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

by Patrick J. Kennedy

  In school, I was really impaired by depression. I could sleep seventeen hours a day. The only reason I made it through, actually, was a great teacher named Robin Crawford, who taught early American history and really helped me emotionally. The irony is that he was known as the toughest teacher on campus—he never smiled, and he had this grimace, just a stone-faced, miserable-looking guy, like a drill sergeant in the marines. He was also in charge of college counseling, and he was notorious for taking all these smart, preppy, Ivy League–bound kids from privileged backgrounds into his office and leaving them crying by the time they left. He almost relished giving them a dose of the real world. I remember all the smart kids would raise their hands in class, and he would just eviscerate them. So he was the most unlikely person to take me under his wing.

  He gave essay tests, and I didn’t do well on them. During one of our final essay exams—which was worth like a third of the overall grade—I just blanked on it. I was sitting there falling apart, in this big exam hall. After most of the kids had finished the test and left, I was still sitting there, with pretty much nothing. Finally he said we had to turn in our papers and I brought mine up. My eyes were filled with tears and I was heartbroken that I couldn’t get it together. I felt I really had let him down.

  He said not to worry. And that kindness meant everything to me. (So did passing his class.)

  Today, we have a much better idea of the role teachers can play in the early recognition, diagnosis, and treatment of mental illnesses. They can be much better trained on warning signs and emergency care and suicide prevention, through programs like Mental Health First Aid, and they can be given more tools than just sending kids to the nurse or detention. They also need more training on the finer points of what is called “social and emotional learning,” an idea my cousin Tim Shriver helped spearhead over twenty years ago. In 1994, he co-founded CASEL, the Collaborative for Academic, Social, and Emotional Learning, which promotes student self-awareness, social awareness, and responsible decision-making skills.

  But this all has to start with teachers who go the extra distance for those students who need extra care. I was one of those students, and thank goodness Robin Crawford was one of those teachers.

  —

  IN THE SUMMER OF 1985, I stayed with my brother, Teddy, in the house he bought in Somerville, Massachusetts, to establish residency there. He was twenty-three, and my father really wanted him to run for Congress. Speaker of the House “Tip” O’Neill had just announced he wouldn’t run again for that seat—the very same one where President Kennedy had begun his career in elected office. From a timing and publicity perspective, you couldn’t have asked for a better narrative, and everyone knew it. Dad recently had taken Teddy with him to South Africa on a trip hosted by Bishop Desmond Tutu. And NBC had just agreed to make a TV movie called The Teddy Kennedy Story, detailing his heroic recovery from cancer and scheduled to be shown during the fall of the election.

  We were both getting more attention from Dad than we were used to, Teddy because of the congressional seat—which he still wasn’t sure he really wanted to run for—and me because Dad was constantly calling me asking, “What’s going on with your brother, what’s he thinking?”

  I remember one afternoon my brother and I were sitting together in the bleachers at an empty baseball field in a park in Somerville. Teddy was very emotional, and he said, “I don’t think I’m ready for this. Dad wants me to do it, but I’m not up for it.” He was active in disability advocacy and other medical causes, and was thinking about law school.

  I remember being proud of him for announcing, that July, that he wasn’t going to run, clearing the way for our thirty-three-year-old cousin Joe Kennedy Jr. to successfully seek the seat. It took incredible courage for him to say he wouldn’t run.

  —

  BACK AT SCHOOL THAT FALL, I was increasingly out of control: lots of lost weekends on cocaine, many weekday nights calmed down to sleep by Xanax, lots of weekday mornings too depressed to get up, my own bipolar cycles just made more vicious by chemicals. Then on Sunday, March 16, 1986—just three months before I was supposed to graduate from Andover—I flew down to Palm Beach for a week with a couple of my high school friends and a chaperone.

  We were staying at my grandmother’s house down there, and I thought we had enough drugs to make it through the whole vacation. But what was supposed to last a week was gone by the third day, and I started realizing I couldn’t go on. I was doing a lot of drunk-dialing when I was high. So I called my dad, called my mom. I don’t recall much of what I said, but I know I just kept telling them over and over and over how much I loved them—a cry for help.

  My dad had a sort of tough-love response, and then he turned me over to Larry Horowitz, who as a physician had a much clearer understanding of what was going on and what to do. Larry arranged for someone to come get me and fly me home. I left my friends down there on vacation and was taken immediately to the rehab he had arranged.

  By Friday, I was checking into Spofford Hall, a rehab facility in New Hampshire, as “Patrick K.” And soon I found myself filling a kelly green college notebook with all the AA sayings from the pillows I had been making fun of in my mom’s living room.

  The first things I wrote were “One day at a time,” “Obsessed with possessing,” “No more mind altering,” “Live and let live,” “There are no degrees to addiction,” “I’ll get sober if it doesn’t interfere with the rest of my life,” and what later became my life’s motto—in good and bad ways—“Fake it until you make it.”

  —

  I DID NOT TAKE REHAB as seriously as I should have. In my first group meeting, I was asked what I would do instead of drugs.

  “Hunting and scuba diving,” I shot back, getting a laugh. Afterward I scribbled to myself that “it was sick” my glib answer had come so easily and definitively.

  On my self-reporting forms, I wrote I used marijuana and alcohol infrequently; hallucinogens, narcotics, amphetamines, barbiturates, inhalants, and PCP never; and tranquilizers like Xanax and Librium daily. Next to “cocaine” I checked the box for using one or two times per week, but then wrote in “would be” and an arrow toward the box for “every day.”

  After ten days, I was checked out of Spofford Hall early, against medical advice, because my family had other ideas for my treatment. They wanted me to return to Andover, but under constant live-in supervision. They hired this guy Don Juhl, who ran a concierge recovery service for people who didn’t want to stay in rehab. He was the same guy who had “supervised” my cousin David, back when the family thought that might help him overcome his addiction.

  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. There was also an assessment from my Spofford caregivers. I was told that the prognosis offered about my future was simple: I was never going to get well. I was a child of an alcoholic and showed all these indications of such trouble at a young age. My prospects of living a healthy, productive life were pretty bleak. I was apparently defective long-term, the curse of the illness.

  I was eighteen and knew I was already considered hopeless.

  I can understand how, at the time, this wasn’t such a hard vision to subscribe to. My mom was already totally incapacitated by this illness. But nobody should ever put a teenager in that kind of box.

  —

  YEARS LATER, I had a revelation about this time period with my dad. 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.

  I was moved out of the dorms and into an apartment where there was room for Don; when he needed a break, his wife and partner, Patty, would be with me. His job was to make sure I finished high school. It was actually pretty great to have someone’s total attention all the time. I had never realized how much I wanted that. Don dropped me off for classes and picked me up afterward. We played basketball together, talked about life together.

  At the beginning, I was supposed to go to twelve-step meetings pretty much every day—on discharge from Spofford they require “ninety in ninety,” which means ninety meetings in the first ninety days. There was also an aftercare support group at Spofford twice a month.

  But Don Juhl, who was overseeing my care, was not a strict AA guy. He subscribed to what was referred to as the “Malibu Model,” which grew out of a rehab in Malibu, California, and was based on the idea that perhaps alcoholism wasn’t a disease, and perhaps complete abstinence was not necessary to remain functional and well. This is, of course, part of a very large, emotional, and never-ending debate in the world of addiction. Since its inception in the 1930s, AA has always been completely unwavering on this issue: there is only one definition of sobriety—complete abstinence.

  There has been some liberalization over recent years concerning the use of psychiatric medication for patients with comorbid alcoholism and mental illnesses. (More debatable in AA are the medications prescribed to help wean people off drugs or alcohol, some of which are themselves addictive but not disabling.) But the general goal is to treat the addiction with abstinence, spirituality, and meetings, and nothing else. But from the moment that AA and the twelve steps became popularized, there were programs that wanted to retrofit the twelve steps into something more forgiving.

  When I was in my teens and twenties, this seemed logical to me. This was especially true since I had two parents who abused alcohol but who functioned—or failed to function—pretty differently. My mom was the classic poster child for the AA approach, since she could only function if she was completely abstinent, going to meetings, working the twelve steps. My dad had a drinking problem and was deeply in denial about it, but, well, he did still function as a US Senator, and a powerful one. So it is unsurprising that he didn’t believe in abstinence. And even after I had been in rehab at eighteen, he didn’t seem concerned about my drinking, or even drinking too much. He seemed mostly concerned that I not get into trouble or attract any negative attention to the family.

  For example, less than three months after I left rehab, I got a letter from him, on Senate stationery, in which he attempted to lay down some rules about my use of his house in McLean, Virginia, and the family house at the Cape. He was mostly concerned that I alert him and the staff several days in advance if I was going to have any guests. He did note that the liquor bill my friends and I had run up the previous summer was “still vivid in my mind.” But rather than suggest or reinforce that I shouldn’t be drinking, he explained, “The rule that I want you to understand for this summer is that any time you are with me, picnic lunches, cocktails, or dinner, I am glad to entertain our guests . . . but, what I don’t want this summer are the last minute drifters returning to the house and then feeling free to help themselves to the bar and the icebox. I think if we follow these guidelines, we’ll avoid some of the problems we’ve had in the past. Love, Dad.”

  At the time, I thought this letter was fine. Now it seems pretty surprising. At the time, I also thought the Malibu Model made sense. Now, I have to say, I know it could never work for me.

  —

  DON HELPED ME get through high school, although I ended up not graduating with my class—which my parents weren’t happy about—and finishing one term paper over the summer. And then, after several years of living near Boston, and near my mom, 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 went to DC for a summer class at Georgetown to get a head start on it, and to work as a page for Senator Bill Bradley. But without supervision, I started drinking—binge drinking.

  I did maintain my cocaine sobriety. But since I needed stimulants to help push me out of depression and into hypomania, I was using more and more caffeine—in coffee and over-the-counter pills. I would also exploit some of the euphoric effects of the prednisone prescribed for my asthma.

  I lasted at Georgetown only a few weeks. I was in way over my head, and out of my head. In disgrace, I quietly moved out of my dorm and back in with my dad, feeling like a complete failure.

  Our house in McLean had a tennis court, and sometimes early in the morning, my dad’s good friend Connecticut Senator Chris Dodd would come over to play. Chris’s father had been a powerful senator, so he knew all about generational issues, especially in Irish political families.

  One morning after a tennis match, Chris told me he thought it might be mentally healthy for me to get a fresh start in a smaller fishbowl, somewhere away from the glare of DC or Boston. He had gone undergrad to Providence College, and he thought his alma mater and the town of Providence, Rhode Island, would be a great place for me to begin again.

  My dad agreed, but for a different reason. “Yes, Rhode Island is great politically,” I recall him saying. “If you ever want to think of running for office, it’s a great place.”

  I was utterly blown away to hear him say this. The fact that he even mentioned the possibility that I could have a political career meant that even though I had been in rehab and had blown everything at Georgetown, I might have a second chance. Or at least my dad thought so—which was, to me, actually more important than if it were true.

  Saying this was like throwing a lit match on a fuel depot. I just exploded—I knew exactly what I was going to do. I would move to Providence, get back on track academically, and show my father I might be worthy of his confidence.

  Chapter 7

  It was in Providence as a second-try college student that I first became aware of the larger world of mental healthcare. 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. It was the very beginning of my education in the mental health system—besides, of course, being a consumer—and it came at a time when the field considered itself deeply under siege. This was largely because of cutbacks from the Reagan administration—which decided to get the federal government out of the mental health business but didn’t really fund or empower the states to do the job. But 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. For many people, mental illness and substance use disorder care were becoming increasingly do-it-yourself.

  This was still the early days of suicide hotlines, and the technology that helps them work. We didn’t have cell phones and caller ID and reverse directories available to us so we could quickly identify where the person was calling from and send someone to revive them. There were a lot of calls where the person passed out on the line, or the line went dead, and you just didn’t know what happened. It was very frustrating. We couldn’t send police to them; we were generally trying to get them to go to emergency rooms.

  While I suppose, deep inside, I did understand that the people I was talking to and trying to help were like me in some way, I mostly did this to get out of myself and as
an educational 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.

  At the same time, I had taken on an honorary position for Aunt Eunice at Let’s Play to Grow, one of the spin-off organizations from Special Olympics. The group focused on helping parents connect with their babies and infants with intellectual disabilities by breaking down their fear of playing with their children, and also being involved in local clubs—there were several hundred around the country—with other parents facing similar challenges.

  As for taking care of myself, my parents helped me find a psychiatrist in Providence who I could consider my own doctor. It was a smart thing to do and, at the time, something pretty uncommon. 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). It is the first time that most young people have complete freedom to use drugs and alcohol. It is also the exact time when most young people have outgrown their pediatricians and really need to start taking control of their own health.

  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.) So it wasn’t uncommon that nobody noticed there wasn’t a real safety net until you (or your kid) fell through it. I’m sure in 1987, the idea of seeing a private psychiatrist off campus seemed like an indulgence. It’s now much more common, and student health plans offer many more options for on-campus care. But one thing is still the same—at eighteen or nineteen, it is incredibly important for young people to take some control of their healthcare, especially their mental healthcare.