In last night’s first and only debate between Pennsylvania Senate candidates John Fetterman and Mehmet Oz, Fetterman’s speech was often halting, his thoughts were occasionally incomplete, and the words and phrases he used didn’t always fit their context.
In May, Fetterman survived a stroke caused by a blockage in one of the arteries in his brain, his campaign has said. It has left him with what he calls auditory processing issues (commonly known as an auditory processing disorder) — that is, problems with the brain’s work of processing speech. As a result, Fetterman sounds very different compared to how he sounded before May — and very different from what pundits and many members of the public expect from political campaigners.
Ever since, his campaign has been dogged by questions about what his disability means for his capacity to serve in the Senate — questions loaded with biased assumptions about disabilities, and misunderstandings about how a stroke impacts cognitive capacity.
Two weeks ago, in his first televised interview since the stroke, Fetterman used live captioning technology for assistance. When Fetterman’s interviewer, NBC correspondent Dasha Burns, made pointed observations about his need to read her questions in order to understand them, it touched off an avalanche of questions and bad takes.
Among the swirling questions are ones about whether Fetterman’s stroke has caused cognitive changes that render him unfit to serve in the Senate. On their face, these are not unreasonable — although in both the NBC interview and in a podcast interview recorded October 10 with New York magazine’s Kara Swisher, herself a stroke survivor, Fetterman’s thinking and expression appeared to be intact.
But the questions become ugly when they ask if someone who requires accommodations similar to the ones Fetterman used can do the job of governing. Questions like this conflate the use of language-assistive devices with intellectual delays. More broadly — and especially when they’re weaponized politically, as they have been by the campaign of political rival Mehmet Oz — these questions conflate disability with weakness of character and mind.
Take a look at legislative bodies in the US and you’ll see that many of our elected officials use assistive technology, from glasses to wheelchairs to hearing aids and beyond. So do nearly two-thirds of our working public. The Americans with Disabilities Act (ADA), passed in 1990, requires employers to make these kinds of accommodations so people with disabilities can complete their job functions.
The ADA acknowledged that excluding people with disabilities did them a disservice by preventing them from contributing to and fully participating in the world around them. But it also helped uncover another important truth: that the whole of society makes meaningful gains when workplaces of all kinds include people with a range of disabilities.
If Fetterman wins his race, the accommodations he may use as a senator are ones that could also meaningfully benefit his colleagues without disabilities. Furthermore, say advocates, his mere presence in a high-stakes campaign as a political figure acknowledging and working through a disability can move the needle — not only on what the public imagines when it conceives of elected officials, but also on what legislators imagine they can do for us.
Disability accommodations benefit everyone
Several stroke rehabilitation experts told me it’s impossible to assess from afar whether Fetterman will be able to successfully complete the functions of being a US senator. However, they noted that language processing differences and speech changes like the ones Fetterman demonstrated in the NBC interview — for example, he mispronounced “empathetic,” recognized his error, and corrected himself — signify he may have a type of language disorder that’s not uncommon after a stroke and which does not indicate changes in reasoning ability.
When people have a stroke, “that does not mean they can’t think through and rationalize and objectively analyze every question,” said Swathi Kiran, a neurorehabilitation professor and speech language pathologist at Boston University.
The brain can do a lot of recovery in the first six months to a year, said Kiran. But recovery varies from person to person, said Ronald Lazar, a neuropsychologist specializing in stroke recovery at the University of Alabama at Birmingham. “Making an assumption about what he can or cannot do because you don’t know is not always, I think, a fair thing to the patient,” he said. Stroke rehabilitation — like most illness recovery — usually happens in private, but Fetterman is recovering from his stroke in public.
Most people with the kind of stroke Fetterman had don’t return to work as soon as he did: studies have suggested that only about 40 percent of stroke survivors return to work within six months, even if they are young and otherwise healthy. In one Swedish study that followed stroke survivors for six years, about half had gone back to work in a year’s time following their strokes, and some took up to three years to get back on the job.
Different people have different reasons for not returning to work after a stroke. Recovery takes time, and the road to improvement is often rocky. People who have speech or other communication problems after a stroke are less likely to return to work at all.
But for many survivors, returning to work may actually have a therapeutic effect, providing them with a sense of autonomy and purpose and improving quality of life overall.
Although it’s unclear what path Fetterman’s recovery will take in the future, the conversation about his need for a disability accommodation is an opportunity to revisit the ways such accommodations have already benefited all of us.
In his interview, Fetterman used live captioning, a technology that was originally invented for deaf and hard-of-hearing people to help them enjoy films. US law has required live captioning for all television programs since the 1990s. These days, it is a fixture among assistive technologies used to help people with language or hearing problems.
But live captioning offers a wide range of other benefits, too. Among hearing people, captions help children learn to read, improve adult literacy, speed up learning of second languages, and improve people’s ability to remember orally delivered material. The technologies have become a fixture in my own life: The real-time transcription program I use on a near-daily basis makes my work immeasurably easier, and the captions I use while watching TV allow me to go slack-jawed in front of Stath Lets Flats episodes without hovering a finger over the rewind button.
Captioning is just one of many accommodations initially created for people with disabilities that have dramatically improved life for people without disabilities, said Rosemarie Garland-Thomson, a disability justice scholar and professor emerita at Emory University. Curb cuts, the tiny ramps that allow wheels to smoothly climb a curb, are a great example, she said. “A curb cut was mandated for, basically, wheelchair users, and it has made the world more accessible for people like you and me and our rolling suitcases, and people who use bicycles,” she said. Another big beneficiary: people pushing baby strollers.
The captioning technology Fetterman is using — if he still needs to use it once his rehabilitation is complete — may actually confer important benefits to his colleagues in the Senate if he’s elected, said Garland-Thomson. People with hearing difficulties (which are inevitable with advanced age, which is itself inevitable in the Senate) would benefit from being able to read captioned proceedings.
It’s also important to keep in mind that if Fetterman is elected and needs communication accommodations to do his job, he wouldn’t be the first elected official to do so. David Paterson, the New York State lawmaker who in 2008 became the country’s first legally blind governor, used several kinds of assistive audio to do his job, and Washington state’s former Lt. Gov. Cyrus Habib, who is also blind, used a Braille keyboard to preside over the state legislature.
Additionally, many people absorb and retain information better when it’s delivered in writing in addition to being communicated verbally. “When they’re in place, it’s really useful for people to have them,” Garland-Thomson said of these types of accommodations.
Having disabled people in leadership positions can reduce stigma and lead to more inclusive legislation
When people with disabilities work in prominent positions, their presence on the job makes disability more “legible” in the public sphere, said Garland-Thomson. She noted the examples of Tammy Duckworth, a senator from Illinois who uses leg prostheses, and of Haben Girma, a lawyer and disability rights advocate who is deafblind. “Witnessing people who have pretty significant disabilities doing a job that we imagine they can’t do is itself an important function,” she said.
The effect may be particularly powerful when the disabled role model has a traditionally masculine presentation. Cultural scholars have argued that masculinity and disability are in conflict, in part because disability’s connotations of reliance bump up against masculinity’s connotations of independence. Part of Fetterman’s appeal to working-class voters is his brawn — he is 6-foot-8, played football in college, and still has the build of an offensive lineman. If elected, he could help destigmatize disability within communities where it’s currently highly stigmatized.
We assume that living without a disability leads to having a better life, said Garland-Thomson — and similarly, we might assume it makes for being a better politician and legislator. But over decades, elected officials have demonstrated that disability can be a source of strength.
Having a disability, whether outwardly visible or not, could make leaders more compassionate toward their most vulnerable constituents, and may lead to more inclusive legislation. For example, after former Sen. Mark Kirk had a stroke in 2011, his aides described him as a “mellower” boss and a more emboldened policymaker — including on social issues such as same-sex marriage, for which he declared his support in 2013.
Disabled policymakers have often been the ones to spearhead legislation that advances equity for people with disabilities. Sen. Bob Dole, who had sensory and movement problems in his right arm due to a wartime injury, was instrumental in passing the ADA. Duckworth has introduced bills aimed at improving reproductive health care access for women with disabilities and expanding small businesses’ accessibility. Former Rep. Tony Coelho, another ADA sponsor who also supported 2008 amendments that made it more inclusive, has epilepsy. And President Franklin Delano Roosevelt, who used a wheelchair, enacted the New Deal, many of whose health, vocational, and funding programs benefited people with disabilities.
In the NBC interview, Fetterman said his experience surviving and rehabilitating from his stroke has keenly attuned him to the needs of his constituents. “I always thought I was very empathetic before having a stroke. But now, after having that stroke, I really understand much more the challenges that Americans have day in and day out,” he said. Health care saved his life, and speech therapy has been critical to his recovery, he added. “Those are the resources everyone deserves to get.”
People can make a lot of judgments based on what they think of as “normal,” said Garland-Thomson. But to her, it’s more productive to question whether being “normal” is really an asset to begin with. “There are many people who look at disability, and living with disability, as a benefit — that it has made good lives for them,” she said.
The public can choose to dwell on the doors disability can close. Perhaps we owe it to ourselves, and each other, to instead generously imagine what doors disability can open.
Update, October 26, 1:50 pm: This story was originally published on October 15, and has been updated to reflect John Fetterman’s performance in the October 25 Senate debate.