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

by Patrick J. Kennedy

  —

  ALMOST TWO WEEKS AFTER the Thomas approval vote, the Institute of Politics at the Kennedy School at Harvard was celebrating its twenty-fifth anniversary in a two-day event. Dad was giving the opening address on Friday afternoon, and I was coming up the next morning to sit on a panel about young politicians. The evening before Dad’s talk, word circulated that he would be delivering what the Globe called a “mystery speech.” His office would not release an advance text.

  I couldn’t be there, but I was hopeful. After all, in the past six months both my older brother and my mother had very publicly faced their struggles with alcoholism, gone to rehab, and made a commitment to sobriety. For my father to follow them would have been not only the right thing to do personally but, honestly, the right thing to do politically as well.

  But Dad just couldn’t do it.

  The best he could do was to acknowledge “the disappointment of my friends and many others who rely on me to fight the good fight” and to then admit, “I recognize my own shortcomings—the faults in the conduct of my private life. I realize that I alone am responsible for them, and I am the one who must confront them.”

  Many people thought this was his great mea culpa. To me, the speech reinforced the denial I had lived with most of my life.

  I do understand that, for my father, it was earth-shattering that he would even remotely acknowledge any of this. And as I get older and further on in my own recovery, I feel a little more sympathetic because mostly this was a demonstration of how powerless we all are against addiction. In recovery we talk about a “moment of clarity” when we have reached a point of pitiful and incomprehensible demoralization. But other people can’t force you into a moment of clarity, and they don’t get to vote on when you should have one. You have to find it yourself.

  My dad was the most resilient persevering human being that I have ever known. He had problems, and sure, some people would characterize him as an alcoholic. But, ultimately, it only mattered if he came to that realization himself. He managed his life in a way that was full of turmoil, but he always managed to survive, which reinforced his sense that this was manageable. His gifts of resiliency and strength were something I envied and for a long time wished I had. But, frankly, as I think about it these days, I am very glad I don’t have those traits. I am glad to have a fuller realization of my powerlessness. What I once would have looked upon as weakness I now see as the key to empowerment.

  But, at the time, my siblings and I were stuck. We had to decide: would we be true to ourselves or true to the family code of silence?

  This is the struggle for all children growing up with the family disease of alcoholism. That is why many in recovery also attend some meetings of Al-Anon, the group for spouses, siblings, and friends of problem drinkers, which was founded by the wife of an AA member in 1951 and added a group for younger people, Alateen, in 1957. Some prefer meetings of ACOA, the Adult Children of Alcoholics organization, founded in 1978 by a group of twentysomething New Yorkers who had aged out of their Alateen group. ACOA focuses more on the challenges of our adult lives—providing twelve-step support with our struggles over the foundational emotional causes of our own insecurities—where Al-Anon is more about helping to cope with someone in your life engaged in active alcohol dependence. I am fortunate to have been helped by both groups.

  —

  IN EARLY DECEMBER OF 1991, my cousin went on trial for sexual assault in Palm Beach, in one of the first court proceedings ever covered live on national TV. My father and I both testified on Friday, December 6, and after my forty minutes on the stand—for which I had been excessively and expensively prepared—it would have been great if my involvement was almost at an end when he was acquitted.

  Unfortunately, by then, the National Enquirer was covering me too. A guy I had briefly been in rehab with, back in 1986, sold his story of my treatment for cocaine addiction to the paper. The issue came out just as the trial was winding down. I prepared a statement and a letter to my constituents that we planned to release before the issue—in fact, the day after I testified in Florida. But my dad’s large staff of political advisers convinced my extremely small staff this was a bad idea. The letter and statement instead came out just after the magazine. In both, I admitted to going to Spofford Hall and noted that “as a teenager I had started down the wrong path in dealing with the pressures of growing up. I mistakenly believed that experimenting with drugs and alcohol would alleviate them. I finally decided not to escape from those pressures but to confront them.” I explained, “I have taken no drugs whatsoever since then” (true), and said, “I use alcohol only in moderation” (not exactly true, but since most of my binge drinking was alone, at night, to get to sleep, probably defensible).

  While I was hopeful this letter and statement would find some sympathy with the voters in my college town, I was mostly concerned about the reaction of just one man. And it wasn’t my father.

  Frank Di Paolo, the godfather of Providence politics, was by then in his eighties and had become a complete surrogate political father to me. He had retired from running the Castle Spa, but he still cooked for me whenever he could. When I was in Providence, I always came to his house for Sunday dinner—usually homemade pasta e fagioli.

  When I found out he had seen the National Enquirer, I was horrified. He was really old-school, just a gentleman of every sort. So I went to his house in the morning, and he was in the kitchen, at the stove, stirring the pasta e fagioli for dinner, stirring and stirring; he didn’t turn around. I was thinking, This is so awful, and I knew that if he divorced me I could be through in local politics.

  Finally he turned around.

  “Son,” he said, “I saw that story.” And then he paused for a second. “That rat,” he said, “that rat!”

  At first I wasn’t sure what he was talking about—was I the rat who had betrayed his trust, or was he talking about the guy who sold out to the Enquirer?

  “That RAT!” he yelled. And then he turned his head and whispered, “You want me to do something about this?”

  No, no, buddy, I said, that’s all right. I love you and I’m just sorry for having let you down.

  “You don’t need to listen to those gagoots [idiots]!” he said. And then that was it. “What do you want to eat?”

  He made me breakfast. Big thick slices of ham off the bone, an omelet big enough to feed a family of five. He smothered Italian toast with butter and put a big jar of grape jelly in front of me. I was in heaven. I couldn’t get up for hours. By the time I did, I knew he and I could make this all right with the voters.

  —

  BUT THERE WAS still my dad to deal with—not about my scandal, but his. My siblings and I felt very strongly that Dad needed to do a lot better than the “shortcomings” speech. He needed to actually stop drinking for the first time since we had known him. This no longer felt like a private family issue—there were pundits writing about it in the paper every day, some of them his greatest admirers. It was like some kind of national intervention that he refused to attend.

  This was also the time when my father started seriously dating Victoria Reggie, the Washington lawyer he would later marry. I acknowledge that the prospect of my dad’s getting involved with someone did affect me—divorce and the potential for remarriage never stop being weird for the kids. But my main concern was that he take better care of his health.

  Several weeks after the end of the Palm Beach trial, my dad was told that my siblings and I wanted to speak to him privately, in his study at the house in McLean. He had no way of knowing that we were planning a surprise intervention. I had been scribbling down notes wherever I was to get myself prepared for this—some of them on envelopes from my personal stationery, others on lined notebook pages or index cards—because, honestly, I was scared to death to actually confront my father.

  At the last minute I wrote myself a little pep talk. Because m
y voice tended to rise and shake when I got nervous, I had been through thousands of dollars in presentation prep and vocal training for the Palm Beach trial. So I still had that high-priced advice in my head.

  “Be firm,” I wrote to myself. “No anger. No shrill voice. Not demanding. Keep to same point.”

  When the time came, we went back to Dad’s private den, which had big comfortable couches; books everywhere; windows overlooking the Potomac; a high ceiling with an original harpoon from whaling days hanging from it; a scrimshaw coffee table made from planks from the USS Massachusetts; and a fireplace with a picture of my grandfather above it. It also had these big pocket doors, and I can still remember him sliding them shut behind us, so nobody else in the house would hear our conversation. He sat down in his favorite big, blue suede chair, and he was exactly in his comfort zone. And then we started talking.

  Looking back, what we were saying was a pretty modest, watered-down intervention, nothing compared to what you could see today on A&E’s Intervention any week. It was so anemic I’m not sure it even qualified as an intervention. We had our heads between our knees, almost, saying, “Dad, we’re concerned, we’re worried about you, and we think you’re drinking too much.”

  And then we all cried.

  He took it the exact opposite way we had hoped. What he heard was that we were abandoning him when he felt most vulnerable to the world and the judgments being made about him and his fitness as a father, as a senator, and as a man. He thought we were taking sides against him, siding with all “those people,” the ones who didn’t understand how difficult his life was and all that he had to shoulder and bear. We suddenly became part of the chorus of criticism that isolated him and made his life harder.

  He was silent for a long time. He just looked at us and didn’t say anything. Then he started talking briefly. “I’ve been seeing a priest,” he said, “but you wouldn’t know that. If you had bothered to ask me rather than just accusing me, you would have known I’m trying to get help.”

  So we were sitting there waiting for Dad to say something else to us. And suddenly he got up, slid open the pocket doors, and walked out of the room. That was it.

  That was Monday, December 30. When I didn’t hear back from him, I immediately sent him a follow-up note, reiterating the need for him to stop drinking. Then on New Year’s Day, he sent me a six-page handwritten letter.

  He began by explaining that it had been a difficult letter to write but that he wanted me to know that “I get the message, the point has been made.” Then he pretty much proceeded to demonstrate that he hadn’t received the message at all. He complained that we’d ambushed him, leaving him “no time to think what I might be able or willing to do—No just the hard fast pitch.” He complained that we hadn’t bothered to talk to the priest he was consulting or the doctor he claimed to have seen twice.

  We had mentioned in the meeting that we thought his drinking was driving our family apart. He thought “the talk about the family was particularly disingenuous,” saying, “What in heaven’s sake does anyone think has been on my mind day and night, in restless dreams and sleepless nights—My God, Our family—my sisters and the cousins and the brutality of treatment to John and Bobby and I wonder how much I am to blame for all of this and I have to listen to ‘What is happening to our family’ from someone who rarely returned a phone call last fall and demonstrated little outreach during the most painful time.”

  He went on to say that he assumed from what we all said that we would not be staying with him for a while. So, he suggested that if I was in DC, I would stay with Kara, and at the Cape I would stay with my mother.

  “That probably is a good idea for a while,” he wrote. “Hopefully we can keep this in the family.”

  He explained that he would continue to “do anything for you politically just as before.”

  He ended this way: “This letter sounds like it’s written in bitterness. It isn’t. It’s written with great disappointment and enormous sadness and I thought 1991 was over. Love, Dad.”

  Over the next weeks there was a lot of correspondence with my father. For every letter I sent there were dozens of handwritten drafts and false starts. But I was trying to be firm on one issue—he had to stop drinking and get help.

  This was especially dramatic because Dad’s sixtieth birthday was coming up at the end of February and his birthday parties were always particularly well lubricated. In early February, he sent me a note on Senate Armed Services Committee stationery, asking if I would come to his weekend of birthday celebrations and letting me know that Kara had agreed to attend and help. The letter ended, “I hope you are doing well, I miss you. Love, Dad.”

  I told him I wouldn’t attend the parties unless he agreed to stop drinking. When he wouldn’t agree to get treatment, I didn’t go to any of his sixtieth-birthday parties.

  No, 1991 wasn’t going to be over for a long time.

  Chapter 9

  The Decade of the Brain started without me. This was hardly surprising at the time—I wasn’t at all public about my own mental healthcare, and it wasn’t a major issue yet for me politically. But when I later got deeply involved in mental health parity, it was clear that a lot of people I was working with had been doing this for a long time. And the Decade of the Brain—proclaimed by President George H. W. Bush but largely unfolding during the Clinton White House—was their shared reference point. It was when the worlds of mental health politics, economics, science, advocacy, and patienthood that we still live in today came of age; it was when the anger and outrage of medical discrimination against mental illness and addiction was first crystallized.

  The Decade of the Brain had been declared in mid-1989, and in theory, the timing couldn’t have been better. The idea was to do what we are still trying to do today—force the federal agencies and powerful institutions and clinicians and companies that focus on neurological illness and psychiatric illness to work together more and admit they are all dealing with the same brain. Unfortunately, the effort got off to a rocky start, because President Bush and Congress didn’t attach any real increase in funding to it. When President Nixon declared his “War on Cancer” in 1971, it came with a $1.5 billion increase in funding over three years. (In 1990 dollars, a similar investment would have been around $5 billion; in today’s dollars it would have been around $7 billion—which puts the recent $100 million–per–year funding of President Obama’s new BRAIN Initiative into perspective.) So the Decade of the Brain wasn’t even an underfunded mandate—there was really no mandate at all.

  In fact, when the Decade of the Brain was proclaimed, the New York Times compared it not to the War on Cancer but to “National Prune Day, Tap Dance Day . . . [and] Dairy Goat Awareness Week” and asked whether it was time for Congress to stop commemorating and proclaiming so many things. So it was no surprise that when the National Institute of Mental Health (NIMH) and the National Institute of Neurological Disorders and Stroke (NINDS) met to create a strategic plan for the decade, they couldn’t even agree on a way of working together.

  One of the first big political moves of the Decade of the Brain involved bringing the medicine and science of mental health and addiction back under the umbrella of the National Institutes of Health (NIH), so it would hopefully be taken more seriously and funded more aggressively. This decision had been debated for many years—not only in terms of bringing the NIMH back to NIH, but whether or not the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) should become part of the NIH separately, or together as one addiction institute, or not at all. While these were political decisions, they had huge implications for how these diseases were viewed by the government and the public.

  Finally, in 1992, the government broke up the nearly twenty-year-old Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)—which had, under one roof, all the “hard science” research into causes, treatm
ents, cures, and preventions, as well as “softer” behavioral and social science research, training, and public education. NIMH, NIDA, and NIAAA went to NIH. (By the way, I share your utter disbelief that the world needs this many acronyms, but this is how we talk in government.) But since NIH only funded hard science, all the behavioral and social science, training, and education had to be moved to a new agency with a new acronym: the Substance Abuse and Mental Health Services Administration (SAMHSA, which we call “Sam-sa”—the H is silent). Yet with all this political and acronymic maneuvering there was, initially, no significant increase in government funding for brain disease research and treatment.

  Still, there was enormous hope that all the people who would benefit from a real Decade of the Brain might be able to will it into being, even without additional government support. And, in many ways, they did. Luckily, the Decade of the Brain came at a moment of real hope in the treatment of mental illness: two of the breakthrough medications of the twentieth century had recently been approved.

  Most Americans recall this as the time when everyone they knew started talking about the new drug Prozac, and the possibilities of an intriguing and controversial new class of widely used antidepressants. But people with family members suffering from intractable mental illness—especially schizophrenia and schizoaffective disorders—remember this as the moment when clozapine arrived. Marketed under the brand name Clozaril, it was the first “atypical antipsychotic” medication, able to cause an almost Awakenings-type response in many patients, making their visual, aural, olfactory, and other hallucinations either disappear or recede to the point where the patient could more easily understand they weren’t real. (In mental healthcare, completely getting rid of symptoms is often not possible—the best we can hope for is medication and supportive therapy that allow those with the illnesses to have “insight” into their illness processes and see symptoms as nothing more than symptoms. So, as for the late mathematician John Nash in A Beautiful Mind, the hallucinations are still there but no longer controlling our actions; similarly, patients with “suicidal ideation” can understand that this is a medical symptom and not what it sometimes feels like, an existential call to self-destruction.)