While I suppose you could argue that “Just Say No” had one message consistent with the abstinence called for in twelve-step programs, it offered no funding for the supports that would help someone struggling to keep saying no. It also laid the groundwork for the problem we still experience today: we now have a handful of medications that can be successful in helping treat addiction, but some people are refusing to use them because they think you’re supposed to “just say no” to them, too.
All this “Just Say No” moralizing pervaded the culture just as some major breakthroughs were happening in mental health that could really have helped reduce stigma. In diagnosis, the DSM-III went from being an obscure technical manual for a small number of clinicians to a bestselling book used by teachers, lawyers, and judges to make sense of the growing field of psychiatric diagnosis. For the first time, when clinicians all over the country used the terms “schizophrenia” and “depression,” most of them now meant the same thing. The book did not suggest how to treat the illnesses—just how to identify and describe them more accurately. But there were also advances going on in new medications and forms of shorter, more directed therapies.
This should have been a time when treatment began dramatically improving and discrimination against brain disease actually began retreating. Instead, this period in mental health is mostly significant because the situation became so terrible that consumers had no choice but to, out of sheer frustration, create the modern consumer medical advocacy movement as we now know it. The only good thing about the years to come in mental health is that they were so bad they encouraged much of the consumer advocacy we take for granted today.
—
AFTER MY FATHER’S PRESIDENTIAL CAMPAIGN, I felt lonely. Over the previous year, my whole nuclear family had spent more time together than they had since I was very young. And now it was over. Dad was back at work in the Senate, my mom was back in Boston, Teddy and Kara were away at college, and suddenly the house in McLean seemed very big and empty.
My father really did try his best to make sure we had private father-son adventures during holiday breaks. We went to Latin America together, just the two of us. We took this wild fishing trip to Alaska, which ended with our almost being arrested in the Anchorage airport because we tried to bring home a petrified twenty-four-inch walrus tusk we found on Round Island in Bristol Bay. (“The youth returned the tusk,” said the Associated Press story on our vacation gone awry.) Looking back, I can see how hard he tried to compensate for how I was feeling about the impending end of my parents’ marriage.
But he couldn’t really make up for the isolation of my daily life with him in McLean. Especially the evenings, after I went to bed. My bedroom was the one closest to the main driveway, so I would always hear if someone came to visit my dad at night. He and my mom were separated by then, so, in theory, he was free to do what he wanted. But it was still very weird for me to realize what was going on behind his closed door.
I developed a way of expressing my feelings without actually saying anything. There was a phone intercom system in the house and my parents’ bedroom was button number one. When I realized he wasn’t alone, I would often push button number one, and hold it down as long as it took for my dad to pick up the phone. Then I would hang up and pretend I was asleep.
After all those nights pressing the intercom, I decided to ask for a change of scenery. So I actually told my father I wanted to be sent away to boarding school, preferably somewhere closer to my mother. I went to Fessenden—my dad’s alma mater—which is in West Newton, near Boston, as a full boarding student for eighth grade. Of course, I wasn’t at boarding school long before I started missing my dad.
I recently discovered a letter sent to my dad during this time, apparently written by a clergy member who knew our family pretty well, which offered a really harsh and insensitive portrayal of my mom and her illness and how it could affect his ongoing personal and political life. It chilled me to read it. The writer referred to my mother’s “use of liquor and all too frequent recourse to psychiatry” and expressed a “deep-seated worry” about my mother’s custody of me. While acknowledging that “you have both lived through tragedy,” the writer went so far as to suggest that unless my mother made “contact with God as he is (not as she wants him to be)” the result could be “the loss of a mighty good president for the U.S.A.” Whoever wrote this unsigned letter has not made contact with the compassionate god I worship.
With my parents’ formal divorce approaching, they decided I should have weekly therapy with a top adolescent psychiatrist with an office at McLean Hospital. Mom would pick me up from school one day a week, drop me off at the doctor’s office, wait for me for an hour, and then drive me back to Fessenden.
I don’t remember much about the therapy—I felt I was doing it for my parents, not for me. But one thing does stick out. The psychiatrist would often ask me to be more specific about my experiences in my family. I was unsure if I could trust him to keep things private, so I would edit things out.
Some of that burden of ultra-secrecy was finally dropped the next year, when my father announced that he would not run for president against incumbent Ronald Reagan—and basically said that his children were the deciding vote against another campaign. While he did talk to Teddy, Kara, and me a lot about whether or not to run, in retrospect I think the press was encouraged to overplay this—almost as if we were making the decision and not my father. Since I had already learned quite a bit about politics, I vaguely understood then—and better understand now—what was really going on.
The whole idea of asking us what we thought has really been misinterpreted by people who don’t understand politics. In my view, you don’t run for office because you weigh this and weigh that. You run because you have the fire in the belly for it. You either have that or you don’t—there’s nothing deliberative about the decision at all, it’s totally intestinal. It’s about motivation, not calculation.
My dad had a lot of expectations on him, people always wanting him to run. Remember, a lot of people staked their careers on his running, people working for him to create public policy and churning out amendments and markups and speeches. He had all the smartest people working for him, the cream of the crop. You couldn’t attract such a high-powered group and not understand they had higher expectations. After 1980, when he knew it wasn’t in the cards for him, he also understood that he had the biggest campaign infrastructure in the country of any Democrat. He had to back down in a very methodical way; he couldn’t roll it back abruptly. He had to do a lot of listening sessions, follow a calculated process—all of which was a way for him to internalize a decision he had already made. He wasn’t going to run and he was going to commit to being a senator, but he couldn’t just say that. And nothing works better than “the kids are worried about my safety.” You say that, and everybody will back off.
Personally, by that time, I didn’t really think as much about the safety issues. Both of my uncles were killed before I was old enough to be conscious of what was happening, so this trauma was not embedded in me as it was for my siblings and cousins. I grew up and honored the anniversaries; I saw my dad wear a bulletproof jacket and be protected by Secret Service. But I also really liked it when my dad had run for president. I consistently spent more time with him that year than during almost any period I can remember in my entire childhood and adolescence. I was like the son who wanted every day to be “take your kid to work day.”
So I wasn’t the only reason my dad didn’t run against Ronald Reagan. I was just part of the way that he and my family could let that dream die, so all the work could go on and the causes could endure.
Chapter 6
By the time I was fifteen and at high school at Andover, I was ill. It would be years and years before anyone suggested I had bipolar disorder. And it’s one of the only times in my life when I wasn’t getting much of any mental healthcare. But as I look back now, a
lot of the behavior that was blamed on my asthma during the week—and easily correlated with my drinking and drug-taking on the weekends—was pretty textbook bipolar disorder.
Actually, at that time, the textbook—the DSM—only described one basic kind of bipolar disorder with a few variations. But research had already begun to tease out two distinct types of the illness. In traditional manic-depressive illness—one of the first psychiatric diseases ever categorized, by German psychiatrist Emil Kraepelin in the late 1800s, and now called bipolar I—patients generally swing between long periods of full-blown depression, and the increasingly out-of-control racing thoughts and hyperactivity of full-blown mania, with periods of wellness in between.
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.
Bipolar II is in some ways a more unpredictable illness than bipolar I, and often harder to diagnose and treat. And my symptoms got more significant when I was fifteen and sixteen.
My dad used to joke that I logged more time in the infirmary than any student in Andover history. But I just don’t think he understood what was going on. There was always some other reason—I had mono, had recurring asthma. But mostly what I had was depression. And because I did have asthma, it was an easy thing for the nurses to say I “needed to rest.”
I was seriously impaired by depression. And I really did not want to feel that way. So on the weekends I’d go out to nightclubs. Early on, my sister was at Tufts and sometimes she and her boyfriend would take me out with them, sneak me in. 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. Or sometimes I would go myself. From Andover I used to sneak out of my dorm and take the bus into Boston, and come back early in the morning, violating all the rules. I would just introduce myself to the bouncer, and nobody ever kicked me out. They all knew who I was.
Also, well, it was the eighties. Besides kamikazes, there was cocaine everywhere in the clubs. I really liked cocaine. It made me feel good, so I just tried to get more.
—
I DON’T REMEMBER any of this behavior feeling particularly risky, just fun. I was, in many ways, happy for the relief that self-medicating brought, along with the sense that I could now fit in with the older kids. In early 1984, however, the party turned scary.
My cousin David, who was twelve years older than me, had a serious drug addiction that had many in my family worried. During Easter break of 1984, we were together in Palm Beach because my grandmother was very ill after a series of strokes, and they weren’t sure she would make it.
David was, by this time, suffering from what we would now call a “stage-four addiction.” (Substance use disorders are generally viewed as having four stages: experimentation, steady use, dependence, and addiction.) He had reached the point where it wasn’t comfortable for him to stay with us at the Palm Beach house. So he got a room at a hotel nearby and would periodically visit the house but not stay very long.
I was into Hacky Sack at the time, and I remember being behind the house, showing David how to play. It was just my teenage way of trying to connect with him a little bit. I never knew what to say, what to talk about with the older kids, especially him, because he was brilliant and sensitive and in seemingly constant turmoil. At the same time I really appreciated that he would take the time to play with me.
So we were all waiting to hear if my grandmother was going to make it. And then I remember the doctor saying she was going to pull through, so I should go back to school, there wasn’t any sense in waiting around. So I went back. The next day, my dorm master at Andover pulled me aside and said, “Your brother is calling,” and I thought, Oh my god, my grandmother. He took me down to his apartment on the first floor of the dorm, and since kids weren’t ever allowed to use the housemaster’s phone, I was really bracing myself.
My brother said, “I’ve got some really bad news.” And when I asked, “Oh, Gramma died?” he replied, “No, David died.”
It was very difficult to reconcile this with the very clear image I had of David from just the other day: he was wearing his shirttail out and his collar kind of open with his long hair hanging over it, and he was young and thin and we were playing Hacky Sack. And now he was dead from a drug overdose.
I remember driving to the wake at my aunt’s house, Hickory Hill, with my father. He didn’t say a whole lot.
The house was full of family and friends and I remember just the two of us went into the room where David’s casket was. I sat down with my dad and he started talking about his brother, my Uncle Bobby. He remembered Bobby telling him that, as a father, he needed to spend more time with David.
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.
After David died, the family started paying much more attention to what all of us were doing. Especially because, just days after the funeral, a controversial new book about the family came out—The Kennedys: An American Drama. It was written by two magazine journalists, one from Rolling Stone, and it included some interviews with several of my cousins, including David and Chris Lawford.
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.
The book also included a scene of David hanging out with gonzo journalist Hunter Thompson. Afterward, Thompson reportedly said of David, “This kid’s going to the edge, all right. But I don’t know if he’ll make it back.”
It never occurred to me that, just a few years later, people would be saying the same thing about me.
—
LATER THAT SUMMER, something scary did happen to me. I was riding with my dad in Hyannis Port, a couple blocks from the house, in his beloved blue 1972 Pontiac GTO convertible—one of a pair that he and his close friend, California Senator John Tunney, had bought together. We were heading up a slight hill when a pickup truck pulled right in front of us and we collided.
Dad wasn’t hurt badly. But I was—in a way that was minimized when it happened, as most head injuries were, but now may help explain a number of things. At the time, it was announced to the press that I had a “mild concussion.” In fact, according to the documents from a series of neurological tests I had beginning later that year, I suffered a fairly substantial head injury: a small skull fracture in the left frontal area and a laceration over my left eye that required stitches. I was unconscious for nearly a half hour and had amnesia of events before and after the crash.
In the months after my head injury, my parents and my school noticed some changes in my sleep
ing habits—I could sleep twelve or more hours a day unless forced to wake up—and the attention deficit I had long experienced in school seemed to be getting worse. My mother also thought I had had a slight personality change, that I had become less inhibited. And they noticed I was having trouble with memory and with calculation. 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.
Today, I would be seen as someone still recovering from a relatively serious head trauma—a neurological patient. Back then, the recommendation for my treatment after all this observing and testing was “Patrick should continue in psychotherapy so that he can develop a greater ability to recognize and accept his feelings and expend less energy in avoiding them.”
In reality, some of these things they were suddenly noticing about me now appear to be clear signs of a mood disorder worsening at the age when many of these illnesses commonly start to become clinically significant. And, while the head trauma didn’t help, 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). It may have been because the family was being more vigilant after David’s death that anyone noticed any change in me. But more likely it was the head injury, because now there was a “reason,” an “excuse,” for my mood swings.
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. Over the next year and a half, I struggled in school and in life.
A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction Page 7