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(CNN) — In the spring of 2019, Democratic Sen. Tina Smith of Minnesota was busy putting the finishing touches on a bill that sought to expand mental health care access for kids in schools.
But she couldn't shake the feeling she was being less than honest about just how personal the issue of mental health was for her.
Smith was on the precipice of an election. She had no obligation to open up about her own depression that she says happened twice — once in college and once as a young mom. But in May 2019, on the floor of the US Senate, Smith, delivered a speech about mental health and admitted, "The other reason I want to focus on mental health care while I'm here is that I'm one of them."
"I remember being nervous," Smith recalled of delivering the speech. "I was concerned that people would think that I was trying to like make it be about myself, but once I got beyond that, and I realized that there was power in me telling the story — me particularly being a United States senator, somebody who supposedly has everything all together all the time, then it started to feel really interesting, and I could see right away the value of it."
The National Alliance on Mental Illness estimates that one in five adults in the US — nearly 53 million Americans — experience mental illness every year. The Centers for Disease Control and Prevention reports more than 50 percent of Americans will experience mental illness in their lifetime. But for politicians — often far away from home, under high levels of stress and pressure, all risk factors for mental illnesses like depression and anxiety — talking about their own mental health is still a relatively rare admission.
It's why in February when Pennsylvania Sen. John Fetterman announced he was seeking inpatient treatment for clinical depression, lawmakers on both sides of the aisle celebrated not only his decision, but his transparency.
"It's tough in politics, there's a lot of scrutiny, you're clearly in the public eye a lot. There are consequences to the things you say and talk about, but I think in a circumstance like this, it helps the conversation," Senate Republican Whip John Thune said. "It helps people realize and understand the impact that this disease has on people across the country."
A senator shares her story
Years after coming forward with her own experience, Smith said she doesn't have any regrets. In light of the Fetterman news, she feels even more the importance to share.
"I think that every time a somebody like John or me is open about their own experiences with mental illness or you know, mental health challenges, it just breaks down that wall a little bit more about people saying, 'Oh, it's possible to be open and honest and not have the whole world come crashing down on you,'" Smith said.
It's been decades since Smith experienced depression, but she said she still remembers so much about that time.
"I thought I was just off," Smith said. "Something is wrong with me. I'm not with it. I'm not doing well enough and then you start to sort of blame yourself, and I was sort of in that cycle," Smith said.
It was her roommate in college who first suggested she talk to someone. Reluctantly, Smith took herself over to student health services and started talking to a counselor. She said she started to feel better and eventually noticed her depression abated.
But as Smith tells it, mental health is a continuum and about a decade later, as a young mom with two kids, she found herself experiencing depression once again. At the time, she said she was caught completely off guard.
"This is the thing that's so treacherous about depression in particular. You think that the thing that is wrong with you is you," Smith said. "I'll never forget my therapist telling me, she said 'You're clinically depressed. That's my diagnosis. I think that you'd benefit from medication to help you.'"
Smith said she initially resisted. But, after a continued conversation, she agreed to start medication as part of her treatment. She remembers it took time to work, but eventually she noticed a major improvement.
When she emerged from her depression, Smith was in her early 30s. She said she hasn't had a resurgence of depression since then, but that she does pay very close attention to her mental health now.
A risk for lawmakers who get too personal
There are 535 members of Congress and just a handful of them have shared personal stories related to mental illness. Most of those who have talked about their experiences publicly are Democrats. Most of the men who have shared their stories talk about them in the context of military service. In part, it's a risk for lawmakers to get too personal. The history of reactions to politicians being open about their mental illness has been checkered in the last several decades.
"People still remember Tom Eagleton," Smith told CNN.
In 1972, Eagleton was newly selected to be the running mate for Democratic presidential nominee George McGovern. He admitted to being treated for clinical depression and receiving electroshock therapy. Days later, he withdrew from the ticket even as he continued to serve for years in the Senate.
Memories of those kinds of episodes impact members in how they approach talking about mental health, even in recent memory.
"When I was in Congress, I did everything I could to keep everybody from finding out that I needed help," former Rep. Patrick Kennedy told CNN.
Kennedy represented Rhode Island in Congress from 1995 to 2011. He suffered from addiction and bipolar disorder. While he was there in 2006, he crashed his green Mustang convertible into a barrier outside the Capitol in the early morning. Following the crash, he pointed to sleeping pills as the culprit and checked himself into the Mayo Clinic for treatment.
"And is the case with anybody with these illnesses is it is the worst kept secret in town and you are often the last one to realize in what bad shape you are. People won't tell it to your face because you are a member of Congress, your staff is walking around on eggshells," Kennedy said.
"When I did go to treatment. I kind of did it after I had been revealed to be in trouble like I'd gotten in a car accident."
But when he got back, Kennedy heard from many colleagues about their own struggles with issues related to mental health.
Kennedy predicts when Fetterman returns to the Senate, that might also happen to him.
"I think he is going to have our colleagues from both the House and the Senate look for him in order to tell him what is going on with them. He's the only one they know," Kennedy said. "While stigma is going away, there is a less forgiving attitude toward people who suffer from mental illness and addiction."
A traumatic event on the Capitol Hill
The aftermath of January 6, 2021, was another moment where the conversation around mental health started to shift on the Hill. Suddenly, members and their staff had undergone a traumatic and shared experience in the workplace.
Democratic Rep. Sara Jacobs of California was just four days into being a new member of Congress on January 6th when she was trapped in the gallery above the House floor with several other members of her party. The experience — the sound of gas masks being deployed, the frenzy to escape, the echo of a gunshot — left her reeling. Jacobs said she considered herself well positioned to seek help. She already had a therapist. But, she noticed some of her older colleagues didn't have the same tools.
"I remember actually, after January 6, talking to some of my colleagues here who were a bit older and encouraging them to seek therapy and to get help because it was just something that that wasn't as accustomed for them," she said.
The group of lawmakers who were trapped in the gallery also sought therapy together via Zoom and kept in touch via a text chain.
For Jacobs, the trauma of January 6 manifested itself in unexpected ways. Suddenly, fireworks — something she once loved — were triggering. Loud people chanting or gathering somewhere made her tense up. She said a lot of her colleagues also dealt with anger, "lots of anger toward colleagues who went back that night and continued to deny the election."
When her brother got married in the fall and had fireworks, she had to excuse herself to another room because "it was stressing my body, my nervous system so much."
Rep. Dan Kildee, a Democrat from Michigan, also came forward after January 6 to talk about his battle with post-traumatic stress disorder after that day.
It wasn't easy.
"There is still a stigma. People still make their own judgments and that was one of the reasons I decided to talk about it so that people would see that it can happen to anybody. You just have to get the care that you need."
"Not everybody was accepting when I sought treatment. My former opponent ridiculed it," Kildee said.
For Jacobs, who has been taking medication for anxiety and depression since 2013, stories like Fetterman's are a sign that maybe the discussions around mental health are beginning to change on the Hill and maybe even in the rest of the country.
"I think there's absolutely a generational divide. And there's also a gender divide and that's why I think it's so incredibly brave that Fetterman not only got the treatment needed, but talk about it," Jacobs told CNN. "I think for me as a young woman, I spent a lot of time with my friends and peers talking about mental health, talking about therapists and what we're learning in therapy, but I know that that is not something that other generations really have felt open to do."
It's not clear, ultimately, how Fetterman's openness around his mental health will impact the Hill going forward. It's not clear what resonance it will have in the rest of the country or even back home for voters. But for lawmakers who've taken steps already to share their stories, there is some hope that it could make a major difference.
"It doesn't take a statistician to tell you that of the 100 of us in the United States Senate, mental health issues are going to have touched every single one of us in one way or another," Smith said. "I think it gives people some permission to maybe speak a little bit more openly about it."
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