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. This was insulting to not only all the Americans who had been diagnosed with trauma-based illnesses when they were first recognized in Vietnam vets and sexual abuse victims, but now to the first “wounded warriors” from Iraq and Afghanistan. (PTSD was actually one of several illnesses that we worried would not be fully covered under the Senate bill.)
I was working to amend the Wounded Warrior Assistance Act, which was making its way through House committees, to beef up mental health provisions for veterans returning with what were starting to be called the “invisible wounds of war.” While it was crucial to improve the mental healthcare within the VA, many people didn’t understand how many veterans do not or cannot access mental healthcare through their veteran’s benefits. A 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.
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THAT SUMMER, I decided to spend the first week in August—for which I’ve been with my family at the Cape pretty much every year of my life—at an intensive five-day workshop on recovery, coping skills, and spirituality at the Caron Foundation near Reading, Pennsylvania. 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.
And while it was easy enough to blame this on the pressure of living up to the Kennedy legacy, the more I was confronted in therapy, and watched others be confronted in group therapy, the more I had to admit that my family issues were not unique at all. Fathers and sons, worrying about expectations and legacies, speaking but not really talking. Families trying to ignore mental illness and addiction. These are common problems, really common.
And the way to treat them was also common: hard work, commitment to recovery and medical treatment, humility, building more connections to others who knew my real self, living in the present, and not making every little thing said—and unsaid—a referendum on the past.
So I made a deal with myself that I wasn’t going to seek anything from my father anymore. Easier said than done, of course, but I was going to try. And if I couldn’t handle being in big group settings with everyone at Hyannis that year, it would be okay. I felt a little guilty not being there as much, assuming people would be talking about sulky Patrick avoiding the family. But I was just trying to break some endless cycles I felt were challenging my ability to remain sober, and remain committed to the medication and psychotherapy for my bipolar disorder. And you can’t ask everyone around you at the shore not to drink, you just can’t.
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AS CONGRESS GOT BACK to work after Labor Day, the parity fight got more intense and, if possible, more personal.
I had strongly suggested to the leading lobbyist in Washington for addiction care, my friend Carol McDaid—who was in recovery herself—that she try to organize every group that felt left out of the form of parity proposed by the Senate bill. So she brought together over two hundred organizations from across the country to create the Parity Now Coalition, which went to Capitol Hill battle with the more establishment Coalition for Fairness in Mental Illness Coverage. (The only major group straddling both coalitions was Mental Health America.)
Then on September 17, Jim Ramstad announced that he wasn’t going to run for reelection in 2008. So, more than ever, the mental health and addiction equity bill was going to be his legacy.
The very next day, the full Senate approved the parity bill sponsored by my father and Pete Domenici. The day after that, our bill was approved by the House Ways and Means health subcommittee, which meant it would be sent to the full committee.
And then two weeks later, Pete Domenici stunned Washington by announcing that he wasn’t going to run for reelection and then disclosing the reason why: he had been diagnosed with a serious neurological condition, frontotemporal lobar degeneration. By the time he left office, we were heartened by the news that his diagnosis had changed somewhat. The cognitive impairments that had led to his original diagnosis appeared to plateau rather than worsening quickly as predicted, so his prognosis improved considerably. But his announcement in early October of 2007 just reinforced what we already knew—that he considered his version of the mental health bill to be his legacy.
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EVEN THOUGH this was the toughest political battle I had ever experienced, something else was going on behind the scenes that I found equally remarkable. There was an outpouring of sympathy, empathy, and openness that I had never imagined possible in Washington. People were frequently taking me aside to share stories of their own mental illness and addiction, or that of a spouse, parent, child, or close friend. They wanted advice on treatment options—figuring that by now I had tried every inpatient facility and outpatient treatment, and had consulted (either personally or professionally during a hearing) with every major government, academic, and private expert there was.
These outreaches were, honestly, the most bipartisan phenomenon I had ever seen on Capitol Hill. I associated them not only with my openness about my illness and our legislation, and the fact that I was attending AA meetings, but something else I had never expected to be part of my Washington life. As the search for spirituality became a larger part of my recovery, I decided to attend some Capitol Hill prayer meetings, which included many of my colleagues who were also prominent members of the Christian Coalition.
Now, coming from a liberal and Catholic family background, I knew little about the Christian Coalition except that they sometimes supported legislative positions that didn’t seem all that “Christian” to me. But in these prayer meetings I had with members, I must say, there was some serious soul searching. These guys would lay it all out! There was as much or more being put on the table as there was in our process groups at Mayo.
Each week someone was assigned to read a portion of the Bible, comment on it, and tell their story. It was a fascinating bonding experience, and afterward when you passed each other in the hallway at the Capitol you knew you’d shared a level of intimacy and understood something about what made each other tick—and it could be profound.
I started realizing this when I first went to Mayo and I got more heartfelt get-well cards from Republicans than Democrats to a tune of, maybe, eight to one, which blew my mind. I had been the chair of the DCCC, pummeling the Republicans relentlessly. This was just so unexpected, and so reassuring.
That said, they didn’t all vote with me. I had many experiences with colleagues who came up to me after meetings and shared that their spouses had tried to commit suicide, or their friends were struggling with mental illness or addiction, and then they voted against the parity bill.
I do wonder today how some of them feel about that, especially now that there is more openness in society about mental illness and addiction as illnesses rather than moral failings.
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AS WE HEADED into the fall of 2007, the supporters of the Senate bill started panicking. They were afraid that if there were no compromise on parity before the presidential campaign got into full swing, we would miss our chance. The loudest voice in the advocacy community for this position was NAMI’s national office in Washingt
on, which was pledged to the Senate bill. But they also knew that, at the grassroots level, a lot of their state chapters and local members supported what we were doing. It was a confusing political time.
Privately, of course, I kept getting more messages that Jim and I were on the right path, and that we couldn’t let mental health parity be passed without attaching it to equity for substance use disorder treatment.
In my own family, while I was struggling to stay sober and healthy, my sister, Kara, had a slip and decided to go back into rehab just before Thanksgiving at Father Martin’s Ashley in Havre de Grace, Maryland. She sent me a card from there that I treasure, not only because of the moving sentiment of her note but because I took the card with me to a meeting where I had a real breakthrough in my understanding of all I had to keep balanced to stay well. I actually used the inside of the envelope the card came in to take notes: drawing a circle with four quadrants, one for my physical challenges, one for my mental challenges, one for my emotional challenges, and one for my spiritual challenges.
My mother was also going through a rough time that fall and winter. 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. This is a pretty common dynamic in medical guardianships and an extreme version of the challenges of any consumer/caregiver relationship: out of sheer frustration over not feeling better, it is easy to blame the treatment rather than the illness. And there is, in twelve-step recovery and other modes of treatment, an ingrained fear of patients overbelieving in what has classically been referred to as “the geographical cure”—the old-fashioned notion that there is nothing wrong with you that a “change of scenery” couldn’t fix. Still, there was nothing wrong with the idea that she might benefit from a restful wellness retreat where she could also be monitored, and she chose Canyon Ranch in Arizona.
While she got good care there and 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.
In one note she apologized to me for her drinking and said she admired my sobriety. “I want what you have,” she wrote. “Will you share some of your strength with me?”
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DURING THE HOLIDAY RECESS in late 2007, I was with Senator Arlen Specter on a trip to Israel, Syria, and Pakistan. As representatives of the Senate and House appropriations committees, we went first to Jerusalem, where we met with Prime Minister Ehud Olmert and Defense Minister Ehud Barak, and then to Islamabad.
It was an intriguing trip with a number of very long plane rides, where Senator Specter and I had a lot of time together, just the two of us. We talked about a lot of things and I even asked him what it was like to be on the Warren Commission investigating my Uncle Jack’s assassination. He said he just remembered the whole thing being rushed, in a way that nobody could really understand—because it was such an unprecedented situation and they were aware they had to balance the search for the truth with their fear of the country falling apart if they took too much more time. But he knew they hadn’t had a chance to pursue all the leads he would have liked. This didn’t shock me at all; in fact, it made me understand the situation better. It was also ironic that we discussed it, considering what happened next.
In Pakistan we met first with President Musharraf and then with Afghanistan’s President Karzai. That evening, we were scheduled to meet with Benazir Bhutto, the former prime minister of Pakistan and opposition leader who was considered crucial to the country’s future and any peace process. She had a long-standing relationship with my family, as had her father, starting from when she had been educated at Harvard. I had first met her in 1989, when I was in my early twenties, at a dinner my father hosted for her at the JFK Presidential Library. We weren’t close, but we had been crossing paths for a long time in international politics.
I was just leaving my room at the Serena Hotel to go meet her at her home for dinner when someone who was traveling with us called out and said I should see what was being reported on television—the horrifying news that Benazir Bhutto had been attacked. The first news stories made us fear the worst, but we initially received word through the US embassy that the media might be exaggerating the story and they had heard her wounds were superficial. Which made it all the more stunning when, an hour later, we heard she was dead, at the age of fifty-four.
It was hard to know what exactly we should do. Senator Specter and I decided it would be too dangerous to go to her house and try to pay our respects, so instead we went to the headquarters of her party, the Pakistan Peoples Party, and laid a wreath under a large poster of her outside the building. 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. The situation was so unstable our military attaché felt we needed to get out of there as soon as possible. They flew us out very early the next morning.
Chapter 21
By the time our parity bill finally approached a vote on the House floor in early March of 2008, there had been a seismic shift in Washington. The American economy had begun its free fall, with the Dow diving and subprime loan specialist Countrywide Financial collapsing. In the aftermath of the Iowa caucuses, several prominent Democrats, including our friend Chris Dodd, dropped out of the presidential race. Then my cousin Caroline, followed by my father, proceeded to stun the party by endorsing Barack Obama. After her op-ed in the Times and his announcement, the three of us appeared with Senator Obama at a rally at American University to drive home the strong Kennedy family endorsement.
On March 5, the day the bill was scheduled for a vote, we held a big lunchtime rally outside of the Capitol, attended by all our congressional supporters, led by Nancy Pelosi, Paul Wellstone’s son David, and perhaps our most resonant ally, Rosalynn Carter. Jim and I met her when her limo pulled into the horseshoe in front of the Rayburn building, and there was a ton of press, all sticking microphones in her face. Somebody yelled out, “Mrs. Carter, do you have a position on who you’ll support, Senator Clinton or Senator Obama?” Jim and I immediately thought we were doomed, because whatever she said would steal all the thunder from the parity bill.
Mrs. Carter paused for a second and then, with a big smile, said, “I support . . . Patrick Kennedy for President!” The media were perplexed, but it was a brilliant dodge of the question.
We were sure we had the necessary votes and in normal times that would have been enough. But these weren’t normal times. The economy was imploding; New York brokerage house Bear Stearns was just days from announcing that it was almost out of money. 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.
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OUR FLOOR DEBATE in the House began at one fifty-seven P.M. While there were many speeches in favor, there was also a lot of very specific opposition. One of the more vocal opponents was Pete Domenici’s colleague from New Mexico Heather Wilson, who entered into the record the names of the hundreds of organizations supporting the Senate bill, as if they all opposed our bill (which of course many didn’t, since Rosalynn Carter’s Mental Health Program was on the list).
Pete Domenici was still very much battling us. When asked that day for comment on our bill, he told a reporter, “To me this is an absolute disaster.” Besides the opposition
from insurers and employers, even President Bush came out against us: the day of the vote the White House Office of Management and Budget announced our bill would “have a negative effect on the accessibility and affordability of employer-provided health benefits and would undermine the uniform administration of employee benefit plans.”
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.
Now, I had grown up watching my father on the Senate floor, and even after being elected to Congress, I sometimes went over just to see him in action. But my father rarely came over to the House to watch me; it had happened maybe twice in thirteen years.
I was stunned. He came up to where I was, put his arm around my shoulder, gave me a squeeze, and then sat down next to me.
I felt empowered and eight years old at the same time. And I was very conscious of just how many people on the floor and in the observation areas realized how big a deal this was—to me, and to mental health parity. It was like we were all watching a movie, and in their minds, everyone was saying “ahhh” the way they do when the couple finally kisses, the lost dog returns, or the estranged father and son finally break down and hug. And as I caught myself looking at it from the outside, as I always did, I focused on being there, in that moment. It was a moment I had been waiting for as long as I could remember.
A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction Page 26