All By Himself John Fetterman insists he is in good health. But staffers past and present say they no longer recognize the man they once knew.

When John Fetterman was released from Walter Reed hospital in March 2023, Adam Jentleson, then his chief of staff, was proud of his boss for seeking help for what the senator’s office and his doctor had said was a case of clinical depression. His six weeks of inpatient care had been the latest medical setback for the Pennsylvania Democrat, who had had a stroke mere months before being elected to the U.S. Senate in 2022, nearly derailing his campaign against Republican Mehmet Oz. But a year after his release from the hospital, Fetterman’s behavior had so alarmed Jentleson that he resigned his position. In May 2024, he wrote an urgent letter to David Williamson, the medical director of the traumatic-brain-injury and neuropsychiatry unit at Walter Reed, who had overseen Fetterman’s care at the hospital. “I think John is on a bad trajectory and I’m really worried about him,” the email began. If things didn’t change, Jentleson continued, he was concerned Fetterman “won’t be with us for much longer.”

His 1,600-word email came with the subject line “concerns,” and it contained a list of them, from the seemingly mundane (“He eats fast food multiple times a day”) to the scary (“We do not know if he is taking his meds and his behavior frequently suggests he is not”). “We often see the kind of warning signs we discussed,” Jentleson wrote. “Conspiratorial thinking; megalomania (for example, he claims to be the most knowledgeable source on Israel and Gaza around but his sources are just what he reads in the news — he declines most briefings and never reads memos); high highs and low lows; long, rambling, repetitive and self centered monologues; lying in ways that are painfully, awkwardly obvious to everyone in the room.”