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John Fetterman’s hospitalization and the meaning of “stigma”

Last Friday, John Fetterman (D-PA) returned to his Senate seat after a month-long hospitalization. He was receiving inpatient treatment for a severe depressive episode that caused him to feel “indifferent” about life — something that, according to the National Institutes of Health, 1 in 10 Americans and 1 in 5 young adults have also experienced. In an interview with CBS News, Fetterman explained that he did not consider his experience and recovery “political,” stating that he was “just somebody that’s suffering from depression.” 

State Rep. Noah Arbit (D-MI), however, rejected Fetterman’s professed modesty. “This is as profoundly impactful as any bill a U.S. Senator could introduce. A sea change,” Arbit tweeted in response to Fetterman’s initial hospitalization in February, praising the Senator for “normalizing seeking mental health care as an elected official.” 

Vox’s Li Zhou used similar words, applauding Fetterman for “normalizing a conversation around mental health.” If the word “conversation” wasn’t a good enough indicator, Zhou’s article touched on more than a few mental health tropes. She lamented the “degree of vulnerability… and the stigma that has surrounded mental health in the past” and looked to Fetterman as someone who could “serve as a model for others” by “dismantl[ing] stereotypes and preconceived notions” with his “tough-guy image.” 

The American Psychological Association chimed in, specifically addressing “restrictive gender roles that prohibit psychological help-seeking because it is seen  as… unmanly” and “constrict… [men’s] ability to cope with psychological distress.” The Boulder Daily Camera declared, “many still fear the stigma and judgment associated with mental disorders. They fear people will consider such admissions a sign of weakness.” But perhaps CNN’s Peggy Drexler put it most succinctly when she wrote “many people do not get their depression treated. It’s a sign of strength to know when you need help and to get it.”  

For those of you who haven’t been paying attention to these established truths, let me sum it up for you:

1. There is a lot of stigma surrounding mental health.

2. Having a mental health condition “is seen” as weak, effeminate and abnormal.

3. The stigma prevents people from seeking care — to the extent that they’re even able to process that there is a problem. 

4. Seeking care, therefore, is a sign of strength.

And there you have it. It’s clear that the stigma is our enemy, and we must impale the dragon of stigma upon the blade of normalization.

Except it’s not that simple. In that Vox article I mentioned, the author conceded that in 2018, 87% of Americans agreed that struggling with mental health is nothing to be ashamed of and only about 4.9% avoided talking about their mental health due to “stigma.” But how can this be? What, besides stigma, could possibly prevent someone from seeking treatment for their mental health? If John Fetterman, whose political opponents even attacked him for having a stroke, can do it, why can’t the average American?

Well, the truth is that Sen. Fetterman isn’t “just somebody that’s suffering from depression.” The care that Fetterman has access to and the care that everyday Americans can enjoy are dramatically different — and before we start normalizing any conversation about anything, we need to understand the barriers to seeking help beyond mere stigma.

Let’s start by taking a look at Fetterman’s treatment. Fetterman spent five weeks in Walter Reed National Military Medical Center. I don’t fault him whatsoever for doing that and I don’t doubt that the treatment helped him greatly. That’s exactly why it’s worth asking what might have been available to him were he not a senator.

If you’re a member of Congress, you go on a gold-tier Obamacare insurance policy, which covers 80% of out-of-pocket medical expenses. You also receive federal subsidies covering 72% of premiums (monthly insurance fees). On top of that, you’re entitled to specialized medical care from the Office of the Attending Physician, which, according to ABC News, “rarely turns away” congressmen who do not pay the annual flat fee. Fetterman consulted the OAP before checking in to Walter Reed, but if his providers had instead recommended that he seek outpatient medical care, he’d be in an even better spot: Members of Congress can receive those services for free from military facilities in the area. 

The situation is somewhat bleaker for everyday citizens. Let’s first assume that the extreme national shortage of psychiatric hospital beds isn’t a factor. I can’t estimate how much five weeks in Walter Reed would cost — partially because hospitals often charge more than their reported costs — but what we do know is that, in 2012, an NIH survey found that only eight days of inpatient depression treatment had an average cost of $6,990. Sometimes, the treatment is only part of the cost. The last time I needed to go to the hospital, I found a bill in my mailbox a month later charging me $2,000 for the ambulance ride. I’m lucky that I’m not one of the 43% of Americans who are uninsured or underinsured, because I did not choose to need the ambulance.

It’s true, of course, that Fetterman’s health makes him an outlier. As a stroke victim, he likely wanted to be in a supervised environment before taking any psychoactive medication. Most people who are depressed but not suicidal (like the senator) don’t need to seek inpatient treatment. However, the horizons aren’t exactly promising for any of the other options. The Association of American Medical Colleges reported in 2018 that 60% of US counties don’t have a single practicing psychiatrist — a wider gap than any other medical specialty — and that demand is expected to outpace supply by up to nearly 16,000 psychiatrists in 2025. 

What about therapy, one of the most effective treatments for depression? To the extent that therapists are available (in 2020, 41% reported being “unable to meet the demand for treatment”), economic concerns once again present a large barrier. GoodTherapy estimates that one session costs between $100-$200. Since insurance companies do not tend to reimburse mental health providers sufficiently, many therapists don’t even take insurance, leaving potential patients to cover the lofty price out of pocket. 

This would be like if I baked a cake, put the cake inside of a bear trap and then wrote a billion op-eds asking why no one wanted the cake and what social stigma might prevent people from eating it.

Amidst the climbing cost of hospital care, the scarcity of available resources and the uncertainty of economic conditions, we need to reevaluate where “stigma” really comes from. 4.9% of Americans avoided talking about their mental health because they feared a negative reaction. 39%, however, have avoided mental health treatment to save money. If you have a feeling something is wrong but there’s no one in your area who can help, that’s a thousand times worse than being “seen as unmanly.” If seeking treatment for your depression would demolish your savings, then it doesn’t matter how many “conversations” you “normalize.” Being institutionally punished for getting help is a far, far greater stigma than any rude comment or weird look.

I still applaud Fetterman for speaking out on his condition. When you’re depressed, you often feel as though you’ve somehow fallen out of lockstep with the rest of the world. There’s no doubt that Fetterman’s words will remind ailing individuals that they are not alone in their suffering. But all the macho 6’8” senators in the world can’t defeat mental health stigma just by staring it down. What we need is for senators, congressmen and presidents — whether tough-guys or limp-wristed — to finally pass legislation guaranteeing health care to Americans who need it. That, I’m confident, would do infinitely more than any one statement.

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