The Diagnosis

He asked for help. That was the hard part. Everything after that was supposed to be the system working.

He called his insurance. They gave him a list of providers. He called fourteen. Three were no longer in network. Four weren’t accepting new patients. Two had moved. One had retired. The remaining four had waitlists. The shortest was eleven weeks.

Eleven weeks. He’d spent two years deciding to make the call. The system’s answer was: wait eleven more weeks.

He waited. The appointment was fifteen minutes. The psychiatrist was kind, efficient, and managing a caseload of four hundred patients. The diagnosis took eight of those minutes. The prescription took four. The remaining three were paperwork. Follow-up in six weeks.

The prescription helped. Not the way he’d hoped — not like a fix, more like a floor. The thing that kept him from going lower. The follow-up was a ten-minute check-in. How’s the medication. Any side effects. Okay. See you in three months.

He wanted to talk. Not about the medication. About the thing underneath it. The psychiatrist doesn’t do that. For that, he needs a therapist. The therapist has a waitlist too. Eight weeks. Insurance covers twelve sessions per year. The therapist recommends weekly. He can afford every other week if he skips the sessions insurance doesn’t cover, which is most of them after March.

The system isn’t designed to help him get better. It’s designed to help him get stable. Stable enough to work. Stable enough to function. Stable enough to not become a crisis, because crises are expensive. The fifteen-minute appointment isn’t treatment. It’s maintenance. The institution needs him operational. It doesn’t need him well.

He’s operational. He’s not well. But he’s not on the waitlist anymore. That’s what the system counts.