A Common Struggle

Patrick J. Kennedy, a former US Congressman from Rhode Island and the son of Senator Edward "Ted" Kennedy, chronicles his lifelong experience with bipolar disorder, addiction, and anxiety in this memoir while tracing the political history of mental health advocacy in the United States. The book interweaves Kennedy's personal struggles with the legislative fight for mental health parity, a legal mandate requiring insurance companies to cover mental illness and addiction on equal terms with physical illness.

The memoir opens with the event that forced Kennedy's private struggles into public view. In early May 2006, he crashed his car into a police barrier outside the US Capitol at 2:30 A.M. after mixing the sleep aid Ambien with the anti-nausea drug Phenergan on top of his other medications. He had no memory of the incident. Capitol Police quietly took him home, but when the story broke, his father dismissed it as "a little fendah bendah," urging him to downplay the situation. Instead, Kennedy admitted everything publicly and checked into the Mayo Clinic for rehab. That September, he and Republican Congressman Jim Ramstad gave a joint New York Times interview about their recoveries. His father's fury at this openness reflected the family's ingrained code of silence, but when his cousin Maria Shriver defended Patrick's candor at a family gathering, Kennedy committed to breaking that silence.

Kennedy traces the roots of his family's advocacy to his Aunt Eunice Kennedy Shriver, who in the 1950s redirected the Joseph P. Kennedy Jr. Foundation to help people with intellectual disabilities, inspired by her sister Rosemary. Rosemary was born with a developmental disability and in 1941 received a lobotomy ordered by their father that worsened her condition. Eunice launched a 1962 summer camp that grew into the Special Olympics and publicly revealed Rosemary's condition, beginning the Kennedy tradition of using family health struggles for advocacy. President John F. Kennedy signed the Community Mental Health Act in October 1963, three weeks before his assassination. Kennedy argues, however, that the law closed large institutions without funding replacements and inadvertently contributed to mass incarceration of people with mental illness.

Kennedy describes growing up in a household shaped by untreated illness. His mother, Joan, had alcoholism and spent much of his childhood isolated and drinking. His father likely had undiagnosed post-traumatic stress disorder after the assassinations of his brothers but self-medicated with alcohol. Born in 1967 as the youngest child, Kennedy grew up amid cascading crises: Bobby Kennedy's 1968 assassination, the 1969 Chappaquiddick accident that killed Mary Jo Kopechne, and Joan's miscarriage. Patrick's severe asthma became his "safe zone" because attacks were the only thing that made his busy father drop everything. Joan joined Alcoholics Anonymous in 1977 but was betrayed when fellow patients sold stories to tabloids. Ted's 1980 presidential campaign ended at the Democratic National Convention with the declaration that "the dream shall never die." President Reagan's dismantling of the Mental Health Systems Act and the "Just Say No" campaign reinforced the idea that addiction was a character flaw, setting back policy for a generation.

Kennedy's illness deepened in adolescence. At Andover, he was severely impaired by depression, sleeping up to seventeen hours a day. His cousin David Kennedy died of a drug overdose in April 1984. In March 1986, Patrick ran out of cocaine during spring break and called his parents in distress; his father's aide arranged rehab at Spofford Hall in New Hampshire, but Kennedy was discharged after ten days. He transferred to Providence College, where he began seeing psychiatrist Dr. Peter Kramer, who later wrote Listening to Prozac and focused therapy on helping Kennedy mature and take responsibility.

Shortly after spinal surgery to remove a benign tumor, Kennedy ran for the Rhode Island state legislature at twenty-one, still wearing a neck brace, after his father remarked that Rhode Island would be "great politically." He later reflected that the decision may have been partly manic. He won, defeating a five-term incumbent, and in 1994 won a US House seat at twenty-seven. On the Appropriations Committee, he controlled budgets for nearly every federal agency affecting brain disease while privately hiding his bipolar disorder and substance use.

The legislative history of mental health parity forms a major thread of the narrative. In 1996, Republican Senator Pete Domenici and Democratic Senator Paul Wellstone made deeply personal speeches about their families' experiences with mental illness, leading to the first Mental Health Parity Act, which was limited and excluded substance use disorders. Kennedy was offered chairmanship of the Democratic Congressional Campaign Committee in late 1998 on the condition that he stop drinking; he agreed but began abusing OxyContin, a powerful prescription painkiller, instead. In February 2000, he spontaneously admitted to being treated for depression, his first public acknowledgment of mental illness. After 2001, he devoted himself to parity legislation while privately deteriorating. His sister Kara was diagnosed with lung cancer, and Wellstone was killed in a plane crash in 2002, devastating the movement. Kennedy was secretly admitted to multiple rehab facilities, including the Mayo Clinic, where he first experienced cognitive behavioral therapy.

The 2006 crash was caused by medication interaction, but Kennedy recognized it as his chance to tell the larger truth about his alcoholism, addiction, and bipolar disorder. Ramstad, a fellow person in recovery, became his AA sponsor, visiting every Saturday during his twenty-eight-day stay at Mayo. Together they drafted a House parity bill covering all mental illnesses and substance use disorders, while Ted Kennedy and Domenici sponsored a narrower Senate version excluding addiction. The House passed the bill 268 to 148 in March 2008, with Ted coming to the floor to sit beside his son. In September 2008, with the economy collapsing, Senator Chris Dodd, a longtime Kennedy family friend, engineered the combination of the parity bill with the bank bailout legislation, ensuring it could not be voted down. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act passed on the last day of the session.

Ted Kennedy was diagnosed with brain cancer in May 2008 and died on August 25, 2009. Patrick fought to deliver a eulogy at the nationally televised funeral, and a posthumous letter from his father validated his decision. His last term in Congress was marked by continued substance use and rehab stays. House Speaker Nancy Pelosi arranged for him to leave rehab to vote on the Affordable Care Act (ACA), then return immediately. He announced he would not seek reelection, and after the ACA passed, visited his father's grave at Arlington National Cemetery, leaving a note: "Dad, the unfinished business is done."

In March 2010, Kennedy met Amy Savell, a junior high school teacher. After a turbulent courtship, he left Congress and entered detox. Living with Amy's parents, he attended twelve-step meetings and ran daily. On February 22, 2011, his father's birthday, he committed fully to sobriety. They married that July at the Kennedy compound. Kennedy co-founded One Mind for brain research collaboration and the Kennedy Forum for parity implementation. His sister Kara died suddenly at fifty-one in September 2011, and their son Owen was born in spring 2012. The final parity rules were not issued until November 2013, over five years after the law's passage.

The book closes with Kennedy acknowledging the chronic nature of his diseases and the recent suicide of a friend, a reminder that recovery requires daily vigilance. He presents a National Behavioral Health Platform with twelve priorities, including universal mental health screening, tripled brain research funding, and enforcement of parity through insurer transparency.