Abstract
I agreed to review former congressman Patrick Kennedy’s new book, A Common Struggle (with coauthor Stephen Fried), out of respect for his many contributions to the field of behavioral health. I expected to browse the major sections and provide some respectful comments. I did not expect to be so engaged, informed, andmoved by the story. I ended up reading it cover to cover. The book reads very much like one of those movies that examines the same important event from several different perspectives. In this case, events in the former congressman’s life are examined simultaneously from three unique perspectives: a patient who has continuously suffered from physical illness (chronic pain and asthma), mental illness (attention deficit hyperactivity disorder and bipolar disorder), and substance use disorders (alcohol, cocaine, and opioids) since his early teens; a scientific historianpresenting an informed and detailed history of the major research discoveries in the behavioral health field over the past quarter-century and their impact (or lack of it) on health care; and a political insider describing thebehind-the-scenes intrigues associated with the major policy changes associated with mental illness and substance use disorder. The subject matter and the unique perspectives of the book alone make it worthwhile reading. But, in addition, the text was truly engaging and at times dramatic. Yes, part of the interest was because the protagonist is a Kennedy, but the book offers no titillating revelations. What held my interest were the remarkable and continuing contrasts and ironies throughout the book. An inescapable irony for me was the fact that Kennedy had unlimited access to the “best” doctors and medical teams to treat his illnesses—yet even the best available carewas almost never integrated or even coordinated to adequately address his mental, physical, and substance use illnesses. In the end, he has gottenbetternotbecauseof, butdespite, the care he received. The famous2006automobile accident that led to the congressman’s admission that he had long battled bipolar disorder and addiction was also a study in incongruities. First, this accident was one of the few he had that did not involve alcohol or illicit drug use but was instead caused by a serious interaction of two medications prescribed to treat his illnesses. Second, Kennedy’s public admission pierced the “secret” of his substance use that had been considered necessary to preserve his career—and the family name. Instead, revealing that secret was critical to the preservation (although not immediately) of Kennedy’s health, important legislative successes, and stable recovery with a fulfilling marital and family life. The ironic crescendo was the recounting of the period surrounding the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This act that ultimately created far greater access to behavioral health care for Americans was created and coaxed into law by Kennedy and his father, Sen. Ted Kennedy, during a time marked by very serious episodes of mental and substance use illnesses for both of them. The resulting act might be the most important personal rights legislation since the Americans with Disabilities Act of 1990. The behind-the-scenes father-son struggle between the Kennedys over the breadth of coverage of the lawmade this part of the book particularly dramatic. There are a lot of lessons here. The first involves the limits on the prognostic ability of the field of mental health and substance use treatment.Howmany clinicians would have bet on a favorable prognosis for an early-onset case ofmultiple, chronic substance use disorders, complicated by serious physical and mental illnesses? How many employers would risk hiring a youngman with this background? How many families would want their daughter to marry a person with such a history? The second lesson is heartening for clinicians and families alike. Even severely affected individuals can triumph over daunting obstacles and potentially debilitating conditions. At this writing, Patrick Kennedy has several years of solid, stable recovery from these myriad health problems. He was and remains the youngest congressman ever “hired” (repeatedly) by the citizens of Rhode Island (he was just twenty-one when elected to the Rhode Island House of Representatives). And he is a very happily married father of four children and continues his long history of public service through the Kennedy Forum, founded in2013 andaimedat improving the lives of people living with mental illness and addiction. And the final lesson for this reader was that, yes, there are significant benefits to being born a Kennedy—but it’s not for the faint of spirit. ▪
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