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

by Patrick J. Kennedy

When I look back at my journals during this time, I didn’t really understand much about myself or what was wrong with me. So it was probably a good thing I wasn’t anywhere near ready to be “out.”

all I have to say to you is, play with the devil, die with the devil. “There are families out there, Mr. Speaker, and the gentleman will never know what it is like, because they do not have someone in their family killed. It is not the person who is killed, it is the whole family that is affected.”

Parity seemed like a pretty basic concept, but it actually wasn’t: there were a lot of possible moving parts, each of which came with its own economic and political price tag.

which made him want to go into politics, so he could stop people struggling with mental illness from being “put into parentheses.”

It is not so unusual anymore to hear this kind of testimony in Congress. But to hear this from senators, late in the evening on the floor of the Senate in 1996, was a revelation.

When President Clinton signed the HIPAA bill on August 21, he made it a point to express his “disappointment that the Congress dropped from this legislation the mental health parity provision that received such bipartisan support in the Senate,”

“We didn’t even get half a loaf, we just got crumbs,” Paul Wellstone later told a colleague. “But,” he said, “it’s a start.”

Most people agreed that the trauma of war, or the trauma of sexual or other physical abuse, could trigger mental illness, and throughout the history of mental healthcare, practitioners and patients were taught that memories can be powerful and debilitating without being completely accurate. So it was shocking when parents began suing therapists claiming they were deliberately destroying families by blindly overbelieving patients.

my own mental health was getting worse. But I was getting really good at hiding it.

I worked incredibly hard for the party all over the country, hoping my local constituents would understand that this would ultimately help them as well. (Some in the local press understood better than others.)

I was also too immature and insecure to be in a committed relationship and didn’t even know what one looked like.

I thought I was doing a pretty good job of appearing pretty normal. In fact, my swinging moods and occasional morning hangovers became predictable enough that my schedule was built around those cycles.

after the runaway success of Prozac—which dovetailed with the relaxing of FDA rules that had all but prevented medications from being advertised on television—mental

under the mistaken assumption they had an adolescent form of bipolar disorder and needed a baby dose of these medications (which would be a little bit like giving baby doses of skin cancer chemotherapy to kids with acne).

I am very concerned about the health and economic impact of overprescribing and illegal promotion of medications. But I am also concerned about the millions of Americans with mental illnesses who need medication and refuse to take it, or won’t even go get evaluated or diagnosed because of stigma and discrimination.

you should have even bigger issues with those companies getting out of the business of trying to treat or cure your medical problems.

I didn’t see this for what it was—my first-ever intervention, by someone who held my professional future in his hands.

I never for one minute thought, I must have a pretty serious problem if the House Minority Leader is this worried about it.

I already realized that in Washington everyone knows everything. I just, somehow, believed that was true for everyone else but me. I had grown up in a family culture where we continued to deny, even to ourselves, what everyone else seemed to already know.

When the task was stoking Democratic pride and filling party coffers, that’s when the power of this name I inherited, which elevated me in ways I have spent my life trying to fully understand, was perfectly clear.

looking back, it is amazing how much people were willing to ignore or explain away.

I shared chronic back pain with almost every male member of my family. I just didn’t need quite as much pain relief as I was starting to give myself.

My heart was pounding; I couldn’t believe this was happening. But since I wasn’t in pain—I could barely feel anything—it was like I was a third-party witness to my own disaster.

The physician said, “Be sure not to take too many of these.” And as I did with every other doctor who said that to me—and, over the years, there were many—I responded, “Okay.”

If it was not already clear that such a conference was long overdue, a major tragedy made the point horrifically and poignantly.

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).

previously, people with autism or Down syndrome had better disability protections than people with schizophrenia and mood disorders.

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).

which we now describe as “completing suicide” because “committing” suggests a crime.

given my poor impulse control over much of my young life, if I were often feeling suicidal, I might not still be here.

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.

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.

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.

In public life, once you say something out loud, you can’t take it back. But you can use it to your political advantage—and as a way of deflecting what you didn’t say.

Even though I was drunk and not in my right mind, there is no excuse for any of this behavior.

While I don’t want to oversell what the Gores might have been able to accomplish, I still imagine what might have happened if a couple this committed to mental health, addiction, and neuroscience had made it to the Oval Office.

you could say that I came out part of the way to get everyone off my back—enough that if, say, I got into a scuffle with an airport security guard, that might be blamed on my depression without anyone’s asking if I had been drunk.

(When asked about the difference between campaigning for me and for my dad, she reportedly shot back, “Patrick says thank you.”)

referring to me by my party call sign, which was “Blue Jay”—because Leader Gephardt was “Cardinal,” since he was from St. Louis.

I do sometimes wonder about this blaming language we use for “relapses” and “sabotage.” If these are chronic illnesses, why not blame the illness for recurring and act less surprised when it does?)

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.

a Democratic news conference at the Rose Garden—named after my grandmother—at

Denial is actually really aggressive. It’s hard work. And I was doing quite a lot of it.

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.

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.

The Democrats actually lost four seats in the House in that 2002 election. I kept my seat, but we were worse off than before. Dick Gephardt decided not to run again for Minority Leader (and later not to run again for his seat), so we elevated Minority Whip Nancy Pelosi, making her the first woman to ever lead a major party in Congress. Nancy was a strong, smart San Francisco liberal with a unique emotional presence not usually found at the highest levels of Washington—I hesitate to use the term “maternal” because she was that but so much more.

Since I was allergic to almost everything, and my dad knew that the Pelosi house was smoke-free and pet-free, he asked if she would be willing to put me up, along with a few other kids. We pretty much went wild there, and I started a water fight in their elegant home, just barely missing all their wonderful art and other memorabilia.

the caregivers at the hospital suggested we try something that was becoming popular in mental health and addiction care—a family contract, in which Mom acknowledged in writing her alcoholism and depression and the need for proper treatment to prevent a relapse. In this case, the contract was created as a precursor to what we felt needed to happen if inpatient treatment failed again:

The mental health court system had been growing since 2000, when Congress expanded funding for it with the America’s Law Enforcement and Mental Health Project act. Sponsored by Republican Senator Mike DeWine from Ohio, the law helped deal with the exploding problem of mental illness in prison and the 25 to 40 percent of all Americans with mental illness who had some interaction with the criminal justice system.

court-ordered care and medical guardianship are always going to be emotionally scarring. All we can do is acknowledge the scars and try to help heal them.