From Eisenhower to Kennedy: Why the fight for wellbeing is still uncomfortable
Stigma has eased around individual mental health, but society still struggles to name the systemic drivers of our pain.
The John F. Kennedy Center for the Performing Arts is the kind of place you dress up to visit. The red-carpeted, marble-walled landmark is known for its elegance and formality. But last week, a former U.S. congressman shed the pretense to talk about his raw, chaotic journey with bipolar disorder and addiction. He told a story about visiting the emergency room to get stitches for his hand. A recovering addict but not asked about it by the nurse, he volunteered that he’s “allergic” to opioid painkillers. When she inquired about his symptoms, he replied, “I might break out in handcuffs.”
The messiness of Patrick J. Kennedy’s past might have seemed out of place at the Kennedy Center if not for his family name. Yet his culture-shifting candor and 13 years of continuous sobriety are what embody the vision of past presidents who set the stage for him even before he was born.
In 1953, President Dwight D. Eisenhower declared mental illness as one of America’s “most difficult and costly problems,” establishing National Mental Health Week to recognize it. Five years later, he signed the National Cultural Center Act to build an “artistic Mecca” in the nation’s capital. It ultimately became the Kennedy Center, renamed as a “living memorial” to the young president following his November 1963 assassination. A month before his murder, the last bill JFK ever signed was the Community Mental Health Act. He said people with mental illness and intellectual disabilities “need no longer be alien to our affections or beyond the help of our communities.”
More than a half century later, individuals don’t face as much stigma for talking about mental illness, thanks to the personal stories of people like JFK’s nephew, Patrick, Olympian Simone Biles, entrepreneur Andy Dunn and actors Constance Wu and Mark Duplass to name a few. But the United States as a political and social system still inherently treats millions of people like it is their fault for getting sick.
Building a movement
Kennedy’s approach has helped immensely, yet it is only one part of the effort. As an advocate, he’s focused on telling his story and that of others, mobilizing public and private allies and pushing insurers — and the government — to treat mental and physical health equally. At the Kennedy Center on Sept. 24 and 25, he was joined by about 400 health providers, activists, entrepreneurs, philanthropists, government leaders and the CEOs of leading advocacy groups including the Kennedy Forum, the National Alliance for Mental Health, the National Council on Mental Wellbeing and Mental Health America. The heavy hitters.
Dubbed the Alignment for Progress, a take on JFK’s Alliance for Progress, they are rallying around an ambitious goal. By 2033, they are aiming for 90% of the U.S. population to be screened for mental health and substance misuse issues, 90% of diagnosed individuals to receive treatment, and 90% of people treated to manage their symptoms effectively. (Read my Washington Post column about the movement’s roots here.)
In 2023, just 45% of U.S. adults diagnosed with a mental illness and 6.5% with a known substance use disorder received treatment, according to Mental Health America. Setting high benchmarks is helpful to catalyze funding and support to improve these numbers. That’s what the United Nations did to fight HIV/AIDs. But it carries risks, too.
The 90-90-90 mental health targets invite the possibility of prioritizing numbers over quality, potentially lowering the standards for screening and care. And they place an emphasis on treating symptoms rather than the root causes of people’s problems. We can and must do both.
The roots of stigma
Mental illness and addiction are public health threats, yet the U.S. still hasn’t found the collective will to prevent them. This is like refusing to clear the dry brush, then blaming the forest for the fire.
Why do we do this? If I’m generous, it’s because most people are just starting to understand that these are complex biopsychosocial issues influenced by genetic, psychological, and environmental factors, not personal moral failings. If I’m realistic, it’s because excavating painful truths requires having difficult conversations that people feel threaten their peace, power or money.
Let me explain. Upstream barriers like discrimination based on race, gender or sexual orientation, and limited educational and job opportunities, often lead to chronic stress, exacerbating mental health risks. Trauma, particularly adverse childhood experiences, significantly increases the risk of substance use disorders as people may turn to drugs or alcohol to manage emotions and pain. And high stress events, as well as genetic factors, neurochemical imbalances and structural brain anomalies, play a role in the onset and exacerbation of brain disorders like schizophrenia and bipolar disorder.
Addressing controversy
Most people publicly agree on high level talking points — mental health is health; teen suicide is a nonpartisan issue — but when it comes to making these words a reality, to addressing these upstream barriers, it suddenly gets complicated.
Case in point: The Biden administration recently issued new rules to expand access to care by strengthening the Parity Act that Patrick Kennedy championed and President George W. Bush signed in 2008. This is a victory for the Alignment for Progress and all Americans who want insurance to cover their bills for therapy or crisis intervention. But, backstage at the Kennedy Center last week, when I spoke with Oklahoma’s commissioner of Mental Health and Substance Abuse Services, she noted there’s no guarantee these new regulations will be fully implemented. If former President Donald Trump is elected, he can reverse his predecessor’s policies. The last time he was in office, Trump dismantled President Barack Obama’s signature achievements. So, the commissioner, Allie Friesen, told me she’s focusing on what she can do within the existing law.
I appreciated her pragmatism. It left no room for the kind of illusion or complacency that can take hold with groupthink. The Republican appointee stood out at the Alignment for Progress conference not only for her political affiliation among a parade of Democratic officials, but for her willingness to publicly reflect on controversy. She joined a panel I moderated with Illinois Chief Behavioral Health Officer David T. Jones, a Democratic appointee, to discuss the challenges of mental health advocacy in a hyper-polarized environment. I told her she was brave for joining the conversation in an era when cross-party confabs are increasingly rare. Turns out the chat was easy compared to what Friesen faces back home.
Just seven months on the job, the Oklahoma official has dealt with a former state employee charged with embezzling funds meant for mental health advocacy, is navigating a feud between the attorney general and governor over a class action suit related to incarcerated individuals' care, and is watching the rollout of restrictions on reproductive rights, anti-LGBTQ bills, the defunding of diversity, equity and inclusion programs and an order for public schools to incorporate Christian Bible lessons into grades 5 through 12. I wondered how states are reckoning with the mental health impacts of policies that hinder people’s ability to make autonomous decisions about their body, mind and beliefs.
To the surprise of the audience, I asked Friesen about all of it. On corruption and political infighting, she asserted that Oklahomans deserve better — an effective, unified health system. On abortion rights and racism, she joked that it was like the question she faced at her senate confirmation hearing about Israel and Palestine. Friesen, a White woman, then suggested people need to get together to discuss issues on a case by case basis. It was a diplomatic, noncommittal response and left the door open for Jones, a Black man, to draw on facts: Addressing social determinants of health can prevent mental illness and lead to better mental health outcomes overall.
The quiet parts are deafening
After the panel, several people told me it was refreshing to hear the “quiet parts” uttered aloud. They said they face these complexities everyday in New York, Utah, Texas and beyond, and it does not help to dress up the problems for a conference at the Kennedy Center. It helped, they said, to see Friesen and Jones model civil discourse in real time. People need practice at this. We need to witness folks break the stigma of speaking the truth: The U.S. political and economic system values some lives more than others. Without addressing this, individuals will continue to be unfairly blamed for being anxious, depressed, psychotic or suicidal.
On an individual level, people often hide or deny their health issues for fear of losing relationships, jobs and opportunities. On a systemic level, people uphold harmful policies for the same reasons. This carries a steep price. America’s suicide rate recently reached its highest peak since 1941. Our way of life is killing us, and it is not just the fault of social media and cell phones.
Decades ago, Dwight D. Eisenhower and John F. Kennedy, a Republican and a Democrat, recognized that mental illness is one of the nation’s most pressing problems. Some things have improved, in no small part to movements like the Alignment for Progress. Getting insurance companies to pay for mental health and addiction care is transformational. Setting goals to improve screening, treatment and recovery is vital. Sacrificing a bit of our comfort to address the causes of people’s pain — the systemic social determinants of health — is heroic.
We need heroes.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org.
Who’s Kate?
I’m a journalist, analyst and budding social entrepreneur focused on the relationship between mental health and democracy. At The Washington Post, I won the Pulitzer Prize for Public Service with colleagues covering the U.S. Capitol attack on Jan. 6, 2021. I also pioneered a mental health column and led a documentary film unit. In 2024, after two decades in newsrooms, I opted out of the corporate media machine to create Invisible Threads, a storytelling venture uncovering individual, communal and systemic forces and narratives that keep people sick and separate. I’m also a fellow at Georgetown University’s research and design unit, The Red House, focused on intergenerational trauma and wellbeing. This chapter deepens work I’ve pursued for two decades, from reporting on an authoritarian regime in post-genocide Cambodia, to the decline of democracy in Hong Kong, to the 2021 U.S. insurrection.
What bowled me over…
Scarcity is the mother of invention. Despite mental health disorders accounting for 15% of the global disease burden, only 1-2% of financing is directed toward mental health. So, on Sept. 23 in New York City, the African Philanthropy Venture Alliance, Clinton Global Initiative, Kokoro, McKinsey Health Institute, and Wellcome launched a global alliance to encourage investors to bridge the $200 billion annual mental health funding gap. What’s their plan? Combining philanthropic and venture funding, integrating mental health into areas such as education and women and girl’s health, and making the business case for investments. With the mental health market projected to grow to $500 billion by 2028, I can already see the lightbulbs going off. The trick will be to keep quality and integrity amid the gold rush.
What I’d invite you to explore…
Childhood inflammation linked to higher risk of mental health disorders in adulthood — Eric W. Dolan, PsyPost
FDA approves first new medication to treat schizophrenia in more than 30 years — Alex Arger, Scripps News
New Study Shows Bipartisan Struggles with Depression, Reveals Gaps in Mental Health Care Access — Lindsey Cull, Johns Hopkins Bloomberg School of Public Health
The election is really stressing out your employees. Here’s how you can help — Tarun Galagali and Amy Airbus, Fast Company
What I’d invite you to do…
Pick up Profiles in Mental Health Courage by Patrick Kennedy and Stephen Fried. The personal stories of mental health advocates with their own challenges are gripping, and the resources for how to act are empowering.
