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

by Patrick J. Kennedy

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.)

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)

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 went on a weekend drinking spree, which happened maybe a dozen times a year,

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

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

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).

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.

people still didn’t seem to understand the last lesson Aunt Rosemary had to teach us.

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.

I hope, one day, that improved diagnosis and treatment of mental illnesses for those with developmental disabilities will also be part of her legacy.

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.

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.

the first doctor I saw described me in his notes as a “pleasant, medically complicated gentleman,”

What was happening with a lot of people like me, who were addicted to opioids, is that they slowly, invariably were making the transition to heroin—which was much cheaper and, from what I heard, more powerful and pleasurable. I was, honestly, afraid I would like heroin too much to try it.

But it was a big step in the right direction. So was the creation, in 2003, of a new advocacy partnership called the Campaign for Mental Health Reform.

I also proposed several pieces of legislation with strong mental health and family themes. One was the Keeping Families Together Act, which would combat an utterly appalling problem we were hearing more about: states were forcing families to give up custody of their children with serious mental illnesses as a condition of providing them treatment.

(Since I also sat on the committees appropriating for DEA, I did wonder why Oxy abuse was being treated primarily as a law enforcement issue rather than a health issue.)

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.

“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.

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!”

ended up in the hospital getting six stitches in what was now my very stiff upper lip.

But nineteen days later, I wasn’t so lucky. Or, maybe, I was actually luckier.

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.

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.)

I realized this might be my only chance to tell the actual truth, the bigger truth.

“Is there something you want to tell me?” Finally, the answer was yes.

it was raining wingtips and boat shoes.

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.

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 had, at the same time, lost and won.

we came to realize we were operating in closely linked worlds. The science of developmental disability and the science of mental illness were starting to overlap more and more as they both became part of the growth of neuroscience and genetics. So the politics of our work was starting to overlap as well.

That was fair criticism, and honestly, nobody said anything about me that I hadn’t already said, much more cruelly, to myself in my darkest hours.

I was nowhere near ready to actually leave treatment and return to the real world—especially my real world.

They were going to discuss their own neuroscience research and the future of their fields—which were starting to overlap more than ever as new advances in neural imaging showed the similarities between how the processes of mental illness and addiction appeared in the brain.

I would not only speak to the group of over three hundred coming to Brown but would make this my first public appearance since going to rehab, and then hold my first press conference afterward.

I announced that I planned to have “the most transparent recovery that anyone’s ever seen” and if my constituents expected me to come out and assure them there would be no more slipups or embarrassing incidents—well, that was a promise I was not able to make. Recovery was one day at a time.

June 5, 2006, was the first day of the rest of my “comorbid” life.

IN MEDICINE, “COMORBIDITY” is a fascinating and complex term. It refers, technically, to the existence of two medical conditions simultaneously. But the inherent question comorbidity raises is the relationship between the conditions.

I’ve met people who really prefer to be seen as mentally ill and would be embarrassed to be thought of as having a substance use disorder (because, to them, mental illness is a disease and addiction is a weakness) and others who would prefer to be seen as having an addiction because they would sooner die than admit to being “crazy”—and sadly, some die by their own hand precisely for that reason.

I decided I would answer all these questions carefully and comorbidly.

Part of my job was to make comorbidity accessible.

“Frankly,” I said, “I didn’t know how miserable I was until I started feeling better.”

We aren’t living for the future; we’re trying to survive and actually enjoy the present.

We discussed strategies for how to avoid getting caught up in cycles of obsessing on the past and assuming that my current feelings of anxiety could be cured by somehow making sense of what happened when I was ten.

I told the therapist I was glad I had discovered mental health advocacy, because there were times when it was the only thing that made me feel useful and hopeful for the future.

I spent the summer just trying to get through the summer.

This is a common irritant for people with mental illness; everyone discussing how you “feel” without ever asking you how you feel.

mental health parity and addiction equity (the phrases we were developing to combine the comorbid illnesses)

where all the drinks were soft but the revelations were often quite hard and emotional.