PROFILES in MENTAL HEALTH COURAGE

by Patrick Kennedy and Stephen Fried

(Dutton, 30 April 2024)

Interview by Anna Roins

Profiles in Mental Health Courage portrays the dramatic journeys of a diverse group of Americans who have struggled with their mental health. This book offers compelling stories about the bravery and resilience of those living with a variety of mental illnesses and addictions.

Several years ago, Patrick J. Kennedy shared the story of his personal and family challenges with mental illness and addiction—and the nation’s—in his bestselling memoir, A Common Struggle. Now, he and his Common Struggle co-author, award-winning healthcare journalist Stephen Fried, have crafted this new book sharing the untold stories of others—a special group who agreed to talk about their illnesses, treatments and struggles for the first time.

When Kennedy’s uncle, President John F. Kennedy, published his classic book Profiles in Courage, he hoped to inspire “political courage” by telling the stories of brave U.S. senators who changed America.

In Profiles in Mental Health Courage, former Congressman Kennedy adapts his uncle’s idea to inspire the “mental health courage” it takes for those with these conditions to treat their illnesses, and risk telling their stories to help America face its crisis in our families, our workplaces, our jails, and on our streets. The resounding silence surrounding these illnesses remains persistent, and this book takes an unflinching look at the experience of mental illness and addiction that inspires profound connection, empathy, and action.

In this collection, you’ll meet people of all ages, backgrounds, and futures, across politics and government, Hollywood and the arts, tech and business, sports and science—some recovering, some relapsing, some just barely holding on, but all sharing experiences and insights we need to better understand. You’ll also meet those trying to help them through—parents, siblings, spouses, therapists, bosses, doctors, and friends who create the extended families needed to support care and wellness.
 
The personal stories they share with Kennedy and Fried are intimate, sometimes shocking, and always revealing. Caregivers, family members, policymakers, and the public—just as those  who feel alone, may find solace in the book. We talked with co-author Stephen Fried, about the work.

AUTHORLINK: Hi Stephen. Thank you for joining us on Authorlink today to discuss the book you co-authored with Patrick J. Kennedy, a mental health advocate and former member of Congress. 

Stephen, you are an award-winning investigative journalist, non-fiction author, and Columbia University professor, who has written many articles and remarkable works of non-fiction.

You first helped Patrick write his memoir, A Common Struggle, 2015, which chronicled his struggles with mental illness and addiction. Patrick used himself and his family as an example of the stigma and confusion surrounding mental illness in the US and explained the history of mental illness and mental health policy in that context. 

How did you and Patrick decide to write his memoir, together?

FRIED: Patrick and I were introduced in early 2011 by a mutual friend, pharmacologist Dr. Raymond Woosley, who was involved with Patrick’s first big mental health advocacy effort after leaving Congress. I had written about Ray in my book Bitter Pills, which had brought attention to the world of pharmaceutical safety, and included a lot of reporting on mental health medication—including interviews with bipolar disorder expert Kay Redfield Jamison, who also knew Patrick and I. I was allowed to audit the public and private meetings of this advocacy effort but decided it was too soon to write about it, and we mutually decided not to move forward with anything. Then an editor at Philadelphia magazine heard I knew Patrick and asked if I wanted to write a profile of him, because he had moved from New England and into our readership area–South Jersey—but also because he had fallen in love with a schoolteacher there. That actually sounded like a better story than the conference, so I agreed to ask Patrick and his fiancée, Amy, if they would let everything I had already witnessed be on the record—and, if not, I understood and I wouldn’t do the story. Instead, they said yes, I did the piece—in which they were both enormously open, especially about Patrick’s addictions and mental health problems, and how they confronted them together. There is nothing I find more rewarding than mental illness and addiction stories where the reader can actually go deep into people’s experiences, and I am trusted with sensitive and uncomfortable truths. (When Kay Jamison had decided to “come out” about her own bipolar disorder before publishing her monumental “An Unquiet Mind,” she did it in an article I wrote for the Washington Post, and in my first book, about the model Gia, who had mental illness and opiate addiction, many of the people who took care of her in rehab and in outpatient methadone treatment spoke openly for the first time.) After the article, Patrick asked if I’d consider writing a book with him. I told him I would only if he would let me write it in a similar narrative to the magazine piece, and we would get people interested in the policy issues involved in mental health by intertwining their history and the mental illness and addiction history of Patrick and his family. We started doing interviews, and I asked him to request his medical records from everyone who had ever treated him, because I don’t like to rely just on people’s memory, especially with medical issues. (One of the first people Patrick and I ever interviewed together was his college psychiatrist, Peter “Listening to Prozac” Kramer.) It was a fascinating process.

AUTHORLINK: Your second book together, PROFILES in MENTAL HEALTH COURAGE pays homage to Patrick’s uncles’ book, Profiles in Courage (1956) by John F. Kennedy, (co-authored by his speechwriter, Ted Sorensen) which won the 1957 Pulitzer Prize for Biography. It was an inspiring book that profiled American political leaders.  However, Patrick once said, “Public narratives tend to be sanitized, glossing over those messy realities that many individuals grapple with every day, oftentimes alone. Our society desires these neat, linear descriptions, but the truth is, as you well know, mental health issues are far more intricate” – (Advocate, 22 MAY 2024). 

In your opinion, why do we often misunderstand what it is like to experience these diseases, and fail to support a friend or loved one ? How do you hope this narrative will change our perceptions, and why is this a timely message?

FRIED: I’ve been thinking about that very thing a lot—both during the writing of the book and since it came out. The simplest answer is that there is still so much stigma about these illnesses and discrimination against those who have them (and their families) that people are afraid,to tell the truth—and when they do admit to having a mental illness diagnosis or addiction, they usually only tell a tiny bit of the truth. Enough to feel they are being honest and support the cause, but not enough to really offer a deeper view of what having these illnesses means. And, in general, whether privately or in the media, we hear about these illnesses primarily from people who feel well or “cured,” or we are writing about the untimely death of someone with mental illness, substance use disorder, or both. There is an awful lot of unexplored emotional landscape between “I was diagnosed with depression/anxiety/panic and I’m fine now” and a funeral, after which many families never really talk about the mental health issues again. Patrick and I both felt very strongly that until mainstream America had a much better understanding of what it is really like to have these illnesses—the successes, the setbacks, the near-death experiences, the challenges in finding friends and loved ones who want to understand these treatable but mess conditions—all the smart policy advocacy in the world could never be successful. We also felt strongly that too much writing about these conditions are siloed, just like the clinicians and institutions that treat them. People want to say they have a mood disorder but not substance abuse, they have addictions but not underlying mental illness—to use vernacular we hear all the time, they are willing to say they are “crazy” or they are “addicted” (to drugs, alcohol, whatever) but rarely will admit to both.

I’m glad you feel the book is timely, but I often question if this should really be seen as a “timely” message, because these diseases, and our lack of understanding of them, are as old as recorded history, and certainly medical history. And, actually, each time they are written about, the excuse is that it’s “timely” because they are for some reason perceived as worse—when, honestly, I think the reality is simply that circumstances allow more people to perceive what is always there: mental illness, addiction, suicide and overdose, all of which society needs to diagnose, treat and prevent more actively.

We hope these stories address some of these issues, and also show how people and their friends, their spouses, their parents, their bosses, deal with these challenges, and what they can do to better understand, be more patient and more supportive. But it’s not a how-to book, or a policy book. It’s twelve unbelievably in-depth stories that make you understand and feel, from the narrative and in people’s own voices, just how hard it can be, but also how gratifying it can be when people do understand the situations better.

 AUTHORLINK: You analyzed public reaction to Olympic World Champion medalist, Simone Biles’ decision to pull out of the 2020 Tokyo Olympics to prioritize her mental health. Was this the idea that sparked your second book?

In your opinion, why hasn’t anyone taken an ‘up close and personal’ approach before? Why can’t we see mental health as an illness like cancer, where family and loved ones rally around to support?

FRIED: Patrick and I had said for a number of years after A Common Struggle that if we were to do another book it would be about other people’s stories. It just so happened that during the Tokyo Olympics we had a text exchange about how badly people were treating Simone Biles, how little they understood about what was going on with her, and also, frankly, how little she was able or willing to share—although we understood why. In the middle of this text exchange, I wrote to him “you and I should do a mental health/substance use disorder ‘profiles in courage’ book where we do fresh interviews with interesting people openly struggling and include some suicide and OD cases because their struggles were still courageous.” Patrick wrote back “I like it.” And so,we started reaching out to people who might help us connect to people who would tell their stories for the first time. We quickly realized it didn’t matter if the profile subjects were well-known or not—in fact, in many ways it was better they weren’t and that their stories were fascinating simply because they were fascinating.

I don’t think we are the first to take this kind of “up close and personal” approach. But I think, generally, this approach is primarily taken with famous people who “come out”—even if only a little bit—or after famous people have died from suicide or overdose. Also, there is writing people do about close family members with the illness or close friends. But we thought it was long overdue to just say these illnesses were as interesting and important to write about as all others—that there is the need for “mental health parity” even in storytelling and journalism—and that the learning curve we have seen in society on cancer, HIV/AIDS, heart disease, and other conditions once only whispered about could really help people support people with mental illness and addiction, as well as their families.

AUTHORLINK: After four years of the COVID-19 pandemic, stories about the mental health crisis in the United States continue to emerge. According to the Centers for Disease Control and Prevention (CDC), more than 1 in 5 US adults live with a mental illness.  Are family members of mentally ill overlooked?

FRIED: I think they are often overlooked, because just as people with the illnesses are scared to tell the truth about what they experience—for fear of being judged—their family members go through much of the same stigma, and are also afraid of betraying confidences, or sharing something they never shared with their loved one. And parents have the added burden of blaming themselves for largely biological conditions because they were taught, incorrectly, that these diseases come from bad parenting. And, in most journalistic settings, the journalist is thrilled just to have the cooperation of the person with the illness—they often don’t push to make sure family members and clinical professionals are included in the conversation and have permission to speak openly (which, for the clinicians, sometimes meant the patient signing releases.) Having done this kind of work my whole life, I viewed this book project as something that might allow breaking through of all these barriers: that a person who knew they were being interviewed by the country’s leading mental health advocate and a veteran mental health writer, and who also knew we expected to interview others in their lives, even if they weren’t always going to agree, might allow us to do a really special kind of medical and emotional investigative reporting. One person we were interviewing said, “I’m not speaking to my mother, but if you want to talk to her here’s her number.” In another case, one of the people we were interviewing had really blown up his life, in his law firm, as well as at MSNBC, where he had been an intern and had been mentored there by, among others, Rev. Al Sharpton. But he hadn’t spoken to any of them since his frightening bipolar psychotic experience and didn’t know how to restart that conversation. We asked if we could reach out to Sharpton, who Patrick knew, and tell him what happened. They ended up reconnecting initially only in the pages of the book, and then reached out to him after it was published.

AUTHORLINK: In the book, you propose that mental illness cannot be separated from addiction, and should be treated together. Is that from a DNA point of view? A life experiences point of view? Or both?

FRIED: As Patrick and others who have them both illnesses will tell you, they are both best understood and treated together as one complex continuum of diseases of the brain and mind. And for many characters in the book, their struggle has been to understand how mental illness fuels addiction, and how addiction can rarely be treated successfully without an understanding of underlying mental illness. In the earliest years of American health care, people with mental illness, addiction, epilepsy, developmental disability, or any combination of them, were all locked in the same dungeons and asylums because we had no useful treatments for anyone whose brain was significantly different. In the 20th century diagnosis improved before the development of treatments that were successful, and eventually psychiatry and the twelve-step world of rehab and sobriety created their own institutions and silos, followed later by the world of psychology, and the more moral treatment of developmental disabilities. Each of these worlds is separate and self-sustaining, which makes it challenging for patients and their families who want to know what combination of these perspectives can help them. I don’t think this is about DNA—we don’t really know enough about genetic treatments for these diseases, just how deeply inheritable the tendency toward them is. A big part of the problem is that people feel they need to understand where psychiatry ends and psychology begins, where neurology fits in, etc. These are all interesting things to think about, especially if you’re a scientist. If you’re a patient who just needs evidence-based help, relief, a chance to return to your regular life, you really don’t have the time and ability to navigate all these intellectual silos of thinking. Patrick and I can’t solve the age-old questions of nature or nurture, or a hundred other questions about how to separate mental illness and addiction—and part of the idea of the book is to show how people who just want smart medical care get caught up in these theoretical debates, which are part of what fuels even their own self stigma, and can put people at risk.

AUTHORLINK:  Many accomplished people are portrayed in the 12 selected stories. For instance, we read about Henry Platt, a singer from a high-profile family in entertainment, and his journey with depression while attending the University of Pennsylvania. He revealed to your readers that he was able to stand up to the school’s president and advocate for more adequate mental health resources for students when, at the time, the university didn’t have therapists on weekends, and long wait times during the week. Penn’s national reputation for mental health was very poor. His story encouraged the University to change its policies and create a ‘Chief Wellness Officer’ position.  How many other changes have occurred as a result of this book

FRIED: We were really happy to have Henry’s story in the book. I went to college with his parents, and had heard a little bit about his struggles from his mom at one of our class reunions. We didn’t know Henry had confronted the president of the university—it just came out in the interviews. We also didn’t know how being the younger brother of actor/singer Ben Platt had been for Henry, especially since “Dear Evan Hansen” was still on Broadway when Henry was going through his difficult freshman year. Henry just told us these stories because they were part of his experience, and what we learned from him, and all the other people in the book, is that all they wanted was for people to understand what was really happening with them—but also be in a place where they could really hear and empathize with their stories, and not judge them, or immediately tell them “well, if you had just done x y or z thing everything would have been fine.” I think one thing we learneddoing the book and others learn reading it, is when people share really true stories, they are NOT looking for your insight, criticism, advice or pep talk. They just want to be heard, their experiences acknowledged, along with the lack of an easy solution to their medical challenges. I think Patrick and I learned a lot about how to help people take what they consider their “lived experience”—which is often a first draft of what really happened to them, and what is still happening—and turn it into storytelling that helps the reader become more interested and empathetic, and more humbled that there are no easy answers.

AUTHORLINK: Speaking of which, you attended the University of Pennsylvania.

Did you ever feel there could have been more support for struggles in mental health while you studied there? 

FRIED: I did go to Penn, and I am fortunate to teach there (as well as at the medical school at Columbia.) One course I teach there is on writing about mental illness and addiction, so I hear from a lot of students about what they feel could be better about mental health services at the school, but also their mental health services from home and how their families handle their illnesses. Penn has been through a learning curve like many colleges and universities on how to handle mental health—everything from increasing access to services 24/7 to changing the rules for medical leaves. I think Penn got demonized somewhat for its handling of these issues because there were access and waiting time issues, and the administration often struggled with how to inform the university community of tragedies. But I will also say that the way too many journalists cover mental health, and the public views it, is there has to be a “worst” place so we can pretend all the other places are a lot better. One of the themes of this book, in relationships and institutions, is the need to stop making people and institutions the enemy, and instead focusing on the diseases as the enemy.

AUTHORLINK:  We love the topics for your magazine articles and your non-fiction books. They are inspiring. How do you settle upon a new book idea and what’s next for you?

FRIED: I was lucky to grow up at magazines—regional and then national–that appreciated writers who were interested in a lot of different subjects, and could go deep in many kinds of journalism, in the third person or first person (anything but second person). Then after 9/11, I also found myself getting interested in narrative American history books. So I usually have a narrative history book and a contemporary book—often medical—that I’m working on at the same time, which is fun and mentally energizing, but sometimes a little confusing to my Penn student researchers. It’s also sometimes a little challenging to know what section my books go in on store shelves. But I like the variety and the challenge. Before Patrick and I agreed to do PROFILES, I was already working on a new historical biography for Hachette of William Gibbs McAdoo—a complex and astonishing figure in early 20th century America and progressive politics, who dug the tunnels under the Hudson River to first connect New York and New Jersey by train (we still use his tunnels and system, it’s called the PATH trains) and then became the most powerful and controversial Secretary of the Treasury since Alexander Hamilton. During peacetime he started the Federal Reserve Bank, he shut down the stock market to keep it from being destroyed by the onset of war, and he married the president’s daughter, which made him and the family life of the Wilson White House especially interesting. When America joined the war, he almost single-handedly raised the money to pay for it—not just the billions America spent, but the billions it loaned England, France and Italy so they could afford to fight. He should have been elected President in 1920—you’ll have to read the book to find out why he didn’t, but how he later helped get his friend Franklin Roosevelt elected, and many of his ideas fueled the New Deal. When he died, his obit was on the front page of the New York Times, which lauded him for “anticipating by twenty years the social and economic responsibilities of government which everyone now accepts.”

AUTHORLINK: Fascinating! Last question and just for fun. What is your perfect writing environment? And if you could invite anyone for drinks after work, living or dead, who would they be, and what would you drink,  and who would be your guests?

FRIED: I can write anywhere there’s a desk and internet—so I can go down as many research rabbit holes as possible. But I have a wonderful office on the first floor of our home in Philly (my wife, fiction writer Diane Ayres, also my primary editor, works on the third floor and we meet on the second for dinner), I can write at our family beach house on Long Beach Island, NJ (as long as the family isn’t there), and for decades we also wrote in a cabin in the mountains above Pecos, NM, at a restored fishing compound called Tres Lagunas. But the friend of ours who loaned us the cabin sold it. So I’m still looking for a place to write in New Mexico, because that’s our home away from home. As for drinks after work, I’m not the biggest drinker—very straightforward lagers and clean Irish Whiskeys or Ryes—but I would drink with my writer and ex-writer friends as I normally do, and my imagined drinking companions would be my father and my mentors Nora Magid, a longtime New York magazine editor who ended up teaching at Penn, and Ed McFall the former UPI bureau chief in Philly. And, as they did in life, my father and Ed would drink me under the table.

AUTHORLINK: Ha, ha, ha. That’s gold! Stephen, thank you so much for sharing your time and thoughts with us at Authorlink! We  look forward to your next book.

About the Authors:

Patrick J. Kennedy is a former member of the U.S. Congress, the nation’s leading political voice on mental illness, addiction, and other brain diseases, and the New York Times bestselling co-author of A Common Struggle. During his sixteen-year career representing Rhode Island, he fought a national battle to end medical and societal discrimination against mental illnesses, highlighted by his lead sponsorship of the Mental Health Parity and Addiction Equity Act of 2008—and his brave openness about his own health challenges. 

Soon after his father, Senator Edward “Ted” Kennedy, passed away, he left Congress to devote his career to advocacy for mental health. He has since founded The Kennedy Forum, which unites the community of mental health, and co-founded One Mind for Research, as well as other non-profit organizations addressing these issues. He lives in New Jersey with his wife, Amy, and their five children.

Stephen Fried is an award-winning journalist and New York Times bestselling author who teaches at Columbia University Graduate School of Journalism and the University of Pennsylvania. He is, most recently, the author of the historical biography Appetite for America, and the co-author, with Congressman Patrick Kennedy, of A Common Struggle. His earlier books include the biography Thing of Beauty: The Tragedy of Supermodel Gia and the investigative books Bitter Pills and The New Rabbi. A two-time winner of the National Magazine Award, Fried has written frequently for Vanity Fair, GQ, The Washington Post Magazine, Rolling Stone, Glamour, and Philadelphia Magazine. He lives in Philadelphia with his wife, author Diane Ayres.