Publisher Health

Lynn Rivers, a Democrat from Michigan, opened up about her diagnosis with bipolar disorder during a radio call-in show when she first ran for Congress. Her opponents had been hinting she had mental health problems. She decided, spur of the moment, to let it out.

“Finally, I just said, ‘Are you asking me if I have depression? Yes, and so do thousands and millions of other people,’” she recalled. “I was like, ‘OK, here we go. The ball is thrown at you, just hit it.’ And so I did.”

That was 1994. Ms. Rivers was elected, despite a Republican tidal wave, and served four terms.

Now another Democrat, Senator John Fetterman of Pennsylvania, has announced that he has entered a hospital to be treated for clinical depression. Politicians of both parties are praising him for his openness. Mental health experts say he is a powerful symbol — especially for men, who are less likely to seek treatment for depression and suffer higher rates of suicide.

Yet the stigma around mental illness remains strong — especially in politics, where questions about temperament can determine a candidate’s electability. Mr. Fetterman and others face a continuing challenge: How much do they really want to say?

“We’ve come a long way; people are willing to say they have a diagnosis or that they’re going to therapy,” said Patrick J. Kennedy, a scion of the political Kennedy family, who disclosed his treatment for bipolar disorder and drug abuse when he was a congressman from Rhode Island. “But we’re still not in a place where people are comfortable saying any more than that. And really the question with Senator Fetterman is: How much is he going to disclose?”

Clinical depression, also called major depression, is a severe form of the disease. Symptoms may include feelings of sadness, hopelessness or guilt; angry outbursts; loss of pleasure in ordinary activities; fatigue; anxiety; reduced appetite; and thoughts of suicide. In recent years, there have been great strides in treatment.

So far, Mr. Fetterman’s staff has not been explicit in public about his symptoms or his treatment. In announcing on Thursday that he had admitted himself to the Walter Reed National Military Medical Army Center, the senator’s office said that he had suffered depression on and off throughout his life, but that it had only become severe in recent weeks.

Mr. Fetterman, a freshman, has had difficulty adjusting to Senate life. He is also a stroke survivor who requires significant accommodations, including closed captioning devices, to communicate. Experts say that about a third of people who suffer strokes also suffer depression.

“After a stroke, people inevitably — and I think Senator Fetterman is an example of this — have to adapt to a new life, particularly if there are impairments,” said Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University and a past president of the American Psychiatric Association. “That can be hard, and can be a contributor to the incidence of depression.”

Mr. Fetterman is not the first Washington politician — or even the first member of the Senate — to be open about a mental health struggle.

Senator Tina Smith, 64 and a Democrat from Minnesota, shared her diagnosis of depression in a speech on the floor of the Senate in 2019, describing seeking care as a college student, and then as a young mother. Two House Democrats — Representative Ruben Gallego of Arizona and Seth Moulton of Massachusetts, both veterans of the Iraq War — have spoken about seeking treatment for PTSD.

But it can be hard, even today. Mr. Moulton served for six years before talking about his experience. Mr. Gallego disclosed his treatment early in his career in Congress when a reporter asked about it. He said critics on social media still harass him.

“They accuse me of being a baby killer in Iraq, and that’s why I have PTSD, because of guilt,” he said. “People have said that my PTSD is rage-filled, and that I can’t be trusted in government. They have certainly tried to weaponize it.”

Older Americans well recall the experience of Thomas Eagleton, who was forced to withdraw as George McGovern’s running mate in 1972 after his past hospitalization for depression, and treatment with electroconvulsive therapy, became known.

Social scientists say there is demonstrable evidence that the public is growing more accepting of people with depression. Bernice Pescosolido, a professor of sociology at Indiana University and the lead investigator on the National Stigma Study, which tracks public attitudes toward mental illness, said the shift in public sentiment has been “dramatic,” but it only goes so far.

Dr. Pescosolido’s research shows that between 1996 and 2006, people’s attitudes about what causes depression changed significantly, with more people seeing it as “a disease rather than as a moral failure.” But there was no change in stigma, as measured by people’s willingness to associate with depressed people, such as marrying into the family of a depressed person.

There was, however, a significant drop in stigma toward people with depression between 2006 and 2018. During that time, she said, advocates shifted tactics. Instead of likening mental illness to physical illness, she said, they began encouraging people to talk about their own experiences.

“The narrative change meant that more people were talking about it and sharing about it,” she said. “I think there’s no better example than people like Fetterman.”

Political strategists of both parties say that if Mr. Fetterman recovers and can function as a senator, his future in politics will not be hurt.

“I don’t think that the fact of having depression or dealing with a mental illness in and of itself would impede his career,” said David Axelrod, a Democratic strategist whose father’s death by suicide has led him to advocate better mental health treatment. “But if people come to believe that he has disabilities that would prevent him from doing his job, that is a different thing.”

Whit Ayres, a Republican strategist, agreed, saying, “It’s all about whether he is able to do the job to which he was elected.”

One Republican candidate who talked often about his struggles with mental illness, Herschel Walker, lost his bid for the Senate in Georgia. But Mr. Walker, who asserted he had “overcome” dissociative identity disorder, formerly known as multiple personality disorder, faced other hurdles as well, including allegations that he had paid for abortions for two girlfriends (he was running as an abortion opponent).

For years in politics, candidates took pains to hide their struggles with mental health. Ms. Rivers, who came up through Michigan’s state legislature, recalled elected officials who “would prefer to be thought of as alcoholic, because it was more socially acceptable.”

Staff members become adept at hiding evidence and concocting alternate explanations for officials who required hospitalization for mental illness. And public figures themselves learned to hide.

Robert A. Antonioni, who served for 20 years in the Massachusetts state legislature, used to dress atypically in shorts and a baseball cap and drive about 20 miles to another town to pick up a prescription for antidepressants, he said.

“I thought, I know the people in my town, and the people at CVS, they would be, like, ‘Bob was in here today picking up his Zoloft,’” he said. “The psychiatrist who prescribed it to me said, ‘Bob, there are so many people that take this.”

Mr. Antonioni began talking openly about his depression in 2003, after a newspaper reporter asked why he was working on suicide prevention. He told the reporter about his younger brother, who had died by suicide, but demurred when she asked whether he had ever had similar thoughts. He hung up, but thought better of it, and called her back.

“Eventually, I just thought, ‘I’m not being honest,’ ” he said. “I remember the reporter being like, ‘You know, it’s going to be in the paper, Bob.’”

Mr. Kennedy, who is now a prominent advocate for mental health treatment, said he was “outed” in 1991 during his first term as a state representative when someone who had been in treatment for substance abuse with him sold his story to The National Enquirer. He survived re-election and went on to win his House seat in 1994, the same year as Ms. Rivers.

In 2000, when Tipper Gore, then the second lady, came to Rhode Island to campaign for him, he stood on a stage with her and told his constituents about his bipolar disorder. It was an unplanned announcement.

“I was still very reticent to say much about it,” Mr. Kennedy said. “And even when I did talk, I was trying to be very calculating — only disclose as much as I thought politically I could survive.”

The fear at that time was of being seen as weak, or flawed in a basic way.

Mr. Moulton said he shared his diagnosis with just one or two close advisers. Their advice to him? “Better not talk about it.”

On Thursday, after Mr. Fetterman’s office announced his hospitalization, Mr. Gallego took to Twitter. “There is never any weakness in seeking help,” he wrote, coupling his message with two emojis showing flexed biceps.

Depression is a very individual disease that will affect roughly one in five Americans during their lifetimes, Dr. Appelbaum said. Some people have one episode, receive treatment, and go on. Some people may have recurring episodes.

Treatment at first typically consists of a combination of medicine and psychotherapy — often cognitive behavioral therapy, in which patients learn how to control their thoughts. If that does not work, there are also more aggressive treatments. Studies show that electroconvulsive therapy, which involves a brief electrical stimulation of the brain while a patient is under anesthesia, is effective in between 80 and 90 percent of patients, Dr. Appelbaum said.

Some officials who have spoken openly about their experiences with mental illness said they have found it freeing.

Ms. Smith, the senator, said she decided to go public after the subject came up in a discussion with senior staff members, and she realized how rare it was for politicians to describe this part of their lives.

“There was power in me telling that story,” she said.

Speaking out also gives politicians control over their own narrative, enabling them to time the disclosure and choose the outlet. In 2019, preparing for what became a brief presidential run, Mr. Moulton revealed in a speech that he had consulted a therapist for PTSD.

“I thought there was a good chance that it would end my career,” he said. Instead, he added, “to this day, people come up to me all over the country and say thank you.”