A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction

by Patrick J. Kennedy

  As the conference approached, Tipper also made a bold revelation. She had, for years, been explaining that her deep interest in mental illness had grown out of her own academic studies—she had two degrees in psychology, although she never practiced—and the fact that her mother had suffered serious depressions. But then, several weeks before the White House conference, Tipper did a Q & A with USA Today in which she revealed an even more personal reason why mental health was her main concern. She said that she had been treated for depression with psychotherapy and medication ten years earlier, in the aftermath of her six-year-old son’s severe injuries in an auto accident. In 1999, that kind of revelation from a public figure was still big news.

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  THE CONFERENCE ITSELF, held on June 7, lasted only one hour and thirty-nine minutes. But it was a fantastically concentrated burst of science, policy, and advocacy. I still recall sitting in the packed room at Howard University—with innumerable members of Congress, leaders of government agencies, and power players in the mental health caregiver and patient advocacy communities—being amazed at how much cutting-edge information and smart medical politics were crammed into such a short period of time.

  The presentations were carefully orchestrated, with Tipper moving three high-powered conversations deftly onward. The first was moderated by her and included moving testimony from three successfully treated patients, including Mike Wallace from 60 Minutes, who was now speaking openly about his three major bouts with depression (the first one had come during a high-profile lawsuit against CBS; the other two, he explained, happened mostly because he kept going off his medication). Then the Vice President walked stage right and moderated a conversation about how families and communities and businesses can respond to mental health issues, with a mother from his home state who had to navigate the system for her bipolar child, and the medical director of Bank One Corporation, who discussed how offering better mental health coverage to the company’s employees saved them money. He also spoke via satellite link to Surgeon General Dr. David Satcher, who was joining the discussion—along with a large audience—from Atlanta.

  Then Hillary Clinton walked to stage left and talked about science and treatment with Dr. Steven Hyman—the outspoken young biological psychiatry researcher who, at age forty-six, had been the director of the National Institute of Mental Health for three years and was being talked about as a possible candidate to run the entire National Institutes of Health in a Gore administration (which would have been the first time a brain scientist ever ran the entire organization). Hyman showed some of the slides that had been making such an impact at recent medical conferences—images that for the first time allowed even a layperson who didn’t “believe” in mental illness to see the undeniable differences in the brains of people suffering from depression and schizophrenia. Hillary moved on to child psychiatry expert Dr. Harold Koplewicz from NYU and then to my House colleague from Michigan Lynn Rivers. She was the nation’s highest-ranking elected official who was open about suffering from mental illness, having revealed her bipolar disorder in 1994 on a call-in radio show during her first campaign for Congress.

  Then the President got up and gave a very moving address, which included announcements of several changes he could make immediately, with just his executive authority. He was mandating that federal civil service hiring could no longer have different disability standards for people with physical, developmental, and mental disabilities: previously, people with autism or Down syndrome had better disability protections than people with schizophrenia and mood disorders.

  And he was righting a wrong that my uncle had originally addressed in the early sixties, only to have his effort reversed by President Reagan. He ordered the nation’s largest private insurer, the Federal Employees Health Benefits Program, which covered over nine million Americans in three hundred health plans, to begin providing full parity for mental health conditions, “equal coverage for mental and physical illnesses,” beginning in 2001.

  The President also called for congressional hearings on mental health parity for the rest of insured Americans—knowing, of course, that this was going to take much longer to achieve and that it couldn’t be accomplished with just a stroke of his pen.

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  OVER THE NEXT FEW WEEKS after the conference, the NIMH unveiled a new $7.3 million study that would, for the first time, explore in depth the prevalence of mental illness in the US and the treatments currently in use. This was information that nobody had and the only way to have a benchmark from which to improve, as well as a way of assessing what mental health parity might actually mean in practice. NIMH also announced $61 million in new funding for two large much-needed clinical trials: one to examine the relative effectiveness of antipsychotic medications, the other to study long-term effects of different sequences of drug therapy and psychotherapy for treatment-resistent depression.

  Surgeon General David Satcher also began a major initiative on suicide in July. This was surprising only because his office was still working on the first-ever US Surgeon General’s report on mental illness, which had been under way for nearly two years. But with growing public concern about the aftermath of Columbine, he decided to make a surgical strike on the issue of teen suicide, which had become the third-leading cause of death among young people (and, unfortunately, is now their second-leading cause of death).

  Choosing suicide as a focal point was an interesting approach: I have personally left many large mental health conferences—where there are many well-meaning factions competing to get their illnesses or treatment approaches or facilities funded—thinking that the one thing all brain diseases ultimately have in common is that, for too many of their patients, their end point is a suicide attempt. Working backward from suicide is a way of being very inclusive to all mental health and addiction care, and it’s also a way of working to prevent our biggest shared fear and medical emergency.

  Everyone mourns when someone takes their own life—which we now describe as “completing suicide” because “committing” suggests a crime. But the truth is that up until that life is lost, people sometimes minimize the risk of self-harm or treat certain statements and actions too cavalierly. If a person is alive and in treatment for mental illness, even if the patient is vocal about having suicidal thoughts and plans, there is often too much discussion among family members, teachers, and even caregivers about how “real” or how “serious” the symptoms really are. How many times have we heard people parse whether or not a suicide attempt was “serious” or just “a cry for help,” as if those were two different things.

  I am extremely fortunate that suicidal ideation and behavior have not been components of my illnesses. So while I have been self-destructive, I am not plagued with the compulsion toward self-harm. This is one of the luckier aspects of my genetic loading for brain disease. Because given my poor impulse control over much of my young life, if I were often feeling suicidal, I might not still be here.

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  MOST OF MY RECOLLECTIONS of the summer of 1999, however, are overwhelmed by a deeply personal loss: the death of my cousin John Kennedy Jr. John was seven years older than me, so growing up, he was part of that older generation of cousins.

  We had become closer during recent years after he founded the great new political magazine, George, in 1995. The magazine’s offices were in New York, but John was frequently in DC. It was great having him in town more often, bringing a young, irreverent voice to Washington culture during a period of generational and political upheaval.

  Besides the articles in the magazine, he also did a number of promotional events that were great fun. In fact, the last time I saw him was June 17 at the US Airways Center, because he asked me to be part of a politicians-versus-pundits road race to raise money for breast cancer research, co-sponsored by BMW and the Susan G. Komen foundation. It was me, Jesse Jackson Jr., and several other Democrats, along with Republicans Mary Bono, Jim DeMint, a
nd Lindsay Graham, racing in BMW 3 sedans around the parking lot against Ann Coulter, Laura Ingraham, Juan Williams, and others. John couldn’t drive in the race himself because his leg was in a cast—he had recently broken it while paragliding.

  In mid-July, the week of my thirty-second birthday, I was scheduled to spend the weekend in California for Democratic fund-raising events. I wasn’t happy about this, because it was going to prevent me from being at the Cape, where most of my family was assembling for the wedding of my cousin Rory. I landed in San Francisco and was whisked to a fund-raiser, after which I went to bed. Early Saturday morning, I received word that John’s plane was missing and immediately arranged to fly home. I didn’t get to Hyannis until late Saturday afternoon. By then Rory’s wedding had been postponed, and the family gathering had been transformed into a vigil for John, his wife, Carolyn, and his sister-in-law, Lauren. But since a small bit of wreckage from their plane had already been found, prospects were grim.

  Early Wednesday morning, we received word that the divers had found something. A helicopter came to pick up my father, my brother, and me, landing on the front lawn of the main house and taking us to the Coast Guard station on Martha’s Vineyard. We were transported on a Coast Guard cutter to the site, and by around two o’clock in the afternoon we were on the Navy salvage ship, the USS Grasp, whose divers and robot cameras were working over one hundred feet below the surface.

  Over the previous few days, we had been consumed—and perhaps even a little distracted—by the technical details of the search, which were provided to us in the depersonalized language the military adopts when looking for anyone or anything. But when we were out on that cutter, just my brother and me flanking my dad, it was starting to become more and more real. I thought about how many tragedies like this my father had been forced to confront and process: his older brother Joe and his older sister “Kick” dying in plane crashes in the 1940s; his older brothers Jack and Bobby being shot to death in the 1960s. I understood, intellectually, how those traumas had formed him and my family over the decades. But I had no real understanding of that moment of incomprehensible pain and isolation, what it probably felt like when my father flashed back—until we heard on the radio that they were going to start bringing up what they had found and the winch began cranking.

  My father couldn’t really react except to put his hand on my shoulder. He was so deep inside himself that he just shut down. He couldn’t comprehend what we were witnessing; it was too much, so raw. The only comfort I could take from being with him at that moment is that we were really with him—in a way that only a grown child, or a brother, can be.

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  IN THE FALL OF 1999, the preliminary draft of the first-ever Surgeon General’s report on mental health began quietly circulating for comment. This five-hundred-page report had involved an incredibly accomplished cast of characters from all corners of mental healthcare, the current and the upcoming best and brightest. They all devoted hundreds of hours to this landmark enterprise, an attempt to create one large document that, in plain language, explained the challenging history of treating brain diseases and the current state of treatment, research, facilities, caregivers, and patients, and offered for the first time a smart conceptual road map for change.

  All Americans should read this report. It’s smart and provocative and comprehensive, and in many cases can help patients, families, and caregivers better understand what is known and not known about these illnesses and the efficacy of various treatments, and also help them not to be surprised or shocked by controversies everyone working in the field already knows about.

  So, with the White House Conference on Mental Health, the Surgeon General’s report, new executive orders to combat medical discrimination against mental illness, and a popular incumbent Vice President running for President on a platform of prioritizing care for brain diseases, things looked very promising for a second, even better Decade of the Brain. All we had to do was win the election.

  Chapter 14

  On Tuesday, February 29, 2000, at the Woonsocket Senior Center in northeastern Rhode Island, my life took a dramatic turn.

  I was hosting a campaign appearance by Tipper Gore for some two hundred senior citizens. Woonsocket was an old industrial town on the northern end of my district, politically important because it was a powerful Democratic stronghold and housed the corporate headquarters of the CVS drugstore chain. It was also close enough to Boston that my mom decided to join us.

  This event wasn’t supposed to be anything special, just a chance for Tipper to give her stump speech on mental health and for me to speak generally about the problem of stigma.

  I had no plans to share anything personal that day. In fact, I was not feeling or looking well: I get especially seasonally depressed in the darker days of winter, and I was taking too many Oxys.

  During the Q & A session after Tipper’s remarks, I got on a roll talking about the stigma of depression. Here I was in a room full of senior citizens concerned about this subject—many, I assume, because they were suffering—and sitting with my mom, who had been remarkably open about her alcoholism but still, even privately, had trouble admitting she was depressed.

  I was already well-known to my staff and my House colleagues for going off script in public appearances and pushing the envelope. One of my top aides came to refer to me as “the Ratchet” because I was never satisfied with normal messaging and, in front of a microphone, always wanted to “ratchet” things up. But none of them knew—nor did I—what I was about to say.

  “I myself have suffered from depression,” I blurted out. “I have been treated by psychiatrists.”

  There was a hush in the room.

  Finally, I said, “Oh, my god, it’s out! That’s another skeleton in the closet!”

  When that produced a chuckle, I kept going: “Yes, I am on a lot of different medications for, among other things, depression. I have suffered with depression since I was young. But I’m here to tell you, thank god I got treatment, because I wouldn’t be as strong as I am today if I didn’t get that treatment.”

  “People with depression are suffering, but they’re suffering in silence,” Tipper said. “Tell yourself to get help. Don’t suffer in silence.” And then we got back to the messages we had come to deliver.

  After the event, reporters had more questions that, honestly, I really wasn’t up for answering. I didn’t feel that great, I was sort of in shock over what I had just done, and I didn’t want to give out any more information. I also didn’t want it to appear as unplanned as it was, so I did my best to spin it as if this were all part of my plan, as my staff rolled their eyes. I told Charlie Bakst, the Providence Journal reporter who covered me the most, that I had decided to reveal this ahead of time, which is why I had invited my mom, who had suffered with alcoholism and depression. I told him that if I was going to tell senior citizens to get treatment and push past the stigma of mental illness, “I ought to walk the walk.”

  My mom told him she thought it was “wonderful” that I had spoken out. And then she had a great Mom line with so many meanings.

  “People like honesty,” she told the reporter.

  So they immediately asked her whether she was seeing a psychiatrist. She said she hadn’t seen one in five years but “would call one tomorrow if I needed one. But I’m so lucky—I can afford one. A lot of people can’t.”

  The reporters pressed me for the name of my psychiatrist, the names of the drugs I was taking. I didn’t want to go there. I just tried to keep on message.

  “I hope that my admission that I get help and that it makes me a stronger person—along with Tipper’s admission and others who are coming out—will help make more people realize there is nothing to be ashamed of. It should be treated as a private issue, but for the purpose of breaking the stigma, I have no problem saying that.”

  When I got back to Washington that night, I dashed off
a handwritten note to Bill Emmet, who had been the first person who ever talked to me about mental health parity, back in Rhode Island. He was now in Washington too, as deputy executive director of NAMI. I wrote, “Dear Bill, I’ve always admired your work, and now you know why.”

  He was called for comment after a local radio show made fun of me the next day for my public admission—basically saying that since I was a Kennedy, what did I have “to be depressed about?”

  “Mental illness is a biological brain disorder!” Bill shot back. “Saying Patrick has nothing to be depressed about is like saying Patrick has no reason to have heart disease, no reason to have cancer. Stigma is very real, and it’s going to take a lot more public officials to burn away the stigma!”

  Other media, however, did get it. The Boston Globe, which was not always so friendly to me, did a really nice op-ed that said, “Representative Patrick Kennedy performed an important service when he told a Rhode Island political gathering that he has been treating depression with medications. In doing so, he demonstrated that it is possible to lead a successful career while coping with a mental condition requiring medical treatment—an example to counter the stigma still applied to those who suffer with mental illnesses.”

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  WHILE THIS WAS ALL VERY KIND, I wasn’t coping with my mental condition. Not really. The fact that I had just blurted out private information about my treatment was, arguably, a symptom of my mental condition (as was, probably, running for public office at the age of twenty when I was still a college student).

  Also, when you have what is called a “dual diagnosis”—one that involves a mood disorder and a substance use disorder—it is easy to use one to cover for the other. At that time, my mood shifts were probably secondary to, and being fueled by, my overuse of narcotic painkillers (in public) and my drinking (in private). And because of the broad cycles in my moods, while it was true I had suffered “depressions,” they really had been part of the swings of bipolar disorder.