By Joe Mozingo, Soumya Karlamangla and Richard Winton

Los Angeles Times

Carrie Fisher never said she had conquered her problems. The quintessential child of Tinseltown never expected a Hollywood ending. She talked openly and often about her 45-year fight with bipolar disorder, alcoholism and drug addiction, explaining how opioids in particular “dialed down” her manic episodes.

She shared, in her distinctive brand of gallows humor, such episodes as Dan Aykroyd performing the Heimlich maneuver on her after she got so wasted she choked on a Brussels sprout. She wrote about getting her stomach pumped and receiving electroconvulsive therapy.

While many young stars who have died from drug abuse became mythologized, stuck in an immortal fast lane, Fisher laid out the much more ragged and tedious reality of a constant struggle that millions of Americans fight.

A coroner’s report released Monday about her death in December said alcohol, cocaine, heroin and ecstasy were found in her system. Although the pathologists could not conclude how toxic the drug levels were or how they affected her death, their use after so much medical intervention and therapy testifies to the sheer relentlessness of Fisher’s battle.

“Unfortunately there are so many Americans and people across the world who are suffering from addiction and mental health problems, and her life truly highlights how devastating addiction and mental health problems can be as a disease,” said Adam Leventhal, director of the Health, Emotion and Addiction Laboratory at the University of Southern California.

Carrie Fisher lived in rarefied circles as the daughter of Debbie Reynolds and Eddie Fisher, and the actress best known as Princess Leia in the blockbuster “Star Wars” franchise.

Fisher’s willingness to talk about her mental illness helped destigmatize it for many ordinary Americans, and likely led to more people talking to their friends and family about their feelings, and eventually seeking treatment, Leventhal said.

He said the problem is that many mind-altering substances — alcohol, methamphetamine, ecstasy, cocaine, heroin — “trick the human brain into believing” they’re needed to feel right.

“Drugs made me feel more normal,” Fisher told Psychology Today in 2001. “They contained me.”

Her drug of choice was Percodan, an opioid medication that became available in the 1970s. At her lowest point, she was popping 30 Percodan a day, she told the magazine. “You don’t even get high. It’s like a job; you punch in,” she recalled. “I was lying to doctors and looking through people’s drawers and medicine cabinets for drugs.”

At 28, she landed in the hospital with a tube down her throat to pump her stomach because she was not conscious enough to tell doctors what she had taken.

In recovery, she was diagnosed with bipolar disorder for the second time in four years. The first time, she ignored it, feeling the diagnosis just gave her an excuse for her moral failings as a privileged child turned drug abuser. This time, she accepted it and got treatment for it and her addictions.

She went on to write about the rehab experience in her best-selling semiautobiographical novel, “Postcards From the Edge.”

An estimated 6 million Americans have bipolar disorder.

At least half of those “have a lifetime alcohol use disorder, and about one-third have a lifetime drug use disorder,” said Samuel A. Ball, president and chief executive of the National Center on Addiction and Substance Abuse. “Medications for pain, anxiety and sleep can be often misused in an attempt to self-medicate the emotional pain, agitation or sleep problems that accompany either the manic phase or the depressive phase of bipolar illness.”

With treatment, Fisher took nearly two dozen pills a day, sometimes reluctantly for fear of stifling a bout of creativity that came with the mania. She also told interviewers that writing gave her a way to channel her hyperactive mind.

She became a prolific author and script doctor, and her comic, self-flagellating tales of excess seemed to be rooted in the past.

“There is treatment and a variety of medications that can alleviate your symptoms if you are manic-depressive or depressive,” Fisher told USA Today in 2002. “You can lead a normal life, whatever that is. I have gotten to the point where I can live a normal life, where my daughter can rely on me for predictable behavior, and that’s very important to me.”

Many were inspired by her message. Charlotte Horton, a 20-year-old student at the University of Cincinnati, said she felt isolated as a teenager after she was diagnosed with bipolar disorder, anxiety and depression. She didn’t have any friends to talk to about her illness and felt as though she would never achieve anything in life.

Then she found online articles about Fisher and Demi Lovato, a singer and actress who’s also spoken out about living with bipolar disorder.

“Looking at people who had it gave me a sense of I’m not alone when times are tough,” Horton said. “I can become successful. I can make my own story rather than just let my mental illness control my life.”

Fisher was in a highly productive period of her life before she died. She had just finished filming the “Star Wars” sequel “The Last Jedi.” HBO had released a documentary about her relationship with her mother called “Bright Lights: Starring Carrie Fisher and Debbie Reynolds.” And she was touring her latest best-seller, “The Princess Diarist.”

Fisher stopped breathing Dec. 23 on a flight from London to Los Angeles. Her assistant told authorities that Fisher had slept most of the flight and had a few episodes of sleep apnea during the journey, which was usual, the coroner’s report said. Toward the end of the flight, Fisher could not be stirred awake, the report said. A few minutes later, she began vomiting profusely and slumped over, the report said.

She was taken to Ronald Reagan UCLA Medical Center, where she was placed on a ventilator and died four days later.

Steve Sussman, professor of preventive medicine, psychology and social work at USC, said it’s hard to know what pushed Fisher toward drug use in the few days before her death, but the decision to use is often a response to stress. The mind associates positive feelings with a drug, and then seeks out that drug to self-medicate.

“Everything is moment by moment with addicts,” he said.

Natasha Tracy, who blogs about mental illness and wrote the book, “Lost Marbles: Insights into My Life with Depression & Bipolar,” called Fisher “a bright light” for people who struggle with mental illness.

More than just opening up about it, Fisher showed that she could have a family and a career, and write books and do stand-up comedy.

“I think it makes it easier to come out with your own struggles. Look, people with mental illness aren’t just crazy people. … People with mental illnesses have lives and can in fact achieve great things,” she said.

Tracy said that since she was diagnosed with bipolar disorder nearly two decades ago, she’s found comfort in others speaking out about their illnesses. She recalled reading about Fisher having a manic episode while performing stand-up on a cruise.

“That moment alone is such a teachable moment because it says that no matter how badly your mental illness screws up your life — and it can be very, very, very, bad — you can come back from it, and you can continue on with the life that you want.”

Tracy said the fact that Fisher died with drugs in her system doesn’t tarnish her legacy of resilience and tenacity in battling mental illness.

“You can fight and fight and fight and fight and fight and sometimes you lose,” she said. “If anything it shows how much pain and how much struggle she had that she had overcome for such a long time. … The end is really unfortunate, but all of the in-between is amazing.”