America’s Psychiatric Assessment

The U. S. takes to the couch

Photo by Alexander Grey on Unsplash

(A reprint of an oldie but a goodie on the occasion of America’s semiquincentennial.)

PSYCHIATRIC MEDICAL EXAMINATION REPORT

Date of consultation: July 4, 2026

Patient: America, United States of

Age: 250

Consulting physician: United Nations, M.D.

Past psychiatric history:

Patient experienced traumatic birth in 1776 involving dramatic separation from mother country. Unsuccessful suicide attempt in 1861. Long history of alcohol use although America was able to maintain sobriety for the period 1920–33. Ongoing severe addiction to foreign oil.

Allergies:

Patient suffers from sensitivity to outside criticism. Particular severe allergy to all things French.

Current medications:

Daily dose of Hubris® administered ironically with several billion Chinese yuan.

Review of physical systems:

Patient reports no chest pain, no shortness of breath, no headache, and no blurred vision. In summary, America admits to absolutely no problems.

Mental examination and observations:

Patient presented with signs of depression. His infrastructure is dilapidated and sorely in need of repair and there seems to be a lack of concern regarding these matters. His financial status is desperate with an unserviceable debt load. Despite an abundance of riches, America is unable to provide for himself much of the time. He has trouble coping economically and is often verging on bankruptcy, real or imagined. Patient exhibits delusional thinking and frequently engages in conspiracy theorizing. Despite having a surfeit of weapons, he continues to amass more and obsessively fears that he does not have enough. Although his taxation levels have significantly decreased over the years, he is convinced that he is paying even more tax than before. Even though crime rates have fallen and poverty has increased, he insists on spending more on prisons and less on social programs. America shows signs of paranoia, frequently accusing others of persecuting him. He often lists various foreign enemies who he claims are attacking him. There are signs of narcissism manifesting themselves as an exaggerated opinion of self as the best in all respects and a tendency to demean and belittle the accomplishments of others. Patient experiences repeated incidents of historical amnesia. More recently, there has been a marked splitting of mental functions between his red and blue states of mind.

Assessment and diagnosis:

Having observed the patient over several sessions, it is my expert opinion that America suffers from schizophrenia. The delusional and paranoid thinking coupled with the lack of attention to personal appearance and financial well-being is typical of this condition. The irrational fear of enemies and the excessive focus on imagined problems have led to ignoring real problems such as health, welfare, and education. The patient’s irrational narcissistic belief belies a less than stellar performance based on standard lifestyle metrics. America is more and more isolating himself from others including even himself thereby further exacerbating his condition.

Recommendations and plans:

Patient be treated with both medication and psychotherapy. However, since America is averse to subsidized medicine, it may be difficult to get him to consistently take any prescribed medication. Likewise, his aversion to state-financed therapies may make psychotherapy impractical at this time. Sadly, it may be necessary to let the patient achieve acute levels of the disease at which time he can be committed and a suitable treatment plan can be imposed. Over time, it is hoped that America’s condition can be brought under control and that he can resume a normal life.

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