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

by Patrick J. Kennedy

  As my time at Mayo was coming to an end—I had to get back to Washington—there was discussion in sessions of other issues I hadn’t spent much time considering in therapy, like the role of forgiveness and spirituality in my recovery. Even though I was still in the day program—which was, in retrospect, still a sign I wasn’t completely committed to treatment and my own recovery—I attended the medallion-closure ceremony with my peers from the inpatient unit. When I left Mayo after what had turned into a full month there, I felt healthy and optimistic.

  —

  TWO WEEKS LATER, I was standing in front of a packed crowd at the National Press Club, talking about a new report called “The State of Depression in America” funded by the Depression and Bipolar Support Alliance (DBSA). Long based in Chicago, but now also working out of DC, DBSA (formerly the National Depressive and Manic-Depressive Association) had, for years, been the nation’s major advocacy group for mood disorders. Even though it correctly called itself “the leading patient-directed national organization focusing on the most prevalent mental illnesses,” DBSA was less politically powerful than NAMI, which did its best to speak in Washington for all serious mental illness but skewed toward families with members disabled by schizophrenia and the most debilitating mood disorders. DBSA was, primarily, a national web of support groups for mood disorder patients who could care for themselves; NAMI had started as a political force largely for patients who could not always take care of themselves, and was run more by parents, family members, and researchers than actual consumers.

  We were releasing the report in the aftermath of President Bush’s last State of the Union address, in which he mentioned mental illness a total of zero times, followed by a budget proposal that cut $88 million in funding for mental health programs in SAMHSA, NIMH, NIDA, and NIAAA. I appeared at the Press Club event along with Mike Wallace from 60 Minutes and a number of top mood disorder experts.

  It was the beginning of what was expected to be a jam-packed spring of events and legislative proposals to try to push the lack of mental health parity—and the solutions to this problem—onto the front pages of the nation’s newspapers and the top of lawmakers’ agendas. I was, during this time, doing everything I could to function at the highest level during the day and take the best care of myself during whatever free time I had.

  After leaving Mayo, I had enrolled in the day program in Fairfax at CAPS, a well-regarded mental health facility. It was the first time I had ever tried a day program as an outpatient, the way they are supposed to be used. For an outpatient, a day program—also referred to as a “partial hospitalization program” (PHP)—is somewhere between a forty-five-minute outpatient psychotherapy session or twelve-step meeting and a full day of inpatient care. It’s a more intensive way to spend part of a morning, afternoon, or evening in treatment while still maintaining your work and life, less fully one-on-one than psychotherapy but more multifaceted and medical than a recovery meeting. Someday, people with mental illness and addiction will use day programs much more often and effectively. In our current model of treatment—which offers mostly acute care for these chronic illnesses—most patients with coverage bounce between inpatient stays and then just being out in the world jousting with everything.

  I also liked the day program because it felt a little safer than attending an AA meeting closer to where I lived and worked. However, because CAPS was further away, I started going less frequently.

  I was committed, during this time, to not abusing prescription painkillers. And I didn’t. But I was still occasionally drinking at night. And, because I was having trouble sleeping, I started taking Ambien again. That would have gotten me in trouble at CAPS if I had told them, so I didn’t. And then I felt bad I was lying to my rehab counselors, who are the last people in the world from whom you need to keep secrets. So I finally just quit the program.

  —

  AT THE END OF MARCH, the New England Journal of Medicine published a landmark study we had been anticipating for some time; the unprovocative title, “Behavioral Health Insurance Parity for Federal Employees,” belied just how politically provocative it was. Written by a team led by Dr. Howard Goldman, a psychiatry professor at the University of Maryland, and Harvard health economist Dr. Richard Frank, the article analyzed the recent experience of the federal government’s insurance plan for its employees, which President Clinton had ordered to establish mental health and addiction parity in 1999. The study compared seven federal employee health plans that had added parity and paired the findings with results over the same period of seven other plans—not covering federal employees, but insuring a similar group of patients—that did not offer parity. The findings were a surprise even to us, because in many cases the plans with mental health parity hadn’t seen any increases in costs at all; some even saw decreases.

  Interestingly, the study also didn’t find any evidence of the dreaded “moral hazard,” an insurance economics concept that was often brought up by opponents of parity. “Moral hazard” refers to a phenomenon—real or imagined—where if people have increased coverage for any medical problem, they will use it, even if they don’t need it, just because they can. It is a particularly troubling concept to use when discussing mental health and addiction care, where the real problems are the dramatic underutilization and underavailability of care, and the challenge of keeping patients who can get care in treatment.

  The percentage of Americans who, each year, have a mental illness or substance use disorder yet refuse to treat it is actually measured by the government. In general, in any given year, about one-third of the people with the most serious, debilitating illnesses do not have any treatment at all; in the broader category of people diagnosed with any mental illness, that number is actually over one-half.

  We hoped the study would show that parity didn’t increase costs more than 1 percent—and it didn’t, although of course experts representing the businesses that would have to add coverage criticized the methodology. But there were actually more mixed feelings about the fact that utilization didn’t dramatically increase when there were fewer financial impediments. Because this meant that even with parity, a lot of people suffering from mental illness and addiction were still not getting the treatment they needed and deserved.

  Politically, however, that battle was far down the road. We could worry about such morally hazardous concerns after we actually made parity law—or at least got some of the other bills passed that we had proposed so many times in so many Congresses.

  For example, the day this study came out, I was on the floor of the House trying to raise interest—for the third straight session—for my proposed legislation to improve child and adolescent mental healthcare by increasing the number of caregivers hired in that area of behavioral health, and incentivizing a larger next generation of caregivers with college loan forgiveness. I brought with me to the House floor a young woman from South Dakota who had developed bipolar disorder as a teen—which is when it begins to manifest itself in many people—and ended up dropping out of school and attempting suicide. Why? Because when her family tried to get her psychiatric help, they were told that since there was a severe caregiver shortage she would need to wait four months for an appointment.

  “Millions of American families need hope,” I hollered. “Millions of them need help. The number of suicides is twice the rate of homicides in this country; thirty-six thousand people take their lives every year successfully. Every day in this country, one thousand three hundred eighty-five people attempt suicide. It is the third leading cause of death for young people. . . . This year alone, fourteen hundred college students will successfully take their lives. Mr. Speaker, we need to make sure that we have adequate personnel to make sure that the services are delivered, and the services will never be delivered unless there are enough people to deliver them!”

  —

  SEVERAL DAYS LATER, I had my first appointment with a new psychiatrist at Georg
e Washington University Medical Center. I did my intake meeting with him but then didn’t show up the next week for my first actual session. At the last minute I had to be in Rhode Island for meetings.

  In fact, at the time I would have been meeting the psychiatrist, I was in my district office in Providence being hit in the mouth with a hammer. I was doing a presentation with an out-of-state manufacturer who was thinking of opening a factory in my district, to manufacture a type of shock-absorbing gel, used in vests and saddles and shoe inserts. He put one of these pads on my glass-top desk and prepared to hit it with a hammer to demonstrate its shock-absorbing powers. But when he swung the hammer, the head flew off and hit me in the face. There was blood everywhere, and I ended up in the hospital getting six stitches in what was now my very stiff upper lip.

  They offered me opiate painkillers, which I took, and a prescription for more, which I went out the next morning to fill. I unwisely drove myself—in the car I kept at my home in Portsmouth, a late-model silver Ford Crown Victoria—over to my local CVS. On the way over I was observed swerving a bit on the road, and when I tried to turn quickly into the CVS parking lot, I pulled right in front of another driver, whose car crashed into mine.

  I was in a total panic because I realized I was under the influence. I got out of the car, and there was an older woman in the parking lot who had seen the whole thing—in fact, I apparently had almost hit her car a few minutes before, and she was angry. As I got out of my car, she asked if I realized I could have hit her. Then she saw I was swaying and my eyes were a little glazed. And instead of acting like a jerk, as she probably expected, I contritely said, “I’m sorry for the fuss.”

  Both she and the guy who I caused to hit my car recognized me—after all, I was their Congressman—and I guess they either felt sorry for me or didn’t want to be bothered with all the aggravation of making what would have been a perfectly warranted accusation against me. From the moment the police arrived to take our statements, I was convinced I would be arrested. But the police officer wrote “appeared normal” under “condition of the driver” and left me with paperwork for my auto insurance. I went into the drugstore, filled my prescription, and drove home.

  Honestly, I couldn’t believe I didn’t get arrested.

  But nineteen days later, I wasn’t so lucky.

  Or, maybe, I was actually luckier.

  Chapter 18

  After my crash at the Capitol, everyone wanted to know if I had been drunk that night. I wasn’t, but people who understand these illnesses realize that was the wrong question. Both addiction and depression come in cycles of waves, which you think you have adjusted to until a bigger one knocks you down. It isn’t all that revealing to chart how that last wave hit; it’s more important to understand what you were doing out there in the water in the first place.

  So the real story of the week that forever changed my life starts not on the Wednesday before I crashed, but two days earlier, on the Amtrak Acela coming back from New York after a long day of meetings. During that three-hour ride, I drank—to the best of my recollection—eight straight vodkas from those little one-ounce travel bottles before arriving at Union Station.

  I felt awful the next day, for all the obvious reasons, but there was also one developing medical issue: a lot of pain and discomfort in my whole lower abdomen. So in the early evening I went to the Attending Physician for the Congress and was given Phenergan liquid. It helped the pain and was a little sedating, so I took it again before bed.

  The next day I had a lot of meetings, because a lot of mental health advocates were in town lobbying on the Hill. In between meetings, I was on the House floor voting on everything from increased accountability and transparency for lobbyists, to prohibitions on price gouging in the sale of gasoline and other fuels, to amending the Internal Revenue Code and ERISA to reform pension funding rules.

  I then left to say a few words at a reception in the Rayburn Building for the “National Council”—the nickname of the National Council for Behavioral Health, one of the more powerful and ambitious forces in mental health. The National Council represented every state community mental health organization in the country. (Back then, in 2006, that was about 1,300 organizations with some 250,000 caregivers and staff; today they represent over 2,000 organizations and over 750,000 caregivers and staff.) In the two years since its new executive director, Linda Rosenberg, had taken over, the National Council had become a much more prominent political player, pushing to develop the kind of muscle that once only NAMI could exert. Linda had advocates in town from all over the country for their “Hill Day.”

  I was scheduled to meet with her again the next morning, along with the executive directors of several other major mental health groups representing the leadership of the formidable Campaign for Mental Health Reform, which was now in its third year of being the most organized effort ever to lobby for change in behavioral healthcare. So, basically, a lot of people who mattered to me politically in the world of brain healthcare and advocacy were in town.

  Because it would be a bad idea to be seen drinking at a National Council reception, before I went I walked around the corner to the Hawk ’n’ Dove. I went to the back room bar and, as I always did, ordered a drink that was dark—Jack and Coke—so it could be mistaken for a soft drink. It turned out the female bartender also worked as an IT specialist for one of my congressional colleagues, so we talked a little politics, I watched a few minutes of the baseball game they had on—it was about 6:30 P.M.—and then I had a second drink and left.

  After the National Council reception, I returned to the House floor to vote on one last bill, concerning maritime and cargo security, and was done a little after nine P.M. I called a woman I had been dating to see if she wanted to come over. She arrived around ten, and before we went to sleep I took my meds.

  As always, there were a lot of them, including Ambien, which I took to help me sleep. I generally took two ten-milligram pills, somewhat higher than the standard 12.5-milligram dose recommended at the time but still considered safe. Seven weeks earlier, the Washington Post had actually run a big story in its Tuesday health section about a dramatic rise in side effects of Ambien, including sleepwalking and sleep-driving and even sleep-shoplifting. (While doctors were already wondering if these effects were dose related, it wasn’t until 2013 that the FDA officially announced that dosing for this drug was too high across the board and cut all the recommended doses in half.)

  But the truth was, I had been taking twenty milligrams of Ambien to sleep on and off for many months and had never had a problem. I took it when I knew I needed to sleep soundly because I had an early morning meeting.

  The only new med I was taking that night was the Phenergan, which I had been gulping for my stomach all day. The drug was not known to interact with Ambien, but it was itself capable of making people drowsy.

  We were asleep before midnight. And when I woke up the next morning and went to work my life had completely changed.

  —

  THE IRONY OF MY THREE A.M. car crash into a Capitol barrier is that it was pretty much the only disaster of my professional life that wasn’t caused by excessive use of alcohol or opioid painkillers. It really was a case of sleep-driving because of the Ambien and the Phenergan. So there were plenty of people close to me who were sure I could get out of this just by telling the pharmacological truth.

  But as that Thursday unfolded, and I found myself locked in my office trying to avoid the dozens of cameras waiting outside, I realized this might be my only chance to tell the actual truth, the bigger truth.

  I was an alcoholic; I was a drug addict; I had bipolar disorder and anxiety disorder, and I hadn’t been properly treating any of them. And for the first time in my life, at the age of thirty-eight, I just wanted to stop lying about all of this. Because it is the lies and the secrets that eventually kill you.

  When word broke of the unfolding contr
oversy, I was on the floor of the House and was called to come to one of the private phone booths in the cloakroom. One of the first things I heard my chief of staff say to me on the phone was, “Is there something you want to tell me?”

  Finally, the answer was yes.

  I realized I had been living, for as long as I could remember, with this constant fear of being found out, of the other shoe finally dropping. Now, every other shoe was dropping; it was raining wingtips and boat shoes. On top of everything else, part of what was driving the story was my long-ago-damaged relationship with the police unions: when they found out the Capitol Police brass had handled my case the way they would have handled the case of any Congressman or Senator in that situation—with more dignity than I deserved, perhaps, but by just taking me home to sleep it off, without breath or blood tests—they raised the specter of “special treatment,” which pushes every possible political button. While, in politics, we all know that what goes around comes around, it’s rare for so much to come around at precisely the same moment.

  And that’s why, honestly, my feelings of dread started giving way to an overwhelming sense of relief. I had been waiting for this day my entire life. As long as I could remember, I had been trying to please people and manage their expectations so I could, just by a little, exceed them. I isolated myself when my feelings were overwhelming—which happened more often than anyone would have believed for someone so public—and I kept my emotional and spiritual distance from people so they couldn’t destroy me. At the same time, I had been seeking out self-destructive, exhilarating, risky situations that would take me out of the anguish of being all alone. All this was built on the question I constantly asked myself: “Is anybody going to find out?”

  I remember sitting in my office with a growing feeling of freedom. I felt so overwhelmed that I just let go, first with a nervous-giddy laugh and then with a much more profound release. I finally didn’t have to white-knuckle my life anymore. I no longer had to worry about the small stuff I had spent my life obsessing over, because the fight was finished. I had, at the same time, lost and won.