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

by Patrick J. Kennedy

I joked that I had never before taken direction from any Republican.

Senate Republicans, who, like many of his friends across the aisle, wanted to give Pete Domenici a well-deserved namesake bill for all his years of groundbreaking advocacy for serious mental illness.

So now all three of us—including my much more resilient older siblings—had ended up in recovery from this family illness. Yet substance use disorders still weren’t covered equitably in my father’s Senate bill.

Early in his career, my father had taken an unconventional tack in his effort to pass healthcare reform: he held what were called “field hearings,” all over the country. The idea was to re-create the kinds of intense, well-orchestrated, full-day hearings usually held on Capitol Hill and take them to the public, state by state, to build local support. I went along on some of them. They were great fun and often fascinating because of the chance for public testimony. Jim and I decided we would do the same thing for parity.

the Denver suburb of Aurora (where, five years later, a young man with mental illness would kill twelve people and injure seventy more in a movie theater shooting);

The stories we heard from patients and family members during those hearings stay with me to this day. The pain of what we heard—and, in so many cases, it was pain that could have been prevented, remedied, or reduced—was sometimes hard to comprehend. So was the hope some people were able to maintain after incredible loss.

At the same time, we heard amazing stories of the value of evidence-based, gold-standard care and the importance of treating mental illnesses as truly chronic, rather than acute and episodic—practices that not only improve patients’ lives but save insurers money.

When told that, yes, the patient reported having plans to shoot himself, the insurance reviewer then asked if the patient had a gun. When the doctor replied that he did, the insurance reviewer actually asked this question: “Does the patient have bullets?”

Just probably seven or eight minutes ago, we passed that bill out of our committee, eighteen to three. You’re the first ones to hear about it!” He explained that with that large a majority, he felt very good about the prospects for its quick passage on the Senate floor.

when Pete was mad or frustrated he didn’t just raise his voice, he threw his entire body language at you.

He made it clear he would do everything he could to stop us. And we made it clear we weren’t going to stop.

congratulating me on finishing my first year in recovery—and the most sober twelve-month period in my life since, well, around age twelve or thirteen.

I am one of the few people I know who shuttles back and forth between the worlds of recovery and medical mental healthcare, as a politician and a patient, with equal trust in both approaches and faith that eventually they will be integrated.

I tearfully admitted that I had always felt the most emotional connection to my father when he was drinking. When he wasn’t, he seemed more intense and difficult to bond with. I also had to admit that, as I had grown older, I felt more emotionally connected to him when we drank together. And remaining sober meant figuring out how to feel more emotionally accessible without alcohol or drugs.

this thing called “parity,” which was a great idea but, like “racial equality,” something you couldn’t just snap your congressional fingers and make happen.

There was also the looming issue of mental healthcare in the military, which was starting to get more attention after the scandals about substandard care at Walter Reed Army Medical Center and the upcoming fifth anniversary of the Iraq War—which dovetailed with whispers about a dramatically rising suicide rate among recent vets. At this time we were just beginning to understand the problem that post-traumatic stress disorder and other trauma-based brain diseases were not being taken seriously enough.

surprising number of vets rely on insurance provided by their post-service employers, which meant they needed the protections of mental health parity like everyone else.

It was a relief to be going to a rehab facility for a positive reason—I had been alcohol and drug free for exactly one year and three months—and the experiential therapy and lecture sessions were really helpful. It all reinforced something I knew intellectually but, especially in my more challenged moments, still couldn’t get past. I was, always, seeking my father’s approval more than self-approval. Because I still didn’t know who I was or which self I approved of.

living in the present, and not making every little thing said—and unsaid—a referendum on the past.

And you can’t ask everyone around you at the shore not to drink, you just can’t.

She decided that the root of her depression was not mental illness but the “jail” of her guardianship by us, and that she should go away for long-term treatment somewhere far from Boston.

we were pleased she was being aggressive about trying something different, her letters home made me a little concerned. They seemed to suggest that she was blaming her shame, especially her “public shame,” for her alcoholism and depression, rather than the illnesses themselves. She also blamed the guardianship itself for her symptoms, saying that it had made her sicker and more depressed than she had ever been before.

A photo was taken of us, flanking the poster with looks of complete shock on our faces, as Pakistanis surrounded us, placing flowers all over. That night, we watched from our hotel as the city went up in flames. I remember thinking that this must have been what it felt like all over America the day Dr. King was killed—her death, like his, dashed the hopes of so many.

perhaps our most resonant ally, Rosalynn Carter.

On the eve of the fifth anniversary of the war in Iraq, remaining support for American involvement there was cratering. And the presidential primaries just made everything a lot louder.

After nearly two and a half hours of debate, there was a break for a procedural matter on another bill. At 4:28 we began again, and as we did a buzz began on the floor and from the gallery. I was sitting up front so I didn’t initially see what was causing the commotion, but then I turned and saw. It was my father, walking toward me.

I felt empowered and eight years old at the same time.

It was a moment I had been waiting for as long as I could remember.

Because my father was there, New Jersey Congressman Frank Pallone yielded me time so I could give my speech. I began a little nervously, trying to keep to my prepared remarks and conscious of my dad’s presence. And then I just put all that aside and spoke.

The truth is, we sometimes rely on these potential triggers as ways of explaining our mood disorders to those who don’t have the illnesses: it’s easier for them to understand the disease if breakthrough symptoms are triggered by something external, something that makes sense to them.

It was a challenging few weeks, especially because I was starting to realize that I had stopped moving forward in my recovery, and I wasn’t as comfortable relying on my sponsor and telling him everything that was going on.

The process doesn’t make all the resentments just disappear—any more than doing the proper medical treatment makes all your mental illness symptoms disappear—but it helps you find a way to see all these insults more objectively. And by better understanding how your own actions played a part in them, you become more accountable.

There are aspects of twelve-step and CBT that are very similar, although accomplished in different settings: if you can afford the cost in time and, in the case of therapy, in money, I can say from experience that each has its value. The biggest issue in either is your own commitment to the process and to yourself as a well person.

as I was completing my second year of sobriety, I was beginning to understand the difference between abstinence and real recovery.

how many acts of emotional bravery, large and small, it really takes to care about someone with these illnesses.

He gave my father an extra year of life. And he gave all of us who loved Dad an extra year as well.

MEANWHILE THE STAFFS from the House and Senate were still “conferencing”—which is a euphemism for political hand-to-hand combat—over the two versions of the parity bill.

we never thought our bill was going to codify the medical necessity of insurance coverage for everything listed in the DSM. That’s not what the DSM is for. It’s just the most up-to-date book of diagnostic codes and descriptions, an encyclopedia of what to call all the things that might be wrong with your brain or mind, and a resource for how to differentiate between them when making a diagnosis.

“With all due respect, we’re talking about a bill that will save the lives of millions of people. Who the hell cares whose name is on it?”

when they’re doing a roll call, no matter where they are in the alphabet, if a member comes in who wasn’t present when his name was called, they call him. So they yelled out, “Mr. Kennedy,” and he walked to the table near the front, banged on it—which was also a way to steady himself—and yelled out, “Aye!”

He fully expected to be at the Democratic National Convention and at Obama’s inauguration in January. And then he hoped to get back to work—because he was convinced that Obama would be the President who finally passed the sweeping healthcare reform he had worked for his entire career.

there was still no clear path to getting the bill to a vote in the House and Senate and onto the President’s desk to sign. In the meantime, the economy kept getting worse, the Iraq War casualties mounted, the presidential campaign kept getting more brutal, and on a personal and political level, it felt like time was running out.

just before my father was ready to go out, the teleprompter guy said, “I appreciate your work on mental health.” People affected by this truly are everywhere.

I remember the look on Vicki’s face when she saw me for the first time in a couple weeks. Without saying anything, she let me know: “You’re not healthy, you’re uncomfortable to be with.” There was a little moment of clarity in the way she looked at me, and I remember that startling

came up with a brilliant Hail Mary solution. What if the toxic TARP bill was actually attached as a rider to the beloved parity legislation, instead of the other way around? What if the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act became too big to fail?

I still cannot believe the confluence of events that made this happen. If any of this had taken place during ordinary times with a normal calendar and the opportunity for people to dig in and mess everything up, it probably never would have passed.

It was a miracle. An incredibly quiet, deft Washington miracle, with the power to improve, or in some cases save, millions of American lives.

When I felt really depressed, there was a question that haunted me, something I had never had the guts to ask my father before he became ill. And now it was probably too late. Did he realize that one of the families that this bill was supposed to help destigmatize was ours?

and then the President signed a copy of the bill. At a typical signing, he would have used several pens so each of us could have one. But since this was ceremonial, he announced he was going to use just one pen—which, because of all the history the bill represented, he said he wanted for his presidential library. And then, at the last minute, he gave the pen to my dad anyway.

I turned to President Bush and gave him a look that only a second-generation national politician could possibly understand, like we would always just be the kids, full of existential fears of being loved and living up to expectations. The President had these issues with his dad as a young man. And, of course, my dad had those issues with his own father. It was political déjà vu all over again.