When Mental Health Treatment Becomes a Political Identity

As a rising young Democratic star and the top elected official of Harris County, the most populous in Texas, Lina Hidalgo surprised many people last summer when she announced that she had checked herself in at a residential mental health clinic for serious depression.

She had been struggling privately for years, even as she stepped forward assertively to preside over Houston’s response to the coronavirus pandemic and help residents throughout the county deal with flooding and a devastating winter freeze.

Then, during a brutal re-election fight in 2022, her mental state worsened. Aides were aware that something was wrong — there were missed campaign events, and shortness with staff members — but few knew just how dire things had become.

“I remember feeling really suicidal, and saying to David, my boyfriend, and to my therapist at the time, ‘We have to do something,’” Ms. Hidalgo said.

Since her return from nearly two months of treatment at the clinic, Ms. Hidalgo has spoken openly and often about her mental health, making her struggles an increasingly central part of her political identity.

In an extended interview with The New York Times, she talked candidly about her depression, her decision to seek treatment and the trauma of childhood sexual abuse that she has rarely discussed.

“The more we talk about it, the more it’s going to help somebody else,” she said.

Ms. Hidalgo, 32, has added her name to a growing list of politicians — most of them Democrats — who have chosen to be public about their mental health. She benefited from such openness herself, she said, taking inspiration from Senator John Fetterman of Pennsylvania, who announced that he was receiving inpatient treatment for depression several months before Ms. Hidalgo sought that kind of care.

But the approach remains politically risky. Political consultants still point to Senator Thomas Eagleton, a Missouri Democrat whose history of mental health treatment doomed his prospects as a vice-presidential running mate in 1972. And while the number of politicians who are willing to discuss their mental health treatment has grown, it remains small.

“They feel that once you’ve got that scarlet letter, people are always going to look at you sideways,” said Patrick Kennedy, a former congressman who sought help for addiction and mental health issues after he crashed his car into a barrier at the U.S. Capitol. He has since become an outspoken advocate for mental health treatment. “We’re still negotiating all of this in our modern work world,” Mr. Kennedy said.

Representative Ritchie Torres, a Bronx Democrat, has been candid about his mental health as a member of Congress. But when he was starting his career in local politics in New York City, he was much more private about the fact that he had been hospitalized for depression. Even so, he recalled, rumors circulated about his mental health during his first campaign for a City Council seat.

After that experience, “I made a decision to be open and honest about it,” he said. “There’s a value in telling your own story.”

Ms. Hidalgo was born in Colombia and lived in Peru and Mexico as a child; her family moved to the Houston area when she was in high school. She was a student at Stanford University, she recalled, when she first told her mother that she had been sexually assaulted when she was 11 by a tennis coach in Mexico. Ms. Hidalgo said she had sometimes sought out people who knew her as a child to help her understand what had happened to her. Mostly, though, she kept it private.

“It was like the stereotypical thing where the shame is so big that we can’t even talk about it,” she said.

She said she did not seek residential treatment until after her re-election, which she won by about 18,000 votes. During the campaign, some members of her staff discussed whether she should take time out, but they worried about what the impact would be on her re-election prospects, according to several people who worked with her.

“For Lina, being a young Latina in a blue city in a red state meant that she was already in the cross hairs before she disclosed her diagnosis,” said Rodney Ellis, a longtime Democratic commissioner in Harris County and an ally of Ms. Hidalgo. “It’s not the recipe for a successful campaign to admit that you have mental health challenges.”

Still, the political impact of such a disclosure would depend on the kinds of voters a candidate was seeking to attract, according to Jeronimo Cortina, a political science professor at the University of Houston. “It can be a liability, but that may be only among an older segment of the electorate, who were used to seeing mental health as not being a part of health,” Mr. Cortina said.

Ms. Hidalgo rose to prominence almost overnight in 2018 when, as a progressive first-time candidate and a 27-year-old immigrant, she shocked the conservative establishment in Harris County by defeating a popular Republican for the position of county judge, a role that in Texas amounts to the county’s chief executive.

Suddenly she was presiding over the county’s five-member commissioners’ court, and serving as the emergency manager for the nation’s third most populous county, with 4.7 million residents. She quickly became so recognizable a face in Houston that at times she had to wear a purple wig and glasses to visit the city’s art museums anonymously.

In her first term, she dealt with catastrophic events including flooding, a major chemical fire and the coronavirus pandemic, and clashed with Republican state leaders, including Gov. Greg Abbott, over mask mandates and other public health restrictions that she sought to impose. Republican donors in Houston poured in money to support her opponent in 2022.

She saw a psychiatrist for the first time a few months before the 2022 election. She received a diagnosis of anxiety and a prescription for some medication, and figured she could keep going. “But I was still crying all the time,” she said. She tried never to be alone, and would not drive a car herself, out of fear for what she might do.

She won her race for re-election, but her depression persisted. She vacationed in Thailand and was the subject of a glowing profile in Vogue magazine, but nothing seemed to help.

Along the way, there were public outbursts that raised questions about her performance. She cursed during one commissioners court meeting while discussing District Attorney Kim Ogg, a fellow Democrat with whom Ms. Hidalgo has frequently clashed.

(Three of Ms. Hidalgo’s former aides have been indicted by Ms. Ogg’s office and accused of providing a vendor with inside information before the county awarded an $11 million coronavirus contract. Lawyers for the former aides have denied there was any wrongdoing.)

Shortly before Ms. Hidalgo finally sought treatment, she contemplated stepping down. “I’m so glad I didn’t do it, because it wouldn’t have fixed anything,” she said in the interview.

After she broke down crying during a medical visit, she said, her primary care doctor connected her with a new psychiatrist, “who immediately realized that I was in a really perilous position” and recommended the Lindner Center of Hope, a clinic in Ohio. She said seeking help saved her life.

She acknowledged that not everyone could afford the seven weeks of residential treatment she received, at a cost that she said came to about $88,000 in all. She said her boyfriend, David James, a civil rights and personal injury lawyer, paid most of the bill. In January, the couple became engaged.

When Ms. Hidalgo decided last year to seek treatment, she told her advisers and political confidants first, including Mr. Ellis, who ran county meetings in her absence and held a vote to approve the county’s annual budget. Then she told everyone.

“It is important for me personally and professionally to confront this issue swiftly,” she said in a public statement last summer.

Her decision was praised by local Democrats. At the same time, when her absence stretched on, some Republicans, including her former opponent, called on her to “return or resign.” Others began seeking to remove her from office.

Back on the job after the treatment, she has faced new political obstacles, and signs that her hold on the commissioners court has weakened even though Democrats hold four of the panel’s five seats. Recently, she strongly objected to a pay raise for a county official, but was outvoted 4 to 1.

The newly elected mayor of Houston, John Whitmire, a fellow Democrat who received strong Republican backing in the officially nonpartisan mayoral race, has yet to meet with Ms. Hidalgo. The two leaders held separate news conferences on emergency measures during a recent bout of severe winter weather.

At the Houston Marathon last month, she tried to greet Mr. Whitmire with a hug. But as she approached him, she said, he held out his arm stiffly to keep her back, and shook her hand instead. “I couldn’t reach him to hug him,” she said, adding that he then walked away from her.

(Mary Benton, a mayoral spokeswoman, said Mr. Whitmire “prefers a friendly handshake” to a hug when working, adding that he did not walk away, he “was there to celebrate all the runners.”)

Ms. Hidalgo said she was trying to put such things in perspective. She has been studying notes from what she learned in treatment, consulting them constantly on her phone, and has continued to take part in group therapy over video.

“This week’s lesson was about bitterness,” she said. “Which is really helpful in the political context, right?”