When John Fetterman’s office announced in February he had checked himself into the hospital to receive treatment for clinical depression, the news rippled through Congress. But for a group of current and former lawmakers who have dealt with their own mental health issues—some more publicly than others—it stirred up complicated feelings: compassion, anxiety, and a hope that the political calculus around mental health issues was finally shifting.
While other Senators have had to take time away from the Capitol for physical ailments in the past, it’s far rarer to do so for mental health treatment. Fetterman’s hospitalization comes at what lawmakers who have had their own mental health challenges say is the best time in history to seek such treatment. Visibility is at an all-time high, both in society writ large and within the halls of the Capitol. Yet those with the most personal experience around mental health in Congress also say the staid institution still has a long way to go to eliminate shame about mental illness, in part because the state of today’s bitter politics encourages opponents to use potential vulnerabilities against each other.
The long workdays, the constant pressure, and the knowledge that one wrong word could cost you your job can all make Congress a less-than-ideal workplace for mental health. Though there is no reliable way to estimate how many members have had their own experiences, 2021 data from the Substance Abuse and Mental Health Services Administration indicates that 22.8% of American adults experienced mental illness that year.
“It might be tempting to think that the power and prestige of public office insulates you from the feelings of personal inadequacy that depression produces,” says Rep. Ritchie Torres, a New York Democrat, who has been open about his longterm battle with depression. “Quite the opposite: one’s struggle with depression can be compounded by the mental strains and stresses of public life.”
Read More: Ritchie Torres on How Struggling With Depression Makes Him a Better Congressman
With Fetterman, a Pennsylvania Democrat, the latest and most high-profile example of a lawmaker needing mental health support, how Congress responds to his treatment will be an important indicator about how it will evolve to accommodate members going forward— just as it has adapted to Fetterman’s physical needs during his recovery from a stroke. In this case, it isn’t the infrastructure that needs to change; multiple lawmakers told TIME Fetterman has much easier and more affordable access to health care than many Americans. Instead, it’s the continuing stigma around mental illness that shapes who can comfortably represent Americans in Washington.
‘It’s all about perceptions’
Mental illness has long been taboo in politics.
When former Rep. Patrick Kennedy, the son of Senator Ted Kennedy, was elected to Congress as a Rhode Island Democrat in 1994, he tried to keep his drug addiction and mental health issues quiet. He insisted on receiving treatment at the Mayo Clinic, which he thought people might associate with physical illness. “It’s all about perceptions,” says Kennedy, who is now a mental health advocate. “Even though these are chronic illnesses and people knew that I was someone who suffered from them, I didn’t want them to think that I was still suffering from them… because then they would get really suspicious and then think, ‘Oh, he’s not well.’”
Former Rep. Brian Baird, who practiced clinical psychology for 20 years before representing Washington state as a Democrat in the House, remembers consulting the House physician about a mental health issue while in office. “Merely being seen going into the office of a psychologist or psychiatrist can be a big issue,” Baird says. When it comes to the attending physician, “Nobody knows whether you’re going to him for a head cold or a torn rotator cuff or whatever.”
Even current members of Congress who have spoken about their mental health struggles initially worried about what doing so might mean for their careers. That small group includes Rep. Seth Moulton, a Massachusetts Democrat, who in 2019 became the first modern major party presidential candidate to say that he had gotten mental health treatment when he talked about suffering from post-traumatic stress disorder after his service in the Marines. “I recognized that it could well end my political career, because it had that effect for others in the past,” Moulton says. “Everyone asks, when you go into politics, ‘Do you have any skeletons in your closet?’ And this was my one skeleton that I didn’t share with almost anyone.”
He says conversations with other former Marines finally led him to share his own history. Now, he’s excited to hear other colleagues reveal their own experiences, including Torres, who has talked about being hospitalized for depression before he was elected to Congress and taking an antidepressant. When he first ran for public office in a city council race in 2013, Torres says an opponent tried to use his depression against him to suggest he was mentally unfit for office. “I promised myself that never again would I allow my mental health to be weaponized, that I would be honest and open about my struggles with depression, and do it on my own terms, and own it,” Torres says. Now he believes that “elected officials should see telling their own stories about mental health as a form of public service.”
Others, like Senator Tina Smith, a Democrat from Minnesota, have also seen positive outcomes from coming forward with something they were once hesitant to share. In 2019, Smith gave a speech on the Senate floor about how she had used therapy and medication to treat her depression earlier in life. “When I made the decision, I overestimated the potential negative blowback and I underestimated the power of being open about it,” Smith says.
But lawmakers who spoke with TIME also say that they know others struggling with mental health who don’t talk about it publicly.
The members who opt to keep mental health challenges private often do so in part because of the increasingly alienating, vitriolic, and politically polarized environment of Congress, their colleagues say. In private conversations about the difficulty and loneliness of the job, lawmakers in the past have turned to some of the only other people who could understand: each other. These days, it’s a lot harder for members to find those kinds of connections, especially across party lines. “Those informal avenues to get emotional support and understanding and camaraderie from your peers are very rare now,” says Baird. “It’s hard for me to say that [the stigma is] a whole hell of a lot better.”
The unforgiving media landscape doesn’t make openness any easier. After Fetterman checked into the hospital, some conservatives quickly launched attacks blaming his wife and insisting he shouldn’t be in office. “If it were just a normal person, people would be thinking, ‘How can we help him get through this?’” Baird says. “For Senator Fetterman, it becomes, ‘Oh, well, should he stay in the Senate anyway?’ As soon as they learn there’s an opportunity, the sharks start circling, instead of trying to stop the bleeding.”
For their part, congressional Republicans have mostly kept quiet, and some have expressed support, including Senator Ted Cruz of Texas.
Even members of Congress who are candid about their past experiences have mixed reactions about what they would do if they faced more acute mental illness while in office. Moulton says he might not share if doing so would affect his family. Smith says she would think about whether telling the public would help her achieve a larger purpose, like making others feel less alone. She says she probably wouldn’t feel obligated to publicize regular psychiatrist visits for low-level depression, but might talk about certain issues. “What Senator Fetterman has done is not only courageous, but it’s also sensible,” Smith says. “This is not a place where you want to be keeping secrets.”
The biggest practical concern for a member who is away getting treatment for mental illness is missing votes.
It isn’t unheard of for a lawmaker to miss votes when sick: former Sens. Tim Johnson and Mark Kirk, a Democrat from South Dakota and a Republican from Illinois, were absent for more than eight months each while managing physical health issues more than a decade ago. Senator Ben Ray Luján, a New Mexico Democrat, was away from the Capitol for a month last year while recovering from a stroke.
But with Democrats controlling the Senate by a tight 51-49 margin, Fetterman’s absence for a key vote could have political consequences. Fetterman has been in the hospital for three weeks. In a tweet Monday, his chief of staff said he “will be back soon” and included photos of the Senator conducting Senate business remotely. Fetterman’s office declined to comment on the record for this story.
Kennedy doesn’t think votes will end up being a problem—and he speaks from experience. One afternoon in 2010, Kennedy was staying at a rehab center in Maryland. The staff told him he needed to call his office, which quickly patched him through to then-Speaker Nancy Pelosi. She told him she needed him to take a quick trip away from the center if it wouldn’t impact his treatment; the House was going to vote on the Affordable Care Act.
Accompanied by a rehab center employee, Kennedy drove from the Maryland shore to Capitol Hill and went straight onto the floor of the House. He voted in support of the landmark healthcare bill. “Once we had won by just a handful of votes, Nancy Pelosi turned to me and said, ‘Okay, honey, time to go back to rehab,” Kennedy recalls.
If Fetterman ever receives a similar plea from Majority Leader Chuck Schumer, Kennedy thinks depression is unlikely to stop him: “Believe me, if Schumer needs the vote, he’s gonna be there.”
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