Patrick Kennedy on Mental Illness and Treatment

This year’s Rosalynn Carter Symposium on Mental Health Policy focused on the question of how to help veterans — centering on the National Guard and reservists — reintegrate within their community when they come home. The Guard and reservists have an especially difficult time, because they are outside the usual military structure of benefits and services (although more recently, some benefits have been extended to them because of the extended fighting in the two wars the U.S. has been engaged in in Afghanistan and Iraq).

The two-day meeting presented views, personal stories and data on three main themes of veterans’ “reintegration” — within the family, the workplace and the community. It also offered the opportunity to learn about dozens of great service programs around the country that are reaching out and trying to help this group of returning soldiers (during a poster session).

Today, I’m going to focus on the beginning of the symposium, because of Rep. Patrick Kennedy’s energetic opening remarks to the group.

This year’s meeting started off with some moving photographs from freelance documentary photographer Nina Berman, as well as the usual warm and personal welcome from the former First Lady herself, Rosalynn Carter.

Then Congressman Patrick Kennedy (D – Rhode Island), son of the late Senator Ted Kennedy, took the stage to offer opening remarks to the meeting.

Patrick Kennedy has had his own troubles with substance abuse and depression in his life, and decided earlier this year not to seek re-election.

The older background history here is also interesting, because President Jimmy Carter had to run against Ted Kennedy in the Democratic primary in the election of 1980. Some point to the heated primary contest between the two men contributing to President Carter’s losing his bid for re-election that year.

Adding proverbial fuel to the fire were President Carter’s remarks earlier this year after the publication of a new book that detailed his diary entries while president. Carter attributed the lack of movement in three decades on government healthcare reform to Ted Kennedy. So you might think that — given this history — Patrick Kennedy might be reluctant to speak at a Carter event.

I’m glad he did, though.

The speech Patrick Kennedy gave was forceful, thoughtful and rousing, and regularly invoked war imagery to spark our imagination in the “fight” against mental illness. I’m not much into political dynasties, but after hearing him speak, I can understand why the Kennedy’s have had such a long and successful run in politics.

“When we say combat operations are over, we mislead our citizens to say the fight for our soldiers is over,” Rep. Ted Kennedy said. “Why are we leaving our solders prisoners of war? Prisoners of their war injuries like TBI (traumatic brain injury) and PTSD (post-traumatic stress disorder).”

“[Our veterans are] held hostage by depression, addiction. They’re held behind enemy lines by stigma. To them, it’s a moral failure,” Kennedy said. “Alcoholism, lashing out at their spouse… These are just the symptoms.”

“When we talk about ‘mental health,’ we re-stigmatize these disorders. Separate but equal. You have this [mental health] issue, you go over there to this other system. [It’s like] Plessy versus Ferguson — separate but equal.”

Patrick Kennedy has a point. We have two separate systems in the U.S. — one that deals with the physical health problems, and one that deals with the mental health problems. These two systems are so separate, many physicians aren’t even aware of how the mental health system works. There is very little coordination of care unless a specific professional or patient works hard for it.

He ended his speech with a challenge: “We need a new mission to the moon — a ‘moon shot’ to the brain. How are we going to get there? Let’s map the genetic markers. Let’s get the sequencing to every neurological disorder.”

Good ideas in theory, but it looks like we’re chasing ghosts when it comes to nailing down the genes of mental illness. In most of the disorders studied over the past two decades, mental disorders seem to come from hundreds of mutations on dozens of genes, with little rhyme or reason to them. The evidence today suggests we will never find clear genetic markers for mental illness because they may not exist.

But does that mean we shouldn’t try, or that we shouldn’t pursue other avenues of potential treatment and research? Of course not. Researchers are doing that right now, and indeed, it would be nice to see more funding poured into that effort. Rep. Kennedy suggests that new funding sources won’t come from the NIH, whose budget is capped by discretionary spending limits, but from the Department of Defense and the Department of Veterans Affairs, because their budgets are virtually unlimited.

It makes sense. To help the wounded warriors who return not just from this war, but from future wars too, we may need to get far more aggressive in our research. We need to advance treatment faster than it has advanced in the past 10 years (which is to say, very little at all).

It took courage and conviction to speak so forcefully on these issues as Patrick Kennedy did on Wednesday, and his speech resulted in a rousing standing ovation when it was over. He came to motivate and energize the policy-makers in the room that day, and I think I can safely say — mission accomplished.