This intimacy and honesty helped her garner new fans and reinspire old ones. In short, it has been good business. But it’s also exactly what we need at a time when expertise is under assault, we still pay too little attention to mental health, and we don’t do enough to protect people and help them feel comfortable with their vulnerabilities. Leadership like Swift’s is commercially savvy, but it also shows how celebrities can now speak directly to fans, doing tremendous good in the process.

The very idea of a celebrity is rooted in the star system that Hollywood studios developed a century ago. During the 1920s, studio executives discovered that public affection for stars such as Mary Pickford boosted the new industry’s public profile and ticket sales. Creating a “star” required not just a silver screen production but a team of publicists who flooded newspapers and radios with personal stories of the actor’s life to foster an intimate connection with fans.

Gossip columnists such as Louella Parsons and Hedda Hopper became powerful Hollywood women because they walked this line of gossip and promotion, reporting what they found out, but in a curated way, with their goal always being to sell the merits of the industry on which their livelihood was based. Aware that censorship had picked up in the previous decades when salacious stories of Hollywood’s promiscuity and vulgarity commanded headlines, Parsons and Hopper worked with studio publicists to rein in the public behavior of actors — an early foray into public shaming — to push Hollywood celebrities to be positive role models.

In curating the perfect image, the real person behind the star often got lost. The story of Frances Ethel Gumm was illustrative. Signed by MGM at the young age of 13 in 1935, Gumm disappeared, replaced by Judy Garland, who was “born” into the world in a 22-page publicist-written biography, or so Garland herself explained in a January 1951 interview in Cosmopolitan. “When a studio puts you under contract, its publicity department starts turning out news copy about you that you read with astonishment, You think, can this be me they’re talking about?”

The public pressures to remain youthful and beautiful created mental health problems for many stars. Garland, like her friend Mickey Rooney, was constantly critiqued for her image and weight. From her first feature film at age 14, the studio monitored her intake, insisting she consume only chicken soup, black coffee and cigarettes, and would often take food away from her before she ate it. The studio also gave her amphetamines to stay alert and barbiturates to sleep so she could work six days a week for over 16 hours a day, and she became dependent on them. She was addicted by age 17.

These health issues slowly started to seep into the gossip columns during the 1940s. Instead of commenting on her “pep,” the press regularly mentioned her “frailty.” Parsons and other industry columnists initially tried to assert that everything was fine with Garland — just insomnia, or nerves. Then, she missed 16 days of filming “Meet Me in St. Louis” for “sickness” and exhibited signs of paranoia on the set of “The Pirate.” She was checked into a psychiatric facility for three months by the studio. But treatment resulted in weight gain, pushing her to spiral back into pills and anxiety.

Her mental health decline and its monetary cost to the studio caused MGM to ultimately suspend her. At the time, she reportedly cut her neck superficially with a piece of glass, yet the tabloids got ahold of the story and led with the headline “JUDY GARLAND CUTS THROAT.” Hopper’s explanation is telling. She offered psychological reasoning for Garland’s attempted suicide, attributing many of Judy’s problems to her difficult childhood, early family relationships and Judy herself — not, of course, the pressures of the Hollywood studio system.

During the 1960s, studio systems lost the power to control their stars with contracts that regulated their performances, morality and public profile. The rise of “New Hollywood” meant that actors had more control over their decision-making and public image — and they frequently became more involved in issues such as antiwar and civil rights protests.

But this made them more responsible for crafting their star image — and, increasingly, they relied on a personal team of agents and publicists to create their individual brands. In the process, mental health, including substance use, remained an issue and a professional liability. Celebrities with mental illness often worried that filmmakers would not want to pay for the insurance required to protect them on a film set. This insurance, called cast insurance, had existed since the silent film days with stars insuring body parts from injury, but it has grown more complex to protect against injury, death or sickness that could prevent an actor from filming (which can cost upward of $250,000 a day).

Rather than allowing the stars to share their stories on their own timelines, gossip reporters — dedicated to uncovering a scoop that sells rather than protecting the image of Hollywood as an industry — “found out” about mental illnesses. Often the catalyst has been an arrest for a DUI or drug possession cluing the public in that a celebrity had a substance-use problem. Or a celebrity would have a “public breakdown” like Mariah Carey or Britney Spears and would later disclose that they had bipolar disorder on the cover of a magazine. Publicists in these instances swooped in and tried to salvage their client’s image that the media had “damaged.” Sometimes this forced disclosure was criticized as using mental health as an excuse for bad or illegal behavior, but often it was just what happens when someone under a microscope is finally exposed.

Some struggles ended tragically: River Phoenix died of an overdose, Karen Carpenter died of anorexia, and Robin Williams died by suicide. Child stars, like Swift, often have a particularly difficult adjustment to fame — Drew Barrymore was drinking by age 9 and in rehab by age 13; Demi Lovato struggled with an eating disorder, bipolar disorder and drug use; and Justin Bieber struggled with depression and drugs. Swift says celebrities are frozen at the age they got famous and felt she had a lot of “growing up to do to catch up to her [actual] age.”

These high-profile cases demonstrate the effect that celebrities have on mental health awareness. In fact, the calls placed to the National Suicide Prevention Lifeline increased by 300 percent the day after Williams died. Princess Diana’s disclosures about her eating disorders had a similar effect. In a 1993 speech discussing how she had grappled with bulimia, she helped to raise awareness, normalize an illness and then encourage treatment. It worked. Women seeking treatment for bulimia doubled after she spoke, a phenomenon later called “the Diana effect.”

The glare of the spotlight and the need for publicity, as well as the criticism and quick shaming of celebrity behavior, has fueled mental illness for celebrities, but it has a silver lining. It can turn the nonstop media attention on celebrities into a productive conversation about mental health. This means that Swift has launched a conversation that will save lives. This is particularly the case as teen suicide rates in the United States increase, far outpacing other age groups. Depression in girls has also been linked to more time spent on social media, and eating disorders have the highest mortality of any mental illness.