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In an eye-opening and powerful episode, Andy talks to Rep. Adam Smith (D-Wash.), one of the most powerful members of Congress, about the debilitating anxiety he faced for years and his road back. Smith tells Andy about the fight against his inner voice that stirred his self-hatred, no matter how much he accomplished and how many people he helped. In his own revealing moment, Andy shares his own challenges with anxiety with Adam and his listeners.

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Check out these resources from today’s episode: 

• Check out Adam’s book, “Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety”: https://www.simonandschuster.com/books/Lost-and-Broken/Congressman-Adam-Smith/9780757324628
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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Adam Smith, Andy Slavitt

Andy Slavitt 

This is in the bubble with Andy Slavitt. Adam Smith, Congressman, ranking member of the Foreign Service committees on the show today not to talk about Ukraine, but to talk about the mental health crisis that he’s experienced. And we’re going to talk about congressman who felt incredibly broken with deep anxiety. And he’s coming on the show to get into it in really excruciating detail. If you are someone who has experienced or is experiencing anxiety, depression, even things that are causing you to doubt yourself worth, I hope you listen to this and I hope you get something out of it I did I find these conversations to be incredibly important to listen to and to run that. And if you’ve never experienced something like this, I assure you, you have immediate family members and friends, whether they’ve disclosed it to you or not. That are or that have. So I thought it was important to talk about. And in the process of the conversation I will allude to the fact that I’ve had my own issues with anxiety. And so you’ll hear that there’s a part of this dialog where I can very much relate to some of the things he said. And we kind of go back and forth on that. And I’ve never talked about that on the show before. But couldn’t possibly have him on and not do that. It’s not an easy thing to talk about. It’s really easy to talk about mental health issues and others, it’s very hard to talk about them in ourselves. And that’s because we stigmatize ourselves, I think we stigmatize ourselves worse than than anybody else. And I don’t think I think we spent a lot of effort and energy probably trying to avoid understanding the parts of ourselves that we don’t like, or the parts of our history that make us uncomfortable, or feel guilty or regretful or angry. And we all have them. And we all have to deal with them. And I don’t think there’s any shame in saying that we should get some help in dealing with those kinds of issues. And so I wanted to have Adam on. He’s written about this in his new book called lost and broken. I got to know him a little bit during the pandemic is when he was chair of the Armed Services Committee. And I was before I went to serve at the Biden administration, and we talked about how to make sure that we were helping the armed forces and that we were securing supply chains and all kinds of things. And I had no inkling of the fact that this was a man dealing with the kinds of issues we’re going to talk about in this show. Except for one, he jumped one clue. And we’ll you’ll hear that clue, talked about on the show. He is going to tell his personal story. He’s going to relate it to I think stories that probably all of us can relate to in one form or another. I’m appreciative that he came on. Let’s have that conversation right now.

Andy Slavitt 

Congressman Adam Smith So, welcome to the bubble.

Adam Smith 

Thank you appreciate the chance.

Andy Slavitt 

We are in the bubble now. And we’re going to have a, I think, a really personal conversation, the kind of conversation that people don’t hear from Congress people a lot. And maybe we’ll get into some my own personal experiences with mental health, as well. You’ve just written a book called lost and broken and it details not just through battles, but your recovery back from your experiences, the things it and with chronic pain. But let’s go back to start at the beginning a little bit, if you don’t mind, tell us who you are and what you’ve accomplished in life.

Adam Smith 

Yeah, you know, do the quick little elevator speech resume here. I’m currently the member of Congress, who represents the ninth district of the state of Washington. I’ve been in Congress now. 27 years just got elected to my 14th term last year. I’ve done a lot of things during that time, but I’ve been on the Armed Services Committee the entire time, I’d been the ranking member, which means the top Democrat on the committee since 2011. And I chaired the committee for the four years that Democrats were in the majority from 2018 to 2022. And then my background is I grew up in SeaTac, Washington. My father worked at United Airlines as a ramp servicemen. So I grew up in a blue collar family. I got a degree in political science from Fordham University law degree from the University of Washington, got into politics, when I was in my teens started working on campaigns got elected to the State Senate, when I was 25, just when I was finishing up law school, spent six years in the State Senate then moved on to Congress. I’ve been married for almost 30 years now and have two children who are 23 and 20.

Andy Slavitt 

It’d be your biggest achievement.

Adam Smith 

Yeah, that’s my wife and I do talk about that. So yeah, so that’s the basic resume background there.

Andy Slavitt 

You are about the same age, I was born in 1966. And I’ve been married almost 30 years. But when one listens to that one gets the picture of certainly an accomplished person, certainly a driven person, certainly a person of service, who gives back and you know, it depending on where you are in your life. You go, I might I envy that person, you know, that person has achieved. So much continues to contribute. And then you talked a little bit about your origin, your dad growing up working class, because I think all of our origins, it turned out to be a key to a lot of things. Absolutely. Fact us tell us a little more about your your origin, where Adam Smith came from as you came to learn?

Adam Smith 

Yeah, no. And that was something that that I dealt with, and certainly contributed to my anxiety. And one of the big lessons here is if you’re going to deal with mental health issues, you really have to understand your own personal history, which sounds simple. At first you lived it, right? You know what it is, but you may not have focused on certain parts of it that are more important than you realize. And those parts may still be affecting you later in life. And in my case, I was adopted. I say I grew up in SeaTac. But I was born actually at George Washington University Hospital. My biological mother was in the Foreign Service. She was a code clerk, and my biological father, I think he was a general services guy in the Foreign Service as well. Not married. So when she got pregnant, my biological father didn’t want to have anything to do with it. So my biological mother decided to give me up for adoption to her older brother. So I was born at George Washington. And actually, my mother spent, like 10 days at what they actually called a home for unwed mothers. I was born in 65. So st. period, and then made that decision. So I flew across the country 10 days into my life, and grew up in SeaTac. But, crucially, I was never told that I was adopted. And I didn’t actually learn that until after both of my adoptive parents had passed away. This was when I was 26. My father died when I was 19. And my mother passed away actually, the night before I got elected to the State Senate in 1990. So you know, I had some issues in my childhood that I sort of blew past. I basically viewed that once I got my career on track. Once I got elected the State Senate, I was doing what I wanted to do, I met my wife. That’s all in the past. We’ll just forget about it. Move on. So that was where one of the challenges came from, to be sure.

Andy Slavitt 

Right. And so your parents turned out to be your biologically your uncle in your hand. Yeah. And you learn that later in life, while you’re already kind of on a path. And so it kind of felt like, hey, that just is what it is and doesn’t matter. And maybe, maybe the person I am right to me to have faced adversity and that and I’m all I’m all the better for it. But it speaks to this question of how we define trauma. And I wanted to speak to that because I had Jason Kander who I know you know For conversations that number of times about his his own battles with PTSD. And he said his big unlock was that he never gave himself permission to define the things that happened to him as trauma for the very simple reason that he knows people who have had worse trauma.

Adam Smith 

Amen. That’s exactly what I documented in the book when I started having these, you know, and basically, I’ve been a high stress person my whole life, but it was always manageable. And then in 2005, it wasn’t, I went through about four or five months of really uncontrollable anxiety went away, came back in 2013. But as we started talking about as I dove into the world of mental health, and tried to figure it out, that was one of my big sticking points is people told me that, you know, a lot of times, you know, childhood trauma can manifest itself in the future. And I thought, I, in my job, I know people who have experienced trauma, you know, people who grew up with abusive parents, people who had addicted people in their family who servicemen and women, oh, exactly. People who see people die right in front of them and all that, and you’re saying that I have trauma, and that’s one of the big points. Trauma doesn’t have to be any specific thing or big, it just has to be something that upset you, and that you never properly processed and never thought about how to deal with.

Andy Slavitt 

I think that’s worth emphasizing. Yeah. Can you say that one more time? Sure.

Adam Smith 

It doesn’t have to be there’s not a list, okay? It’s not okay, here are the eight traumatic events that human beings can experience. So let’s go through and see if you’ve had any. And it doesn’t have to be something huge. It can be just something that impacted you at a certain point in your life in a way that you didn’t know how to deal with.

Andy Slavitt 

Your brain has no way to compare, I mean, your brain, your brain doesn’t sit there and say, Alright, this is only relative to somebody else that only has an absolute sense of how it responds. Right?

Adam Smith 

Yeah. And I think the other big thing about trauma and the reason that you don’t want to think that you have something that you can’t do anything about, that was certainly part of my perception was, you know, you tell me that and I, on the pain side, I had knee surgery, when I was kid, I’ve gone through knee and back pain. And now I go to chiropractors do this stretch, do this exercise, whatever. But you’re telling me my brain is broken? I can’t fix that. So let’s just not go there.

Andy Slavitt 

Okay, right. Well, not only that, but it’s like, how do you tell me that the thing that creates my conception of myself isn’t working?

Adam Smith 

Absolutely. Yeah. So I think we have to sort of demystify that a little bit. And also, it’s hard, but it is a manageable part of human existence, you don’t necessarily know who you are just automatically, it takes some time to think about it. And if you think about it, and figure it out, you’re in a vastly better place.

Andy Slavitt 

Yeah. I want to bring up a really heartbreaking moment in your book and your story. The part that I think it stops everybody in their tracks when they read this, and they will read this. And everyone needs to read this. And that really broke me up and you said to use to wake up in the morning. And the first thing you’d say to yourself is I hate myself. Yeah. And we just talked about the fact that you are a person with a amazing family, a terrific marriage, a career that everybody would envy objectively. And by the way, life experiences that are real traveling overseas in the world, a really rich, rich life of accomplishment, achievement and service. Okay. How do you explain waking up with that thought?

Adam Smith 

At the time, I couldn’t explain it, it just hit me. And that’s the way I felt. What I felt was like, I felt like I was failing. And I was not living up to my responsibilities to my family to myself, for that matter. And I just, I hated the idea of failure. Now what I learned was what that meant was, I had created this idea in my mind that it was completely unacceptable for me to fail. So obviously, throughout my life prior to this moment, I had failed. Okay, you know, I had done things wrong said things wrong. So I had failures, but I always viewed them as a step towards the ultimate success. Okay. The failure was fine, because I got elected the State Senate. Okay, I got, you know, buried to a terrific person. It all worked out. But then I got to the point where it’s like, yeah, but these failures, they’re not working out. Okay. You know, I’m lying in bed, I can’t move. I’m taking drugs I’d rather not take. I’m in pain. I am objectively a failure, and there ain’t no way to the other side. And this was totally unacceptable to me. And I was like, I just did that’s why I think I said, and I didn’t even know the depth of it didn’t even occur to me as I was saying it. It just, it just hit me every morning when I was like, I can’t do this. I can’t do that. I hate myself. It was It wasn’t just anger at my circumstances, I focused it on me and my responsibility for that.

Andy Slavitt 

So it sounds like you’ve created this image of yourself as someone who was bound to be successful. And when you found yourself in a circumstance where your own self image didn’t appear to be true, you had a choice but to look at the package and say, I don’t like this person.

Adam Smith 

Exactly. And that’s where the psychologists that I found who eventually helped me. And one of the things when you’re seeking help understand, you might not necessarily find it in the first therapist, you know, you got to find someone that you click with someone who gets you someone that works for you. Yep. So I went through a series of them. But what this psychologist identified upfront was, as he said to me, you don’t think you have a right to exist? That’s the first thing he said to me in our first session, and he explained to me that basically, I didn’t have that inherent sense of self worth. And my approach to this was to argue the case was like, Okay, no, I’m good at my job. I’m a good husband, a good father, I tried to not just convince him but convinced me, sir, really. And he said, Look, that’s not how this works. This isn’t, you know, you’re, you have self worth, because you are alive as a human being and sitting across from me at this moment. You don’t have to prove it. That’s the whole point. All right. I kept trying to prove it. And you keep running faster and faster, and that treadmill speeds up. And eventually, you can’t prove it, you have to accept your basic sense of self worth, that is always there, no matter whether you succeed or fail?

Andy Slavitt 

Well, it’s interesting, because it says, You didn’t believe this notion that everyone has the right to love and acceptance and self worth. And you kept using the comparison of the but what about a serial killer? And, and because of that, you know, potentially one potential corner case, if you were willing to grant that you were like, if that’s true, that I probably don’t deserve it either. You know, I mean, for those who don’t know, chair, the Armed Services Committee, is a really big deal. You got to be a smart, logical, thoughtful, thinker, a person of action, a person who can be trusted with taking in very complex situations. And then here you are, someone trying to tell you something that to the outside years, but it’s pretty basic. And yet your mind doesn’t intend to give you permission to accept it. Yeah. Now,

Adam Smith 

it’s a good description. And what I came back to, is the point about the serial killer, and all of that is saying someone has self worth isn’t saying that that person is perfect or right about everything, or doesn’t deserve to be punished in the world that we live in today. Okay, it’s not it’s not this, you know, blank check, excuse so that no matter what you do, everything’s fine. Now, everything isn’t fine. You should work to be you know, whatever values you want to put out there a good husband, a good father responsible and all that. And if you don’t do that, you should hold yourself accountable. But it’s not existential. Yeah. Okay. It doesn’t mean because you did that, that you don’t have a right to exist. And if your mind isn’t in the right place, if you don’t have that basic healthy sense of self worth, you go there, as you described, you just you put this your mind starts turning on you in creating a world that you know, you can’t win.

Andy Slavitt 

Alright, I want to take a quick break here and come back and talk about what happens when you wake up everyday telling you you hate yourself. And you got to function. As a member of US Congress to boot we’ll be right back. So let’s get into this interior dialogue conversation, which I found to be very fascinating. But I found your book to be helpful because I’m someone who’s experienced some anxiety. And I want to point to something. That is a distinction to me, and maybe it has to it, maybe it isn’t. But to me anxiousness and anxiety are different things. And here’s what I mean by that. Absolutely. Like, you describe periods of your life when you were doing things that would make anybody anxious in a war zone, stressful things happening. And you were basically like, I’m fine. I am an appropriate level of anxiousness about the situation. It’s heightening my response. It’s making me planful it’s giving me a caution. And then there are other times in your life when absolutely nothing was going on. That would make you feel anxious, and you were wracked with fear. And I’m wondering if you can just explain that.

Adam Smith 

Sure. And you’re right, that’s a key part of it, stress normal anxiousness about situations around you is not the same as anxiety, the anxiety, there can be things going on around you, that sort of heighten your overall anxiousness. But anxiety is a feeling of existential fear. I mean, when it first hit me in 2005, I get homeland and it just I’m, imagine in your mind, if you are, I always imagined, a homicidal maniac with a machete is coming at you. And that’s the way you feel lying in. But no matter what you’re doing, that’s the way you feel your heart races. In my case, I found it very difficult to eat impossible to sleep, you know, a constant tension in my gut, just that constant, sort of like you’re in the fearful moment, all the time. And you don’t fully understand exactly why you’re feeling that way. Yes, you may have some stresses, the first time this happened to me in 2005, was a very stressful period of my life, my children were young, I was flying back and forth, a whole bunch of stuff going on. But that is different when it crosses over and becomes that uncontrollable level of anxiety. And that usually has a deeper trigger than what is immediately going on. You know, it’s not Oh, I just went to the doctor, and you know, he saw something on my lung, and maybe I have cancer, you know, this is outside of that. So there is something that’s going on, in your sense of self, from your childhood from somewhere that is causing this to happen, that you don’t eat. It’s not immediately apparent in the sense of all those other examples. I cited.

Andy Slavitt 

It. It’s confusing. You remarked at one point how, literally, I think you said if I saw a movie or a TV show, read a book, just anything that was innocuous, would be frightening. Now, in those moments, what I find about what you were writing to be true is my own case is that there’s two manifestations. There’s the physical manifestation, your heart’s racing, you’re sweating, etc. But then there’s the the thoughts you have in your head. Yeah, right. Which is the process, anything happening around you?

Adam Smith 

The way you process information, I can think of certain examples where, you know, you see something happening that’s potentially upsetting, but very quickly, your brain goes, No, I’m fine. You know, in this case, you never get to that I’m fine part, trying to think of the proper example. Maybe it’s like, you see a car coming down the road and it looks like it might be swerving into your lane, but then it’s not and it’s okay. And so you stop worrying about it. Here. It doesn’t matter what you see or read. It feels threatening in a way that you can’t explain away that the threat doesn’t just go away, it stays and you can’t explain it.

Andy Slavitt 

So I want to get into why where do we think that comes from but I first have to ask How do you function given that constant feeling? And I’m imagining I know a little bit about the kind of life you lead. But we’re, you know, you have committee hearings, and you’re grading constituents and and talking to voters about their problems and issues, and you’re traveling at codicils to war zones, and you’re getting briefed by national security folks. Is all this stuff going on? Inside your interior dialogue? Absolutely. And how do you how do you function through that?

Adam Smith 

Well, fortunately, and this will differ from person to person I was I was, I’m reasonably high functioning. So I could be sitting there having a conversation, you know, about some national security issue with the, you know, group of generals or whatever. And I could focus on that conversation. Okay. While at the same time, half of my mind was still focused on the existential threat. But I was able to do both and I was able to, you know, are I reasonably articulate as I stutter, saying that, so I can I, I can, I can always talk, I can always okay, here’s the idea. Here’s the thing I’m trying to explain. Here’s the thing I’m trying to understand. Now, I will tell you that when I’m in that anxiety, it gets more difficult. I certainly as stuff is explained to me, I have times when, you know, I can’t pick it up as quickly as I normally do. But by and large, I was able to be high functioning through that.

Andy Slavitt 

Or maybe do you feel like you’ve you describe it in the sort of monotone response? Where you are like, mechanically? Absolutely. Because you’ve got pattern recognition, you’ve been in the experience before, so you can tend to say and do enough of the right things. But but you know, you’re not engaged. Yeah.

Adam Smith 

Well, the other thing that’s helpful to me, I love explain, I love understanding and explaining things. And that’s much of my job. You know, if I’m speaking to a rotary club, they’re gonna ask me, you know, what’s your position on the Affordable Care Act and why? Okay, my mind has always worked that way, I think through you know, okay. What level of defense budget do you support? Why, okay, you know, what are you doing about homelessness? Why in my mind thinks like that. So one of the things that helped me a little bit is if I happen to get up, and I was speaking in front of a group, that was the one thing that could give me a little space, the anxiety never went away. But I was capable of Okay, great. We’re talking about the Affordable Care Act and how to make health insurance more available to people in America. I know that Yeah. Okay. Let’s talk about that, sir. So the demon would come down just a little bit? Well, you’re

Andy Slavitt 

Distracting yourself.

Adam Smith 

Exactly. Right. So sleeping, or any sort of the stationary part, you know, even as I’m sitting here, I’m feeling like, you know, to just if you told me, just sit, don’t think that would that’s where it would just just and I was getting to sleep, I couldn’t sleep. I couldn’t sleep as I lay down, and it was just racing through my head. And just that was that was really harsh.

Andy Slavitt 

Well, we do, I think in many ways we do everything we can to avoid the one being with the one person that we don’t want to spend time with. And that’s ourselves. That’s a good way of putting it. Yes. But does it make you think, because everybody who would run into you, presumably had no idea. It’s pretty good, except for your wife, baby, and some other clubs confidence that this was going on? Does it make you wonder when you run into, say, you know, 435 people? Or, or, or just in a room with 100 people giving a talk? Are there people in this audience who are going through that right now? And if I read that the numbers and the statistics, maybe a lot of people in this room are?

Adam Smith 

Well, actually, I got to that second point where I don’t wonder anymore. If I wonder who I mean, because statistically speaking, you know, that’s just sort of where we’re at either anxiety or depression or pain. And actually, you know, I document this in the book in a different way when I was trying to figure out what to do about it. And I was so worried about medication and that that’s something I do want to talk about, because I think we weigh over prescribe. We’ll get to that. Yeah, medication. But so I’ve been sitting in a room trying to figure out, okay, I’m taking an SSRI, and it worries me a lot. All right. So what I wanted at that point is I wanted to know that here’s five people who are doing the same thing, and they’re fine. It’s okay, it worked. So I would sit in the room and I’d wonder, okay, statistically, somebody and I just want to say, you know, you’re taking Zoloft. How’s that working out for you? Okay, you know, I want them to tell me, it’s great. It’s fine. The side of it, you know, and so yes, I really tuned in to the fact that other people are going through this much the same thing.

Andy Slavitt 

For those of you who don’t know what an SSRI is, it refers to a class of medications. That is the most commonly prescribed antidepressant and anti anxiety medication. Alright, let’s take one final break. And then we’ll come back and talk about how we treat these kinds of conditions, both pharmacologically and with therapy. And Adam, your perspective on some of the pros and cons and dangers of what works. For all these different kinds of therapies, we’ll be right back. Let’s talk about the components of of dealing with anxiety. And you talk about diagnosis. And we talked about treatment. And I want to try to as cleanly as possible break it into those two categories. Because I think as people are experiencing this chart, it is useful to think about it in this order, which is what is wrong with me? And why and can I get as good a diagnosis as possible? And then if so once I do that, the good news is there are a whole bunch of treatments, some with a fair amount of evidence, not necessarily everything that works for everybody. But it’s certainly a hell of a lot easier than when you’re throwing a bunch of stuff at something you don’t quite understand. And you talk about having interacted with over 100 healthcare professionals and trying to figure this out, and we even talked about it, but you had chronic pain and physical ailments as well. But I’m not focusing as much on that right now. But can you talk about that experience, I think you made a very important comment about not every provider works for everyone. And what you learned in that process that is encouraging to people to seek out that diagnosis?

Adam Smith 

Sure. First of all, when it comes to the number of healthcare providers, I saw the overwhelming majority of those were on the physical pain side. That was see physical therapists, chiropractors, acupuncturists, massage therapists, podiatrists, you know, I probably saw, I don’t know, somewhere between 12 and 15, therapists on the mental health side of one kind or another. And what I was missing from the first few part of it was a connection that I mentioned earlier, you really do have to click with your therapist was part of it. None of them told me about the incredible importance as a starting point of having that healthy narcissism of having that sense of self worth. They dove right into cognitive behavioral therapy, which is trying to teach your mind how to better process the information that was coming at you. Okay, and cognitive behavioral therapy is really important, all right. But if you don’t have that baseline up front, it’s not going to get you there. So that’s one of the biggest things I learned is you have to understand that baseline number one. Number two, psychotherapy is really important if you’re trying to establish that healthy narcissism and that sense of self worth, the things that are chipping away at it are probably something that happened in your life that you haven’t properly dealt with. And the best sentence I’ve ever heard about psychotherapy is the purpose of psychotherapy is not to correct the past it is to help the patient understand his history and to grieve for what he has lost. Number one there don’t try to correct the past and that was what I did wrong. I wanted someone to come in and help me correct the past so that all of my mistakes all the things that I felt bad about. I could make go away and I wouldn’t have to cringe about them anymore. Okay, let’s fix that. Now, but you do have to understand it. You have to be what what is bothering you about what happened your childhood or what’s going on in your life right now. You have to be honest, it At least with yourself, it is helpful if you can have one or two people in your life that you can be honest about, okay? Maybe one of your kids is driving you insane to the point where you got up in the morning and you’re like, I wish I didn’t have this kid. And that’s a horrible thought. Okay, you know, and it is one ultimately you shouldn’t have. But you should be honest. Okay, how did how do I deal with it as opposed to No, I know, you have to be honest with yourself. That’s step two. And then the final thing that I think is really important, and then there’s been a lot of analysis now about serotonin and all the different things that go on your brain, and how if you have depression, or you have anxiety, it’s because of a chemical imbalance, for lack of a better way to put it, you have a greater tendency to depression, and you You’re, you’re less stimulated. That’s one thing you’re, you know, in all that is true. I mean, we’re all different physically, I mean, some people are taller, some people are shorter, some people are faster, slower. And I’m sure that’s true. But just because you have a slightly different brain chemistry, doesn’t mean that that has to be drugged. You can also change how you think about things, you can teach your brain that you don’t have to chase after every single thought. And that’s where meditation ultimately helped me, I was not able to do meditation in the, let’s just sit for 30 minutes and not think about anything. But I was able to understand that the main purpose of meditation is to teach you not to chase every thought that enters your head. When you meditate properly, it’s like notice the thought, you’re not going to fix it. Okay? Notice it, move on. And you can train your brain to better process this at this point, I have to throw in a caveat. I know this has been a long answer. I am not for one second, saying that there aren’t some people in the world who probably need medication because of the way their brain is made up. Not saying that at all. I am saying that we weigh crazy over prescribed drugs to people who don’t need them, because it’s the easy button. Okay. And that’s what we all want. You want someone to say here, take this pill in your fix.

Andy Slavitt 

Yeah, I want to, I want to make a point just because I was gonna come to it, but you raised it on medication. You talk about beating yourself up for certain things. And I want to make sure that this is not what you’re saying. Because it’s something that I think is a it’s important. The beating yourself up because you need medication and might even need it forget need, it helps you right, like it’s something that lowers your cholesterol helps you the guilt that some people feel or the sense that I am comparing myself to someone who can get by without medication, if it just helps you. I think it’s important to say nothing wrong with that whatsoever.

Adam Smith 

Absolutely. No, I completely agree with you in that, in the way you’ve described, that sort of gets into a lot of the issues in this is the issue of our Do you know who you are? And are you comfortable with that. And if you’re beating yourself up over every single thing that you’ve ever done wrong, you’re being unfair to yourself, and certainly medication that was part of my problem, because I had the thought that you know, gosh, am I taking medication that shows weakness? You know, I should think about it. So no, I’m not saying that at all. I’m saying that. Be careful with the diagnosis. Okay. Because I think a lot of times the diagnosis is there’s this, you know, you can’t fix this chemical thing. You got to take this drug. And and antidepressants are one thing. anti anxiety medication is really a tougher thing. Because anti anxiety medication is absolutely addictive. Number one, and you build a tolerance early on in my anxiety, Clonazepam, it worked. Okay, it got me to where I was. Then after about a month, I needed to take more of it. All right. So there is a balance and a choice here is all I’m saying. It’s not as easy as sometimes it appears.

Andy Slavitt 

I don’t know if you remember this. Adam, one of the first times you and I spoke during the pandemic, we were talking about the drug supply chain. Yeah. And I don’t know if you remember this, he made a comment to me, because it was one of the things that I was focused on making sure that people who are dependent on medications could get them. It was really early. We didn’t know what was going to happen. We were just trying to prepare for all eventualities. Yeah. And you said, Gosh, you know, I’ve had experience trying to get off of medication I think even may have said what it was and you know, it would strike me that boy if that medication was suddenly unavailable and you had to quit something cold turkey as opposed to tapering off which is which is I think the one of the experiences you describe in your in your book. You don’t know how you get through it. Yeah.

Adam Smith 

Oh, yeah. No, that’s the other thing I want to make sure and medication is right now. And now all medications are different. I didn’t have any problem getting off on my SSRI, at least in terms of any sort of withdrawals but if you’re taking a benzo to AF mean or is with my chronic pain, I took Tramadol and oxycodone for While you don’t want to cut that off cold turkey, because you’ll be desperate to get back on it and healthcare impacts or

Andy Slavitt 

it takes a physical toll. Oh, that I think is a place you just don’t want to be. And it does help it does help you understand addiction better.

Adam Smith 

And also, it’s really important that this varies from person to person, there are absolutely things within your body that can make you more light more prone to addiction. So same thing, if you’re looking at someone who says, oh, you know, I took when I was a pan for two years got off, it wasn’t that bad. You know, and you’re thinking, Oh, it’s just people are different. Okay, there are people who are much more prone to addiction, who are going to have a much tougher time getting off of medication. And I’m not saying that that means you should sit not try. But also appreciate for yourself, don’t look at someone next to you and say, Well, he did it, what’s wrong with me? Nothing wrong with you, it’s just a little bit more more difficult for you.

Andy Slavitt 

The message I’d give people is it can all be done. And look, there’s an acute stage of what you’ve experienced. And there’s a current and more chronic stage of what you’ve experienced, and acute stage of being in a mental health crisis or having a panic attack, or needing some relief. And finding some relief through a prescription from a physician. I’m not talking about something you buy in the street, I’m not talking about something a friend gives you or it’s in someone’s medicine cabinet of document from a physician, it can be an incredible gift.

Adam Smith 

Yeah, look, if I’m being perfectly honest about that, I mean, particularly with the anxiety, before I could even calm down enough to even think about how to approach it. Now, it was probably helpful, at least in the short term to get something to calm me down enough to have that conversation. Certainly, so again, medication can be part of it. It’s just that my view, as I look at the way we approach these issues, is we rely on it too much to the exclusion of things that we can do. That will give us greater resiliency.

Andy Slavitt 

Let’s go back to the therapy part than ever talked about the drugs. After a lot of therapists and a number of years. Did you eventually figure out what it was? The demons? Yeah. And how much did facing that. And as you say, grieving, the teacher description, those things. Did that work to turn around the source of the xiety?

Adam Smith 

Absolutely. Yeah, to two things. One, was I didn’t understand that, because of my, you know, my adoption, both my adoptive parents had some issues as well, I had an older brother had some serious issues, I had a somewhat unstable childhood, let’s just put it that way. And that robbed me of that basic sense of self worth. And I didn’t, I just didn’t believe it, I felt I had to prove myself constantly. So I had to establish that. And then second, I have a ton of guilt over how that played out, which I describe in the book. You know, my father died when he was 19 a night when I was fine. So I did that. But before he died, he died when he was 58. And I was 19, he had a stroke, my mother died of a stroke later, and that they were not terribly happy people. Our family was disrupted, my older brother got into all kinds of criminal activity was disrupted. And I kind of just sort of slid around all of that. Okay. And I lay that out in the book that on the one hand, you know, my parents, my family, they didn’t, you know, they made mistakes, to be sure they should have told me I was adopted for one thing, you know, and I kind of resented that. On the other hand, I’ve got this great life. They died before they were 60. And here I am judging them. Okay. That’s the guilt. Yeah, I felt bad. I didn’t do anything I said in this. It was actually one of the most powerful moments for me and writing the book, I’d written it. And then has a long version of the story. But I’ll show I was watching a movie, blinded by the light, which is a great movie about it’s set in London. I think it’s a Pakistani family, that that the young kids obsessed with Bruce Springsteen, and he’s growing up in a blue collar family, very similar neighborhood situation I grew up in and he was wrestling with the fact that he kind of his parents, he thought were kind of a pain in the butt. But he still liked them. And how do you wrestle through that? And as I watched that, I thought that was a big part of it is I was trying to live a life different than my parents. And I wanted that. But was I saying that I was better than them. And isn’t that like, you know, so I just I wrote out in the book, I said, I’m sorry, to my parents, you know, which I’d never had the opportunity to do.

Andy Slavitt 

Was that cathartic?

Adam Smith 

Oh, gosh, it was unbelievably cathartic. unburdening. Yeah. And so that’s the other part of it. And one of the things that I in our, in our sort of more self focused world here, we focus a lot on the stuff in our past where we think something happened to us. That was unfair, and that we’re upset about and we’ve never quite dealt with or got justice for. But there’s also a lot of stuff you do in your life. Did you kind of feel bad about it and you bury that because there’s nothing you can do about it. Both of those things are important, address what you’re upset about, but also address the things where you think you were wrong. And you never made it right. And you’re not going to be able to make it right. But recognize it and take responsibility for it. I think that’s a big part of it as well.

Andy Slavitt 

So I got to ask, it’s like, I’m reading this book. And I’m thinking, There’s something weird about this book. Okay. And I can’t figure out what it is. And then I realize that, as I’m partway through it, what it is, it’s sticking with me. And that is that you’ve done something that other people claim to do, but never really do, which is you talked about mental health issues as the same way you would talk about them as if they were physical health issues. You talked about your anxiety as if you were talking about diabetes, or heart condition. And I am someone who preaches that all the time, that mental health issues and physical health issues ought to be treated and dealt with the same. There’s legislation we’ve signed as a country called mental health parity, which says we should do that, yet, none of us do that. And that’s the reason is because I think we sell stigmatize. And we believe we’re gonna be stigmatized by others. So this book is a statement, it’s a show, don’t tell type of statement against stigmatization. How did you decide to write it quite that way? Or, or? Or what caused you to feel like, Screw it? There’s a stigma out there, but I’m going for it?

Adam Smith 

Well, I think the biggest thing is what I said earlier about my passion as a human being to simply explain things, even if ultimately, the explanation gets me to a conclusion, that’s problematic for me in my life, I’d rather just lay it out, honestly, than just lay it out in the way that’s going to suit my purposes. I’m just, that’s just kind of who I am in terms of how I explain things. So I want to just simply explain it honestly. And the truth is, that’s the honest way you explain it. And then the second thing is, what you mentioned about viewing mental health as being so different than physical health is one of the things that made it so hard for me to address this. And I mentioned that early on, the idea that I would have a mental health problem was just, it was just ridiculous. No, no, I’m the I’m saying, I’m not crazy. You know, whereas, you know, my physical health, if you know, if I get in a ski accident and break my leg, it’s like, I broke my leg, I got a physical health problem, you know, but there was this division. And I think I learned the hard way. There’s no division here. In fact, a lot of times, mind and body are together on the pain issue. Little that wasn’t necessarily my case. But it’s all connected. And you have to understand your mind and your body to be healthy. And they’re very interconnected. And, and there’s not this line between, you know, crazy insane, in the same way that there’s not a line between perfectly healthy and completely crippled.

Andy Slavitt 

You talked about one moment in the in the book, you ran into a Republican colleague and someone who I wouldn’t say you were friends with, it’s something you maybe had some respect for. But they’re, you know, they were kind of on the other side of things. And yet, you’re dealing with some physical pain at the time, and it was pretty obvious. And he said to you something to the effect of, man, we all admire you because we now you’re dealing with physical pain. As that happened, could you imagine that happened with on the mental health side? Where have you had people? I’m talking about now, particularly fellow members of Congress, because at that moment, it would have been so great if I thought it would have been so amazing if you were able to say or have the dialogue, and he was able to say something to you, akin to that for your anxiety. And and now you’re at a point where people obviously know because you wrote this book.

Adam Smith 

Yeah. No, good, good summary. And I think that’s why I wrote the book, the way I wrote the book is, is I wanted to get to the point. And again, what my goal in writing this book was simply to honestly explain what happened to me. I’m not I’m not lobbying one thing, one way or the other. I learned lessons from that, that I believe in. It’s not an advocacy book is, this is what happened. I want to explain it as clearly and honestly as possible, because I think that’s similar to what people are dealing with. And one key aspect of it is what you focused on, is the fact that we’ve got to start treating mental health in that way, in the same way. This like, you know, we have things that go wrong with us, and then we deal with them. And some of that is within your your mental health, with anxiety with depression. And we ought to be able to talk about that and approach that in the same way we do that physical things. I mean, you walk around the Capitol, you know, through the years, you always see the person who’s in the ankle boot or on crutches or you know, arm is in a sling or the little wheelie thing. And you know, and it’s always a big conversation. You know, I joke with people like that. I don’t want to be the 1500 person to ask you what happened. On the other hand, I don’t want to look like I don’t care. So you know. Yeah, I think Barney Frank was in that situation one time. And before anyone could say anything, you know, I forget what it was, I fell off my bike, I’m fine. He’s just like, you know, but we don’t do the same thing. A because it’s not as visible, obviously. But be because it still has a stigma that people think there’s something wrong there. And we got to get past that if we’re going to deal with it.

Andy Slavitt 

So I know, I know, several senators in Congress, people personally who have told me about their bouts with depression, alcoholism, other kinds of things. Some of them are public, some of them I don’t know that, that they are. I imagine you’ve had a great reception. And a lot of people have said things to like, boy, Adam, you’re super brave, or wow, I really admire what you did, and, and all that stuff. And I think at some level, that’s probably nice. Yet, you must wonder for our people who whether they say something positive or don’t are going hmm, I don’t know if I think the same about this guy anymore. And I’m asking this question, just I want to get at the stigma point of people going boy, but I trust him with my kids. When I trust you know, I mean, that whole thing is buried, maybe Now thankfully, more deeply inside people. But it can’t have disappeared.

Adam Smith 

Yeah, no to two things about that. First of all, I don’t think about it that way. I honestly, I’ve done things in my life, which I won’t get into that. I feel like we’re brave. Okay. Well, I was in a tough situation, I did a hard thing. The right way. So I know what that feeling is. And that is not the way I feel about writing this book. I wanted to tell the story. I wanted to get it right. I don’t think of it as being brave. Okay. And I think the reason is, in large part, because I’ve reached a point in my life, where I don’t feel threatened by those things. Okay. It’s not do I think there might be some people out there who will look at this and think about me in a way that’s like, who Okay, well, maybe he’s like, you just set the maybe a few. I don’t care. Okay. I really don’t. But a big part of the reason why I don’t care is I’m very comfortable in who I am as a person. Yep. All right. And if the worst happens, and you know, I somehow lose my job over this. I don’t care.

Andy Slavitt 

There whatever the point in your life, when you would have cared? Oh, absolutely, you would have been to put in your time with you wouldn’t have said because I’m very comfortable with who I am, you are the opposite of that. That is the incredible part of the journey and the story, which I think as we close this down, I will want to just say that I think this is possible for you, if you’re listening to this, and you’re going through crisis, or self doubt, or fear, or depression, or addiction. And you feel like you’re in that mode, where you’re like, Man, I just can’t figure out how to get out of it. There is another side that other side, unfortunately requires dealing with some some difficult things to pain, some suffering some questions you may not want to ask. But I wonder if you could just close with your very direct thought and message to the people who were you 1020 30 years ago?

Adam Smith 

Absolutely. And this is something I believe in the depths of my soul, you can get better. Now I’m not pollyannish about this. I’m not saying that, you know, it’s guaranteed or it’s going to be perfect. But the thing that I absolutely believe about human beings, both individually and collectively, whatever problem we face, we possess the ability to get better. Okay. And that is absolutely true with with mental and physical health problems. You can get better can you 100% Fix it, you will be absolutely perfect. Depends on what it is. But if you seek help, understand how your mind and body works. You can absolutely get better. And let me tell you something, I doubted that in that same depth of my soul during the course of it. I just was like, there is no way out of this. So whatever you’re feeling at this point, I absolutely felt that. You know, there’s just this that I don’t understand what these people are saying to me. I don’t have this worry as though I 1,000% There is a path, there is a path to getting better. Again, not perfect, but better to do reducing anxiety and reducing pain if you seek it out. So that’s the biggest message that I want to set difficult, maybe. But you can absolutely find that path to getting better.

Andy Slavitt 

Well, let’s leave it there. There are plenty of other things for you to come back in the bubble. And talk to us about Ukraine. A lot going on in the world. Yeah. The mutiny going on, on the Republican side, right now, a lot of those things. But man, I love this conversation. Because what it communicates is for all the things going on in the world, maybe you want to start within, maybe you want to start with yourself, and maybe give yourself permission to do that, as opposed to just all the things we can get distracted with in the world. And the world actually can look like a better place. I think, when you spend that time, as hard as it is to do it. I think your book will encourage a lot of people to do more of that. And that’s why I think this was an important conversation.

Adam Smith 

I can’t say it any better than that. Thanks, Andy. I really appreciate the chance.

Andy Slavitt 

Thank you, Congressman.

Adam Smith 

Thank you. Great to see you.

Andy Slavitt 

I hope you got something out of that episode. I really appreciate you listening to that interview in that conversation. Email the at Andy eliminator media.com. I want to know what you thought. I want to know anything you want to tell me about it. I’m very excited. By next week’s episode. It is basically a podcast scoop. All right. We have the senior adviser to the President of the United States. And Anita Dunn. Coming on the podcast. She is one of the top strategists in the White House. She does that give a lot of interviews. It’s going to be here and in the bubble. really grateful that Anita sat for this conversation. You’re going to be in the bubble with the insider Iest of insiders. And I think you’ll find her terrific and charming. And then after that Tom Frieden, who is the former head of the CDC, is coming on. And we’re going to talk about the new and innovative challenge that he is putting forward to the country and how to respond to pandemics going forward. Love time, love this conversation.

Andy Slavitt 

Thank you for listening IN THE BUBBLE. If you like what you heard, rate and review and most importantly, tell a friend about the show. tell anyone about the show. We’re a production of Lemonada Media. Kyle Shiely is the Senior Producer of our show. He’s the main guy, and he rocks it with me every week. The mix is by Noah Smith. He’s a wizard. He does all the technical stuff and he’s a cool guy. Steve Nelson is the vice president of weekly content. He’s well above average. And of course, the ultimate big bosses are Jessica Cordova Kramer and Stephanie Wittels Wachs. They are wonderful, inspiring, and they put the sugar in the lemonade. They executive produced the show along with me. Our theme was composed by Dan Molad and Oliver Hill, and additional music is by Ivan Kuraev. You can find out more about our show on social media at @LemonadMedia where you can also get a transcript of the show and buy some in the bubble gear. Email me directly at andy@lemonadamedia.com. You can find my Twitter feed at @Slavitt and you can download in the bubble wherever you get your podcasts or listen ad free on Amazon music. It’s a prime membership. Thank you for listening.