Of the 46 million Americans with a mental health problem, only 38 percent end up getting treatment. Among those who don't, 7 percent don't want anyone to find out they have a problem, 17 percent don't know where to go, and 50 percent just plum can't afford it. Doctors who specialize in making sure your brain doesn't have a demon shitting in it are the hardest doctors in the country to find: Almost 90 million Americans live in "Mental Health Professional Shortage Areas." What does that mean? Well, take a look at this chart:

Via Raconline.org
I FUCKING SAID LOOK AT IT!

It means that in parts of our country, there is one psychiatrist for every 30,000 citizens. Considering that 1 in 4 Americans has a diagnosable mental disorder, that's roughly the equivalent of a single NFL referee explaining the last call to each person in the stands individually.

But that's just the numbers-icing on the can't-get-treatment cake. The real problem here is shame, which I guess is trans fat in this metaphor. Christ, I'm hungry. The thing that sets mental health problems apart is that no one's ashamed of getting the flu, and fighting something like cancer even wins you some social bonus points. But aside from the occasional Oscar-bait Ron Howard flick about triumphantly overcoming your cartoonishly simplified version of schizophrenia, insanity is just comedy fodder. Once you're diagnosed as mentally ill, if you're not the butt of some joke about acting weird ("You total nut job!" or "That's mental" if you're Ron Weasley), your entire experience will be dismissed as something quirky ("I have such OCD about not wanting dog poop in my pasta!"). And since most mental illnesses are easy enough to hide, it can seem simpler to just not tell anyone and suffer alone. And that's the problem: If you skip your cancer treatment, everyone will think you're crazy. If you skip your psych meds, no one will.

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You're sad because someone made you wear that sweater, right?

Besides, treatment is expensive, and not just in how much you pay: Being mentally ill makes it harder to keep a job, so a diagnosis gangbangs your wallet from both ends. But unlike the flu, you can't just get over most mental illnesses. They're like the One Ring of Power: The longer you keep one around, the worse its hold over you gets. So you decide to take off your shoes and walk your creepy-looking feet to the local volcano to finally do something about it. But when you show up, you find 17 different pools of lava and 20 different volcano guides telling you you're at the wrong one, because ...

And every part of the system is specialized. An emergency room, for example, can help someone who is on the verge of hurting himself, but once that immediate problem is treated, they're done. The patient is sent home with a stern "don't try to kill yourself again," and nothing treats severe depression better than a stranger in a white coat making perfunctory professional remarks.

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"I'm writing you a prescription of 'stop being depressed.' Take one a day, forever."

It's such a mess that people in desperate need of help have no idea what to do or who to contact. Parents have actually called the cops on their own kids to get them arrested, hoping that throwing them headlong into the system would actually get them the help they need. That might help explain why half the people in prison have mental health problems. I (briefly) taught a poetry workshop in a federal prison, and to me, that fraction seems a bit small -- but it helps explain why so many people in prison end up reoffending when they get out. No matter what fucked up game your brain is playing on you, being locked in a tiny room isn't going to help.

Again, the differences between mental illness and physical illness are thrown into sharp relief: Breaking the law to pay for your cancer treatment is a TV show. Stealing to eat because you're too anxious to work isn't even a headline.

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Sometimes, it just takes a person with a clipboard yelling at you in an alley to get your ass back in gear.

So what does that mean in terms of the system? Well, with regular physical health care, unless your problem is ongoing like diabetes or terminal like the self-punch virus, patients will show up, collect their cure, and then disappear for the next half a year. It's why physical doctors can take on so many patients. It's in-and-out.

Mental health care, however, is oftentimes a lifelong commitment involving not only medication, but counseling and psychiatric evaluations that require more frequent trips to the doctor and close personal interaction. Treating a cold is easy because the symptoms are always the same and it goes away on its own. Treating any of the five types of schizophrenia is an ongoing process that requires constant medication and professional monitoring. Just getting a correct diagnosis of the problem can take months. Sometimes, years.

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"Just relax and breathe deep. We're going to remove your brain to see what's wrong."

Speaking of which ...

In the 1970s, Dr. David Rosenhan was wondering if we were any good at identifying crazy people, so he launched an experiment. He had eight totally healthy "pseudopatients" admit themselves to a psychiatric hospital and then proceed to act completely normal. The answer he quickly discovered was no, we kinda suck big ol' floppy balls at it. All but one of his patients were quickly diagnosed with mental illnesses, and some were forced to take antipsychotic medication before they were allowed to leave. Rosenhan concluded that the doctors in the ward had conditioned themselves to see insanity in totally normal behavior. In one case, they labeled a guy who seemed obsessed with lunch as exhibiting "behavior ... characteristic of the oral-acquisitive nature of the syndrome." In reality, he was just "showing up to lunch early because there's fuck all else to do in a psych ward."

But that was 40 years ago, and that study was hugely influential -- things are better now, right? Not especially. One guy in England spent 20 years bouncing around different parts of the "mental health care system," including prison, while having every antipsychotic under the sun crammed down his throat like loading a Pez dispenser. But instead of the super-schizophrenia everyone assumed had afflicted him, someone eventually figured out that he had Asperger's syndrome.

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"Have you considered that you might just be an asshole?"

Many diagnoses have more to do with the doctor's personal theories than the patient. Bipolar disorder, one of the most common disorders in the country, is initially misdiagnosed in 69 percent of cases, and one-third of those aren't figured out for a decade or more. One-third of people diagnosed with depression may actually have bipolar disorder, a disorder that needs entirely different medication. At this point, it wouldn't be surprising to walk into a grief counselor's office after your mother's funeral and walk out labeled a werewolf.

And as you sit in your apartment, studying the lunar calendar and taking your anti-lycanthrope pills, you wonder how that medication is changing your body chemistry. Is it rewriting your DNA? Is it suppressing the wolf chemicals that make you thirst for the screams of the innocent? Is it like full-body Rogaine?

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"Sanders, go home. You can't be wolfing out in here."

Well, the thing is ...

I've known people who go through different kinds of psychiatric medication the way sensationalist news organizations assume kids go through video games: try one out to silence the raging voices in my brain, get bored, get a new one a month later, repeat forever. It's like chasing the dragon, only instead of the perfect heroin high, people with mental illness are hoping to wake up with a feeling that can be described with actual words instead of a long, tortured moan. And figuring out which medication works is a hell of a grind: 30 to 40 percent of patients won't respond to any given antidepressant, you won't know if something's working until you've been on it for six weeks or so, and some of them actually make symptoms worse. It's like playing a long, slow game of Russian roulette with your brain.

The reason picking an antidepressant is so much tougher than choosing a decongestant is because doctors have no idea how these medications even work. The explanations from antidepressant ads aren't just dumbed down marketing; they're actually not that different from what the scientists actually know.

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WARNING: May cause eye explosions.

Am I saying that you should stop taking your medication, or not seek mental health care because it's too fucked up? No. Jesus Christ, no. Don't ... is that the message you got from this? If so, I ... suck. Listen: If you need medication, go take it. It's good for you in a lot of cases. Talk to your counselor, if you're lucky enough to have one. Do whatever the hell you need to do to keep control of your life. And avoid taking any life advice from me in general. My life's a wreck. I don't even own a car.

What I'm saying is that when your doctor prescribes you medication and it turns out to not work or make you worse, you can't just label him a dumbass and give up. Taking medication for mental issues is far beyond tricky, to the point that they literally have to guess which one you need and then eliminate it if it doesn't work and try the next one on the list. Yes, the actual real life treatment path is like an episode of House. If they tell you it's lupus, just run away. Bad things are about to happen.

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"Give him 12 ounces of mercury and punch him in the face. It's the only cure."

I wish I could offer some smart, helpful suggestions for fixing the mental health care system. But the truth is that if people much smarter than me with master's degrees and Ph.D.s and decades of experience can't get a handle on it, I'm pretty sure I'd crash the whole system and get genuinely sick people diagnosed as "just an asshole." But recognizing the problems is a good first step. I just hope they get it fixed soon, because it's kind of a ridiculous clusterfuck as is.

JF Sargent has a ridiculously pulpy sci-fi adventure story about space mechanics that you can read for free until he decides he wants people to have to pay him for it. And who knows when that'll happen! Also Twitter and Facebook.

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