Is It ‘Kiss of Death in Politics?’ : Stigma Still Haunts Those Seeking Psychiatric Care

Is it still the kiss of death for a presidential candidate to have sought professional help for psychological problems? And should it be?

Sixteen years after Missouri Democratic Sen. Thomas F. Eagleton was forced to withdraw as a vice presidential candidate when his history of electric shock treatment became public, mental health professionals say they still find understanding and awareness of psychiatric treatment to be sadly lacking among the public.

They see the uproar created by rumors that Democratic presidential candidate Michael S. Dukakis had once sought psychological help for depression, which he quashed Wednesday by releasing his medical history, as dispiriting evidence that efforts to destigmatize mental health treatments have failed.

Offhand Characterization

And they worry that the episode, combined with President Reagan’s offhand characterization of Dukakis as “an invalid,” will further cement stereotypes and dissuade those who need help from seeking treatment.

With one in five Americans thought to need psychological treatment at some time in their lives, and with only 10% of those needing it actually getting it, said Dr. Paul Fink, president of the American Psychiatric Assn., “the fact that this is being trivialized is the most exasperating thing.”

Still, as Dukakis discovered as the rumors reached a crescendo on Wednesday, a history of treatment for psychological problems is still largely perceived by the public as automatically disqualifying a candidate for office. A CBS News/New York Times poll found last year, for instance, that more than half of the public would automatically refuse to vote for a candidate who had ever been hospitalized for psychiatric treatment.

The stubborn public perception, admit mental health experts, is that such treatment is evidence of debilitating weakness, at the least, and at worst a sign of instability or even craziness. “There’s an attitude built into the prejudice,” said Fink, “and it was best characterized by President Reagan, who made an automatic judgment that a person was an invalid if they’d ever seen a psychiatrist.”

“I agree that not much has changed,” said Dr. Martin Brenner, a psychiatrist who chairs the public affairs committee of the California Psychiatric Assn. “We’ve made great strides in the area of eating disorders and alcoholism. Being treated for those illnesses has become very accepted. We need to demystify the process of psychiatric therapy.”

One Los Angeles psychiatrist, Dr. Hilda Rollman-Branch, admitted that even she took pause when the Dukakis rumors surfaced: “I thought to myself, it would be terrible if something like that came out because there would go the election,” she said. “Not that I wouldn’t vote for (such a person), but many would not. The fear it must mean you’re crazy is still rampant.”

Like many psychiatric experts, Dr. Daniel X. Freedman, editor of the American Medical Assn.’s Archives of General Psychiatry, argues that seeking professional care should actually be considered a sign of strength. “Why isn’t it that we say of someone seeking treatment that he’s smart enough and knows himself well enough to stay in touch with those sources of treatment?” he argued.

Seeking professional help “is often an indication of mental health, in that an individual recognizes a problem rather than ignores it,” maintained Dr. Norman Tabachnik, president of the Southern California Psychoanalytic Institute. “Also, working on the problem often results in an increase in mental strength.”

In fact, argued Bryant Welch, executive director of the American Psychological Assn., widespread negative attitudes could boomerang. “In the current climate,” he maintained, “there is no question that these decision-makers are being discouraged from seeking psychological care for fear (it) will subject them to being labeled ‘mentally ill’ and unfit for public service.”

Long-Term Problems

But if people have long-term emotional problems and the problems go untreated, Welch said, they “can have unrecognized, but seriously deleterious and insidious impact on the objective, decision-making capacity of the individual.”

Welch, however, believes that “we’ve made enormous progress” in reducing the stigma. “Most people have had an experience with psychological care--either with themselves or a loved one--and know that seeking psychological care doesn’t mean that one is ‘mentally ill.’ ”

Acknowledging that it would be “tough to run” for the presidency with such a perceived handicap, Democratic political consultant Robert Schrum said any stigma really isn’t a political problem.

“The country is not very well educated on mental health,” he said. “It’s a sociological problem, reflected in politics, that there is a lack of information and a contextual feel for what mental health is about.”

According to the National Institute of Mental Health, an estimated 40 million Americans have some form of diagnosable mental illness during any given six-month period. About 25% of women and 11.5% of men suffer a bout of severe depression at some time during their lives, said Welch of the psychological association.

California Assemblyman John Vasconcellos (D-Santa Clara), one politician who has freely disclosed details of his own psychological treatment, maintained that “anybody who has distress in their own life . . . and who recognizes the need for help and goes and gets it is a hero or heroine and ought to be encouraged and legitimated. Anybody who wants to try and make something out of it should get some help themselves.”

Blanket Judgments

Others are less willing to make blanket judgments, however, citing the wide variance among conditions that can be treated.

“If somebody went to see a psychologist or counselor for whatever reason, that shouldn’t disqualify anybody,” said Rep. Tony Coelho, (D-Merced), who talks openly of his own epilepsy. “If the person is having emotional problems and is unable (to function), then you’ve got to ask more questions. It’s degrees.”

The mental health experts tend to agree. Tabachnik said he would “absolutely” vote for someone who had been treated for depression, if he were satisfied such a candidate had demonstrated an ability to function effectively in public life.

“Depression is one of the normal emotions,” he said, “but the causes and the severity vary.”

What the recent furor has pointed up to some mental health experts is not only the need for more public education but also a need for more professional discussion.

“I do feel the public has the right to know about somebody’s physical and mental health,” said Dr. Doryann Lebe, president of the Southern California Psychiatric Society. “But to do effective work, it needs to be done with confidentiality.” And, she continued, when confidentiality becomes secrecy, there is the danger of reinforcing the stigma.

Perhaps, Freedman said, it is time for a politician to test the “kiss of death” assumption.

“It’s no longer the mad aunt in the closet,” he said of psychotherapy. “Twenty years ago if you’d told me a (divorced man) could run for President and win I wouldn’t have believed it. . . . Now we have (one) as President. Public attitudes do shift.”