The Catch-22 of Mental Health Services

Photo by Ian Espinoza

Note: I make generous and unabashed use of the word “crazy” in this essay, in part because it describes so well what my brain feels like on the really bad days. Also, I have extensive and complicated thoughts about how we decide which words should and shouldn’t be used to talk about mental health which I won’t go into here.

Today, I unlocked a major adulting accomplishment. After at least three years of anxiously procrastinating and saying that I’m going to do it, really really really this time, I made an appointment with a psychiatrist. In 2018 and 2019, I had a therapist, but I haven’t been with anyone who could really monitor my antidepressants and change them for at least 10 years. I don’t just want to deal with my ever-present depression; I’ve become more and more certain that my wandering, unfocused brain is at least in part because of ADHD. I want to make that official and see what can be done about it.

Today was the second day I spent on the phone, winding my way through various levels of bureaucracy. I gave them my name, phone number, address, birthdate, and MediCal number multiple times. It didn’t help that the psychiatry network’s files seem to also have a “James Hall” with my same birthdate.

I’m tired and strangely satisfied, and the one thing that keeps going through my brain like an infectious earworm is a passage from Joseph Heller’s novel Catch-22. It might be the most famous passage in the book, because it’s the first place where the eponymous catch is described and defined.

“Sure there’s a catch,” Doc Daneeka replied. “Catch-22. Anyone who wants to get out of combat duty isn’t really crazy.”

There was only one catch and that was Catch-22, which specified that a concern for one’s own safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn’t, but if he was sane he had to fly them. If he flew them he was crazy and didn’t have to; but if he didn’t want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle.

“That’s some catch, that Catch-22,” he observed.

“It’s the best there is,” Doc Daneeka agreed.

Catch-22, by Joseph Heller (Chapter 5, pp 45-46)
From the 1970 movie Catch-22 with Alan Arkin

America’s health system sees Catch-22 as something to aspire to, not a farcical satire. I was finally able to make my way through the bureaucracy because for the last few days, my brain has been relatively clear. It hasn’t been gnawing on itself like a rabid ouroboros — or at least not as much as usual. For a small space in my life, I wasn’t in immediate need of psychological help, and so I could get it. On the days that I’m wracked with suicidal ideation, anxiety, and self-loathing, I am utterly incapable of doing so much as making the call, never mind dealing with all the questions and getting my identification together.

That’s some catch, that Catch-22.

People die because of our health care system’s network of Catch-22s. At first glance, it’s a batshit insane system, allegedly set up to help those of us who are three inches from going insane ourselves. But the horrible truth is that it’s a perfectly sane system if you don’t want people to actually access those services, which is closer to the truth. Capitalism is only part of the problem; maybe even more relevant is that American mythology hates people who are sick, weak, or mentally ill. Asking for help is seen as taking from your neighbors and your community. So everything we have is designed to give enough not to look heartless, but not enough to help the people who are worst off.

I’m feeling kind of proud of myself today: I took a positive step towards surviving a time when surviving is really questionable for a lot of us. But I’m feeling white-hot anger, too, because so many people will never have that little oasis open up long enough for them to navigate the system.

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The Catch-22 of Mental Health Services
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