When Patrick Kennedy was in Congress, he would sneak in his treatments for substance abuse over the holidays, in between congressional work periods. And he refused mental health treatment recommended by his doctors, worried he would be recognized in that wing of the hospital.

Kennedy, a Rhode Island Democrat and the son of the late Edward Kennedy, was eventually forced to reveal his struggles when he crashed his car outside the Capitol while intoxicated in May 2006. He talked openly about his mental health and substance abuse for the first time, and something surprising happened — he became more popular with his constituency, winning reelection by a bigger margin than he had two years earlier.

On Thursday, the office of Pennsylvania Sen. John Fetterman, a Democrat who was elected to the Senate after a bruising campaign during which he suffered a stroke, announced he had checked himself into the hospital for clinical depression. The statement said Fetterman had experienced depression on and off in his life, but it had only become severe in recent weeks.

Fetterman's public struggle is extraordinary in a building where few talk about their own mental health, even while members of both parties have legislation to expand aid for it. Kennedy and a handful of others who have been open about their own problems, or those in their family, say they hope Fetterman's honesty — and his decisive action to get help — will foster more openness among lawmakers and their constituents in the wake of a global pandemic that has had far-reaching effects.

"This is a moment for us to tear down the stigma of depression and anxiety," said Kennedy, who retired in 2010 and has become a leading voice on mental illness. "Sen. Fetterman may do more for people just by admitting that he's getting help for depression than any bill he ends up sponsoring."

The U.S. Surgeon General, Vivek Murphy, tweeted praise for Fetterman, saying he hopes his "courage will serve as an example for others."

Fetterman's Senate colleagues were immediately supportive.

"In every single city and town and rural community there is someone struggling with mental health," said Minnesota Sen. Tina Smith, a Democrat who shared her own stories about periods of depression on the Senate floor four years ago. "If they see somebody else, like John, saying, 'OK, I need to get medical care,' that can be important to people."

South Dakota's John Thune, the Senate's No. 2 Republican, said he thinks politicians have become more comfortable discussing the issue since the pandemic.

"The more open, transparent people can be, the better our understanding is," Thune said.

Fetterman's hospitalization comes after a rough year in which the 53-year-old suffered a stroke just ahead of the May primary election and spent much of the summer off the campaign trail, recovering. He has said the stroke nearly killed him. He also underwent surgery to implant a pacemaker with a defibrillator to manage two heart conditions, atrial fibrillation and cardiomyopathy. He entered the Senate in January, where he has had to adjust to life in Washington and the daily grind of a federal lawmaker.

"It's unreal what @JohnFetterman has been through in the last year," tweeted Sen. Chris Murphy, D-Conn. "A stroke, a recovery, a bruising campaign, a transition to the Senate. I'm so proud of him for taking his health seriously. He's going to be a great Senator for a long time, and I'm pulling for him today."

Texas Sen. John Cornyn said the Senate "can be arduous. So I'm sure if somebody is not up to 100% then it's especially tough, so I wish him well."

Post-stroke depression is common, doctors say. And that could be even more difficult when dealing with it publicly, like Fetterman is.

"Having a stroke in and of itself is devastating and having to recover from a stroke in the public eye only adds to the level of stress as one recovers," said Dr. Bruce Ovbiagele, associate dean and professor of neurology at the University of California-San Francisco.

Dr. Eric Lenze, head of the Department of Psychiatry at Washington University in St. Louis, said he thinks it's "interesting and heroic" for a major political figure to acknowledge depression, "instead of saying they're hospitalized for exhaustion or trying to hide it."

While many members are still loath to talk about themselves or their own hardships, some have been more forthcoming about mental illness in recent years. Pennsylvania Rep. Susan Wild declared from the House floor in 2019 that suicide is a "national emergency" and told the story of her partner, who had recently taken his own life. Rep. Ritchie Torres, D-N.Y., who was elected in 2020, has said he dropped out of college and at times thought of suicide after struggling with depression, substance abuse and grief after the loss of a friend. Smith said she found that ever since she told her own story of periods of depression as a college student and young mother, people still come up to her to talk about it.

Many lawmakers have also been open about their fear and anxiety after the Jan. 6, 2021, Capitol insurrection, when many of them ran for their lives, and the months afterward when tensions between the two parties became even worse. Democratic Reps. Dan Kildee of Michigan and Annie Kuster of New Hampshire both talked about dealing with post-traumatic stress during that time.

The Jan. 6 attack was another inflection point amid the global pandemic.

"We're living in a time of extraordinary stress and crisis," said Maryland Rep. Jamie Raskin, who lost his son to suicide just a few days before the insurrection and has since written a book about his experience. "We've come through a plague, we've had tremendous mental and emotional health problems."

Raskin, who was recently diagnosed with cancer, says there may have been a time when political leaders had to pretend that hardships didn't touch their own families, "but I don't think we are living in that time."

Illinois Sen. Dick Durbin, who has been in the Senate for almost three decades, credits returning veterans from the Iraq war and other conflicts "who have convinced us that this is simple medical, mental health care that many people need from time to time. There isn't a single family that isn't touched by it."

Durbin, the No. 2 Senate Democrat, credited Fetterman for being honest. "This is a challenge, unimaginable challenge, that he's faced in life," Durbin said.

Kennedy says that when he returned from his recovery in the mid-2000s, many of his colleagues sought his help and advice privately. And he has continued to talk to some members in the decade since he retired.

He predicted Fetterman could find a "whole new world of connection with his constituency" when he returns to the Senate, and could help people understand the brain science behind depression.

"This is a very teachable moment here," Kennedy said.

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Associated Press writers Marc Levy in Harrisburg, Pa., and Stephen Groves, Lisa Mascaro, Farnoush Amiri and Kevin Freking in Washington contributed to this report.

Senator John Fetterman’s candid approach to his struggles with mental health is unusual on Capitol Hill, where issues with members’ health are frequently kept hidden from the public.

But Fetterman’s openness has led to praise from mental health advocates, fellow members of Congress, and President Joe Biden, who said in a tweet, "We’re grateful to you for leading by example." 

Such mental health struggles in politics are not new — but they’re not mentioned often.  

In 1972, U.S. Sen. Thomas Eagleton was forced to bow out as the vice presidential pick for Democratic nominee George McGovern after his mental health struggles became public.

And in 2007, then-Congressman Patrick Kennedy opened up on Larry King live about his struggles with mental health.   

After a late-night car crash on Capitol Hill, the Rhode Island Democrat pled guilty in 2006 to charges of driving under the influence of prescription drugs.  

Since departing Congress, he founded the Kennedy Forum, which he describes as a think tank focused on mental health and addiction policy. 

"I think Senator Fetterman, simply by checking himself in saying he needs help and going to get that help, is going to probably help more people in that single act than any other bill that he sponsors or acts that he passes in Congress this year for sure," Kennedy said last week. "When I did go to treatment, I went under the cover of darkness, I did not do what Senator Fetterman has done, and that is to be very public about going to treatment. When I did go publicly, it was because I was forced to go publicly, I had had a DWI."

Fetterman suffered a stroke during his Senate campaign last year. His office said he has experienced depression on and off throughout his life but it became more severe recently.   

Mental health experts say his transparency about his struggles is an important signal to those dealing with similar issues. They say depression following a stroke isn’t unusual. 

 "We know that up to a third of people who have a stroke will suffer depression is the most common psychiatric disorder in people who have had a stroke. So I think for him to be so public about it is so courageous and he's been courageous up until this point, and he continues to do so," said Dr. Daniel Bober, a psychiatrist. 

Before Pennsylvania Sen. John Fetterman checked himself into the hospital for clinical depression in February, he walked the halls of the Senate stone-faced and dressed in formal suits. These days, he's back to wearing the hoodies and gym shorts he was known for before he became a senator.

Male senators are expected to wear a jacket and tie on the Senate floor, but Fetterman has a workaround. He votes from the doorway of the Democratic cloakroom or the side entrance, making sure his "yay" or "nay" is recorded before ducking back out. In between votes this past week, Fetterman's hoodie stayed on for a news conference with four Democratic colleagues in suits, the 6-foot-8 Fetterman towering over his colleagues.

People close to Fetterman say his relaxed, comfortable style is a sign that the senator is making a robust recovery after six weeks of inpatient treatment at Walter Reed National Military Medical Center, where his clinical depression was treated with medication and he was fitted for hearing aids for hearing loss that had made it harder for him to communicate. His hospitalization came less than a year after he had a stroke during his Senate campaign that he has said nearly killed him, and from which he continues to recover.

"He's setting a new dress code," jokes Vermont Sen. Peter Welch, who is the only other newly elected Democrat in the Senate and spent a lot of time with Fetterman during their orientation at the beginning of the year. "He was struggling. And now he's a joyful person to be around."

Senators do occasionally vote in casual clothing — Republican Sen. Ted Cruz of Texas, for example, is known for sometimes arriving in gym clothes. But Fetterman's regular attire is redefining fashion in the stuffy Senate. He's turning heads on a daily basis as he walks the halls in his signature baggy Carhartt sweatshirts and saggy gym shorts, his hulking figure surrounded by much more formally dressed Washington types buzzing around the Capitol.

The senator's staff had originally asked him to always wear suits, which he famously hates. But after a check with the Senate parliamentarian upon his return, it became clear that he could continue wearing the casual clothes that were often his uniform back at home in Pennsylvania, as long as he didn't walk on to the Senate floor.

Welch said Fetterman was quiet and withdrawn when he first came to Washington and often sat in the back of closed-door caucus meetings. Now he's standing up and talking, sometimes joking and ribbing Pennsylvania's senior senator, Democrat Bob Casey.

Fetterman, Welch and Republican Sen. Katie Britt of Alabama became friends at the orientation, and those two colleagues stayed close with him through his recovery. Britt says that in those early days, Fetterman would only really engage if she started the conversation, but they bonded over having children of a similar age and the fact that Britt's former football player husband, Wesley, is the same height as the Pennsylvania senator. When Fetterman checked into the hospital, Britt's staff brought food to his office next door.

Britt later visited him at Walter Reed, at his request, and found Fetterman to be totally changed. "When I walked in that day, his energy and demeanor was totally different," Britt said in an interview.

Now, he's loud and outgoing, she says -– even yelling "Alabama!" at her down a hallway when he caught sight of her last week, giving her fist bumps and asking about her husband and family.

"That shows you the difference that treatment can make," Britt says. "It's just incredible to see."

Fetterman's decision to seek treatment won bipartisan praise from his colleagues, a sharp turn from his bruising Senate race against Republican Mehmet Oz that was the most expensive in the country.

Joe Calvello, a spokesman for Fetterman who has worked for him since the beginning of his campaign and before the stroke, said his boss is more back to his old self after a difficult year. Fetterman is getting to know all his staff after his return to the Senate on April 17, making friends with his Senate colleagues and speaking out on progressive issues on which he campaigned.

"It's good to be on the other side of that," Calvello said.

Last week, Fetterman stood alongside the other senators in suits to urge President Joe Biden to raise the debt ceiling on his own under a clause in the 14th Amendment instead of negotiating with Republicans. He also questioned bank executives at a hearing — dressed in a suit, as he does for committee meetings — and asked whether they should be subject to work requirements like those Republicans have proposed for food aid recipients in the debt ceiling negotiations.

Fetterman's words are still halting and sometimes hard to understand, due to his stroke. He has auditory processing disorder, which makes it harder to speak fluidly and quickly process spoken conversation into meaning. He uses iPads in conversations, meetings and congressional hearings that transcribe spoken words in real time, and when he speaks publicly he often appears to be reading closely off a sheet of paper. He rarely speaks with reporters in the hallways.

While questioning the bank executives his words were occasionally jumbled, due to his auditory processing difficulties. "Shouldn't you have a working requirement after we sail your bank, put billions in your bank?" Fetterman asked.

The senator's conservative critics have frequently jumped on his stumbles, mocking them in television spots.

But his chief of staff, Adam Jentleson, tweeted that the moment at the banking hearing was unscripted -– and a surprise to even him.

"John Fetterman just asked the Silicon Valley Bank CEO if there should be work requirements for CEOs who crash banks and dear reader, I almost fell out of my chair," Jentleson wrote.

Constituents he has met with say it can take a moment to get used to his speaking difficulties.

The president of the Pennsylvania Farmers Union, Michael Kovach, said Fetterman unexpectedly popped in when Kovach was meeting with the senator's staff in Washington. It was only Fetterman's second day back, but he stayed for a half hour, using a transcription device to read Kovach's responses in their discussion about helping farmers who keep good conservation practices on their land.

Kovach said Fetterman asked thoughtful questions, made thoughtful comments and joked about beard envy with Kovach, who sports a long graying goatee.

"It's the same Fetterman that I recall as lieutenant governor, it's just difficult for him to communicate, so the elephant in the room obviously is the screen that he's reading from," Kovach said. "It's a bit of a distraction, but something I got quickly used to."

Fetterman is also back to social media, which was a staple of his campaign before the stroke. This past week he posted a photo of himself and Welch on Twitter sitting in a Senate courtyard and wearing hoodies.

Welch is hosting Fetterman and Britt at his house for dinner soon. Fetterman is "on his game" these days, Welch said.

Another Democratic colleague, Illinois Sen. Tammy Duckworth, said she noticed that Fetterman was "inwardly focused" when he arrived in Washington. But he's now gregarious and cracking jokes.

"It's really, really great to see, it's a good message to send to people to seek help," Duckworth said. "It makes a difference."