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

by Patrick J. Kennedy

In what is now called bipolar II, patients go all the way to the depths of depression but are less prone to experience full-blown mania where they completely lose control and become “psychotic,” or thought-disordered. They are more likely to swing only to the less intense—and often sometimes hyperproductive—state of “hypomania,” but are also more likely to “rapid cycle” between depression and hypomania, and have very agitated “mixed states.” That’s me.

I just went right for the kamikazes (vodka, triple sec, lime juice); I didn’t want anything but to get obliterated. No drinking beer for me. I just wanted the strongest drink they had so I could feel better—or at least different—right away.

“stage-four addiction.” (Substance use disorders are generally viewed as having four stages: experimentation, steady use, dependence, and addiction.)

He also recounted a story Uncle Bobby had told him just before his own death. On the day before the California primary, the Robert Kennedys had gone swimming in Malibu, to relax together. David had been knocked over by a wave and got caught in the undertow, and his father had come to his rescue. When Uncle Bobby told my father this story, he talked about “the undertow” in broader terms, how there was an undertow in life and David, who was then only thirteen, already seemed vulnerable to it. And then, just hours later, Uncle Bobby was murdered as David watched the TV coverage in their hotel room upstairs. It was unbelievably poignant to hear my father tell this story. David was in the casket next to us. And I wasn’t that much older than David was when his father worried whether he could survive the undertow.

Among many other things, the book revealed some of the controversies surrounding Aunt Rosemary’s lobotomy, which had been previously reported but never publicly acknowledged by anyone in the family. The book quoted David—who was likely under the influence when he gave some of these interviews—suggesting he was the Rosemary of his generation.

When my parents sent me to get tested during winter break, the first thing the doctor recorded was that I came into the office very concerned that I had undertipped the cabdriver because of difficulty figuring out what I owed him.

I had been suffering from cycles of deep depression and then little bursts of mania for a while (to the point where I was figuring out how to trigger hypomania to quickly finish all the work I had ignored while depressed).

With all the medical attention I received as a child and an adolescent, it still astonishes me that nobody talked to me about the possibility of depression when I was so obviously depressed.

IF DAVID’S DEATH and my head injury were supposed to be a wake-up call, I slept through them.

I felt like my dad wrote me off at that point; I was just an enormous disappointment, like my mom. Just the idea that I had the same guy with me who had taken care of David made me feel shunned. At the time, I was told that my father had convened a meeting of the best and brightest about me and my health—just as he had when Teddy got his bone cancer, and on numerous occasions concerning my mother.

I was apparently defective long-term, the curse of the illness. I was eighteen and knew I was already considered hopeless.

nobody should ever put a teenager in that kind of box.

He admitted that before I went to rehab, “I knew you were in trouble.” When I asked how, he said, “I used to get all of the receipts from your ATM bank withdrawals, three o’clock in the morning when you’re blowing hundreds of dollars.” I thought to myself, Why didn’t you do anything? But, of course, I didn’t say that.

It was actually pretty great to have someone’s total attention all the time. I had never realized how much I wanted that.

I moved back to DC to go to Georgetown. I was surprised I got in at all, especially to the School of Foreign Service. But Robin Crawford, the college counselor who helped me at Andover, knew someone there and my father was, well, my father. In reality, whatever strings may have been pulled, nobody really did anyone any favors. I was in no way prepared to be at Georgetown, especially the highly competitive foreign service program, either academically or psychologically.

I was utterly blown away to hear him say this.

I volunteered to work on a local suicide hotline—where my code name was “Patrick 507”—and I had to learn not only how to talk to people who were floridly mentally ill, but how to connect them to emergency healthcare.

the cutbacks were exacerbated by the rise, during the 1980s, of the first generation of managed care—which made mental health and addiction care, already stepchildren to all other medical care, even less well funded and more aggressively capped.

This was still the early days of suicide hotlines, and the technology that helps them work.

adventure. I wanted to have this window into suffering that I couldn’t make sense of myself. I felt a great sense of satisfaction doing it. I never left that room without feeling like I had in some way helped someone.

We now know better that the beginning of college is one of the most vulnerable times for anyone with any predisposition to mental illness or addiction. It is when many of the major mental illnesses begin to express themselves in earnest, with symptoms that simply can’t be blamed on anything else (although they still too often are).

Back then, student healthcare was often grossly inadequate. (For mental health it still is at many schools, and organizations like the Jed Foundation—the nation’s leading nonprofit for campus mental health and suicide prevention—would be even more effective if the colleges and universities were more proactive.)

antidepressants can make bipolar patients manic, sometimes dangerously so. This is a predictably unpredictable response—a patient and clinician often only know it when it happens.

my parents—who were, for me, both distant and dominating.

It was an unusual way to meet a twenty-year-old candidate. But, given the percentage of elderly people in the district, my condition—and my ability to make jokes about it—made it easier for me to strike up conversations and connect with voters of all ages.

I wasn’t going into this to be a big outspoken public figure—I wanted to ring doorbells, hear people out, learn how day-to-day politics really worked.

This was my maiden voyage as a very local politician in Rhode Island, and I wanted to be seen as a neighborhood guy, my own guy, and not just a Kennedy.

I don’t have much to add to the story of that night—except to say that when my father woke up my cousin and me and asked if we wanted to get a nightcap with him, I went along basically as the designated driver. I spent most of the evening nursing ginger ales.

I felt every cell of my body was in turmoil. This was about so much more than anger over an op-ed—it was the first time I really got in touch with what, in recovery, we say is that shame we carry within us.

Sometimes it is what we don’t do that changes people’s lives.

My parents attended the graduation, and that day went pretty well (until the Associated Press incorrectly reported I graduated with honors, and then issued a correction with the headline “Patrick Graduates, but NOT with Honors”).

I remember that conversation like it was yesterday. I remember it mostly because I felt, for the first time, that, thank god, I was no longer alone with this stuff among my siblings.

other people can’t force you into a moment of clarity, and they don’t get to vote on when you should have one. You have to find it yourself.

I am glad to have a fuller realization of my powerlessness. What I once would have looked upon as weakness I now see as the key to empowerment.

there were pundits writing about it in the paper every day, some of them his greatest admirers. It was like some kind of national intervention that he refused to attend.

No, 1991 wasn’t going to be over for a long time.

It was when the worlds of mental health politics, economics, science, advocacy, and patienthood that we still live in today came of age; it was when the anger and outrage of medical discrimination against mental illness and addiction was first crystallized. The Decade of the Brain had been declared in mid-1989, and in theory, the timing couldn’t have been better. The idea was to do what we are still trying to do today—force the federal agencies and powerful institutions and clinicians and companies that focus on neurological illness and psychiatric illness to work together more and admit they are all dealing with the same brain.

the Decade of the Brain wasn’t even an underfunded mandate—there was really no mandate at all. In fact, when the Decade of the Brain was proclaimed, the New York Times compared it not to the War on Cancer but to “National Prune Day, Tap Dance Day . . . [and] Dairy Goat Awareness Week” and asked whether it was time for Congress to stop commemorating and proclaiming so many things.

(By the way, I share your utter disbelief that the world needs this many acronyms, but this is how we talk in government.)

He saw me the way I would only much later see myself, as someone who never had a real sense of a safe, normal home.

The book was the first place where many Americans heard the term Kramer had coined, “cosmetic psychopharmacology,” and heard him ponder whether Prozac made some people “better than well”—suggesting the drugs would be used not just to treat illness but to enhance the performance of well people.

We desperately want new treatments and greater understanding of the processes of the brain. But we also know that the biggest struggle is convincing those who are ill to try any treatment at all, then get them on the right treatment (which can be a frustrating process of elimination), and then keep them on the right treatment—especially after they get some relief and start to think maybe they don’t need treatment anymore. (This is also the same cycle we go through in recovery with sobriety.)

(From 1987 to 1997, the percentage of patients who got psychiatric meds from primary care docs doubled to nearly 75 percent; today nearly 80 percent of all antidepressants are prescribed by general practitioners, in most cases without making a psychiatric diagnosis.)

I was, as far as I could tell at the time, doing pretty well. In retrospect, however, I was trying to re-create my insides by re-creating my outside—getting my life validated on the surface while minimizing the confusion of my inner life.

My dad was great about not holding a grudge. He had a strong temper but also a sense of life that was profound because he had seen so much of it—his big picture was really big.

He explained that Special Ops had the best mental healthcare of any other branch of the service. When I asked why, he said, “We don’t look at mental healthcare as a safety net. We look at it as a force multiplier.”

my dad and I made a visit to Arlington National Cemetery, to the graves of his brothers. Rabin’s death felt, in so many ways, like the deaths of my uncles—not just the murder of an incredible human being but the attempted murder of a cause, uniquely led by this inspiring individual through the power of his own personal narrative. When he was taken, the dream was taken. My father decided it would be appropriate to carry dirt from Arlington to sprinkle on Rabin’s grave.

He had incredible empathy, because he always brought with him the experience of losing so many family members tragically, suddenly, and in their prime.

It was unusual to be an expert on such trauma. Especially back then, when the impact of trauma was so little understood and appreciated. It is amazing, actually, how the world of PTSD and trauma-based mental illness has changed over the last two decades.

When Rabin died, there was very little understanding of the role of trauma-based illnesses. And except for Vietnam veterans, many patients who suffered from post-traumatic illnesses had their traumas questioned, downplayed, or even denied; they were sometimes told it didn’t matter if their traumas were real or imaginary, for the purposes of treatment, something we would never consider saying to someone traumatized in combat. I think, honestly, most Americans didn’t really take PTSD very seriously until after 9/11, when the traumas and their impact were undeniable, and shared by so many.