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

by Patrick J. Kennedy

  My parents got a recommendation for a psychiatrist in Providence, Dr. Peter Kramer, who had worked previously in Washington for what was then called the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)—the federal entity that, since 1973, had overseen the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Among his responsibilities during that time was to help refute damaging testimony to the Senate Finance Committee about the efficacy of psychotherapy that claimed there was little proof it was anything more than “rent-a-friend.” (This has been an ongoing issue in mental healthcare. At the time, in the 1980s, there were few actual studies to prove the efficacy of psychotherapy. There are now many studies proving the effectiveness of several types of psychotherapy—especially cognitive behavioral therapy—either paired with medication or by itself.)

  Kramer was now teaching at Brown, had a small private practice, and had just begun writing a regular column for the Psychiatric Times. He was a youthful forty and seemed closer to my age than any therapist I’d seen.

  This was long before Dr. Kramer wrote Listening to Prozac. In fact Prozac—fluoxetine—hadn’t even been approved by the FDA yet. (That happened in December of 1987, almost a year after I had started seeing him.) Mostly, Kramer was listening to me. Since I was depressed, he did try me on the drug that was, at the time, the gold standard of treatment, imipramine. That landmark antidepressant had first come on the market in the late 1950s and was—with lithium and Haldol—the beginning of truly effective psychiatric medications for the major mental illnesses. Each, of course, had its side effects, as all medications do, and some had dietary restrictions: imipramine was easier to take than the other popular antidepressant of the day, Nardil, which had some annoying food interactions.

  As with all psychiatric medications, there were also risks that grew out of the challenging process of diagnosis. Antidepressants are created to yank the brain out of a depression, which means pushing it in the other direction. Mood stabilizers for bipolar disorder are created to balance swaying moods. Mood stabilizers won’t bother patients who primarily suffer from depression (although antidepressants will work better). But antidepressants can make bipolar patients manic, sometimes dangerously so. This is a predictably unpredictable response—a patient and clinician often only know it when it happens.

  The problem can be quickly identified and corrected, which is why it’s so important for patients on new meds to be closely monitored. But until we learn enough about the brain to have reliable tests to clearly see the difference between unipolar depression and bipolar disorder, some patients will only learn which illness they have because of a bad reaction to medication. (There are now some early stage genetic tests to help inform psychiatric drug choices; they hold out promise that there can be “personalized medicine” for brain diseases just as we are coming to expect from the rest of healthcare.)

  I actually tolerated imipramine pretty well, for someone who would later be diagnosed with a bipolar disorder. But my drug situation was complicated by all the meds I took for my asthma. Dr. Kramer believed that any psychiatric medication I took would mostly be useful to control my symptoms enough so I could work on what he considered my more pressing problem, which was growing up, taking more responsibility for my actions and my life, and moving past my childhood and my parents—who were, for me, both distant and dominating. Mostly, the treatment was about process, about ways to try to control symptoms and control actions.

  —

  UNDER DR. KRAMER’S CARE, I tried my best to make a new life for myself in Providence while struggling with symptoms of depression and anxiety. Getting up for classes was a huge challenge; picking up my mail at the student center sometimes caused me total panic. But I did my best to muddle through. Even as a freshman I lived off campus, alone, so I wouldn’t risk anyone knowing what was really going on with me.

  In addition to school, I interned at the State House, acting as a page for legislators and doing research for the Legislative Council. In the fall of 1987, I worked for the Lieutenant Governor in his attempt to unseat US Senator John Chafee. I revived the Young Democrats group at Providence and decided to run as a delegate for the 1988 Democratic National Convention, pledged to Michael Dukakis. In early March of 1988, I was elected as a delegate.

  And this probably would have been what my life looked like for the foreseeable future—school, political and mental health volunteerism, therapy, drinking sprees, and oversleeping—if I hadn’t developed that tumor on my spine. Instead, I entered Mass General on April 18 for back surgery and got caught up in receiving the same family and media attention that had greeted Teddy when he faced his amputation.

  I was still in my hospital bed recovering when I first told my dad that I planned to run for office, immediately. He was not, initially, very supportive of the idea, said he was worried about my health and whether I was jumping in too soon. But then, like he always did, my dad started thinking politically. He shifted his queries to more practical matters, like whether I really knew enough about the district I would run in. I convinced him I had been studying all the players and the dynamics of the district and really did know what I was doing. Also, the state legislature in Rhode Island was part-time, sitting only six months of the year, so it would be possible to stay in school and be a state rep.

  By the time I was discharged from the hospital on May 7, we were already using my coming-home party to announce my campaign. We had four months until the election, and I spent the first weeks going door-to-door, still wearing my full neck brace and walking with a cane. It was an unusual way to meet a twenty-year-old candidate. But, given the percentage of elderly people in the district, my condition—and my ability to make jokes about it—made it easier for me to strike up conversations and connect with voters of all ages.

  Early in the campaign, I was fortunate to get the support of the state’s current Democratic Senator, Claiborne Pell, who had been elected the same year John Kennedy became president and had many legislative triumphs—the best known of which was the Pell Grants for college students. He came to a kickoff breakfast we had but, perhaps because I was challenging a five-time Democratic incumbent he had known for many years, he didn’t immediately rise to speak like some of the other politicians there.

  As people were just starting to leave, I got up the courage to go over to him and ask if he might say something. He didn’t speak loudly—he never did—but I never forgot his words.

  “I want to say why I’m here to support Patrick Kennedy,” he said. “I believe that he shares the values of President Kennedy. And every night since we’ve lost President Kennedy, I’ve knelt down on my knees and prayed that this nation would live up to the promise of John Kennedy. I believe that Patrick Kennedy will and that’s why I support him.”

  That’s a lot for a guy just turning twenty-one to live up to.

  While I was honored to have the support of Senator Pell and some other national figures from Rhode Island, such as retired Senator John Pastore, I found myself gravitating to more local politics, retail politics. I wasn’t going into this to be a big outspoken public figure—I wanted to ring doorbells, hear people out, learn how day-to-day politics really worked. I was lucky enough to quickly make friends with Frank Di Paolo, the elder statesman of Providence politics and a lifelong Kennedy supporter. Frank owned and ran the Castle Spa, a diner in the district I was running in. I started eating breakfast there almost every day while campaigning, and he became my first character witness in the neighborhood when I was accused of being nothing but a carpetbagging student. He always said, “I have two boys and two beautiful girls, and my buddy Patrick, he’s my third son.”

  Election Day was September 13—it was a primary, but since there were no Republican candidates, the Democratic winner would get the seat. It seemed like the entire Kennedy family descended on Providence to help out. We won, but I can�
�t say the media was very impressed. The last line of the Boston Globe story about the election quoted a local bartender describing me as “a college kid who won’t be around long.” For a business owner in a town of college and university transients, that wasn’t a completely unfair assumption.

  When it came time for my swearing in, I was torn about what role, if any, my father should have in the events. He flew back from vacation in Hawaii to be there, and we arranged to borrow the Fitzgerald Bible—the same family Bible JFK had used at his inaugural—for my swearing in. But when Dad got there, I realized I didn’t want him to be on the floor of the State House standing over me in every photo. This was my maiden voyage as a very local politician in Rhode Island, and I wanted to be seen as a neighborhood guy, my own guy, and not just a Kennedy. I was constantly conflicted about my identity—I guess almost everyone is at that age—and I didn’t want it to seem like my being elected was all part of this big plan masterminded at the Kennedy compound for us to take over. I wanted to make sure people were getting to know me.

  So at the last minute, before we walked out to do the ceremony, I said to him, “You can’t come on the floor with me.” He was pretty shocked, especially since he had just flown fourteen hours to be there. But he understood. Afterward, we went to the secretary of state’s private office and did another ceremonial swearing, with no press, just for my dad and me. We took a great picture of me with my hand on the family Bible and Dad behind me.

  My family has always been very big on sending each other handwritten notes and signed photos to mark special occasions, and it was time for me to start doing the same. I wrote, “To Dad, my father & hero! Love, Patrick,” and had it delivered to him.

  —

  IN THE FOLLOW-UP to my hospital stay for the surgery, my father’s staff sent him a memo about an ongoing discussion about family medical bills. Apparently, since the beginning of my mother’s illness, my father had been paying for all her care himself, by check, rather than putting in for any reimbursement from medical insurance and running the risk there would be a paper trail about her care. Ironically, he started doing this in the 1960s when federal employees actually had the only coverage available in America with full mental health parity—which was finally taken away only in the early eighties by the Reagan administration. But by 1987, with my mom’s struggles with alcohol dependence well documented and their divorce long over, the staff decided to start submitting claims for my mom to medical insurance. (While my parents were divorced, they were still very much in each other’s lives; my mom still always joined us for big family events at the Cape and was a fixture at the Thanksgiving table even after my father remarried.)

  I’m guessing that during my lengthy hospital stay, somebody on his staff noticed that there had never been a medical insurance claim put in on me and decided that was ridiculous. So they tallied up all my unclaimed charges for 1987 and the ones ongoing for 1988 and finally submitted them for insurance.

  What is particularly interesting about the correspondence—on which I was copied (and which I never looked at until recently)—is the way my dad’s staffers explained to him the new managed care rules for mental healthcare coverage.

  “Reimbursement of mental illness care is limited under the insurance policy,” they wrote. “A MAXIMUM of 50 visits per calendar year are reimbursed at 70% of the usual and customary charges allowed; subject to a $75,000 MAXIMUM LIFETIME BENEFIT.”

  Between my rehab costs and my visits to Dr. Kramer, I can tell you that by the end of 1987 I would, at the age of twenty, already have gone through a shockingly significant percentage of my lifetime maximum benefit.

  Chapter 8

  My health was relatively stable as I finished my first two-year term in office. I started my second term in January of 1991, and as spring approached, I prepared to finally graduate from Providence at the age of twenty-three. I was still seeing Dr. Kramer, and whatever went wrong, we were able to deal with it. For a college student who did some weekend binge drinking—like almost everyone else—I was doing okay.

  And then my dad and I met in Palm Beach for the Easter holiday.

  This was the most investigated and publicized week of my life, after sexual assault charges were brought against my cousin William. I don’t have much to add to the story of that night—except to say that when my father woke up my cousin and me and asked if we wanted to get a nightcap with him, I went along basically as the designated driver. I spent most of the evening nursing ginger ales.

  It wasn’t that I was so sober at the time. I was still defining sobriety as not using any illegal drugs. But I just didn’t feel like drinking that night. The truth was, I did much of my drinking—and most of my dangerous drinking—alone, at night, at home.

  For the first few weeks after the charges were filed, I did my best to hold it together, to be supportive of my family and responsible as a young politician. I gave interviews to major media and watched as the coverage focused first on my cousin and then on my father’s lifestyle. That subject had been lingering in the press for over a year, since a devastating (although basically accurate) piece about his aggressively single lifestyle and its possible ramifications for his political authority had appeared in GQ.

  Within two weeks, I could no longer handle the pressure. On April 15, the editor of the Providence Journal published an op-ed ripping my dad, entitled “Downhill All the Way.” I was so livid that I drove over to the office of the Journal—which was, of course, the main publication I relied upon to cover my own political career. This was long before cell phones, so I went to the pay phone outside the ProJo building, called the editor, and started screaming and swearing at him. I dared him to come down and meet me on the street.

  He very calmly said that if I had a problem with anything he had written, I was welcome to submit a letter to the editor.

  I kept on screaming at him, yelling that he was scared I would beat him up. It started out as just totally mad blind rage, but soon I realized I was trembling, I was crying, weeping into the pay phone. I felt every cell of my body was in turmoil. This was about so much more than anger over an op-ed—it was the first time I really got in touch with what, in recovery, we say is that shame we carry within us. And I had never felt so exposed before. I didn’t really have my own identity yet and I felt terrorized by not being able to separate from my parents’ identities, as they were being so harshly criticized. My core of shame was being uncovered for the first time and I was melting down. And I was doing it on the phone with the editor of the Journal, the most important journalist in the world to me.

  And that day, the editor of the Journal did the kindest thing: nothing. He pretended none of this had ever happened. He never reported on the incident.

  Sometimes it is what we don’t do that changes people’s lives.

  —

  I WAS, UNTIL PALM BEACH, a pretty low-profile politician—a member of the part-time General Assembly in the country’s smallest state. After Palm Beach happened, there was press everywhere covering almost anything that could have the word “Kennedy” in it.

  Just days before I was scheduled to graduate from Providence in May, I was approached while entering the State House by reporters wanting comment on my mother—who had been arrested outside of Boston on a DUI. I had been planning a cookout for my constituents on my actual graduation day but then decided to cancel that because of the media attention. My parents attended the graduation, and that day went pretty well (until the Associated Press incorrectly reported I graduated with honors, and then issued a correction with the headline “Patrick Graduates, but NOT with Honors”).

  Over the next weeks, there was a national debate over whether or not my father was “an alcoholic” or if he “had a drinking problem.” The debate included comments from many of his prominent Senate colleagues, most notably his best Republican friend, Senator Orrin Hatch, who admitted on the record that he had told my father he needed
to stop drinking. My dad responded by repeatedly denying he had a problem.

  On May 30, my mother pleaded guilty in Quincy to drunk driving, after turning in her license for the third time. She immediately went to court-ordered rehab.

  While this was all very public, my brother made a private decision. Just weeks after getting his master’s at Yale, Teddy decided he would sign himself into the Institute of Living in Hartford for a three-week rehab. He and I were together with my dad at the Cape the weekend he told us. It was a huge blow to my dad. With me, Dad was kind of accepting—he seemed to associate my vulnerabilities with my mother. But with my brother, Teddy—well, Teddy was his namesake. He thought that would reflect on him. He was not happy.

  I remember my father pulling me aside to discuss this. “Can you believe your brother?” he asked. “Does he really need to do that? Does he really think he’s an alcoholic?” I remember that conversation like it was yesterday. I remember it mostly because I felt, for the first time, that, thank god, I was no longer alone with this stuff among my siblings.

  So Teddy went to rehab. And when he came back, he was a pretty gung ho twelve-step guy. He even told the press he had received inpatient treatment. So my dad was forced to publicly confront this and comment.

  “I’m very proud of the decision he has made,” he told the Globe. “I hope everyone will respect it.”

  But Dad refused to budge on the issue of his own drinking. As the Senate reconvened in the fall, this was no longer just a Kennedy sobriety issue—some believed it was actually affecting public policy. That fall just happened to be when the Supreme Court nomination of Clarence Thomas was being debated—a nomination that my father and other Democrats completely opposed. It was, in fact, one of my father’s staffers on the Senate Labor Committee, which he chaired, who had tracked down Thomas’s former employee Anita Hill. But my father kept a low profile during most of the Judiciary Committee hearings, and when he did speak up in the Senate some of his longtime colleagues—including Arlen Specter and Orrin Hatch—called him out, suggesting he was hardly one to be accusing another of bad behavior. In what many then—and even more today—consider to have been one of the most unfortunate Supreme Court appointments in American history, Thomas was approved in the Senate on October 15, 1991, by a vote of fifty-two to forty-eight. When the televised Thomas hearings were finished, my father’s poll ratings had plummeted to the point where his reelection the next year was suddenly in question.