The Washington PostDemocracy Dies in Darkness

Does John Fetterman’s openness signal new acceptance of mental illness?

Some see the reaction to Sen. Fetterman’s announcement as a sign of progress, but that’s less true than you might think

Sen. John Fetterman (D-Pa.) leaves a classified briefing about the latest unknown objects shot down by the U.S. military on Feb. 14. (Evelyn Hockstein/Reuters)
8 min

On Feb. 15, Sen. John Fetterman (D-Pa.) checked himself into the hospital for treatment for depression. The move marked the culmination of a rough year for Fetterman, who suffered a near-fatal stroke last May. Nearly one-third of stroke survivors suffer from depression, and Fetterman has had a tough road, struggling with an auditory processing disorder that makes it hard for him to understand and render speech, while needing to manage his recovery during the stress of a hotly contested campaign.

Many have lauded Fetterman’s courage, both in seeking treatment and in disclosing his depression. Some have hoped that this disclosure will help to normalize openness about mental health, especially depression and related conditions. The acclaim hasn’t been universal. Some right-wing commentators have leaped at the chance to declare the liberal senator unqualified for office. But overall, the reaction has been more positive than negative.

Many of those applauding Fetterman see this reaction as a sign of progress. They have contrasted it with the way that 1972 Democratic presidential nominee George McGovern removed his initial running mate, Sen. Thomas Eagleton (D-Mo.), from the ticket following the news that Eagleton had received electroconvulsive therapy (ECT) for depression.

Yet, such a narrative is oversimplified, missing both some of the nuance of the Eagleton case, as well as how Fetterman’s admission, while mostly praised, also has exposed some lingering forms of stigma about depression.

On July 14, 1972, after his first few choices declined to accept the vice-presidential nomination, McGovern named Eagleton his running mate, following a background check that was minimal by today’s standards. Some in McGovern’s inner circle had heard rumors of past mental illness. According to former senator Gary Hart (D-Colo.), who ran McGovern’s campaign, Eagleton was chosen because he was Catholic, rural and from a border state between the North and South. The press immediately started looking into Eagleton’s medical history, and on July 25, Eagleton admitted that he had been hospitalized for depression three times between 1960 and 1966, receiving ECT on two of those occasions.

When the story broke, McGovern expressed his full confidence in his running mate and vowed to keep Eagleton on the ticket. Eagleton was surprised that his medical history would be a problem. Even President Richard M. Nixon, the Republican nominee, agreed, saying that policy differences were what mattered to voters. Medical opinion was split. The American Psychiatric Association issued a statement assuring the public that many people recovered from depression quickly and fully after ECT treatment, but some doctors advised McGovern that the stress of high office might prove to be too much for Eagleton.

In the first three days after the news broke, millions in campaign donations were withdrawn and hedged, as contributors worried about the damage the revelations might do to McGovern’s campaign. On Aug. 1, McGovern announced that although he still believed in Eagleton’s fitness to serve, the issue had become too much of a distraction for the campaign, and Eagleton was dropped from the ticket.

McGovern’s quick reversal seemingly indicates that he had concluded Americans wouldn’t accept someone who had openly suffered from depression as vice president, first in line for the Oval Office.

Yet, the historical record is far blurrier. Eagleton’s depression wasn’t the only element of the story. He had been secretive about his health, which rubbed some voters the wrong way. His response, that it was not something one talked about at cocktail parties, may have seemed too glib. The fact that he had received ECT treatment probably mattered as well. ECT itself was — and remains — highly stigmatized. While most psychiatrists consider it one of the most effective treatments available, many lay people are aware of abuses, both real and fictional, and debate continues about how common severe adverse effects are.

McGovern might also have overreacted and misread the electorate, looking weak and disloyal in the process. In a Time poll, 77 percent of respondents said that Eagleton’s medical history would not influence their vote. Further indicating that voters didn’t see the revelations about Eagleton’s health and treatment as a career-ender, Missourians reelected him to the Senate twice more. Even during the Republican landslide in 1980, when Ronald Reagan captured Missouri by almost 7 percent, voters sent Eagleton back to the Senate by roughly 4.5 percent. Neither Eagleton’s popularity nor his effectiveness suffered any apparent lasting damage from the 1972 revelations.

Decades later, McGovern expressed regret over dropping Eagleton from the ticket — confessing that he knew little about mental illness at the time.

The South Dakotan asserted that most Americans were also ignorant about the topic. While we don’t have polling data to assess this claim, the public clearly knows far more about the topic today — if only because the number of people diagnosed with depression, and taking antidepressant medications, has skyrocketed since 1972. Few would be surprised to hear someone talking about their depression or Prozac prescription at a cocktail party today.

Yet, the hopeful narrative that greater knowledge has fueled increased tolerance and understanding, thereby explaining the outpouring of support for Fetterman in the days after his announcement, is too simple. Even some of the support for Fetterman has exposed a critical remaining stigma — doubt over depression’s status as “real” disease. In expressing strong support for Fetterman, for example, Senate colleague Ted Cruz (R-Tex.) stressed that mental illness is real.

The need to offer this reassurance only exposes how that remains an open question for many. As antidepressant use grew in the last decades of the 20th century, many hoped that having a chemical solution would finally cement depression’s status as a medical condition.

Yet, the many memoirs published by those suffering from depression in the years since tell a different story. The authors repeatedly recount struggling to get people to see that they were truly ill, not simply suffering from ordinary low mood or lack of will. Some even confessed to self-doubt about it, despite having severe conditions. Author Tracy Thompson’s depression was serious enough to require hospitalization, yet after she was admitted, Thompson wondered whether she and the other patients were truly sick, the way someone with diabetes or a brain tumor suffered.

Part of the problem is that modern medical culture values clear visual signs or chemical tests to produce a diagnosis. Depression lacks these. Some ambiguity in language also plays a role. Depression refers to an illness, one which can be severe — and which can also be painful and debilitating in milder forms. Yet, the term also refers to a mood everyone faces sometimes. Many news reports about Fetterman used the phrase “clinical depression,” implying a need to set it off from this other kind of depression. But no one ever says a person is hospitalized for “clinical cancer” or “clinical heart disease.”

And while we may be more tolerant than we were in Eagleton’s time, some of the praise for Fetterman reveals another lingering stigma: the idea that admitting to depression is somehow unmanly. That stems in part from depression being considered a feminine illness. The condition is more often diagnosed in, and associated with, women, and while the reasons for this difference are complex, men are probably underdiagnosed because of the gendered way we see depression.

Many hope that Fetterman’s overt manliness — his large size, tattooed body and blue-collar brand — coupled with his openness about his struggles may help to combat the stigma that depression is less manly or that seeking treatment reduces one’s manliness. Less optimistic observers fear that the senator’s manly image may be threatened by his admission.

The concern about men being seen as something less if they admit to depression, along with the need to affirm that Fetterman is suffering from a real and serious illness — especially when viewed alongside the more mixed history of Eagleton’s case — show the progress we’ve made over the past 50 years at overcoming stigmas about depression and mental illness may be less significant than many assume. We’ve learned more about mental health, but many Americans still don’t see mental health ailments as they do physical ones. And until this happens, stigmas will remain.