America’s Longstanding Mental Health Crisis

In 1956, my uncle John F. Kennedy, then a U.S. senator, wrote a book that is probably more famous for its great title than its contents. It was called “Profiles in Courage” and it was about eight U.S. senators who JFK felt had made particularly courageous contributions to American history.

For a while now, I have been thinking about what courage means to me. While growing up with my father, Ted Kennedy, in the Senate, and then serving in the House of Representatives myself for many years, I saw quite a bit of bravery in politics. But the truth is, the most courageous people I know qualify not for what they do in public but what they are able to endure and rise above in private. This is especially true of people who struggle every day with mental illness, or addiction, or both, or who help loved ones or family members in their struggles.

The details and daily dramas of these struggles usually remain private, hidden. And even when people discuss them publicly, it’s often in a brief or very cautious way—enough to admit to having a diagnosis or a problem, or “issues,” in order to support advocacy, but rarely enough to inform a public that wants and needs to understand what living with these illnesses is like every day. When I was younger, and first outed for substance use disorder treatment in the tabloids by someone I was in rehab with, I thought this was all harder for people in the public eye. But I have since learned better: we all live with the same stigma, and pay the same price for our silence.

We often quote the statistic that, at any given time, at least a quarter of all Americans struggle with mental illness, substance use disorder, or both. And while these are still sometimes viewed as two separate illnesses—because two distinct worlds developed to address them—I can tell you as someone who has them both that they are best understood and treated together as one complex continuum of diseases of the brain and mind.

Unfortunately, the percentage of people affected by these illnesses is likely quite a bit higher than 25%. And the percentage of those who don’t feel comfortable and supported enough to be open about their experiences is much, much higher, as is the percentage of those who cannot access or afford evidence-based care and support.

This is an age-old problem. You only need to look at the historic figures JFK wrote about in Profiles in Courage to see it. At least half of them, going back to the earliest days of post-revolutionary America, were known to have struggled with mental illness or addiction, or had the struggle for mental wellness profoundly affect their families.

John Quincy Adams—whose story first inspired JFK and his co-author, Ted Sorenson, to write Profiles in Courage—was nine years old when his father signed the Declaration of Independence, 29 when his father became president, and 35 when he himself became a U.S. senator. John Quincy lost both of his younger brothers to alcoholism, beginning with Charles at age 30. His father also suffered from depression, especially after the trauma of losing Charles and losing the presidential election to his friend Thomas Jefferson— all during the same week in late 1800. John Quincy’s oldest son, George Washington Adams, suffered from depression and took his own life at the age of 28—just two months after his father’s presidency ended in 1829. Not long after learning of his son’s death, John Quincy vowed to use his “remaining days” for good works “tributary to the well-being of others” and soon became the first ex-president to rejoin the government as a congressman. But he continued to experience tragedy from mental illness. In 1832, his remaining brother, Thomas, died from complications of alcoholism at the age of 59. And two years after that, his own son John died from the same thing at the age of 31.

Among the other seven JFK profiled, Massachusetts lawyer and politician Daniel Webster suffered from alcoholism and died from cirrhosis of the liver in 1852.

Sam Houston, a key figure in Texas independence—and the state’s first president before becoming a senator—had a well-known battle with alcoholism and either depression or bipolar disorder. He may qualify as the nation’s first case of political mental health stigma. His nickname among the Cherokee, with whom he had been close since childhood, was Oo-tse-tee Ar-dee-tah-skee, or “Big Drunk,” and his drinking was an open, caustic issue in his public life. His third wife—who he married when she was twenty-one and he was forty-seven—made it her mission to help him remain sober, but his political adversaries continued to publicly shame him.

Lucius Lamar, the U.S. senator from Mississippi, was only nine years old when his namesake father, a prominent Georgia judge, took his own life, just days before his 37th birthday in 1834. He reportedly “entered his house, wrote a short farewell note to his family, and walked into the garden and shot himself in the head with his pistol.”

And these are just the ones we know about and can begin to document.

Each time a new statistic is released regarding the state of mental illness diagnoses, addictions to drug or alcohol, overdoses, suicide attempts, and completed suicides, it is followed by a call for a “new appreciation” of these illnesses, a “paradigm shift.” But part of the paradigm we need to shift is the idea that these are new problems. If there is anything truly new about them, it is how much incrementally worse they have gotten because we have not done enough as a society to address them. Nor have we made sure that the treatments we already have, which aren’t perfect but still can save lives, get delivered to most of the people who need them. Those treatments—which all work but have been proven to work best together—are medical therapies, talk therapies, and healing relationships (everything from recovery and support groups to faith groups). Even those getting some form of treatment might not be getting the most evidence- based or complete treatment, and there is often quite a difference between what is “approved” or “legal” and what is ideal.

None of this should be surprising. But somehow it still is. Our nation is experiencing perhaps its most pronounced crisis of mental illness and substance use disorders in history; already-high depression and anxiety rates rose another 25% worldwide after the first year of the COVID-19 pandemic. Yet, too many of us still don’t understand what the experience of having or treating these diseases is like.

In our society, you don’t have to have cancer, or heart disease, or diabetes, to understand the basic dynamics and challenges of living with these illnesses. Their treatment has become part of our culture, openly discussed and encouraged. But when it comes to diseases that affect the brain—cognition, mood, thought, impulsivity, self-destructiveness—we are surprised again and again, or ignorant in a way that isn’t just unsupportive but can be downright dangerous.

If you or someone you know may be experiencing a mental-health crisis or contemplating suicide, call or text 988. In emergencies, call 911, or seek care from a local hospital or mental health provider.

Reprinted from “Courage to Change” by Patrick J Kennedy, to be published on 04/30/2024 by Dutton, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright (c) 2024 by Patrick J. Kennedy.