Consider This from NPR - How to Talk About Politicians and Mental Health

Episode Date: February 25, 2023

Republican presidential candidate Nikki Haley's call for mandatory mental competency tests for politicians over 75 seemed like a direct challenge to President Joe Biden, who is 80. But she could have been referring to the other announced candidate in the race: former President Donald Trump, who is 76. Or other high ranking leaders over the age of 75 - Senators Mitch McConnell and Bernie Sanders, both 81. Republican Senator Chuck Grassley is 89, but the oldest sitting member of Congress, by a few months, is Democratic Senator Dianne Feinstein, also 89. She has announced that she will not run for re-election next year, however her term does not end until January 2025. On the heels of Haley's announcement, Democratic Senator John Fetterman checked himself into Walter Reed National Military Medical Center to seek treatment for clinical depression, a condition often associated with recovery from a stroke, which he experienced last May. While Fetterman's case differs from age-related cognitive decline, both issues raise questions about how much the public has the right to know about a public figure's mental health, and whether acknowledging these very common, very human conditions alleviates stigma or just reinforces it.Host Michel Martin talks to former Rep. Patrick J. Kennedy about how his decision to speak publicly about his own issues with mental health. We also hear from Matthew Rozsa, who writes about health and science for Salon.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

In the America I see, the permanent politician will finally retire. We'll have term limits for Congress. And mandatory mental competency tests for politicians over 75 years old. When Republican presidential candidate Nikki Haley said this during her campaign kickoff, it seemed she was referring to one particular senior citizen slash politician whose job she hopes to take, President Joe Biden. He's 80. But she could have been referring to the other announced candidate in the race, former President Trump. He's 76. But they are by no means the only people over the age of 75 serving in high office in the U.S. Republican

Senate leader Mitch McConnell is 81, as is Vermont Senator Bernie Sanders. Long-serving Iowa Republican Senator Chuck Grassley is 89, and the oldest sitting member of Congress by a few months, the California Democrat, Senator Dianne Feinstein, is also 89. In Feinstein's case, whispers about her ability to keep doing her job were getting ever louder, and she just announced she would not run for re-election when her term ends in January of 2025. Haley isn't the first to raise questions about whether certain leaders should face tests for cognitive fitness. She's just the latest. But those questions are usually dismissed as a political ploy, even when the politician is raising those questions himself.

So the last time I was at the hospital, probably a year ago, a little less than a year ago, I asked the doctor, I said, is there some kind of a cognitive test that I could take? Because I've been hearing about it, because I want to shut these people up. In a 2020 interview, then-President Trump described acing, in his words, a cognitive test he says he requested during his annual checkup. Trump said he took the test in order to dismiss what he called fake news about his own mental fitness, and he said his then-opponent Joe Biden needed to take a similar test. They say, that's amazing. How did you do that? I do it because I have like

a good memory, because I'm cognitively there. Now, Joe should take that test because something's going on. Now, as ugly as all this may sound, questioning political leaders' cognitive abilities or mental health is not new. NPR science correspondent John Hamilton was asked about this during Trump's term, and he said it's been going on forever. You hear people saying Bill Clinton was a narcissist, Richard Nixon was paranoid, although actually there's better evidence that he had alcohol problems that were pretty severe late in his term. Before he left, Lyndon Johnson was emotionally unstable. John F. Kennedy had psychopathic traits. And of course, the most famous is Abraham Lincoln,

who was suicidally depressed. Recently, the first term Senator John Fetterman, a Democrat from Pennsylvania, checked himself into Walter Reed National Military Medical Center to seek treatment for clinical depression, a condition often associated with recovery from a stroke, which Fetterman experienced last May. Fetterman's decision not just to seek treatment but to go public about it made a big impression on a number of his colleagues. Here's fellow Pennsylvania lawmaker Representative Susan Wild on CBS News. I think it's very, very important that people who are in the public eye

raise the awareness of mental health issues, depression, and by doing so, reduce the stigma of seeking mental health care. And so I'm incredibly proud of Senator Fetterman for publicly discussing this. Cognitive decline due to aging, neurological disorders like epilepsy or stroke or Alzheimer's, brain injury, post-traumatic stress. Those are all different things. But when it comes to public figures, they raise similar questions for the public and for political leaders about how much the public has the right to know and whether acknowledging these very real,

very common, very human conditions alleviates stigma or just reinforces it. Consider this. It's become much more common for celebrities to talk openly about their health, including their mental health. But when it comes to elected leaders, do the old rules still apply? When elected leaders talk about their mental health, are they opening the door to greater awareness or just giving their opponents a bigger target? That's coming up. From NPR, I'm Michelle Martin. It's Saturday, February 25th. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally and always get the real-time mid-market exchange rate with no hidden fees.

Download the WISE app today or visit WISE.com. T's and C's apply. be achieved between respecting privacy and not further stigmatizing mental illness on the one hand and providing the public with important warnings about potentially dangerous behavior on the other. Matthew Roja writes about health and science for Salon, and he's been reporting on how the media and the public talk about politicians and their mental health. He's also talked to a number of psychiatrists about the ethical lines they have to navigate to do so. And he says the guardrails around discussions about a politician's mental health can be traced back to what's known as the Goldwater Rule. The Goldwater Rule is a policy by the American Psychiatric Association which prohibits their mental health professionals from offering diagnoses of public figures. The rule was named after Republican presidential nominee Barry Goldwater, who ran against Lyndon Johnson back in 1964.

Johnson, of course, being the Democrat who took office after Kennedy's assassination the year before. Fact magazine polled psychiatrists for a piece they published with the headline, 1,189 psychiatrists say Goldwater is psychologically unfit to be president, saying Goldwater was paranoid and unstable. After his loss to Lyndon Johnson, Goldwater sued the magazine for libel. In 1973, the American Psychiatric Association implemented the rule to try to prevent members from questioning the mental fitness of a politician whom they had not examined. But Roja says sometimes it is worth letting the experts weigh in.

That is where politics becomes tricky because, for instance, if you're looking at Donald Trump, there were a number of mental health professionals who warned for years that his seemingly narcissistic behavior posed an existential threat to democracy, particularly when he kept saying he would never accept an election outcome unless he was the winner. That is a situation where a mental health issue poses a threat to the public interest. When it comes to evaluating President Biden's performance through the lens of his age, Rocha says critics are not being fair. He says the correlation between age and cognitive decline needs to be evaluated differently.

I just believe that we need to separate questions about their medical fitness with questions that are solely focused on age. The mere fact that you're in your 80s does not mean that you're not fit. Does it mean that you're at greater risk for developing conditions that will make you unfit? Yes, but it is ageist to assume that just because of the number next to his calendar, so to speak, that that means that he will be senile, which is something that a lot of conservatives have said. As for Senator Fetterman's decision to publicly announce that he's seeking treatment for clinical depression, Roja says he sees a teachable moment. In terms of the public discourse, this is an opportunity in schools for teachers to talk to students and say, if you're feeling depressed, it doesn't have to be specifically about this one man. We can take this one man's experience and broaden it so that it encompasses

the experiences of everyone who has mental illness. And we can go to young people and say, a United States Senator is seeking help. He is going to a hospital. There is nothing to be ashamed of. We can go to adults and send the same message. When we have conversations about Fetterman, if people disagree with his policies, have at it, say that he's totally wrong on the issues, but create an environment where conversations about his mental health play no role in any of that discourse. Coming up, a former member of Congress reflects on how he chose to deal with and talk about his mental health challenges when he was in office. That's when we return.

No one willingly chooses to have a mental illness, nor do they choose to have addiction. Patrick Kennedy is a former member of Congress, a Democrat who represented Rhode Island in the House from 1995 to 2011. He's also the son of the late U.S. Senator Ted Kennedy. Although he had grown up in the public eye, Patrick Kennedy still faced difficult decisions about how to address his struggles with depression and substance abuse in the early 2000s, a time when very few politicians openly talked about their mental health, at least not those who hoped to remain in office.

So I asked him what kinds of conversations he had had with his advisors and with himself in deciding to go public. You know, I have no profile in courage. I didn't do this because I wanted a big conversation to take place, unlike what I think Senator Fetterman is doing by the nature of his announcement. In my case, I was outed as having been in drug treatment by someone who was in drug treatment with me and who sold their story to the National Enquirer that they had been in treatment with me, putting me on the front page of the National Enquirer, I ended up surviving that, which this is back in 91. So that was a big deal to survive accusation of drug use. At the time, my constituency in Rhode Island were more upset that someone ratted on me than they were that I was a drug addict. So Because a lot of people have become more open

about mental health issues. And I just wonder, because on the one hand, yes, we can see where public officials can be role models. They can help make it easier for other people and other walks of life. But I do wonder if you think that there's still a different standard for public officials when it comes to this kind of health issue? Well, I personally, my experience was that my constituency voted for me overwhelmingly after even a DWI. They knew me. In fact, before I got the DWI, they knew I had been struggling. And so perhaps the fact that I had been more transparent before it really became a public, you know, shaming probably mitigated the backlash of the DWI. So I had my biggest plurality of my whole time in Congress the year after I got a DWI. The DWI put me on the front page of every paper and newscast.

When I went to my constituents, the response was, no, you're not terrible. But rather, let me tell you about my personal situation. Let me tell you about my personal situation let me tell you about my grandchildren let me tell you about my sister or brother so and i had one uh older constituent who said to me patrick uh i'm on prozac and i said well that's great i'm glad you're getting treated and then she said to me you're the only one who knows besides my son and my doctor. So I can guarantee you, I won her whole family because to her, I now became something much more than just a quote, politician.

I had a level of intimacy with my constituency that I would have weathered any storm. Did anybody ever throw it in your face? Oh, yeah. I mean, politically, because we're in a nasty moment. I mean, as I said, you've lived with politics your entire life, so you probably have seen more than most people. But it does seem like we're in a particularly ugly period of our politics where people feel

that they can say lots of things about people that would not have been considered appropriate in other times. I'm just wondering, do people throw it in your face, and how did you deal with that? No, so, you know, the tabloids, they had a headline in a big newspaper in my area that had a picture of me with a net over me. And the headline was, we need to throw a net over this guy, which has all kinds of inferences that, you know, I need to be put in an asylum and, you know, someone who needs to be locked away and stuff like that. So, yeah, I mean, I definitely got tons of negative, but I would say that a lot of that was people, again, who were already against me and my experiences that every family in America knows this issue in the most personal way. very unattractive and very easy to shun because these symptoms are very antisocial, negative. And that's part of the reason why stigma is so strong is that we all have family members who we also want to avoid because they have one of these illnesses. So the real challenge for us is how do we understand these illnesses and how do we

distinguish between the illness and the person? So I am not my addiction. I am a person with addiction. And Senator Fetterman is a beautiful human being who happens to have a brain illness that can be treated. You know, whether you agree with his politics or not, we all will have somewhere in our lives a moment where we need people to be compassionate. And so we have to practice the kind of compassion that we want for ourselves when we are in need. And if we take that approach, I think the world will be different. That was former Congressman and now mental health advocate Patrick Kennedy. It's Consider This from NPR. I'm Michelle Martin.