SEATTLE — Politicians campaign by convincing the public they're the best person for the job. While serving in office, they have to be confident and ready to engage on policies and talking points at any moment.
But behind the scenes, Rep. Adam Smith often struggled to find the level of "healthy narcissism" needed to keep pushing forward.
In his new book, "Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety," Smith, who serves Washington's 9th Congressional District including South King County, details his journey to understand his worthiness as a human, investigate his childhood, and get a proper mental health diagnosis and treatment. He also writes about the toll his hip and knee issues took on his mental health and his search for alleviation of physical and emotional stress.
In an interview with The Seattle Times, Smith shared his experiences within the mental health system. This interview has been lightly edited for length and clarity.
Q: What was your inspiration for writing this book?
A: For a six-year period, I was in a very bad place. I wrote notepads trying to figure out what was wrong with me. As I was coming out of that bad place in 2019, I thought, "How do I organize my thoughts on that journey? Chronologically, how did this happen? What did I learn?"
It came together and felt like a story worth telling. If you're talking about anxiety, depression, and chronic pain, in some combination, millions of people in this country have gone through something like that. I thought it could be a helpful story.
Q: Have any of the tools you learned through therapy helped you get through the pandemic?
A: Absolutely. It enabled me to process the stress of that situation better. A psychologist told me it's not the amount of stress in your life, it's how you process it. That was completely contrary to my way of looking at the world at that point. I realized later that I was trying to figure out how to reduce the stressful events in my life.
As you experience meditation and cognitive behavioral therapy and better understand how your mind works, things are less stressful for you. I was much more able to deal with [the pandemic] because I had a better mental framework.
Q: Did you face any stigma from colleagues or constituents by sharing your mental health challenges?
A: That was a huge concern of mine. I first had a [major] anxiety attack in 2005 that lasted five months. Throughout that process, and then again in 2013, I thought, "I have to make sure that a very limited number of people know about this because if they find out, I'm done." [Now,] I feel it is really important to share what happened. I understand much better the value of having that conversation for everybody.
Q: Do you think sharing your story and hearing from other lawmakers helps reduce mental health stigma?
A: A lot of progress has been made just in the last three years on reducing stigma. But I don't want people to think that the stigma has been eliminated. If you feel like you have mental health problems that you're not able to handle, [many people think] "Am I gonna lose my job? Am I gonna lose relationships that are important? Will people look at me differently?"
Q: How did you end up finding your specific diagnosis and treatment?
A: [I started with] cognitive behavioral therapy and meditation. [I learned] the way you think about things does, in fact, matter. [For example,] if you get a headache and are in a panic for a full day thinking you have a brain tumor, they teach you to go, "Well, the odds of having a brain tumor if you have a headache are one in a million," so you calm down and that becomes a less stressful event in your life.
[Then I tried] psychotherapy. That's where you get into your childhood and everything going on in your life. Maybe you're in a relationship that you're making work because you think you have to, and you're lying to yourself about how much it's really bothering you. You learn to be honest with yourself about what's really going on. How do you feel about your upbringing and your parents? I had a very complicated relationship with my parents and my adoption.
[Finally, a doctor said] "You don't think you have a right to exist." It took roughly two and a half years for me to fully understand it. You have to have what is referred to as a healthy narcissism. You have to believe that you are worthy as a human being of love. We ran back through my entire life. Did I do what I should have done for my family growing up? Was I a good friend? Have I been responsible in my relationships? And my job?
Whatever it is we're doing, we want to feel like we're doing it well. You can stop and think about how you can do things better, but that's different than [believing] you're unworthy as a human, and that's what I didn't comprehend. I felt like if I wasn't perfect, then my entire existence was in question. That's what combined to give me the right diagnosis and then the right treatment.
Q: What do you think the federal government's responsibility should be toward addressing mental health?
A: I represent 750,000 people, and my job is to help them in any way I can. You're not going to hear me say, "That's more of a county issue." The biggest thing the federal government can do is what we fund. Depending on what Medicare and Medicaid cover, that drives what other private insurers cover. I have a bill to help fund the crisis care centers. I also have a bill to try and help fund Health One.
(Editor's note: Health One is a program that connects people who call 911 frequently with resources and social and health services.)
We all collectively have to look at how we're providing those services and what the approach is, and why it's not working as well as it should. It's not a federal or county or state problem, it's a collective community problem. We need to bring together all of the players to try and give us the best chance of dealing with it.
Q: Providers at many community-based mental health organizations say they need more federal financial support to keep operating. What should the federal government's response be?
A: The United States federal government spends more money on health care, per capita, than any other country in the world. It's not just a matter of more money. How are we spending the money? And how could we be spending it better?
If the only way to solve this problem is to drop another few hundred billion dollars down on it, odds are we're not going to solve the problem. I think there are some basic approaches there that we could do better to reduce the demand on behavioral health services.
[We need an] obsessive focus on competence, accomplishments, objectivity, practical problem solving. [We need to] really dive in and make sure that every last penny that we're spending is actually being spent as efficiently and as effectively as possible. [We need to] hold people accountable for doing that. I want to set reasonable expectations, and then push people to achieve them. So we can get the most out of what we're trying to do.
