Tuesday, October 13, 2015

"A Common Struggle", a book by Patrick J. Kennedy and Stephen Fried

"A Common Struggle" is a book about addiction and recovery, the mental health care system, and the laws that govern that system.  It is also a story that follows much of former U.S. representative Patrick Kennedy's political and personal life and tangentially that of some of his family.

As the book begins one could think, "oh my God, he really did write this book", as much of the beginning chapters are filled with simple childhood remembrances.  The book really has two intertwined parts.  The first is a story of one Kennedy and his immediate family, as told by Patrick. The second is a study of addiction recovery, and the flaws in the healthcare system that make the best information and care difficult to find.  To quote the book, "Mental health parity and addiction equity isn't only about fair and equal insurance coverage.  It's about the world of mental illness treatment and the world of addiction treatment --- each of which grew from what felt like a specific form of being ostracized by society --- working together much more effectively."  This aspect of the book no doubt echoes Patrick's thoughts and benefits from the talented journalist Stephen Fried who has covered healthcare, mental health, and addiction for much of his career.

There were observations for the reader that may not be widely known due to the split between the two supposed different disciplines of treating mental health and addiction.  It was pointed out that the recurring cycle of addiction is similar to the cycle that exists in bipolar II, a less crippling form of bipolar disorder than what is now known as bipolar I.  In fact, when described in the book, the swings between depression and hypomania referred to elicited the observation from Patrick, "That's me."  As an interesting aside this type of hypomania was mentioned as "often sometimes hyperproductive". Put that disorder next to alcohol, oxycontin, or another drug and the effect is exacerbated, on the ups and downs.

When a patient with concerns discusses a potential addiction problem with an internist or other medical professional, they are often told that they are "self -medicating".  Self medicating what, one could ask?  Yet more often that not when consulting a psychologist or psychiatrist for the answer to that question, the only playbook that comes out is the one for treating addiction with the few drugs related to that, and the emphasis on AA, NA, or other twelve step programs.  There can also be the guilt attack method of treatment, as favored by supposed remedy stalwarts like Hazelden.  The possibility of co-existing mental health diagnoses are often, or largely, ignored.  "A Common Struggle" takes on this anomaly in treatment directly and thoughtfully.

Patrick Kennedy was an active and, in the area of mental health in particular, an effective congressman.  At the same time, he was going through the hard work of disguising and hiding his various addictions, most prominently to alcohol and oxycontin, but also including at times cocaine, adderall, and other medications, prescribed or otherwise.  He had multiple visits to the Mayo Clinic and other treatment and rehab facilities, all carefully guarded by his staff and his family.  He had sober periods and then relapses.  As he writes, "like many of us struggling with addictions, just when things begin to look promising, we sometimes sabotage ourselves."

As the book says at the beginning Chapter 18, a passage which works metaphorically so well that the professional writer Fried must be responsible, "Both addiction and depression come in cycles of waves, which you think you have adjusted to until a bigger one knocks you down.  It isn't all that revealing to chart how the last wave hit; it's more important to understand what you were doing out there in the water in the first place."

Kennedy's biggest public "wave" moment came in May 2006 he ran into a police barrier in front of the Capitol building at 3:30am one night, and it became national news.  Apparently in this case it was due to a combination of his usual medications, a large dose of Ambien as a sleep aid, and a just prescribed medication for stomach problems.  He had, and has, no memory of the accident or what preceded it.  The accident led to an examination of his addiction problems, and he openly and honestly discussed them with the press.

That was not the end of his problems, but it was perhaps the beginning of the end.  After 16 years as a representative, he left Congress at the end of 2009 not long after his father's death.  After that he began a relationship that turned into marriage in 2011 and a family, while beginning a period of sobriety that lasts to this day.

This was a book that was enticing here but for which there were no high expectations.  While all of the writing is not perfect and some of the broad Kennedy information about their privileged family is at times tangential to the purpose of the book, in fulfilling that purpose "A Common Ground" is exceptionally well done. What a surprise, and a good one.  The collaboration between Kennedy and Fried most certainly worked.

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