Tangle - John Fetterman's hospitalizations.

I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 11 minutes.

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This week, I am fulfilling a childhood dream of mine by starting to build a little adobe house in rural West Texas. I've been working nonstop since Friday, and will be using the mornings and nights to write Tangle while taking off to work in the afternoons for the rest of this week. Because of this, I may be a little late or delayed in replying to reader emails. Please excuse the tardiness. And wish me luck!

Working the adobe in Texas

Quick hits.

1. President Joe Biden made a surprise trip to Kyiv, Ukraine's capital, and announced $500 million of new aid. Separately, the U.S. says it has concluded Russia violated international law by committing "crimes against humanity." (The visit)
2. Russia says it has suspended its participation in New START, a nuclear arms control pact with the U.S. As justification, President Vladimir Putin said Russia must remain ready to conduct nuclear tests if the U.S. does. (The change)
3. Former President Jimmy Carter has entered hospice care at his home in Georgia. The 98-year-old is the longest-living former U.S. president. (The care)
4. Aftershocks from an earthquake that has already killed over 47,000 people hit Turkey and northern Syria, leaving hundreds more trapped under rubble. (The quake)
5. Rep. David Cicilline (D-RI) will resign from Congress in June to head The Rhode Island Foundation. The 61-year-old former member of Democratic leadership serves in a heavily Democratic district, and his retirement will trigger a special election. (The resignation)

Today's topic.

Sen. John Fetterman (D-PA). On Wednesday night, Fetterman checked himself into Walter Reed National Military Medical Center to receive treatment for clinical depression, according to his spokesperson. The news of the hospitalization came just a few days after Fetterman was released from a prior hospitalization after feeling lightheaded and disoriented during a Democratic retreat.

Fetterman's health has been a contentious issue since his U.S. Senate race against Republican Mehmet Oz. He had a stroke just days before winning the Democratic primary in May, and his difficulty with auditory processing has left him using closed captioning throughout his campaign and during Senate work since. At times during the debates, he had trouble clearly articulating his positions or responding to questions, which raised concerns about his fitness for the job.

Two weeks ago, he checked into George Washington University Hospital and spent two days in the stroke unit undergoing MRIs to see if he had suffered a second stroke. His office emphasized that tests showed he had not suffered another stroke but was just feeling lightheaded. This time, his team said his reason for checking into the hospital was his mental health, not his physical health.

Congress's attending physician, who evaluated Fetterman on Monday, recommended he be admitted to Walter Reed for treatment of clinical depression.

“While John has experienced depression off and on throughout his life, it only became severe in recent weeks,” his chief of staff Adam Jentleson said.

Fetterman, who is 53, is expected to remain hospitalized for several weeks or months. Dr. Eric Lenze, the head of the psychiatry department at Washington University School of Medicine in St. Louis, told The New York Times depression after a stroke is “very common, often very serious and, maybe most importantly, actually really treatable.” Fetterman's wife, Gisele, emphasized that she was proud of him for getting the care he needs and his family is solely focused on his recovery.

Because Fetterman was hospitalized two different times for two different reasons, some of the commentary about his health refers to either his depression, his post-stroke recovery, or both. Today, we are going to examine some opinions from the left and right, then my take.

What the left is saying.

• Many on the left praise Fetterman for checking himself into the hospital for depression and for openly battling all his health issues.
• Some express concern about his ability to serve, but point to reasons for hope.
• Others say Fetterman is helping normalize conversations about depression.

In CNN, Peggy Drexler praised the example Fetterman is setting.

"Figures from the National Institute of Mental Health show that an estimated 21 million adults in the United States—nearly one in 10—has had at least one major depressive episode," Drexler wrote. "The incidence of any type of mental health issue is even greater: one in four Americans have suffered from some form of mental illness, according to Johns Hopkins Medicine. If we’ve been lucky enough to not count ourselves among the afflicted, most certainly we’ve known someone who has. Depression is so widespread that very few of us are not impacted," she wrote. “The good news is that he sought out the help he needs—and that, at least so far, his supporters seem to be compassionate.

"As they should be: Besides the fact that, statistically, most of us have been impacted by depression in some form or another, many people do not get their depression treated. It’s a sign of strength to know when you need help and to get it," she said. "Almost immediately, a number of conservative voices callously and prematurely questioned whether Fetterman was fit to serve... The best response, of course, is somewhere in the middle—commending Fetterman for his courage to seek treatment while considering, with sincerity and when the time is right, whether continuing to serve in a stressful position that impacts so many is in both his and his constituents’ best interests. The fact is that it’s a fair question to ask. But it’s crucial to remember that depression is as common as the common cold. In itself, depression simply isn’t prohibitive to thriving in life and career."

In Politico, Jeff Greenfield wrote about the historical precedent for what Fetterman is going through.

"It’s impossible not to feel sympathy and admiration for Sen. John Fetterman, who disclosed that he checked into Walter Reed National Military Medical Center this week to be treated for clinical depression. It’s also impossible not to wonder how this latest serious health issue affects his ability to serve in the Senate," he wrote. "We also know that depression is treatable; therapy and medicine can lead to a productive, fulfilled life... Fetterman’s office disclosed the information promptly, with no euphemistic evasion. It was his office that described the symptoms as 'severe.' ... Fetterman is coping with his condition now, at the start of a congressional session where his party has a one-seat advantage. He will be facing questions — fair questions — about how long he will be absent.

"The questions may well have reassuring answers, and he is hardly the first senator to be sidelined by illness. Last year, when the chamber was evenly split, New Mexico Democrat Ben Ray Luján spent more than a month recovering from a stroke. In 2012, Illinois Republican Mark Kirk spent a year and a half in therapy recovering from a stroke," he said. "The candor so far displayed by Fetterman and his staff will need to continue: Can he find the conditions he needs to heal from depression as a sitting member of the Senate? Does the combination of depression and the fallout from a stroke pose a special set of difficulties? Or can the advances in treating depression, along with a far more accepting climate, mean that, as his office promised, 'he will soon be back to himself?'... it would take a special level of malevolence for anyone of any political persuasion not to root for Fetterman’s full recovery. But neither can reasonable questions be dismissed by charges of ableism."

In Vox, Li Zhou said Fetterman was normalizing conversations around depression.

"Fetterman’s open discussion of depression is significant, given how rarely lawmakers talk about their own mental health. His willingness to both disclose his medical condition and the treatment he’s sought is also a major step toward normalizing such conversations. While the discourse about mental health has become more transparent in recent years, experts say statements from high-profile figures like Fetterman play an important role in continuing to destigmatize these issues," Zhou said. "Fetterman joins lawmakers, including Sen. Tina Smith (D-MN), and former Rep. Katie Hill (D-CA), in candidly addressing mental health. Smith previously spoke about her own experiences with depression in college and as a parent, emphasizing that treatment should be destigmatized and demystified.

"A 2019 study from the National Institute of Health previously found that men, in particular, have been less likely to seek out mental health treatment due to societal expectations. Fetterman — a politician famously known for projecting more of a tough-guy image with his tattoos and hoodies — could help dismantle stereotypes and preconceived notions that people may have," she said. "His willingness to talk about this issue could demonstrate to others dealing with their own experiences that lawmakers have an understanding of what they’re going through — and serve as a reminder of just how common depression is."

What the right is saying.

• Many on the right express worry about Fetterman's health, and argue that he does not appear fit for office.
• Some criticize the media's refusal to question Fetterman’s fitness.
• Others say Fetterman needs to recover, and the people pushing him to serve in the Senate should be ashamed.

In Newsweek, Jonathan Tobin said the hospitalizations are a reminder the media lied to get Fetterman elected.

"Sen. John Fetterman (D-PA) deserves the sympathy and the well-wishes of the nation. The announcement by a senior aide that Fetterman is likely to remain hospitalized for severe depression for more than a month is sad news," Tobin said. "But... we must scrutinize the way all but conservative media outlets have run interference for Fetterman throughout his successful 2022 Senate campaign and since he took office, in order to prevent the public from knowing the full extent of his impairment and ability to serve... Fetterman's appalling performance during his sole debate with Republican Senate candidate Dr. Mehmet Oz raised serious questions about his health. But it had little impact on the outcome of a race that he wound up winning by a fairly comfortable 51%-46% margin.

"Nearly 700,000 votes had already been cast before the debate, and in the current hyper-partisan environment, it's far from clear that anything would have deterred Pennsylvania liberals from backing Fetterman," he wrote. "Another impediment to inquiries about Fetterman's fitness was the Democrats' success in spinning him as a poster child for acceptance of those with disabilities... there is a difference between a senator who is fully capable of serving but requires a wheelchair and one who is ambulatory but mentally diminished... While Fetterman's apologists claim these disabilities are temporary, his recent hospitalization for what some feared might be a sign of a second stroke, and now his diagnosis of depression, severely call into question the widespread celebration of his presence in the Senate as an ostensible rebuke of ableism."

In The Washington Examiner, Tiana Lowe said shame on those who pushed Fetterman to run for the Senate.

"Here's a quick refresher of how Pennsylvania Democrats and Fetterman's wife Gisele so cleverly conned a stroke victim's way into being hospitalized for depression," she wrote. "Fetterman had his stroke in May. He didn't make a campaign appearance until August, and then, he didn't give an in-person interview until October. When Dasha Burns accurately reported on Fetterman's evident cognitive dysfunction, the press piled on the NBC News reporter. Gisele — since her husband's stroke, inexplicably the face of the campaign — demanded that the journalist issue 'an apology towards the disability community from her and from her network for the damage they have caused.'

"In the process of securing Biden a 51st vote in the Senate and Gisele a series of glowing magazine features, Fetterman's friends and family sacrificed the mental, physical, and emotional well-being of Fetterman, the man. For stroke victims, the immediate aftermath of the incident is the most important time for recovery," Lowe said. "If you skimp on the rest and therapy required, then the known consequences — including devastating, critical depression — will obviously follow. Even Fetterman's chief of staff conceded that this Faustian bargain had been struck... God willing, this latest event is a wake-up call for Fetterman's loved ones. But considering their behavior thus far, it's questionable how much they love him in return."

In National Review, Charles C.W. Cooke said "we all knew this was going to happen" to John Fetterman.

"A few months ago, I wrote an open letter to the American press in which I proposed that nobody really believed its pretense that John Fetterman was mostly fine, that nobody really believed that there would be no significant effects on his health if he were to run for office during his recovery period, and that nobody really believed that it was 'ableist' to suggest that he should not be elected as a result of his condition," Cooke wrote. "Was it, perhaps, the case that running for office made Fetterman’s health permanently worse, as some suggested it inevitably would? Yes, yes it was... What should Fetterman have done?

"Well: 'What you’re supposed to do to recover from this is do as little as possible,' said Adam Jentleson, his chief of staff. Instead, Mr. Fetterman 'was forced to do as much as possible — he had to get back to the campaign trail. It’s hard to claw that back.'... Forced? Forced by whom?" he asked. "At the time, I wrote that 'John Fetterman ought to drop out of the Senate race on the grounds that he is unable to do the job for which he is running.' Many others said the same. Nobody 'forced' John Fetterman to stay in the race and decline to do what he was 'supposed' to. Nobody could have forced John Fetterman to do that. Fetterman’s doing so was a choice — a choice that was defended on the grounds that his ailment was merely temporary, and that, by the time he got to the Senate, it would be better."

My take.

Reminder: "My take" is a section where I give myself space to share my own personal opinion. If you have feedback, criticism, or compliments, don't unsubscribe. You can reply to this email and write in. If you're a subscriber, you can also leave a comment.

• There are distinct issues here: The positive example Fetterman is setting and the question of his fitness for the job.
• Fundamentally, it does not seem like Fetterman is recovering well, and that is cause for serious concern.
• It's possible to question – without malice — whether he can recover while serving in the Senate.

I think there are two separate issues to address here. One is the example of Fetterman checking himself into the hospital for his depression, and the other is considering his fitness for office when you take a look at all the information we have about his post-stroke recovery.

Let's tackle the depression issue first. I think it’s refreshing that Fetterman is being straightforward about this part of his health journey. As many of the commentators on the left noted, there are no limits to the good he is doing by directly and publicly revealing his battle with depression, and setting the example of treating it. Depression, even the most severe kind that requires hospitalization, is extremely common. I imagine it is far more common than most people think, simply because so few people discuss it openly. Nearly one in 10 adults have had a major depressive episode, according to the National Institute of Mental Health. That's roughly 21 million people, and those are just the people who address it.

I'm impressed by the frankness of Fetterman's staff and believe he is setting a healthy example. As someone with even a tiny public-facing persona, I can't imagine what it's like for Fetterman or his team to tell the world he is being hospitalized for clinical depression. I often find it difficult to be vulnerable to the 55,000 people who read this newsletter, and can only imagine the strain of doing so for an audience of millions and the national media. He's doing it, though, and I commend him for it.

Then there are the larger questions about his health or, as politicos often put it, his "fitness for office.” These questions are much more difficult to suss out. When Fetterman was campaigning, I was one of the voices who questioned how well he'd be able to serve. In attempting to answer these questions, I arrived at a few main takeaways: For one, deliberating, debating, and discussing is part of a Senator’s job, and we had good reason to believe Fetterman could accomplish those tasks with assistive technology. Two, many experts expressed optimism he would improve, which was a good thing. Three, his campaign had been somewhere between "cagey and wholly dishonest" on his health, so it was hard to know with certainty what was happening.

Lingering over all this was his debate performance, which was difficult to watch and lent credence to the idea that — even with assistive technology — he'd struggle in his new job.

The good news is his team seems to be acting straightforwardly about his mental health challenges now. The bad news is that he does not seem to be improving as well as his team had hoped. The New York Times published a profile two weeks ago that covered all the challenges Fetterman is facing in the Senate and raised serious questions about his capacity to accomplish the work. He is incapable of getting the rest that doctors want patients like him to get and, even with the accommodations being made for him, he is having trouble in the Senate. The Times profile describes his auditory processing issues as being worse "when he is in a stressful or unfamiliar situation," which are essentially routine for a freshman in the Senate.

Of course, fundamental to the job is being present for it. Fetterman may be hospitalized for several weeks, which is precisely what he should be doing. He needs to take care of himself and get well. But not being in the Senate means he can't vote, debate, lobby for bills, or do any of the work that his constituents put him there to do. This raises obvious doubts about his "fitness," or whatever else you want to call it.

Fortunately for Fetterman’s job prospects, he is on a six year term with a Democratic governor. If he needs to take time to get well he has it, though Democrats will be short a crucial vote while he does. If he decides to leave the Senate, he'll be replaced by a member of his own party who probably shares much of his politics. Still, less than two months into his Senate term, the questions about his ability to perform the job are now at a fever pitch, and his team faces the monumental task of prioritizing his health while trying to get him back to work.

This is what many of the folks who questioned Fetterman's ability to serve in the Senate after suffering a serious stroke worried about. Some of those people were pilloried for expressing those doubts. Now, it's crystal clear Fetterman has an uphill battle, and many of those doubts have been validated. We should all be wishing him a speedy and healthy recovery, but we can also wonder — without malice — whether that’s possible while he’s in the Senate.

Your questions, answered.

Q: How do you choose the “quick hits” news you include before the main topic?

— Mary from Clemmons, North Carolina

Tangle: This is a great question, and one I only get every now and then. Honestly, the "Quick hits" section is one of the hardest parts of my job. There is so much news out there, picking five stories that I think my readers should be aware of is truly difficult.

Generally speaking, the "Quick hits" section is supposed to be five "front page" news items that nearly every outlet is covering in some capacity. These are stories that I'm seeing pop up everywhere, that major news outlets are leading with, and that I think are critical for my readers to know to understand the current state of things. Often, they are stories we might cover in a full Tangle edition later that week.

But thinning the herd is challenging. I usually have eight or nine stories I want to include in that section, and struggle to get it down to five. I try to keep them timely and relevant, and if I can I will move them to another section to include as much in one newsletter as I can. For instance, if someone wrote in to ask a question about one of them, I won’t include it in “Quick hits” but will address it in detail in "Your questions, answered."

All this is to say: Quick hits should be the five "biggest" stories out there (aside from our main topic), which means I’m making a judgment on which stories are “biggest”, and which makes it really hard to do!

Want to have a question answered in the newsletter? You can reply to this email (it goes straight to my inbox) or fill out this form.

Under the radar.

The United States is planning to more strongly enforce its sanctions against Russia, and is  threatening to hit companies it believes are helping the Kremlin avoid those sanctions. Treasury Deputy Secretary Wally Adeyemo is planning to call on the European Union to help the U.S. crack down on companies doing business with Russia, giving them a stark choice: “To do business with a coalition representing half of the global GDP, or to provide material support to Russia.” The plan is both a tacit admission that Russia is successfully evading many of the current sanctions, and a clear warning of a far more hardline approach to them in the future. The Wall Street Journal has the story.

Numbers.

• One-third. The approximate fraction of stroke survivors who experience depression.
• 51-49. Democrats’ current majority in the Senate.
• 49-49. The current Senate make-up, with both Pennsylvania senators currently recovering from health issues outside the Senate.
• 795,000. The number of Americans who have strokes every year.
• 70-90%. The percentage of people with a similar health profile as Fetterman who make full recoveries, according to The Washington Post.

The extras.

• One year ago today, we were off for President's Day, but I shared some fun facts.
• The most clicked link in Thursday's newsletter: Our full and unlocked edition on Trump and Russia.
• One non-political thing: A video review of the 2024 electric Corvette.
• Take the poll: Should John Fetterman be serving in Congress? Let us know what you think.

Have a nice day.

A fifth person has been cured of HIV. Researchers have announced that a 53-year-old man in Germany, dubbed the "Dusseldorf patient" to protect his privacy, has been cured of HIV. The man's cure was first announced in 2019, but researchers hedged that they were unsure if the virus would reappear. Four years later, they say the man still has no detectable virus in his body, even after stopping his HIV medication four years ago. "It’s really cure[d], and not just, you know, long term remission," Dr. Bjorn-Erik Ole Jensen, who presented details of the case, said. The Dusseldorf patient joins a group of others who have fully recovered under extreme circumstances after a stem cell transplant. ABC News has the story.

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