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

by Patrick J. Kennedy

  I guess I should have known with these harbingers that the election wasn’t going to go as planned. Though the House remained under GOP control, we did manage to retain all the seats where incumbent Democrats hadn’t run again, and picked up two other seats from the Republicans. Both my dad and I were reelected. As for the White House, that drama was going to drag on for weeks to come.

  —

  EVEN THOUGH I HAD DONE what the DCCC asked and broke every Democratic congressional fund-raising record, I was devastated that we failed to win back the House. And I decided right then that I needed a new mission. I needed to commit myself to an issue that was bigger than politics for me, an issue that would carry me into the new millennium, an issue where I could make a difference—not just as a Kennedy, but as me.

  I talked to Dick Gephardt and told him I hoped to become the leading Democratic voice on mental health issues—and wanted to use the seat I was about to take on the Appropriations Committee to make a difference on mental illness and addiction. I also told this to the top political columnist at the Providence Journal, so all my constituents would know what I planned.

  Of course, what I didn’t tell them was how much I needed help with my own illness. With Election Day behind me, and the fear of being caught drinking lessened, I started letting loose. And as the press kept digging further into its coverage of my embarrassing boating excursion, things just got worse.

  Several weeks later, I found myself on Air Force One again, accompanying President Clinton on his last trip in office, to Ireland, along with a large delegation that included Hillary, who had been elected Senator; my Aunt Jean Kennedy Smith, the former ambassador to Ireland; and my friend Senator Chris Dodd.

  The trip took place at an important and infamous moment in the history of American politics. The day we left, the Supreme Court heard arguments in Bush v. Gore, the case that would determine the next President, and a lot about the presidency, by interpreting the dimpled chads of the Florida election. That morning, I had appeared in Palm Beach at a Democratic news conference at the Rose Garden—named after my grandmother—at the County Government Center, along with former Ohio Senator Howard Metzenbaum and two local Democrats who had been active in the recount controversy. I flew back to DC in time to be on Air Force One for the early evening departure, and we had a pretty good idea that by the time we reached Ireland, the Supreme Court would be about to rule.

  So the atmosphere on the plane that evening was pretty charged. There was a lot of emotion and frivolity on that plane, and a lot of drinks being served. I was pounding rum and Cokes, and Jack and Cokes, while Martin O’Malley, then mayor of Baltimore, serenaded us with his guitar.

  And I remember, somewhere just before landing in Shannon, I was in the Air Force One bathroom again. This time, I was throwing up.

  Of course, I spent the next day with a splitting headache and feeling miserable, not at all enjoying what was an extraordinarily historic trip—the biggest official American trip to Ireland since my Uncle Jack went there in ’63. And I was just nursing my wounds for the rest of the trip. I felt humiliated once I sobered up and realized that I probably had made an ass out of myself. People were probably talking privately about how out of control I was. But no one said a word to me.

  That is, ultimately, one of the biggest and most constantly surprising and challenging problems concerning these illnesses, how so many people know what’s going on but never say a word—because we don’t know how, and we don’t know if we should. That said, it was nobody’s fault but my own that I wasn’t taking care of myself.

  Looking back, I can see this as the time where I was becoming just one more Washington politician with a mental health or substance use problem that needed to be navigated. There have always been senators and congressmen who people knew not to schedule meetings with early in the morning or late in the day, depending on the cycles of their illness. This doesn’t happen just on Capitol Hill, of course, it happens at companies large and small and in families close and separated. It is one more way that these illnesses, already isolating because the brain isn’t working quite properly and people aren’t connecting quite normally, become even more isolating.

  It also allows people like thirty-three-year-old me to tell ourselves the lie that we are doing fine and brilliantly hiding what is really going on.

  Most people think they are hiding things much more brilliantly than they actually are. It is the things that everyone knows but can’t acknowledge, the things hidden in plain sight, that can really hurt us. And that’s especially sad because these are often the things that could really be treated if we spoke about them.

  People often talk about “denial” like it’s a passive thing, a path of least resistance. Denial is actually really aggressive. It’s hard work. And I was doing quite a lot of it.

  Chapter 15

  As 2001 began, I stepped down from the DCCC and stepped up to my position on the House Appropriations Committee, where I was placed on two important subcommittees: “Labor-H,” which included everything under health, education, and labor; and CJS, which covered science, criminal justice, and commerce. This meant I’d be voting on the budgets for the Centers for Medicare and Medicaid Services (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the entire Department of Health and Human Services (HHS), as well as the scientific budgets for NIH, NIMH, NIDA, and NIAAA, and the budget for the Department of Justice (DOJ), which included the Drug Enforcement Administration (DEA).

  Combined, these budgets controlled pretty much every constituency and stakeholder affecting the wide world of brain disease. While I had been interacting with parts of these communities for years, this was the first time they would be actively lobbying me on budget matters. So we were all about to get to know each other much better.

  Mostly, we were adjusting to the roller-coaster ride of the DCCC finally being over, the election being decided by the Supreme Court in December for George W. Bush.

  Just weeks after he took office, President Bush made a point of inviting my family—including my father and Vicki; my cousin Kathleen Kennedy Townsend, the Lieutenant Governor of Maryland; and me—over to the White House for dinner and a screening of a new movie, Thirteen Days, about the Cuban Missile Crisis.

  We ate ribs, cheeseburgers, and baked beans with the new First Family and did everything we could not to bring up the recent disputed election or what had happened earlier that very day—the controversial confirmation of John Ashcroft as Attorney General. President Bush was trying to mend fences, and it was time for me to step up and be a new member of the House Appropriations Committee. So I was respectful and, at the appropriate time, told him that I hoped I could count on him to support programs for mental health.

  —

  NOW THAT I WASN’T on the road for the DCCC, I was able to get back into a more normal life in Washington—which included weekly lunches with my father. We tried to make sure our staffs arranged for a time, usually on Wednesdays, when we could have lunch in his Senate “hideaway.” Hideaways were private office spaces in the Capitol building that were given to senior senators, separate from the large public offices where they and their staff usually worked. My father had one of the most coveted hideaways, on the third floor of the Capitol, with gorgeous vaulted ceilings and amazing windows that overlooked the Mall, the Washington Monument, and the Lincoln Memorial. The carpets and walls were sea green, and the sitting area in front of the big white fireplace was organized around a long table made from a big piece of the rudder that had to be replaced on his wooden sailboat. While the room had comfy upholstered white wingback chairs, we usually ate in the sunny alcove at a round wooden table with smaller wooden armchairs, facing each other.

  The hideaways had room service; we ordered from the kitchen, which was on the basement level, and food was brought up in an elevator. We always had soup, and then a sandwich or an entrée. My father was trying to
take better care of himself—and his staff was under strict orders from Vicki to make sure he did. (This was one of the many ways Vicki helped him live a much healthier life.) So he would order a piece of chicken with no sauce, steamed vegetables, a protein shake, and some cottage cheese or slices of fruit. It killed him not to be able to have mayonnaise—he loved the mayonnaise. Of course, I would get a sandwich with mayo and french fries with ketchup. He would do his best to resist. And then I’d get a big tasty dessert, three scoops of ice cream and chocolate sauce, and when it arrived he would always laugh, and then break down and steal a scoop of it.

  We would mostly talk about what was going on in the House and Senate, and sometimes a little gossip about the family. Those were such intimate times, the soft banter back and forth. On one level it seemed superficial, but I now see the connection we had while talking about superficial things, the little inflections and the body language that I just soaked up.

  Honestly, I appreciate it more now that he’s gone than I did then. Because back then, I read way too much into every little thing said and not said. But what I really wanted was for my father to come out and ask me how I really was: how are you really feeling, are you drinking at all, how’s your love life, are you making enough time for yourself, all the things I couldn’t tell anybody I was really worried about, obsessed with. I would go to therapy and talk about what my father and I never talked about—not that I was in any way working it through in therapy or getting any real insight into my problems or adjusting my perspectives. I was just complaining.

  I’ve spent my whole life trying to unwind all of that, so I could understand why I felt so emotionally bounced around between my manic devotion to him and the way I could feel so absolutely dejected around him.

  I had a lot invested in each glance, each stolen french fry or scoop of ice cream.

  Since my dad was equally unable to express these feelings, Vicki tried to help. I started getting notes from her. When I did something good in public or on the House floor, invariably she would send a handwritten, hand-delivered note saying how proud my father and she were of me. But since the notes came from her, I was never sure how to interpret them—because I had never been married and just didn’t understand the role spouses can play between family members who aren’t great at communicating. Now that I’m happily married and understand the things Amy handles for us emotionally, as a couple, those notes make more sense. But at the time, they often felt like just one more layer of miscommunication between me and my father. One more thing about our relationship to obsess over.

  So it was best to just eat our lunch and gossip about politics, which was—as I realized way too late—our form of intimacy.

  —

  THE 1996 MENTAL HEALTH PARITY ACT—which had not really created much in the way of parity itself but had inspired many states to create much better laws—was due to expire at the end of September of 2001. Over the past few years, there had been Senate and House attempts to improve and extend it—efforts to broaden its care for children, to extend its parity coverage to include addiction—but none of them had gotten any traction. So on March 15, 2001, Senators Wellstone and Domenici introduced a new version of it, Senate Bill 543, which required full parity for all DSM diagnoses, and we waited in the House for the Senate to hold hearings.

  In the meantime, I held a four-hour public hearing in Providence at the State House with Surgeon General Dr. David Satcher, to try to raise awareness about the specific issues of children’s mental health—the lack of proper funding for their care, and the inability of parents and schools to properly monitor early symptoms and commit to prevention and early treatment.

  It was a challenge to get public and political attention to these issues. The press was mostly paying attention to my poll numbers, which had started to sag, and the ongoing legal struggle over my boat fiasco—even after I tried to take some wind out of their sails by poking fun at it, and myself, at the Providence Journal Follies, the annual get-together of Rhode Island press and politicians. (I arrived, late in the evening, as a surprise guest, dressed in a sailor’s outfit and singing “Patrick the Sailor Man” to the tune of the old Popeye TV show theme.)

  In April, I decided to make major changes in my team, relieving Tony Marcella as chief of staff in Washington and also replacing the manager of my congressional office in Rhode Island. This move was primarily about politics and poll numbers, confronting the inevitable backlash after I’d spent most of the previous two years away from home and in full attack mode against the Republicans. But those who knew Tony and me well understood there was a personal aspect to this that involved our mental health.

  Tony and I had grown up together in politics, and he was my friend as well as my chief of staff. We had shared an apartment together; we had been in the political bunker together and had developed an unhealthy codependence.

  His job was to be my protector. But while he liked crisis management and was good at it, sometimes we found ourselves in the center of storms we helped create. He had the ability to power through his hangovers better than me, while I would be in the back of the car trying to get it together to go to the next event. But, eventually, we spiraled out of control.

  Some close to us might have described Tony as my enabler, but that sounds like I’m not taking responsibility for what I did, what I drank, what I took. And, honestly, neither of us really understood what we were doing and why. It took me years to see our behavior for what it was: addiction and self-medicating. At the time, I viewed Tony as something of a hypochondriac. He said he suffered from bad pain and some kind of nerve problems, which I wasn’t sure I believed—even though, of course, I was saying the same thing. It was true I had my back issues, but also true I was exaggerating to get more medication than I needed. And when I decided to replace Tony as my chief of staff, it was very difficult but, I felt, necessary.

  Several years later, I was stunned to find out that he had been diagnosed with amyotrophic lateral sclerosis (ALS), or “Lou Gehrig’s disease.” Many of the symptoms he had been complaining about—and presumably relieving through self-medication—were consistent with the early stages of that illness.

  So he wasn’t exaggerating. And I tell this story to remind myself and others of how easy it is to be judgmental of the medical complaints of others—especially those describing pain caused by something that isn’t as easy to see as a wound or a broken leg.

  —

  BESIDES REPLACING my chief of staff in DC and my office manager in Rhode Island, I also brought back political consultant David Axelrod, who had helped me years before during my first run for Congress, and I enlisted a new polling team. We did a lot of focus groups and polling over the next months, and while I was not surprised that some voters considered some of my behavior immature and not particularly Congress-worthy, many of them described their feelings with an intriguing form of cautious optimism: they seemed to agree with me politically, and they hoped I would grow up. Even when they completely disagreed with me on something, they didn’t hate me, they just thought I needed to grow up.

  This is, in retrospect, the way I saw myself during this time. And I feel extremely fortunate that, somehow, people generally were willing to give me the benefit of the doubt. They assumed I wasn’t such a bad guy; I was well-intentioned, just a little out of control sometimes.

  Since I was publicly committing myself to be a leading voice in the politics of mental health, it was welcome news to see that this position polled really well. Voters were pleased that I was taking on mental illness and addiction—healthcare issues generally scored well, but mental health especially so. And even the voters who saw me as temperamental and immature were supportive of my being open about my treatment for depression.

  In Washington my higher profile and new role at Appropriations meant diving into the very complex world of brain disease lobbying. This meant figuring out who was who, and who wanted what from budgets,
and also who would support what for proposed laws.

  With my new staff and expanded agenda, we were also writing and proposing more legislation. Our first major mental health bill, introduced in the summer of 2001, was the Foundations for Learning Act, which had thirty-seven other House cosponsors. It was a bill to establish a grant program to improve the mental and emotional health of schoolchildren by having money available for screening and treatment of at-risk kids and their parents. While it didn’t initially get much traction beyond the House Education Committee, my father, who was managing the conference committee for President Bush’s controversial No Child Left Behind law, got it added to that bill. So my first-ever piece of passed legislation can be found buried in subpart 14, section 5542, “Promotion of School Readiness Through Early Childhood Emotional and Social Development.”

  In the summer, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on mental health parity and ended up approving another watered-down version of parity, no stronger than the one before.

  As we waited to see what would happen on both proposals, 9/11 brought life in America to a standstill.

  In mental health politics, two things happened after 9/11. Our ideas about post-traumatic stress disorders were completely challenged, and clinical belief in this once-controversial diagnosis was much expanded, because now there were thousands of New Yorkers and Washingtonians who had, simultaneously, been through an incredibly traumatic experience, the existence of which could not be challenged.

  Also, mental healthcare suddenly became a much bigger defense issue. It was the first time most Americans really understood how terrorism could be a psychological weapon of war and why mental health preparedness could be essential to national security. As the new department was added to the government, it became a “homeland security” issue, and when we later went to war in Iraq and Afghanistan, it grew even larger as a combat and veteran health issue.