Critic Susan Sontag once argued that treating illness as a metaphor was wrong because it effectively shamed patients for being sick. But in politics, illness—and the press and the public’s reaction to the revelation of illness in a political candidate—is useful not as metaphor but as a barometer for people’s trust in that candidate.

Last week, when Sen. Bernie Sanders admitted after several days of obfuscating that he had suffered a heart attack on the campaign trail, political observers wondered if a 78-year-old cardiac patient would be able to continue to endure the rigors of a presidential campaign.

Sanders initially seemed unsure of that himself. “We were doing (in) some cases five or six meetings today, three or four rallies and town meetings and meeting with groups of people. I don’t think I’m going to do that,” Sanders told reporters. “But I certainly intend to be actively campaigning. I think we can change the nature of the campaign a bit. Make sure I have the strength to do what needs to be done.”

But he walked that back in an interview with NBC News on Wednesday, saying, “I misspoke the other day. I said a word I should not have said and media drives me a little bit nuts to make a big deal about it. We’re going to get back into the groove of a very vigorous campaign, I love doing rallies and I love doing town meetings.”

He confirmed plans to participate in the upcoming primary debate in Ohio adding, “I’m healthy and we’re going to run a vigorous campaign and we’re going to win this thing.” He also tweeted out reassurances to his supporters and, politician to the core, took the opportunity to plug his Medicare for All proposal.

Not everyone is satisfied with Bernie’s plucky can-do spirit, however. Arianna Huffington urged Bernie to make his heart attack experience an “amazing teachable moment” by reminding Americans to “take action by examining our lifestyle choices” and realize “how much power we have to make healthy changes in our lives that can lead to better health outcomes.”

Other commentators sensed a patriarchal conspiracy in the media’s treatment of his heart attack since Bernie was given the benefit of the doubt about his recovery while then-candidate Hillary Clinton was not when she suffered a bout of pneumonia on the campaign trail during the 2016 election. Video showed her stumbling and needing help into a waiting van, but her staff wouldn’t allow the press to follow her and claimed she was merely “overheated.” Only later did they disclose that she had pneumonia.

But hardcore Hillary supporters seem to have forgotten that the press only criticized Hillary for her lack of transparency about her condition after previously downplaying the serious head injury (and blood clot) she sustained from a fall when she was secretary of state, and chastising anyone who raised the issue of her health after an earlier coughing fit during a campaign event.

The relationship between political leaders on the one hand and the press and public on the other has always been fraught with regard to those leaders’ health. The total secrecy (and the press’ willingness to keep it) surrounding the illnesses of presidents such as John F. Kennedy (who suffered from Addison’s disease and took strong painkillers for back pain) is no longer tenable in an age that demands transparency, but candidates still must weigh carefully how much physical weakness they disclose.

Remember Massachusetts Senator Paul Tsongas, who suffered from non-Hodgkin’s lymphoma? As the New York Times noted, when he was running for the Democratic presidential nomination in 1992, he “used what he said was his victory over the disease in his advertisements, and demonstrated his health by swimming the strenuous butterfly stroke.” When it emerged later that he had in fact not disclosed a recent recurrence of his cancer, he was heavily criticized, and he “pledged that if he ever ran again, he would submit his medical records to independent experts.”

Bernie, too, has pledged to release his medical records to the public. And the overwhelmingly geriatric quality of the Democratic presidential frontrunners for 2020 in some sense protects Bernie from criticism about his age as a factor in the race (some experts argue that chronological age is less determinative of a candidate’s mortality than other factors).

But Bernie eventually has to decide if he’s going to stay in or get out; researchers have found that two-thirds of people over age 65 who have a heart attack die within eight years, which is not the actuarial message Bernie wants to be sending right now.

There is also the matter of his vast campaign organization. Like Jerry Garcia was to the Grateful Dead, Bernie is the charismatic head of a large operation into which a great deal of money and human capital have been invested. What will happen to his grassroots revolutionaries if their revolutionary leader exits the race? Unlike the Grateful Dead, Bernie bros can’t just replace their dear leader, rebrand, and keep on touring.

If Bernie makes it through the next Democratic debate intact, it might be enough to reassure his supporters in the short term. But if he looks even slightly peaked, the long knives will be out. Some of them already are: Rep. Bobby Rush of Illinois (a Kamala Harris supporter) said this week that it was “egotistical” and “self-centered” for Bernie to stay in the race.

For now, Bernie supporters seem inclined to trust what he tells them about his health, but the press and the public are right to question if such optimism is warranted.

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