For Congressman Adam Smith, his journey from state senator to a 27-year veteran of Congress has been filled with highs and lows. Despite the challenges he has faced along the way – including chronic pain and crippling anxiety – he has persevered through it all, driven by his ambition to make a difference in his community.
Recently, Smith shared with us his inspiring story, which he talks about in-depth in his new book, "Lost and Broken: My Journey Back from Chronic Pain and Crippling Anxiety."
The book takes readers through his journey of courage and resilience as he navigated his way through the difficult period of his life, highlighting how, despite having to deal with chronic pain and crippling anxiety, he was able to find peace in himself and use it to make a positive difference in his community.
Smith hopes that by sharing his struggles, he can help others facing similar issues recognize their own potential and strength, believing that it is important to start conversations about our shared experiences with chronic pain and other mental health challenges to reduce the stigma associated with them.
The full interview with Congressman Smith will be available on the Living and Leading with Emotional Intelligence podcast on June 28th, 2023. Here we have shared some of the key points from our conversation:
Questions/statements by EIM+ have been shortened for better readability. However, they maintain the essence of the original extended communication and questions. Statements by Congressman Smith remain in their entirety, with the exception of filler words and sentence fragments.
In your book, you talk about being a ‘good worrier’ and how you perceived worrying as being an element of your success.
Congressman Smith: Yeah, well, what I said was actually honestly true. I always said it's the stuff I don't worry about that gets me in trouble. I thought I've got to be thinking about it. I got to be playing. I’ve got to be worrying about it. I'm, you know, paranoid, obsessive. Those might be strong words, but, I think a lot, and I try to figure out and solve problems. And what I learned throughout my life was you can do that without stressing out so much. And so, yeah, I was definitely a big worrier about everything that was coming at me, and it helped me in the sense that I would see problems coming, and I would really focus on figuring out how to solve them. However, you can only worry about so much, and you can't solve everything. And those things sort of clashed and really contributed to my anxiety.
How did chronic pain and anxiety, combined, influence your life and work?
Congressman Smith: Yeah. That's the main reason why I wrote this book because as I was going through this [pain and anxiety] and I slowly learned how many people are going through some combination of the same thing. If you talk about anxiety, depression, and chronic pain, there's got to be tens of millions of people in this country who are going through some combination of that. Trying to figure out how to deal with it, I think, is incredibly important for our society.
On the topic of the American healthcare system:
Additional context—the original question: Let's talk about your experience in the healthcare system because that's a strong focus in this book—how the system currently is and how ineffective it can be. We have these views of what healthcare "should" look like and that ["should" way of doing things] is being taught repeatedly without much innovation involved. Would you mind sharing where this all started and where you started to notice it becoming a serious problem?
Congressman Smith: Sure. Yeah. Two pieces to that. One, and the biggest problem, is that it's the money and it's the motivation. Our healthcare system is built around who can pay for what, and insurance is the driver. There are some people who can pay out of pocket for some things, but by and large, when you see what care is being provided, it's because insurers will cover it.
A lot of this is driven by Medicare and Medicaid—big federal insurers who have large pools of people—but then private insurers as well. And once a healthcare provider figures out what the insurers will pay for, then that's what they're going to offer. But is that really what the patient needs?
Within our system, we pay for quantity more than quality. And also, we don't have a lot of time to invest in figuring out what's really wrong with the patient. A healthcare provider doesn't get paid any more if they see you for two hours than if they see you for two minutes.
So, where's the incentive to sit down with a patient and actually talk through the problems? On the other hand, healthcare providers get paid a lot for ordering procedures, x-rays, and MRIs, and they get paid even more for surgeries, hip replacements, back surgeries, etc. I had three hip surgeries. I have two artificial hips.
And look, in certain instances, all that stuff is needed, no question about it. But the incentives, they push us towards ordering those tests and doing those surgeries and drugs, that's, you know... Insurance companies pay for drugs and push us away from an upfront diagnosis of what's really going on. That's the number one biggest problem.
The second biggest problem—and this is well documented by a lot of people—doctors, you talk about emotional intelligence on your podcast, that's not their strength. They [doctors, in general] don't communicate well with people. They think like engineers. They don't communicate with their patients in a clear way, and they also don't listen to their patients in a clear way—often enough.
It’s like they're checking boxes and moving on. And the human body, the mind... I mean, the cause of your pain can be a thousand different things. The cause of your anxiety can be a thousand different things. The specifics of that patient matter enormously in getting the right diagnosis and treatment. And you just sort of [referring to many healthcare professionals/providers] move past it, on to, "Okay, well, we'll order an MRI, we'll get an x-ray, we'll send you to a hip surgeon."
And I was lost, as the title [of my book] implies. I wasn't thinking clearly. One big point I make in the book, that I hope everyone realizes, is, as a patient, you really have to take a far greater degree of responsibility for your own healthcare than you realize. I go to a doctor and say, "I have X problem. You're the doctor. Tell me how to fix it." But as patients, you are going to have to be responsible for figuring that out because the healthcare system is not well designed to help you as much as it should. I could go on, but that's sort of the two big initial points.
On the topic of mental health diagnosis, treatment options, and personal responsibility:
Additional context - Following sharing my own journey with mental health diagnoses and being placed on medication, I stated: I realized that I have more power and control over those chemical imbalances than I thought—and people fight me on that. But I think the fight is with the ego because everybody's looking for that quick fix. As in, "Give me a diagnosis that I can justify not dealing with things or a 'need' to put in the work and instead, give me medication that makes me feel better instantaneously," which, most often, is a placebo effect because it takes about two weeks to get into your system, which shows that our minds are powerful.
Congressman Smith: Yeah. What you just said, I don't think I can say it any better. I just want to really emphasize that point.
You don't have to go where your mind takes you. We all have to learn how to deal with feelings, thoughts, and emotions. You don't have to chase every single one. But to your point, it's hard. Anyone who says to you, "just don't think about it. Don't worry about it." It's like, yeah, but I am.
There are procedures to talk through in psychotherapy and cognitive behavioral therapy (CBT) in understanding your basic self-worth as a person that can put you in a better position to have your mind be able to handle that. And if you're just sort of drug it [your mind] into submission, you're not solving the problem. But there is that tendency to, as you said, seek the quick fix. That's what you want. Like, "I've got kids, I've got a job, I've got...you know... I don't want to have to go to a therapist once a week for the next 10 years. Give me a pill. Make it better."
But it doesn't take 10 years if you really take the time and you get a good therapist, and you do the research you can and everyone's different. I don't want to be glib about it, there are some people who have definitely more profound problems than others, but you can do things that can help you deal better with your anxiety just by understanding how your mind works and using techniques to deal with that.
On the topic of finding the right specialist and resources:
Congressman Smith: Most of these specialists were on the chronic pain side. ... I saw over a hundred different providers over the course of the six years that I was working through this. I probably only saw a dozen psychologists, psychiatrists, and therapists. But it was difficult to find that person who worked. And I did finally find a psychologist, and I think this is an important point that when I do these interviews, I often don't get to this point, but the fundamental thing that the psychologist did for me.
So, I'd been to a bunch of 'em and he had me fill out this long questionnaire and a whole bunch of different questions before I went in. And you know, again, I sit down, he looks at the questionnaire, he looks up at me, and he says, "you don't think you have the right to exist." When he said that to me, my initial reaction was, “oh my God, it's going to be a waste of my time. What the hell are you talking about? I'm very confident in different things.” What he was getting at was you [I] have to have what psychiatrists refer to as a healthy narcissism, a fundamental sense of your own self-worth that is not connected to anything that you're specifically doing.
I don't have self-worth because I'm attractive or because I'm good at sports or good at my job, or even because I'm a good friend or a good husband, I have self-worth because I'm a human being. And you're supposed to get that from a loving, nurturing environment from your childhood. And I didn't really have that. So, I grew up thinking thatI have to prove myself every second of every day. Because my basic existence, my basic self-worth is in question. So I’ve got to be the best. And yes, it motivated me in my career, but it also made me a little unstable and gave me an enormous bought of anxiety.
Once you get that basic self-worth, then you can start dealing with the world around you. And there are challenges there as well. And that's where cognitive behavioral therapy (CBT), and some broader psychotherapy issues come in. But that baseline. And then what psychotherapy is about is being honest with yourself. What makes you nervous? What are you worried about? What do you want outta life? You know, a lot of people hide that and suppress it. It's there, but they're not being honest about it. And you don't necessarily need a therapist for that if you've got good friends, but you need to learn how to be honest.
And then cognitive behavioral therapy is to understand that when the emotion hits you, I try to tell people, It's real. And it could be totally illogical. …
Little things happen in your life. It's not that that feeling is wrong. Just take it in and go, "okay, let me think about it for a second. Is this really okay? No." But you’ve got to learn how to do that. How to process emotions. Meditation is incredibly helpful in this regard. It's not that you're not going to think it's just that the thoughts, come notice them and move on. You don't have to chase all of them, but you do need some help learning that. It's a long answer, but I think it's a really important point.
On the topic of the stigma of being open about mental health, specifically as a man and a government official: Was it hard for you to be open with other people about your anxiety and pain?
Congressman Smith: It was. The main reason it was hard for me at the start is that I felt the weakness that I had, both physically and emotionally, was going to jeopardize my life. I always used to have a good saying that my life was: good husband, good father, good congressman. That's what I want to be. That's meeting my responsibilities to those things. And I didn't want to admit I had these problems because I'm like, how can I continue to be all of those things if I'm freaked out? And yes, there is also the stigma in society against that perceived weakness of admitting you have a problem.
And particularly in my job, I was worried that if people knew their member of Congress was having these struggles, I'd be out of a job. So, I was reluctant to do that. Now, I'm a little unusual in the sense that despite all of this, I've always been kind of willing to talk about this stuff. I was blessed with some pretty good friends growing up, and we talk about stuff. We're not the typical guys who get together, drink beer, play golf, and don't say five words to each other during the course of it.
I think that's maybe just the way I was raised. But I do think that men and women, in different ways, have challenges being open and honest about it. And again, I'll come back to something I said earlier, that's one of the most important steps in dealing with any problem is being honest about what you're dealing with. Allowing people the space to open up, I think, is an important thing we need to do.
On the topic of love and Self-worth:
Additional context: In an early chapter of the book, Smith talks about not seeing eye-to-eye with his therapist on the topic of inherent self-worth and love, which shifts in later chapters. I asked, “What shifted that perspective in you?”
Congressman Smith: It's interesting. It was about a two-year argument that I had with my psychologist. Because I have responsibilities that are enormously important to me. If I have not met my responsibility to somebody, it's really difficult for me. I just feel this drive to meet the expectations. I think probably it's some of the insecurity from childhood. I want to prove myself to my parents and other people. The adoption probably had a little something to do with it. And so the idea that, you know,… I want people to follow the rules. You all know the people who don't do—they don't meet their responsibilities. They don't do anything. They don't take care of their kids, and everything, and everyone else is supposed to pick it up for them. And the idea that that's okay, that it doesn't matter whether or not you do what you say you're going to do, that you are honest and fair with the people you're dealing with, that you're no better or worse a person if you do or not. But the thing is, that's not the point of this. That's not the point.
We can have those discussions, certainly, about what is the right way to live as a citizen, but none of that changes that fundamental self-worth, and that's what I wanted to argue about. I kept arguing with him about, you know, "I'm not sure how good a person I am. Let me walk through some of the terrible things I've done in my life or things that I haven't done well. How do I make up for that? How do I fix that? You know, I'm not perfect." So we had that argument, and it took him forever to make me convinced that those discussions they're interesting, and certainly, if you want to be a better person, think about the fact that you shouldn't have said that. So maybe next time, say something different or apologize. [There are] a whole bunch of different ways to try and deal with that [messing up], but that doesn't change your fundamental self-worth.
We are humans. We are not perfect. And we are all worthy of love. And that's the cornerstone of it. And once you believe that, you can deal with the challenges that you face in life in a way that doesn't have you constantly thinking of it as an existential threat.
And it just, it took a while to give it to my whole mind. My whole life was about "how good am I? Am I a good husband? Have I been responsive to this? Am I really doing a good job with my kids? You know, am I doing a good job as a member of Congress?"
They called me up, and they wanted me to go to this meeting, and I'm like, "Hey, I'm busy. I don't want to go to that." But if I don't go, am I not meeting my obligations? My whole life, I was really obsessed with focusing on what to do. And that's fine, as long as you don't take it as a final judgment on your worth as a human being. And all I can say is what I just said in two or three minutes there took about two and a half years of a very good psychologist patiently explaining it to me.
The above text is simply a glimpse of the depth Smith goes into both in our interview and more extensively in his book. Although the above dialogue is focused primarily on mental health, Smith also spoke and wrote extensively about his struggle with chronic pain. You can learn more by checking out his book, Lost to Broken, now available.
For now, we would like to share Smith's parting words from our interview:
There is hope:
Congressman Smith: Yeah, and the big thing I always conclude with is you can get better. There is help. I doubted that for a very long period of time—you know, maybe I just have to learn to live like this, both with my mind and with my body.
There are things out there. Now, I'm not going to be pollyannaish about this. You can't solve every problem. I'm not saying that you can get back to perfection for every problem you solve. I'm just standing by the basic statement that you can get better; that there are ways to figure out how your mind and body work that will give you greater mental peace and less physical pain.
So persist. Don't give up. Find the people out there who can help you to get better because the human body is an incredibly incredible healing machine. It really is amazing. You know, when you think about the things that the body and the mind can go through that they can get better from. It's incredible.
Again, not a panacea; [you’re] not going to solve every problem, but you can get better, and help does exist in both of these areas.
On behalf of EIM+, I want to thank Congressman Smith for sharing his time with us and sharing his journey in his book so that others may find resolve. And a big thanks to Lindsey at HCI Books for making this interview possible.
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