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Adam Smith on the Campbell Conversations

Adam Smith
Adam Smith

On this week's episode of the Campbell Conversations, Grant Reeher speaks with Congressman Adam Smith. The Democrat has represented the 9th District of Washington State for over 20 years. They talk about his recently published memoir, "Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety."

Program transcript:

Grant Reeher: Welcome to the Campbell Conversations, I'm Grant Reeher. My guest today is Congressman Adam Smith. The Democrat has represented the 9th District of the state of Washington for over 20 years and has been the top Democrat on the House Armed Services Committee since 2011. He served as chair of that committee from 2019 to 2023. He's just published a memoir titled, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.” And he's here with me today to talk about that book. Congressman Smith, welcome to the program.

Adam Smith:  Well, thank you very much for having me. I appreciate the chance.

GR: Well, we appreciate you making the time for this, obviously an extremely important topic. Let me just start with some basic questions. You've been struggling with the problems that you chronicle in your book for a very long time. Why did you decide to write this book now?

AS: Well I, so the struggle basically, you know, I had a lot of issues from childhood forward that were there, but I didn't really recognize them for what they were and I just sort of got through them. And then eventually, you know, by 2013, it just blew up into uncontrollable anxiety and chronic pain. And it took me six years, and as I documented in the book, well over a hundred health care providers of one kind or another to sort of figure it out. And by mid-2019 I was starting to get back to better. And I just thought, you know, this is an interesting story, I would like to understand it. So while it's fresh in my mind, let's just chronologically lay it out and understand what happened. And then as I was writing it and thinking about people I interact with, you know, tens, probably millions, tens of millions of people in this country suffer from some combination of anxiety, depression and chronic pain. And I just thought it would be a story that would be helpful for people facing that and hopefully give us a better path for how to deal with those problems.

GR: Absolutely, I think more than tens of millions. So we'll talk a little bit later about how you figured out what the underlying problems were and how you addressed them. But let's just start again sort of at the beginning. What were your initial symptoms, what happened first?

AS: Well, I can break that down into two categories. There were the initial symptoms that were the ones that I talked about when I was younger that I dealt with. There were just, I just thought, okay, this is who I am is what I have to deal with. As a child I was incredibly insecure and afraid of absolutely everything. And I know a lot of people growing up, they lack confidence, whatever, no, I was on the extreme end of that scale. I was, you know, if I encountered a new situation with new people, I just sort of I didn't know what to do. I was afraid of everything and insecure and all of that. And then, you know, on the physical side, I damaged my knee when I was 12 years old and had surgery when I was 16. And so my knee hurt and then eventually my back hurt, my foot hurt. And so all of that was going on for my entire life up to like the age of 40. And then when I hit 40, I had just this five-month bout of uncontrollable anxiety. I saw a psychiatrist, I took some benzodiazepines, but it went away in four or five months. I didn't really do anything about it, I just sort of got past it. But then as a document in 2013 was when that anxiety came back and it wouldn't go away. And that anxiety was, basically imagine if every second of every day you feel existential fear. You know, I the analogy is like, you know, a homicidal maniac is coming at you with a machete, all right? That's the way I felt. My body was constantly tense hard going, a million miles an hour, couldn't sleep, could barely eat. And it just consumed me. And then a year after that is when my hip pain and back pain got to the point where, you know, I struggled to walk or sit. So that's when the symptoms kicked in to the point where I just, I couldn't live my life starting in 2013.

GR: So one of the questions I wanted to ask you, I think you may have just answered it is, what was the low point? You know, when did you get to where, you know, I've got to do something more than what I'm doing. It was in 2013 then it sounds like where you hit that. So then you turn, in your own approach, to something that becomes more effective. So tell me about, you know, sort of that moment of saying, okay, now I've got to try to address this in a better way.

AS: There are a couple of different moments on that. When the anxiety hit me in 2013, I was like, I’ve got to go find somebody. So I tried to find a psychologist, I did find a couple, nothing seemed to work. And then I dove back into the drugs, specifically clonazepam, which is a benzodiazepine and clonazepam, If you've never taken it before and you have anxiety, the first time you take it, as I say in the book, oh my god, it's just unbelievable. I mean, it just, it makes the anxiety go away. I was myself again, but I knew there’s side effects and also tolerance, and that came. And when that came I was still lost. So I'm still sort of searching my way through what's going on with me mentally. And the easiest way to think about this, is whether it's physical or mental pain health care comes down to two things: diagnosis and treatment. What's wrong? What are you supposed to do about it? And really, this journey that I took was I struggled with the diagnosis as a starting point, on either problem and much less the treatment. So, and really it wasn't until, well, I found the psychologist in 2015. So after, I think I was in between hip surgeries there, I'd had two have surgeries, hadn't had the third one yet. And one of the chronic pain people I was working with said I got, I know the psychologist, he works, you know, he specializes in chronic pain. So I went and saw him. Now, as I say in the book, he told me in the first meeting what was wrong with me. It took me about three and a half years to actually believe him. So I had to go through that and then I didn't find, on the physical side, until I found the muscle activation techniques people who do muscle activation therapy, that was April of 2018 when I went to that guy and it took him about a year basically to rebuild me. But most of the time was spent trying to figure out what's wrong with my mind, what's wrong with my body, what am I supposed to do about it?

GR: You're listening to the Campbell Conversations on WRVO Public Media. I'm Grant Reeher, and I'm speaking with Washington State Congressman Adam Smith about his new book titled, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.” So as you mentioned, you went through a lot of different medications and trying to deal with these problems and you talked about the issue of tolerance and other kinds of side effects. Do you have any insights to share about that experience with medications?

AS: Absolutely. There are many problems with our health care system, which is a big part of my book, is documenting the limitations of that health care system. You know, in part, you know, yes, I’m a policymaker. I was there for the Obamacare debate, I'm a big supporter of the Affordable Care Act, I've been to health care debates for 30-plus years as an elected official. So part of it is policy, but part of it also is to make an individual patient, this is the system. We can imagine some world where we magically fix it, but understand what the system is, and that alone will help you navigate it better. So that was part of it was trying to figure out, you know, how do I get into this and how do I figure out what to do about it? You asked a question there and I missed the last part of it.

GR: Well, just insights about, you know, dealing with the medications and you turn that to the health care system which is appropriate.

AS: Yeah, look, in my big insight there, we pass out medication for this stuff way too quickly in way too many subjects. I mean, benzodiazepines, my opinion, they can help you in the short term, they’re a huge problem in the long term. And the more I've spoken with psychotherapists who really know what they're doing, benzodiazepines block a part of your brain that is necessary for you to have the conversation about why you had the anxiety in the first place. So it makes the treatment less effective if you've got that in your system, because the key to mental health is really understanding what's going on in your brain and understanding that you don't have to be controlled by it. You don't have to chase every emotion, everything that comes into you. It's real, okay, don't let anyone tell you that that feeling of anxiety that you have isn't real, but there are ways to process it within your own brain that can get you to a better place in mental health. Benzodiazepines are going to block it, and I am really not fond of antidepressants. SSRI’s, I forget exactly what SSRI stands for, but it's basically Prozac, Zoloft, that's supposed to even out your serotonin, you know, and on pain. You know, I took oxycodone, I took tramadol for a long time. Those things are never really solutions to your problem or, sorry, rarely, extremely rarely are they solutions to your problem. But what happens is, because both with pain and with mental illness, neither the patient nor the provider wants to take any more time than they absolutely have to deal with this. What you want, fix it, get me back with my life. Okay, here's a pill that'll fix it. See you later. Way too reliant on that.

GR: It's interesting what you said earlier about you being a policymaker, and I want to ask you about this later, but, you know, you have a deep knowledge of the health care system as a member of Congress, and you say you were part of the passage of Obamacare and all that, but then you're in the system now and things are different and it reminds me of accounts that doctors have written about, you know, once they're a patient, everything seems different. And I think that's an important perspective. Let me ask you this though, about how did all of your struggling with this affect your ability to provide effective representation for your constituents? I imagine that was a concern for you.

AS: Yeah, it made it a lot more difficult. I mean, there was really I guess, as I document in the book, I mean, 2016 was absolute rock bottom for me. It was after my third hip surgery, I just started seeing the psychologist a couple of months before. I didn't think I was going to recover. And I was in a bad place at that point, without question. And I say this in the book, I didn't do as effective a job during this period. I didn't go to as many meetings. I didn't interact with people as much, but I kept working. I mean, that was one of the things through this is I was fairly high functional. I could go to meetings, you know, particularly before the chronic pain where the anxiety was overwhelming. But for some reason, you know, it's always awkward when I try to explain to people that one of my strengths is that I'm very articulate because if in explaining that I'm not, then they're like, well, okay, really? But I can talk, all right. And it's always there, you know, hopefully (unintelligible) anxious. But if you put me up there and say, let's talk about the budget, let's talk about health care, answer this person's question, I can do that, okay? My heart may be going a thousand miles an hour, the second I'm done, I may be back, you know, but I can do that. So I did the job. And also, you know, much of the member of Congress, I got a staff you know, both on the Armed Services Committee in D.C. and personal staff. And they did a tremendous job. And I've always, even before all this, I understand that the staff is crucially important to effective representation and I've always empowered them. So that's how we got through that. But I'm sorry, one more quick point on this.

GR: Sure.

AS: This is something that everybody has to deal with. Yes, I'm a member of Congress. But, you know, my father was a ramp serviceman at United Airlines. Okay, if you're you know, if you run a restaurant, if you're, I don't know, an accountant, if you're a mid-level manager, you got to figure out some way to keep your life going, your job and your family while you're dealing with all of this. And that's part of it. You know, a big part of it is you need help, you need help from people around you.

GR: I want to come back to something related to that point you just made at the end a little bit later in our conversation. You're listening to the Campbell Conversations on WRVO Public Media. I'm Grant Reeher, and I'm talking with Congressman Adam Smith. The Democrat represents the 9th District of the state of Washington and has just published a memoir titled, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety”. I had another question about how this affected your political career, it kind of picks up on where we were before the break. Were you ever afraid in all of this that an exposure of your struggles with this, with these issues, would cripple your political career, that, you know, that it would it would really cause some serious damage?

AS: I was constantly afraid of that. From the very first moment, you know, from the even, you know, going back to 2005 when I had my first little four to five-month battle of it. And this hit me, I was like I need help, but I don't want anyone to know that I need help. How do I do that, you know? And I sort of document in the book that, you know, I went and saw the psychiatrist out at Bethesda Naval Hospital, you know, and we didn’t put it on the calendar. I just snuck out a couple of mornings, you know, once a week or whatever and went and saw him. Yeah, my thinking back, certainly in 2005 and even in 2013 was if people find out about this, that's a huge blow to my political career. It'd pretty much be over. And that's one of the things I talk about is, the big challenge is the stigma against mental illness. Now, the last three or four years, we've gotten better at this. A lot more people have come out publicly and talked about this. The stigma is going down, but it is by no means disappeared. There's this and even with chronic pain, there's a general perception that you cannot ever appear to be weak, you know, so people don't seek help and don't, they aren't honest about what they're what they're dealing with because of that fear.

GR: Especially in politics. But I think you're right more generally. So you're more public about it now, you've been talking about it. What has been the reaction from your constituents after you went public about this stuff?

AS: It's been very positive because like I said, I think there's this moment now where people, first of all, you know, all this stuff was going on and no one was talking about it, okay, so now that people are talking to us like, gosh, I felt that. I mean, the biggest reaction I get on both the chronic pain side and the mental illness side is the number of people say, hey, I dealt with that or my spouse dealt with that or my child dealt with it. So the reaction has been just very, very positive that, you know, basically thanking me for being part of opening up this conversation.

GR: Well, and I wonder whether that helped you. It took a little bit of a pressure off and helped your anxiety. It's out there now, you know?

AS: Yeah. No, look, I mean, one of the keys to this is one of the things that I think we as humans struggle with most is being honest with ourselves about what we're feeling, what we want out of life. I mean, that's one of the biggest struggles is, you know, I mean, you tell yourself lies all the time about a whole bunch of different things and you wind up suppressing things that puts pressure on you. Huge key to this is be honest about what you're feeling and what's going on with your life. Even going all the way back to childhood, which was part of my issue, things that I had just sort of blown off as, you know, okay whatever, you know, they're there and you have to honestly address them. And that's one of the points I make early on in the book. Psychotherapy is enormously important and incredibly helpful. Now, not all psychotherapists are good at their job.

GR: Like anything else.

AS: Right, exactly. I think I was reading there's some study I think in The New York Times just a couple of days ago that was like, well, does psychotherapy work? Well, maybe yes, maybe no. And I'm reading through the whole thing as they're analyzing it. And finally, near the end they get to the part where, well, it kind of depends on the therapist.

GR: Right.

AS: Well, yeah! You can't do these longitudinal studies and say, well, we studied these people and half of them said it doesn't work. So, no, it matters whether or not the therapist is good at it, as I learned.

GR: I want to ask a couple of questions to go back to kind of the medical aspect of this for you and the treatment aspect of this. First of all, how are the pain and the anxiety intertwined? Did you start to get, like, anxious about that you were going to get a bout of pain that you couldn't handle? Is that part of it?

AS: Absolutely. Now, and this is a really interesting subject. And I could fill your full 27 just answering this one question.

GR: (laughter)

AS: I'll do my best not to do it. It is clear that physical pain is connected to anxiety and depression. How exactly it is connected is nowhere near as clear. I won't go into all of Doctor Sarno's theory. He wrote a book called, “Healing Back Pain” years ago, he's passed away now. He talks about how those two things are connected. Now, in my case, and I went through this a lot, I was like, as the physical pain came, I'm like, is it connected? And in my case, it certainly is connected in the sense that the anxiety made the pain worse and vice versa. But I had two separate problems. There are many people out there that are like, well, you know, physical pain if you just think about it the right way, it'll be fine. And as you can tell from my comment there, I don't really believe that. Now I think in some instances, yes. I had a guy an ambassador, I forget which country when I was going through this said, he had read Dr. Sarno’s book and he said he had massive back pain and Dr. Sarno’s book says, no, it's because of unresolved issues in your life. So understand that, understand that the pain isn't real and just go live and you'll be fine. And he was. That didn't work for me, okay, so I think you have to understand both the mental side and the physical side. One is not just going to make the other one go away in my view, but there's a lot of different thoughts about that.

GR: And you also mentioned that you weren't a big fan of antidepressants, SSRI’s. That has made an enormous difference for a lot of people, according to them, what is the nature of your concern about that?

AS: Well, a couple of things about it is, again, I am a huge believer, and one of the positive outcomes I had from all of this, the ability of the mind and the body to heal is far greater than I think most people give it credit for. It's not easy, but, you know, you can, in fact, find ways to heal your mind and heal your body. Drugs mask that and stop you from addressing it. And then it's like it's all up and down. And I don't know, I've talked to people like that, too. I talk about in my book how I, you know, I would go on the Internet and say, well, what do people think about Celexa? You know, and “oh I love it.” The whole, you know, of course, as I point out in the book, you know, how many of those people are interns for the pharmaceutical company that makes the drug. They go, hey, it's a great drug, you should buy it. But look, the way antidepressants work is they try to regulate the level of your serotonin in your brain. It's an antidepressant. And right off the bat, when my doctor prescribed it to me, I was like, well, wait a second, I've got anxiety. This is an antidepressant. Isn't that the opposite? And he said, well, it evens out, okay, it takes a few months, it can be initially activating. The first two months I was on Celexa, worst anxiety I've ever experienced in my life. It was just, it was uncontrollably awful. And then eventually it evened out, but it would up or down, it didn't work. And I don't know, I mean, I know we're prescribing antidepressants to ten-year-olds. I'm troubled by that, okay, I'm not a doctor, you know, I’m not a psychiatrist. I mean, I don't know. It just seems to me like we're screwing around in the brain at an early age in a way that we should be a little more cautious about is all I will definitively say on that.

GR: No, I think that's a very reasonable point. If you've just joined us, you're listening to the Campbell Conversations on WRVO Public Media. And my guest is Congressman Adam Smith of Washington State. So where are you now with these challenges? Do you have days without anxiety? Do you have days without pain?

AS: I've never felt better. I haven't had any anxiety since, you know, since I got it. I finally got off all the drugs I was taking in April of 2019, April 5th, 2019 as a matter of fact. So I took my last little carved-up little piece of clonazepam and that was it. And since then, no, I have not experienced anxiety. I mean, there's stress day in and day out and different things, but not nothing like that. And physically, you know, my pain is completely manageable, not like it was before. I mean my body is kind of messed up because of that knee surgery and a bunch of other things and I've got two artificial hips and all that. So, but I went back to playing in the congressional baseball game. You know, I walk, I exercise. Yeah, you know it got my body back where it needed to be. So I've, I understand my mind and body better than I ever have, and it has left me in a very, very good place.

GR: Well that's good to hear. I've got a more sensitive question, perhaps, for you. And I don't mean this to sound as challenging as it might. And this is the question that sort of comes back to something you said before about, you know, everyone dealing with these things. But there is a pattern, I think, in our nation recently, probably around the world. There's a pattern, I think, of celebrities usually with great wealth who encounter the problems that ordinary people struggle with. And then they write about their experiences or they do a documentary about it or whatever, as if they have some relevant wisdom to share with other people when in reality, those ordinary people don't have anything like the resources to deal with the problems in the way that those celebrities did. Now, how is your story and your book different from what I just said?

AS: Did you know how much a member of Congress makes?

GR: (laughter) I don't have great wealth, that would be the biggest way that it is different. In fact it’s one of the things that I struggled with is, you know, a lot of the health care providers that I found didn't take insurance, you know, and my insurance is okay, it's not as good as people think it is. I pay like $700-$800 a month in premiums. I've got co-pays, a whole bunch of other things. No I struggled financially to figure it out. And there were a lot of times when someone would come to me and say, hey, you know, I see you're struggling, I got this great treatment plan. You know, I myofascial release was something that I did one time. You know, it was just amazing, you have to do it, okay, but they're not covered by insurance. I need to see them twice a week, and it's $200 bucks a pop, okay, or a psychiatrist. Very few of the psychiatrists that I saw were covered by insurance. I got lucky. The one who actually knew what he was doing was covered, okay, but I went and saw people and I would genuinely, I would not see a psychiatrist for a week as it's $200 and I can't afford that. Now the one thing that I did have that is a double-edged sword, I know a lot of people, okay, so, and people would try to help me. I say it's a double-edged sword because, yeah, I can pick up the phone, you know, when I first had this problem, I picked up the phone and I called the lobbyist for the University of Washington, who I'd known for 20 years and said, hey, you know, I'm kind of looking for a psychologist. And yeah, they found me one. And maybe your average person would be as able to do that. But a lot of the people I found didn't help me. And to some degree, the fact that I had access to all this information was overwhelming. And I was just sort of sifting through all of it. So I think, you know, and look, I’m mindful of the fact that there are a lot of people in far worse circumstances than I am, but I'm not some celebrity with an endless array of resources. You know, I had a wife, I had two kids, I had a mortgage. I had to fly back and forth, I'm living in my office. That's a long story. So I think I think it's a little bit more relatable, you know, than someone who's got $100 million. But, you know, I'll leave that to others to judge.

GR: By the way, our local member of Congress who just retired in the last term, was living in his office. So in this area, we are familiar with that pattern. We’ve only got about 2 minutes left and I want to try to squeeze in two questions if I can. The first one is just sort of an observation of mine but you quickly comment on. You mentioned a lot of these providers, particularly psychiatrists, not taking your insurance. I think one of the things that drives that is there's such a shortage of these people that they don't have to. That they're in such high demand, it's tough to find these people sometimes. Do you have any thoughts about that?

AS: Well, actually, I would say the main thing that drives that is just the sheer difficulty of filling out all the forms and figuring out if you're meeting the insurance companies, you know, requirements and the fact that actually there are enough people in this country who can afford it that the psychiatric profession doesn't need to take insurance. And that gets into a much longer conversation about how we need to reform, what health care should we pay for, how do we get to best practices? And that's one of the biggest problems, I think with mental health treatment. Lack of access is part of it, but lack of a clear idea, what are you doing? Who are these people who are providing health care? There are not standards for best practices.

GR: So quickly, we just have a minute left, but I want to kind of ask a bottom-line question here at the end. What is the bottom line that you want readers to take from your story?

AS: Well, bottom-line is, if you have a mental health problem or a physical health problem, help exists. It's difficult to find, but go get it. It is not an unsolvable problem in either place. That's the biggest thing. And then there's a whole bunch of other lessons, but it does exist, it can be found, you can get better. You have to work at it, but it exists. That's the biggest message that I want to deliver.

GR: Well, thanks. There's a lot more obviously we could talk about here, but we'll have to leave it there. That was Congressman Adam Smith. And again, his new book is titled, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety.” And Congressman, I haven't said this publicly before, but like you, I've struggled with anxiety at various points in my life. And I've struggled more publicly in the last 20 years with chronic pain, which two major back surgeries can attest to. So I want to personally thank you for writing this book. And, of course, also thank you for taking the time to speak with me about it.

AS: Well, thank you. And I really appreciate you giving me the chance.

GR: You've been listening to the Campbell Conversations on WRVO Public Media, conversations in the public interest.

Grant Reeher is Director of the Campbell Public Affairs Institute and a professor of political science at Syracuse University’s Maxwell School of Citizenship and Public Affairs. He is also creator, host and program director of “The Campbell Conversations” on WRVO, a weekly regional public affairs program featuring extended in-depth interviews with regional and national writers, politicians, activists, public officials, and business professionals.