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

by Patrick J. Kennedy

  After Reid’s moving testimony, his predecessor as Minority Whip, Oklahoma Republican Don Nickles, rose to admit that he had experienced a similar loss, a fact that few of his colleagues knew.

  “My father also committed suicide,” Nickles said. “I am not going to go into the details, but it is a lot of pain.”

  The bill, which would appropriate $82 million over three years for prevention and treatment, passed the Senate unanimously and without amendment—no one would dare. And then it was sent on to the House, where equally swift passage was expected.

  Several years before, the House had been through a similar tragedy: the seventeen-year-old namesake son of Michigan Democrat Bart Stupak had died of a self-inflicted gunshot wound. House members had chartered a plane to his funeral. In the aftermath, however, Bart had focused his legislative attention less on suicide itself than on a psychiatric adverse drug reaction to an acne medicine, which he believed was the trigger of his son’s depression. (There are many common medications—including the top-selling class of antibiotics, the quinolones—that can, in some patients, trigger depression, psychosis, and suicidal ideation; the FDA was already making label changes on the drug, Accutane, that Bart Stupak Jr. had used.)

  And, if that wasn’t enough to garner support for the Garrett Lee Smith law, less than three weeks after the Senate passed the bill, the sixteen-year-old son of another of our House colleagues, Kansas Republican Todd Tiahrt, took his own life.

  That’s why I was so amazed when Senator Gordon Smith called me one day in early September, worried about passage of the Garrett Lee Smith Memorial Act in the House and hopeful I could help him. A group of right-wing representatives whom we referred to as the CATs (because they had been called the Conservative Action Team before rebranding as the Republican Study Group) were trying to block the bill by adding all sorts of ideological amendments to it. According to the book he later wrote about his son, Remembering Garrett, when Gordon—a conservative-leaning Republican himself—tried to talk to the CATs, he was told, “We don’t pass bills over here that Democrats want,” and “Preventing suicide is the business of parents and not the federal government.” When he tried to explain that the government spent hundreds of millions on “physical health” and it was time to be equally concerned about mental health—something he had personally come to understand “only too painfully and too late”—they just stared at him blankly. And when he told them President Bush had already said he was anxious to sign the bill, they said, “Don’t take this personally, it’s just politics.”

  He said, “It’s hard not to take it personally when the bill is named after your dead son!”

  The CATs’ last resort was to add a provision they knew would be a poison pill. They had been attempting for some time to change many school-related programs that had “opt out” clauses for religious objections so that, instead, the law would require every student to “opt in” with parental permission, which would dramatically reduce participation. They believed that if they could get this opt-in clause into any education-related law, the precedent could be more broadly used.

  Until this could get worked out, Senator Smith wanted my help in keeping the Democrats together on supporting the bill—since, even though the Republicans were in the majority, their split on CATs issues meant our votes would make the difference. If the Democrats helped pass it, he was sure he could get the opt-in amendment removed in conference committee. As it turned out, he couldn’t deliver on that, but the conservative Republican chair of the House Energy and Commerce Committee, Joe Barton of Texas, did the next best thing: he changed the opt-in language so it could never apply to any other bill but this one, and created emergency provisions so suicidial students could be treated without being expected to ask their parents to opt-in. We were able to keep the Democratic supporters on board, and the bill was finally passed.

  It was one of the most satisfying moments that those of us on the Hill who were interested in mental healthcare had experienced in quite some time.

  —

  I WAS NOW in an interesting position in Congress. I was one of the go-to guys on mental health and addiction, but nobody really knew how much I was struggling with my illnesses. Because I had become way too good at it.

  I saw a psychiatrist who gave me a cocktail of meds—lithium, Wellbutrin, Lamictal—and listened to me talk about my insecurities, my issues with my parents, and my inability to create lasting relationships; I would tell him when I went on a weekend drinking spree, which happened maybe a dozen times a year, but I didn’t admit to all the narcotic painkillers I was getting from other doctors, even the doctors who took care of us in Congress.

  Since the 2002 election, my chief of staff, Sean Richardson, had been wondering—more out loud than others who had worked for me—why my behavior was so erratic. Initially he thought I was more young and impulsive than unhealthy, and he suspected that maybe I created situations that got a little out of control because I liked them and thought I could be more effective that way. He knew I liked to “ratchet it up.”

  In the summer of 2004, my back started hurting more than usual, and I increased my use of any opioid painkiller I could get. They helped with pain, they helped with sleep, and I moved around so much in the summer between DC, Rhode Island, and the Cape that I could always find a doctor who would sympathize with my stories of my prescriptions running out.

  By the fall, something had changed. This was noticed first, I suspect, by some of the mental health and addiction lobbyists—many of whom were in treatment or recovery themselves, so they had good brain disease radar—but my staff was also becoming more worried. Finally, one day in the late fall I was home at my apartment for lunch and a package arrived at the office from the Attending Physician at the Capitol. My office manager opened it and Sean, just in passing, asked to see what it was. He looked into the package, assuming it was asthma inhalers or something, and saw it was a bottle of OxyContin. And, for some reason, it was suddenly crystal clear to him what had been going on. He called me at home and said he needed to come speak to me in person, right away.

  He arrived, very upset, and started telling a story about an uncle of his who was a heroin addict. The family had convinced his Uncle Joe to go for treatment but there wasn’t a bed immediately available and during the wait he ended up killing himself. This experience had really helped shape who Sean had grown up to be, and he still wondered if he could have helped his uncle. So, even though he had no idea if I was going to fire him for saying this, he had to tell me that he thought I was addicted to narcotic painkillers and I needed help. Immediately. And he was going to take care of the details and get me through it.

  Honestly, I felt an incredible sense of relief. I just said, “Okay, let’s go.” He told me to stay in the apartment while he jogged back to the office to talk to my staff, to my personal financial manager, to my dad and Vicki, and to Dr. Larry Horowitz. It was decided that we would not go public with this hospitalization, even though we realized the risk if it later leaked out.

  Within twelve hours, I was on a plane to Sierra Tucson in Arizona for a thirty-day “medical evaluation.” When I checked in, I gave my name as “Patrick Bennett,” using my mother’s maiden name, just as she always had in rehab. I even signed my name that way, “Patrick J. Bennett.”

  After all those years of being afraid of ending up as ill as my mother, here I was.

  —

  WHILE I LOOKED PERFECTLY NORMAL when I arrived at Sierra Tucson, within a few hours I began to show signs of opiate withdrawal and soon I was severely depressed.

  I began a full testing and treatment regime, and then started group therapy. I was, naturally, concerned about confidentiality in group discussions, since my mother and I had both already been betrayed in the tabloids by people with whom we’d been in treatment. After about five days, I was just too nervous that something was going to leak out about my being there and told them I w
anted to continue with an individual psychiatrist, preferably back home in an outpatient setting.

  After eight days there, and my growing nervousness about my privacy, they agreed that I could leave, even though I wasn’t done detoxing yet. On top of my regular meds, they gave me a prescription for Suboxone, which had only recently been approved in the US after years of use in Europe. Suboxone is a combination of a synthetic opiate, buprenorphine, and a fascinating drug called naloxone, which can immediately reverse the narcotic effects of opiates in the brain (which is why it is, increasingly, used by police and other first responders to save people who have overdosed). Suboxone helps people detox from addiction to opiates and for some patients is a better choice than the traditional methadone. (Methadone is stronger and itself more addictive, and is still preferred for patients with the heaviest addictions to heroin and prescription opiates). When I was done with the Suboxone I could take naltrexone, an older medication used to prevent opiate dependence (or relapse into dependence) by blocking the euphoric effects of the drugs. This was the first time I had ever taken meds like these. They were part of an expanding addiction pharmacology that was coming to be referred to as “medication-assisted treatment” (MAT). This included drugs for alcoholism as well, starting with the older medication Antabuse (disulfiram), which made patients ill if they consumed alcohol.

  All I knew about addiction treatment was what I had gone through once as a teenager and had seen my mom go through many times: you detoxed by just stopping and suffering. In the world of traditional twelve-step recovery, taking any medication in place of drugs or alcohol was considered strictly taboo. But it was a taboo that addiction medicine was trying to change, because for some people, it worked better.

  My home detox took a little longer than planned because the minute I got back to my apartment, I took all the prescription opiates I still had left there. I decided to change psychiatrists, and I tried going to AA meetings but they weren’t for me at the time—I was too scared of word getting out that I was in recovery. So I did my best to stay on my meds and in therapy. It was challenging, since the anti-addiction meds are very sedating, and I went from being borderline manic during the day to occasionally nodding off. I was fighting depression and anxiety.

  —

  THE MONTH AFTER I returned from treatment at Sierra Tucson, my Aunt Rosemary died in a Wisconsin hospital at the age of eighty-six, with my father and my aunts by her side. By this time the family and media were more open about her developmental disability and the tragedy of her lobotomy, but people still didn’t seem to understand the last lesson Aunt Rosemary had to teach us. She wasn’t given a lobotomy because of her developmental disability, which had been relatively stable since her birth; her case actually illustrated perfectly how a certain percentage of the entire population, regardless of their other conditions, will develop mental illness in their late teens and early twenties.

  This medical challenge is still a huge, underappreciated problem. There are many psychiatrists and psychologists who simply will not see a patient with an intellectual disability. And there are many parents and family members of people with intellectual disabilities who still refuse to believe that postadolescent changes in their behavior could be from psychiatric illness. While it is still unclear just how treatable or reversible the kind of brain damage Aunt Rosemary experienced at birth might one day turn out to be, we already know that, today, her mental illness would likely have been very treatable.

  This is, I think, another lesson we can learn from Aunt Rosemary, whose story has already helped destigmatize the world of intellectual disabilities by inspiring Special Olympics and turning shame into something positive worldwide. I hope, one day, that improved diagnosis and treatment of mental illnesses for those with developmental disabilities will also be part of her legacy.

  —

  ONLY WEEKS AFTER ROSEMARY DIED, word leaked to the press about Mom’s medical guardianship, which still had not been finalized. She was terribly embarrassed and angry, and while we thought the situation was getting under control, it then got much worse. I didn’t think, after all these years, it could get any more painful—for her or for us. I was wrong.

  Late at night on a Tuesday evening at the end of March, she was found lying in the street with a concussion and a broken shoulder, and at three A.M. she was taken to Tufts New England Medical Center and later transferred to Mass General, where I met her and spent the rest of the night sleeping in her room.

  I had to speak to the press about this, trying to explain both what was happening to my mother and that our extreme course of action was not as uncommon as the press believed—the world of addiction and mental illness is filled with people who are so symptomatic and unable to care for themselves that family needs to intervene. I also told the truth, which was that while the press had heard about only this incident, there had been many other nights like this when my mom ended up in the ER, which had been kept private.

  We weren’t trying to spin any story. We were trying to save our mother’s life. We had spent a long time in denial about the true seriousness of her condition. We were in denial not because we had no idea there was a problem—of course we did—but because sometimes you learn to tolerate as “normal” what a normal person never would. What most people see as a crisis, you come to see as just another bump in the road. When we had started the guardianship proceedings the year before, the only thing her doctors said to us was, “What took you so long?”

  —

  DURING THIS DIFFICULT TIME with my mother’s health, one thing happened that I did not then appreciate would matter so much.

  Just a week after the initial report about my mom’s concussion and hospitalization, I was sent a handwritten note by a House colleague who I did not know very well. His name was Jim Ramstad, and he was a moderate Republican representing Minnesota’s Third Congressional District, just outside of Minneapolis.

  Tall and mild-mannered, Jim was twenty years older than me—when I was a kid, he was already a lawyer who was serving in the National Guard during Vietnam. I primarily knew him as one of the small group of legislators who was usually a cosponsor of bills concerning alcohol and drug abuse policy. The year before, he and I had founded the Addiction, Treatment and Recovery Caucus in the House, which was attempting to get addiction treatment either its own insurance parity or connect it to mental health parity. But we were not close friends or anything. As far as he knew, I was interested in addiction politics mostly because of my mother and because of the connection between substance use and mental illness.

  Jim was not a big public talker, but he was consistently on record about why he cared so much about addiction: he had been a recovering alcoholic since 1981. And just as my staff had already heard me talk a thousand times about parking far away from my therapist’s office so nobody would know I was in treatment, Jim’s staff had been hearing for much longer about the night of July 31, 1981, when he woke up, hung over, in a jail cell in Sioux Falls, South Dakota, and realized he suffered from alcoholism and needed treatment. He was, at the time, in his first year as an elected official in the Minnesota State Senate, and was told by his staff that the only way to save his career was to say he and the Sioux Falls police had “an unfortunate misunderstanding.” Instead, he publicly announced he was going for inpatient treatment at St. Mary’s Hospital in Minneapolis and afterward that he was in twelve-step recovery. And he was then amazed by just how many people pulled him aside and said, “Now that you’re in the club, welcome aboard, brother”—and how his public admission didn’t hurt his reelection in the least.

  In the world of politics, we write a lot of notes: once you’re elected, you live like a perpetual newlywed, creating an almost endless stream of thank-you notes. On April 5, Jim Ramstad sat down and handwrote this note to me:

  Dear Patrick,

  Your mother and you are in my thoughts and prayers, as I know how difficult it is. I’m her
e for you if I can be helpful in any way, so don’t hesitate to call. As you know, I’ve been there!

  Your friend,

  Jim

  I had no idea that this note, which arrived among piles of others from colleagues, friends, and constituents, would predict the course of my personal and professional life.

  Chapter 17

  During all this turmoil with my mother’s illness, the press was focusing a lot on whether or not I would run for the Senate. I had never actually wanted to run for the Senate—or, rather, whenever I considered it, I quickly realized that the additional media scrutiny could present an insurmountable challenge, and with my illnesses I was safer in the House. I remembered what it was like when my dad ran for President, and how the pressure on a candidate was so much more than what he was accustomed to in the Senate. I always remembered that Roger Mudd interview; it was a symbol of what could happen when you tried to move to the next rung on the political ladder (and also an early indicator of how the media would expand its focus on the private lives of public officials). But my dad really wanted me to run for Senate, so he would occasionally float the idea independently. And when you’re in public office, if people start speculating about whether you would run for higher office, it’s sometimes best to let the speculation keep bubbling because people take you a little bit more seriously.

  While we were handling my mom’s hospitalization, I decided to finally burst the press bubble and announce I wouldn’t run for Senate and was very happy to run again for my House seat. Without any other information, the press assumed I was doing this because I was choosing my mother’s care over my political ambitions.