Ockham's Razor: The name of Belinda's band she formed with Jonathan and fellow musicians.
Aka Occam's razor, it's a principle attributed to a 14th-century English logician, William of Ockham: "Entities should not be multiplied unnecessarily." Shave away unnecessary assumptions to reach the simplest explanation. When multiple theories explain an unknown phenomenon, all things equal, choose the one requiring the fewest assumptions.
Physicists and chemists employ the approach. So do doctors. In medicine, a doctor diagnosing a particular injury or sickness would seek the fewest possible causes to account for all the symptoms.
Doctors offered many theories for what caused Belinda's ills: Nausea and vomiting, abdominal pains, and muscle aches and pains were consistent with opioid withdrawal. Headaches, blackouts, and back pain in a young patient, were consistent with somatization disorder. But all her symptoms had other explanations – for example cyclic vomiting syndrome, migraines, back sprains, neuropathic pain ... and liver failure. A decrepit liver causes fatigue, weakness, nausea, impaired thinking and a general health decline.
Doctors ran many tests during Belinda's hospital visits- CT scans, MRIs, assorted labs. There were clues -- an enlarged liver, GI abnormalities -- but nothing fully explained her complaints "which are believed to be largely fictional," one doctor noted. Doctors then searched for answers in the Diagnostic and Statistical Manual of Mental Disorders.
"This is a 26-year-old Caucasian woman wearing black. She is disheveled." a psychiatrist wrote in a November 2005 consult. "She practices witchcraft." The doctor diagnosed Belinda with somatization and borderline personality disorders. "Her speech is dramatic ... her mood is upset." Belinda told her and others at Cedars that her seven-year relationship with Mike recently ended. She never said why, but her family thinks Belinda's health and hospital visits played a large part. Then, days before that November visit, Belinda learned that Mike had married another woman.
Doctors speculated Belinda sought comfort in the emergency room. Or, maybe drugs. Sometimes Belinda reported her meds or prescriptions stolen or lost. That's not implausible to her friends and family. Belinda lived in a pack-rat's haven: a disorganized, cluttered apartment where she seldom tossed things out. And thieves nab narcotics, which she often toted in her purse. Belinda's friend Avi Tanners remembers her returning from an audition upset - someone took her meds when she put her purse down. She asked him to come to the doctor with her. "They won't believe me" she told him. At least during her last few months, Belinda rationed her pills, say friends who were with her regularly. She knew it would be hard to get more.
Opioids, aka narcotics - such as Vicodin and OxyContin - are often prescribed for chronic pain. Non-opioids -- e.g. Lyrica, Keppra and Neurontin -- offer an alternative treatment for pain rooted in the nervous system. But those are "off-label" uses - not the purpose for which they were FDA approved -so many aren't covered by insurance. At least not by Medi-Cal, the state insurance she'd eventually qualify for. So Belinda had few choices: Cheap and pain relieving narcotics, pricey non-narcotics, or nothing.
Opioids can be addictive, but taking the meds doesn't create addiction, according to the American Pain Society. Addiction is its own disease, an unpredictable adverse reaction in genetically and psychosocially vulnerable patients. Most pain patients who use opioids long term become dependent - physically needing a drug to avoid withdrawal - or tolerant, receiving diminished returns from the same dose. Most don't get addicted, according to the APS. And in her own words, Belinda expressed a disapproval of abusing drugs. The song "Velvet," in which she sings about "stealing dreams from the young stealing memories from the old," was her anti-drug song, she told Snyder.
Doctors still worried about Belinda's heavy reliance on opioids. She took them for years and asked for them at the hospital. An occasional doctor would recommend weaning Belinda. But most doctors noted their concerns and gave her the drugs anyway. She didn't like the pills, say friends who were with her near the end. The pills made her "loopy." She liked Lyrica. It comes with extreme side effects too, including depression. But taking meds with extreme side effects is not unusual in patients with intractable pain. At least with Lyrica she wouldn't have suffered acetaminophen poisoning.