Patrick Kennedy and the politics of honesty

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By any standard – the physical and metaphysical – former Congressman Patrick Kennedy (D-R.I.) should not be alive today considering the extreme comorbidity of his mental illnesses and addictions.

That is one of several conclusions one might reach from Kennedy’s extraordinarily engrossing memoir, “A Common Struggle” (Blue Rider). The book debuted at number three on The New York Times combined Print and E-book non-fiction list on October 25.

Kennedy attempts, and achieves, a “scrupulously honest” work; remarkable for someone who has, the better part of his adult life, struggled with honesty (during a 2009 stint in rehab – one of many – he said, “I found myself being unusually honest… for the first time, I blamed only myself for these situations”). Like a cresting wave, he gradually acknowledges his immaturity, insecurities, and illnesses. Next February will mark five years of sobriety for Kennedy.

The book is part memoir and part advocacy piece (Kennedy makes a compelling case for increasing the collaborative process of treatment and recovery and reducing the stigma of mental illness – what he calls the “politics of the brain”).  It is also part therapy for Kennedy who wonders “if being in elected office was, in fact, a big part of what was killing me. Or was causing me to kill myself.”

But the book is 100 percent redemptive. Through the process of self-discovery and the acceptance of of individual responsibility, Kennedy reveals the politics of honesty.

Kennedy believes that mental illness and addiction are “family diseases” – in so far as our genetics (inheritance) plays an important role and loved ones often suffer as much as the afflicted.

Kennedy also intimates a shared commonality with his family experience and those of ordinary Americans. But, as a scion of a wealthy and politically powerful family, much of his journey was wildly uncommon. After all, he was a politician setting public policy while simultaneously a patient (who could afford and had access to treatment most Americans would envy) interacting privately with a healthcare system he sought to reform.

And there was a surreal aspect to his experience: In November of 2009, as the House of Representatives was voting on its version of the Affordable Care Act, Kennedy found himself in rehab. He writes how then-House Speaker Nancy Pelosi “called and said she really hoped [he] could come back and vote.” Which he did. Afterwards, Pelosi said, “Thank you sweetheart, now you go right back to treatment.” Which he also did.

But Kennedy attributes much of his recovery today to embracing the 12-Step Program and a reduction of the staggering amount of medications he was actually prescribed.

The book excels, however, as an odyssey, where the intensely personal and intriguingly political history of mental health policy intersect.

He criticizes the distinctions between “intellectual disabilities” (those that manifest at a very early age and limit one’s ability to learn) and “mental illness” (which often does not manifest until triggered later in life); the latter was not deemed as serious, causing unintended differences in insurance coverage – what was defined as a lack of “parity.”

Kennedy recalls with an unnerving irony how, during the 1990s, mental health politics, science, economics, medicine and patient care were all advancing, even as his own health was progressively deteriorating.

He charts the rise of “off-labeling” (promoting and prescribing medications outside their legal approvals) in the wake of the efficacy and popularity of Prozac and OxyContin. Primary care doctors were excessively prescribing “psychoactive medications without having patients consult with mental health professionals.” And the Columbine school shooting in 1999 was a harbinger in the debate of gun violence and mental illness.

In keeping the family tradition of advocacy, in 2011 Kennedy founded One Mind (the future of brain research) and in 2012 he founded the Kennedy Forum (a “policy incubator” for the here and now). For instance, he questions the wisdom of widespread legalization of marijuana without “any medical policy” in place. And he looks to move those with “serious mental illness” to community-based treatment, not prison.

On February 29, 2000, at a public appearance in Woonsocket, RI, Kennedy inadvertently, disclosed that he had suffered from depression. His mother, Joan, who herself has endured unimaginable alcoholism and depression, was accompanying him. When questioned by a reporter about his admission, she responded, “People like honesty.” People will also like her son’s new found cause, commitment to recovery, and eloquent new book.

Contributing columnist James P. Freeman is a New England-based writer and former columnist with The Cape Cod Times. Read his previous columns here.