and a Brownie leader, and served as a PTA officer. It was amazing, she thought, how one medication could change her life so drastically. As the years passed, she increased her dosage of Permax-as with any drug, her body had developed a tolerance. But at a daily dose of two milligrams she was still well under the recommended maximum of three to five milligrams per day.
In the summer of 2001, Barbara's younger sister, Kris, who lived in Alaska, suggested they take a girls-only trip to Las Vegas. Why not? Vegas wouldn't have been Barbara's first choice for a getaway, but she had never been there and her sister's excitement was infectious. "I've always wanted to see it," Kris said. "Haven't you?"
Barbara's sole reservation was the gambling. A few years earlier, she and Bob had spent an evening on a floating casino in Indiana with their friends Leslie Donavan and her husband, John Seymour. All four hated it-the blue haze of cigarette smoke, the jangling slot machines, the men in cutoffs and tank tops, the women with too much blue eye shadow. "I remember the whole experience was like an assault on my body," Barbara recalls.
What had depressed Barbara and Bob most was the people at the slots. They sat like zombies before the twirling reels, punching the play button over and over. Some had literally plugged themselves into the machines, clipping one end of a nylon cord to their chest and sticking the plastic card on the other end into a slot. As the players lost, the machines slowly drained away credits. To Barbara it seemed the machines were sucking out their souls.
The experience was enough to satisfy any curiosity the couple might have had. But the invitation from Kris was different. This wasn't just anybody offering. And this wasn't some riverboat. It was Vegas. After talking it over with Bob, Barbara called her sister. "Pack your Elvis suit," she said.
The 35-acre Aladdin Casino & Resort complex shimmered out of the desert like a glittering mirage. Turrets twisted up like candy Twizzlers. The lobby looked as if it were made out of gold. Two sixth-floor pools looked down on the Strip, a boulevard of neon lights and glittering hotel marquees.
The sisters caught a show at the Mirage. They shopped, they people watched. The casino was merely a place to pass through on the way to somewhere else. Still, it was Las Vegas and they felt obliged to set aside at least a few hours for gaming. Kris knew how to play blackjack, but Barbara was a novice, so she took up a spot at a slot machine. She found a nonsmoking area that was mostly deserted and tentatively fed a twenty into the slot. Betting a dollar each time, she lost it all within a couple of minutes. Continuing to play, she climbed ahead to $30 or $40, then watched the money dwindle. She actually surprised herself with how much fun it was. Click, click, click . . . the reels twirled and settled on the payline, diamond, diamond . . . 6 . . . Damn!
She stuck with one machine and whenever she would get a little ahead, she would tell herself, Just wait until you get to $60, then $65, and then cash out. But she never quite got there. Instead, she hit a bad streak. Soon, she was down $100. Wow, she thought. It goes quick. But it's exciting!
The sisters had a couple more visits to the casino, and took in the sights. But Barbara felt distracted. She couldn't get the machine she had played, or the money she had lost, out of her mind. She kept thinking that if only she had cashed out when she was ahead by $20 or $30, she could have won instead of lost. She wished she could play, just one more time. But the weekend was up. The sisters shared a cab to the airport and Barbara saw Kris off to her earlier flight.
With some time left before her own departure, Barbara felt restless. A bank of slot machines caught her eye. Her pulse quickened. A few days earlier when she had seen the machines, she had thought how sad it was that people couldn't even wait to get to a casino. Now . . . she thought she might actually play a little bit before her flight. She found an ATM and withdrew some cash. She checked her watch one more time. One by one, she began feeding twenties into the slot, so absorbed that she barely made the flight.
She returned to Winnetka feeling a bit disoriented, like a space traveler who had arrived home from a strange planet. She spun tales of the fantastic world she had just seen, with its Eiffel Tower and golden lobbies, its pirate ship battles and canals of Venice. She recounted the shows, the pools, the restaurants, the people watching. And, yes, her modest foray into gambling-it was Vegas, after all.
But her losses bugged her. Those damn machines! "I kept thinking, If only I could play them again," she recalls. "I'd know that you've got to quit while you're ahead." For a brief moment she considered going to an Illinois boat casino. Don't be silly, she told herself. But thoughts of playing again nagged her over the next few days, until one afternoon, while she was on her computer, a pop-up ad flashed on her computer screen. "The Gaming Club"-which she could download immediately-promised real Las Vegas action, including the very slot machines found in a casino. Just register your credit card, the ad said, and be playing within seconds.
She started to do it, then hesitated. Somewhere in her mind, a tiny alarm went off. Bob would never approve, for one. Then again, it wasn't as if she were driving to a casino and betting all their money. And what if she won?
With a click of the mouse she downloaded the game. She registered her credit card and charged $50. She promptly lost it. She dropped another $50. God. She bet more, chasing her losses . . . until . . . click, click, click . . . $600! A winner! "I thought, Wow! Cash out!" she recalls. "But I didn't." In fact, she wound up losing more than she had won. She turned off the machine, angry and dejected. But she was also . . . pumped. She couldn't tell Bob. But she didn't really have to. The two of them had their own checking accounts, their own credit cards. He would never see the statement. She would just pay it off and chalk it up to a little treat she had given herself. As she removed the software from her computer, she told herself, This will just be my little secret.
The next day, however, she reinstalled the program. And the same thing happened. Lose, lose, lose, win big, fail to cash out, lose some more. Over the next several weeks, she played out the pattern nearly every day. By August 2001, just a few weeks after her return from Vegas, she had lost several thousand dollars. She knew she was going to have to tell Bob, but the thought terrified her. She felt so ashamed, so . . . stupid. Gambling! Her guilt and shame overwhelmed her one late summer night after dinner. "I have something to tell you," she confessed. "Something terrible." She paused for a moment, avoiding his gaze. "I've been gambling. Ever since Vegas." Bob stared at her. Of the thousand things he thought she might say, gambling wouldn't have made the top 500. "So how much did you lose?" he asked, his mind still reeling. "She swallowed hard a couple of times," Bob recalls. "And then she named a figure." Six, maybe seven thousand dollars. Bob blinked. What? How? Why? "Well, thank God you stopped," he stammered. "I know. I know," she said. "I can't believe how stupid I've been." He put his arms around her as she heaved with sobs. "I don't know what got into me," she said. "I'll never do it again."
Bob paid off the debt. Barbara removed the software. Things returned to normal. But a few days later, temptation struck again. No, she told herself. C'mon, a voice cajoled . . . it won't hurt anything. Maybe you could win some of the money back. . . . True, she thought. Who says I have to lose? She downloaded another Internet casino. I'll only play a little, she told herself.
She played a lot-and lost a lot, much more than the initial six or seven thousand. Within weeks, she had maxed out two credit cards, running them up to $50,000 total. Even that fact might have gone unnoticed had a mortgage banker handling Bob's application to refinance the home not brought the debts to his attention. This time, he was not only blindsided, but enraged. Fifty thousand dollars! What the hell was going on?
In the late fall of 2001, the couple walked into a Gamblers Anonymous meeting. Barbara met with a group of gamblers, and Bob would later attend meetings for spouses and children of gambling addicts. Both found reason for hope. "I had the image of a compulsive gambler as a skid row person," Barbara says. "And here I was in a room with lawyers, doctors, an electrician, who were battling this same demon. They kept telling me if I stuck with the program and worked the steps, the desire to gamble would go away." Bob took heart from stories of others' suffering and from people who assured him he wasn't to blame.
Barbara went nearly every Wednesday and Sunday night for more than a year. But the overwhelming urge to gamble never left her, and as the holidays came and went, she continued playing Internet slots. By now, however, she had become much more adept at hiding what she was doing. "I had learned to compartmentalize it," says Barbara. "So that no one had any idea of this secret part of my life."
Bob assumed Barbara was done with gambling. Still, in February 2002, he found an interesting story in The New York Times that described a curious connection between dopamine levels and people who struggled with compulsions, including gambling. The article reported that fluctuating dopamine levels could actually "make" people do things against their will, such as continue to gamble or take drugs, even when they knew the behavior was destructive. "The first time they win, they get a huge dopamine rush that gets embedded in their memory," the article said. "They keep gambling and the occasional dopamine rush of winning overrides their conscious knowledge that they will lose in the long run." That sounded like Barbara, Bob thought.
He showed the story to her, and it immediately piqued her interest. She was taking a drug that, as far as she knew, had something to do with dopamine in the brain. Perhaps her medicine was playing some role in her compulsion.
Meanwhile, though, she continued to gamble. Over the next two months, she lost tens of thousands more dollars wagering online. "I felt like I was totally over my head," she says. When she confessed for a third time, in April, Bob was beyond livid. "I experienced the visual sensation that must be the original source of the expression, ‘Seeing red,'" he recalls. "It made me wonder how it can be possible to trust another human being."
Not long after, they told the two children, then aged 11 and 12, about their mother's addiction, and Barbara also shared her situation with Kris and Leslie Donavan. All were floored. "Barbara was absolutely the last person on the planet I would have thought would have a gambling problem," says Leslie today. "She's always followed the straight and narrow."
Grasping for help, Bob and Barbara discovered software called GamBlock created to prevent the downloading of online casinos. They cut up Barbara's credit cards. Though Gamblers Anonymous had not proved much help so far, Barbara recommitted herself to the program. She also began seeing a therapist for gambling, and, with Bob, a couples counselor for their marriage.
In May 2002, she found herself walking through the doors of the Grand Victoria, a riverboat casino in Elgin.
She was immediately hooked. This was gambling. Machines whirring, cards flying. Smoky, yes, but she couldn't have cared less. All she could see was rows and rows of shining slot machines, the only game she played. So many possibilities. If one machine was cold, she would simply move to another. She would start betting small, then gradually increase her wagers. Before she knew it, she would be utterly engrossed, exactly like the poor mesmerized souls she had pitied years ago. "I wouldn't be hungry, I wouldn't be thirsty, I wouldn't have to go to the bathroom," Barbara says. "When I gambled I didn't want anyone to bring me food; I didn't want any free drinks. I was there to play and I think I could have sat there for 12 hours straight."
Her mania would begin as soon as she walked out of her home and got in her car. "I knew I was just minutes away [from playing]," she says. "My heart would start to beat more quickly and my mouth would get dry. I would take the cash and my driver's license out of my wallet and set them on the seat next to me, ready to put them in my pocket." As she pulled into the casino parking lot, her hands would nearly tremble. "There was something surreal about it," she says. "My senses seemed dulled. . . . I focused solely on getting myself to the slot machines."
She gave herself over to the compulsion, making the drive from Winnetka to Elgin several times a week. Her cover stories were endless-"I'm going shopping; I'm running errands; I'm going wherever," she recalls. She would monitor the time to make sure she could pick up her children. When she lingered too long at the casino, she would call a friend with a ready excuse.
"I'd say, ‘I'm stuck in traffic. Would you mind?'"
She knew what she was doing was wrong, but, she says, "I just really felt so powerless. It was the most humbling, bizarre thing." When she confessed again that summer, Bob began exploring options, including leaving Barbara and taking the kids. But what would that do? Deprive the children of their mother? And what about him? For all the heartache, he loved Barbara deeply.
He developed severe stress headaches and depression. He began to have thoughts of suicide. But then, the storm would seem to pass, Barbara would return to "normal," and he would begin to think-again-that the worst was over.
Barbara discovered that she could have herself barred from casinos by signing a form at the Illinois Gaming Board. She completed the process on September 26, 2002. "That felt good for a week or so," she says. "Then I began driving to Indiana."
She tried going back to work-not as a lawyer, but as a substitute teacher, earning $75 a day. She loved the job in many ways, but, she says, "it was [also] very humbling, light-years away from a high-powered law practice. But I figured since I was such a bad person I deserved it."
With each failed attempt to stop, she grew more hopeless and more desperate. She had never forgotten the New York Times story about dopamine and compulsive behavior, and had, in the meantime, come across a story that seemed to solidify the connection: researchers had uncovered a link between dopamine therapy for patients with Parkinson's disease and the sudden onset of compulsive gambling. According to the study, conducted by the Division of Addictions at Harvard Medical School, 12 patients had developed gambling problems after they began taking the medication L-dopa for their Parkinson's.
L-dopa isn't a dopamine agonist like Permax. Still, Barbara felt a burst of hope. "I really felt like ‘This is it!'" In August 2002, she took her findings to Dr. Freedom, the neurologist who had originally prescribed the Permax. Dr. Freedom says today that he thought there might well be something to what Barbara was saying. "Based on her lack of any history of this kind of behavior and the literature Barbara showed me, it certainly seemed plausible," he says. At the time, he cautioned Barbara that the findings in the studies were speculative at best and dealt solely with Parkinson's disease, not restless leg syndrome. Nevertheless, as a possible alternative to Permax, he prescribed Neurontin, an antiseizure medication that does not directly affect the body's dopamine system. She could lower her Permax dosage and see what happened with her compulsion.
Barbara shared the study in one of her Gamblers Anonymous meetings. "I know it sounds like science fiction," she told the group, "but what if it's true? That would explain why I can't stop." The reaction was harsh. "They said, ‘Barbara, we all have things going on in our brains. Don't blame it on the medicine. You have to take responsibility for yourself.'" Her therapist was even more dismissive. "As long as you look for an excuse, you will never stop gambling," Barbara recalls her saying. "What we need to be concentrating on is on why you feel the need to test your husband's love-why you think you don't deserve to be happy."
Discouraged, battered, Barbara dropped it. Anyway, she didn't really believe that a drug could make someone do such unspeakable things-lie to her husband, or get behind the wheel of a car and drive to a casino. "If only there had been some authoritative voice," she says now. "If some medical person had said, ‘I know about this.'"
Instead, she returned to thinking that the fault wasn't in a pill, but in her. "There was volition involved in my gambling, it seemed," she says. "I was making choices. How could it be the drug?" She began to suspect that she had discovered a dark truth about who she really was under her "nice" exterior: "I just thought, I am a bad person. And I've just kept it buried all these years."
The Neurontin prescribed by Dr. Freedom was ineffective against her restless leg syndrome, and the reduced dosage of Permax didn't stop her compulsion to gamble further. Conditions at home deteriorated. "There was incredible anger and stress in the house," recalls Barbara. And so, "given the incredible turmoil and pain [Bob and I] were in, the one thing I could change was the insomnia. So at some point . . . I gave up on trying to get off the Permax."
She became resigned to the fact that she was a hardened gambler, who came with cash and credit cards, ready to play. Having earlier arranged to have herself barred from the Illinois casinos, she turned to the boats in Indiana, particularly Jack Binion's Horseshoe Casino in Hammond. Driving to the boat two, sometimes three times a week, she occasionally won-once hitting a jackpot of $68,000. "I came home and gave the check to Bob," she says. "He couldn't believe it. He was so angry. He wanted to tear the check up or donate it to charity. He saw it almost as blood money."
Usually, though, she would drive home, almost frantic with regret. "I remember walking in the middle of the night around [Winnetka] just crying and crying," she says. "The agony was indescribable."
She gambled throughout 2003, losing so much money that she welcomed an invitation to return to work at Schiff Hardin. As a condition of her return, she had to reveal her gambling problem to each member of the firm's executive committee, as well as the heads of the administrative staff and the people with whom she would be working directly. By then, she had plunged into severe depression and, in addition to seeing her therapist, she started going to a psychiatrist who specializes in pharmacological treatments for mental disorders. But nothing worked. Having arranged to have herself barred at casinos in both Illinois and Indiana, she resorted to buying lottery tickets. "I became the scratch-off queen," she says.
She clung to the fantasy that if she could hit one last, bank-breaking jackpot she could bail her family out of four years of losses and thereby shake her compulsion. In September 2004, she wheedled a $15,000 loan from a friend and an additional $15,000 from her bank and turned back to her home computer, which she had, months earlier, reprogrammed to defeat the blocking software.
Each morning, she would enter the Spin Palace online casino with high hopes, believing a huge jackpot was always one play away. "Sometimes I did win big, but never enough so I would stop," she says. "Each afternoon, as my funds disappeared, I would sink into a terrible depression."
She clutched at her delusion until her last penny was gone. Until that moment, she says, "there was a tiny part of me that could still be conned into thinking I could gamble my way out of this. . . . Now, I finally saw the lie for what it was. . . . I could not stop and I never would be able to. And if I couldn't stop gambling, my family was doomed as well. The only surefire way I knew to stop was to be dead."
She chose September 24, 2004-the Friday before she and Bob were supposed to meet four other couples in Three Oaks, Michigan, for an annual bike trip. Her primary concern was to make her death appear accidental-she didn't want her children growing up with the stigma of having a mother who had committed suicide. She settled on drowning herself.
To lay the groundwork, she took walks at Elder Lane Beach, just off Sheridan Road in Winnetka. Everyone who knew her, knew of her passion for collecting sea glass-those little shards of broken bottle polished and shaped by the waves. She also loved swimming, sometimes taking solo swims on warm September mornings. Knowing the lifeguards would be gone by then and that Elder Lane Beach would be deserted in the afternoon, "I decided that swimming and glass collecting would be my camouflage."
That late September day, she tidied her bedroom. In the top drawer of Bob's dresser, she laid the suicide letter she had worked on as she gambled her last hopes away. In it, she assured Bob that her death was for the best. "I was admitting the gambling part of me had won, and I was taking the coward's way out," she says. At a little after 3 p.m., she pulled on a swimsuit, slipped on a cover-up with a pocket, and put three sleeping pills from Bob's medicine chest in her pocket. She grabbed a plastic bag from the kitchen and retrieved a beach towel from the basement. She would fill the bag with sea glass, drop it on the towel, and then plunge into the water. Instead of swimming parallel to the shore as she usually did, she would head straight out, as far and as fast as she could. Having already taken the sleeping pills, "I would get more and more tired and eventually fall asleep, sink, and die," she remembers thinking.
Something clearly held her back, because on her way out the door, without thinking, she says, she grabbed her cell phone. She felt dizzy. Her heart was racing. Could she really do this? She climbed behind the wheel of her car. It was a beautiful fall day, and she glanced at her home washed in sunlight, then dropped her head on her arms and began to weep. "I didn't want to die," she says. "I did not want to leave my family." She picked up the cell phone and punched in the numbers for Leslie.
Her friend drove Barbara to the emergency room at Evanston Northwestern Hospital, where she waited hours in the emergency room under suicide watch. Emotionally and physically drained, she numbly answered the questions of social workers and therapists. Finally, at around 1 a.m., doctors placed her in the psychiatric care ward. After taking a sedative, she curled into a ball and fell asleep.
For months, Barbara's psychiatrist had been urging her to contact an Evanston therapist named Christopher Anderson, who specialized in gambling addictions. Barbara had ignored the suggestions-she already had a therapist. Now that she had landed in the hospital, the psychiatrist gave her an ultimatum: no call, no discharge. She shuffled down to a small dark booth and picked up the phone. The voice that answered wasn't what she expected. It was bright and sunny, with a hint of a Texas twang. "Oh, you're the one with the medication issue," Chris Anderson said. "I was told you'd be calling."
For years, Anderson had been hearing about cases of people on dopamine agonist therapy-usually for Parkinson's disease-struggling with gambling problems. Now he told her that the Permax she was taking might explain her problem. The words hit Barbara like a set of double diamonds. Was it possible that she wasn't the horrible person she imagined? Until that moment, Barbara had thought of herself as very controlled, very much in charge-except for the demon of gambling. But Anderson was suggesting that an outside factor had taken over, that she in effect had become a lab rat, pushing a lever for a pellet of cocaine, or a machine programmed to carry out her own self-destruction. "I felt like I was in the twilight zone," she says.
The first step, Anderson told her, was to get out of the hospital. Next he recommended that her medication be altered-though that wasn't as simple as it sounded. The biggest problem was the drug's almost miraculous effectiveness with her restless leg syndrome. If she simply stopped, the horrific insomnia would return. And she was going to need all her strength to deal with the consequences of her behavior.
For starters, nine days in the psych ward had left her drained and numb-and now her marriage hung by a thread. Bob had been wonderful during her stay there, supportive and kind. And over the past four years he had been patient beyond measure. But the passing of the immediate crisis had exposed vast reserves of underlying hurt and anger that were bubbling up like lava from some molten core of rage. "I didn't know whether to believe this or not," Bob says. "I know I wanted to believe it. But could a simple drug really cause so much heartache?" Meanwhile, there was the staggering debt-hundreds of thousands of dollars.
The first day out of the hospital, when she checked the messages on her voice mail, Barbara discovered that more than a dozen had been left by the two online casinos she had frequented most, Spin Palace and The Virtual Casino. One said that $2,000 had been put into an account for her use. Another asked where she had been. "We want you back!" the voice said. Furious, Barbara fired off e-mails saying she never wanted to hear from them again. "I'm a compulsive gambler," she wrote. "I can't do this."
She immediately began reducing the Permax from her daily dose of two milligrams, and at her doctors' urging she tried a variety of alternatives to the drug. Researching other reports on the dopamine-gambling link, she discovered that the phenomenon had been addressed in more than a dozen studies stretching as far back as 1988. She wrote three times to the drugmaker, Eli Lilly, and also to Valeant-at that time the exclusive domestic distributor of Permax-and asked if they had any information about the link between compulsive gambling and her medication. She also asked that the companies include a label warning of what she saw as a potentially devastating side effect. She says the responses were pleasant, but that a Lilly attorney told her not enough research had been done to establish a link.
Meanwhile, she felt her will eroding. In February, feeling utter disbelief at what she was doing and contempt for herself, she climbed in her car and went to the Horseshoe. Using her lawyerly wiles, she had persuaded the casino over e-mail to drop the ban she'd had imposed on herself. She lost $500 one day, then $500 the next. But the experience put her over the top. She strode straight back to the security office. "Ban me," she said. For life. No outs, no questions. She was a compulsive gambler, and she was never, ever to be allowed back in.
Knowing that she would almost certainly be inviting back the worms, she completely stopped the Permax on March 9th. She didn't care. No torment was worth the hell she had gone through the last four years. She realized that as long as she believed that she could control her behavior-that her inability to stop was simply a failure to straighten up and behave-she would never be able to quit. To win back a new life, to exorcise her demon, she would have to lose the innocence about herself and replace it with something less comfortable, but more real: the idea that a drug could reach into the mind of a smart, ethical person and change a dream life into a nightmare.Last July, the Mayo Clinic issued the findings of a study that dramatically bolstered the link between dopamine agonists and pathological gambling.
Researchers found 11 Parkinson's patients being treated with dopamine agonists who had started gambling compulsively. Eight patients whom the researchers were able to follow had all quit gambling after stopping the medication. It was "like a light switch being turned off," said one participant. (The study also found additional behavior issues, including compulsive eating, increased alcohol consumption, and hypersexuality.)
How can a drug that affects the region of the brain associated with muscle control turn someone into a compulsive gambler? The answer, says M. Leann Dodd, a psychiatrist at the Mayo Clinic and the study's lead researcher, lies in the dual impact of dopamine agonists. Patients with Parkinson's disease suffer from too few dopamine-producing neurons in areas of their brain that affect movement. The dopamine agonist medications work by providing a synthetic form of that much-needed dopamine. Doing so calms the tremors and other movement problems associated with Parkinson's disease-as well as the "worms" caused by restless leg syndrome. But those same dopamine agonists also supercharge areas of the brain responsible for cravings, pleasures, and rewards, overriding chemical messages to stop destructive behaviors. The patient, unaware that his brain has been essentially hijacked, believes he is making conscious choices, when the truth is he has been turned into a virtual automaton.
The almost Pavlovian reward-response nature of slot-machine gambling plays right into this process, by providing an activity that ignites the part of the brain affected by dopamine. The connection wasn't discovered sooner, Dodd says, because behavior such as compulsive gambling, hypersexuality, and overeating carries so much shame that patients were reluctant to discuss these things with their doctors. What's more, few thought to connect their behavior to their Parkinson's medication. After a number of sufferers had come forward, researchers were finally led to make the link. "We can't say we have proved [it] 100 percent," Dodd says, "but the evidence is very suggestive."
Other studies have found similar connections. In August 2003, researchers for the journal Neurology found nine of 1,000 Parkinson's patients had become compulsive gamblers, though they had never had gambling problems in the past. All nine were taking L-dopa and a dopamine agonist when their gambling problems began.
Meanwhile, six people who took the dopamine agonist Mirapex have sued Pfizer and Boehringer Ingelheim Ltd., of Germany, the maker of Mirapex, in a California case that may become a class action. The lawsuit quotes an FDA data base linking Mirapex to 33 compulsive disorder episodes since 1998, including 30 with "catastrophic compulsive gambling effects." The lawsuit also alleges that plaintiffs are aware of nearly 100 cases of compulsive disorders related to dopamine agonists.
Though the Mayo patients were on different brands of dopamine agonists, Barbara has no doubt that the Permax triggered her compulsion. Neither does Anderson, though he cautions that her case is an exception. For most addicts, he says, a combination of Gambler's Anonymous and specialized therapy yields the best results.
For Barbara, the most powerful confirmation is in how quickly she was able to stop gambling after discontinuing use of the medication. She has now launched a campaign to warn others, and to force Eli Lilly and Valeant to include a warning with the drug. (This year, after a TV special highlighted possible dangers, Boehringer Ingelheim started putting a warning in the medicine's package that side effects could include "pathological gambling." The company denies any wrongdoing.)
After a meeting with Lilly executives proved fruitless, in July Barbara and Bob filed a lawsuit against Lilly and Valeant, as well as Elan Corporation, which bought the rights to the drug from Lilly, and Amarin, to which the rights were transferred in 2002. The suit, now in federal court here, claims that even though the corporations were aware of research linking Permax and compulsive gambling, they failed to warn Barbara and others. Barbara and her husband are seeking compensation for pain and suffering endured because of Barbara's gambling addiction, says Joseph M. Dooley III, the attorney representing the family.
"We're not asking that they take the drug off the market," Barbara says. "It's a good drug. But people like me need to know to stop taking the medication. If there had been a warning on that bottle a year ago, it would have made a huge difference for me and my family."
John Dames, a lawyer representing Lilly, said neither he nor the company could comment on ongoing litigation. In a response to the suit filed on August 17th, however, the defendants denied any wrongdoing. Lilly acknowledges receiving letters from Barbara, but denies that it either knew or should have known of a possible link between Permax and compulsive gambling. As for warning consumers, Lilly says it meets the requirements of the Food and Drug Administration.
These days, Barbara insists, the very thought of entering a casino turns her stomach. "I have had not even a flicker of a desire to gamble," she says. "I walk past lottery machines in the grocery store all the time and wonder how I could have ever stood in front of one putting my money in." The person who did that was the consummate con artist, she says, an actress, faking her way through life. "When I was gambling, even if I was sitting and talking to one of my children, half of my brain was somewhere else. For the first time in a long time, I'm fully present."
When she speaks of her return from her experience, she uses words like "reborn" and "resurrection." "I look at my bank account and I have nothing to hide," she says. "I'm pure as the driven snow. I feel like I have my brain back."
But she is not the person she was before. She looks at people, and their struggles, much differently now, with a reluctance to leap to conclusions about who they are and why they do what they do. Yes, people have a responsibility to make smart choices, but if an intelligent person like her, with no history of addiction and an otherwise happy life, can find herself doing such horrible things, acting against her own will, how can she stand in judgment of others?
It is an uncomfortable question, one she would never have thought to ask herself before. But in it lies her redemption, the thing she sought so desperately during those lonely years while she fed a fortune, and her soul, into a slot machine. "I now feel differently toward everyone," she says. "I have room in my life for people . . . I guess it has given me a profound sense of humility." To Bob, their ordeal strikes an equally elemental note: "It is amazingly, profoundly unsettling for what it means to be a human being," he says.
Meanwhile, the consequences of her compulsion will be with her for years. Debts remain. She struggles again with insomnia. Bob is still grappling with the pain of the lies and betrayal. "There's not the easy joy there once was," he admits. How did he stick it out, through seven relapses and confessions? The answer, he says, is pretty simple. "Our marriage is the best thing that has ever happened to me. I didn't want to give up on it. Barbara is a wonderful mother, and even if we were to separate I would want her to be with the kids. The fact is, it just didn't compute for me."
Barbara is now using acupuncture to treat her insomnia, and although she is getting only about three hours of sleep a night, she does so with something more precious than any luxurious slumber: a clean conscience.
One day not long ago, on one of the last warm days of summer, Barbara and Bob took a stroll after dinner at Elder Lane Beach, where Barbara had planned to kill herself. As they walked, they picked up a few pieces of sea glass. "That might sound kind of strange [going there with Bob]," she admits. "But I see it as rejecting the negative feelings about the place and reclaiming the good."
They consider the pieces they collect as symbols of their ordeal's end, though neither Barbara nor Bob would ever call them a jackpot. They don't use words like that anymore. The wiser, stronger people they are, and the more honest, tempered happiness they have found, are blessings, they say. Luck has nothing to do with it.