It’s not just the money. To say that there is less use for a 62-year-old white male (unless you happen to be running for president) these days is not to devalue the social transformations that are rapidly occurring in the age of Trump. You can hail necessary social change and complain about being, to some degree, a casualty of it, both at the same time.

In this way, I view myself — and imagine others — caught in a double bind. My depression springs from my biology, my biography, my choices. But it occurs within a far broader context that could bring just about anyone down, and apparently does. The fact is that the country is not red and blue. It is almost entirely blue.

The real national division, as I see it, is between people who have the resources, inner and outer, to survive their mental illness and those who don’t.

Affording a therapist and finding the right therapist — it is rare: wisdom, empathy and kindness cannot be taught — they are the first obstacles to overcome. Then you might have to find the right and affordable psychiatrist, who will help you make an informed decision about whether to take psychiatric drugs that will or will not help, perhaps even saving your life.

Even more people never receive an actual psychiatric diagnosis. A 2014 study found that 80 percent of all prescriptions for antidepressants were being issued by primary care physicians who had no psychological, psychiatric or psychopharmacological training at all.

Yet even as our mental health crisis proliferates, even as streams of books and articles are published about depression and anxiety, the subject of mental illness has become another voyeuristic exhibition in the carnival of commerce. We talk about it, but we don’t talk about how to address it.

In 1977, Jimmy Carter established the President’s Commission on Mental Health, which led to the Mental Health Systems Act of 1980. Much of that legislation was repealed by Ronald Reagan, but it led to many good policy ideas, including a new emphasis on treatment for African-Americans and women, and for people with a nonbinary sexual identity or a disability. There was also a new focus on organized psychiatric care for children and adolescents, older Americans, those living in rural areas and victims of rape.

Many of these ideas, however, never took hold in practice. And mental health has not been addressed at a sweeping national level since then. Our pandemic of mental illness simply does not come up in the presidential debates.

We need a national leader who will, as President Carter tried to do, address the urgent issue of mental illness, not with piecemeal legislation but with a national crusade. We need a leader who will elevate this crisis to the same level of national urgency as gun control and climate change.

I know what I rationally expect in a president: reason, character, dignity. But I will not feel hopeful about anyone who does not respond to my turbulent unconscious, to my brute, irrational need to be the object of empathetic concern as an individual and to be affirmed as a person.

There are positive and negative means of appealing to that almost biological desire to be protected and empowered. Sadly, Mr. Trump has known how to make that appeal better than anyone on the national stage so far. He addresses himself to the meanest, basest sources of emotion, and this has the effect of making everyone who is indifferent to his appeal feel imperiled and unnerved.

A positive alternative had better come along soon. In the absence of a national resolve to address surging mental illness in America, our politics and its social consequences will continue to toss on waves of depression, anxiety and despair, themselves both a cause and an effect of our collapsing public realm.

As for me, I will keep thinking octavely and grasping my pitons; I will do whatever I can to go on living and to flourish, my loving wife by my side, my rare and precious children ever in my mind.

Lee Siegel is the author, most recently, of “The Draw: A Memoir.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.

This content was originally published here.


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