So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?

Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who have one parent or no parents and are raised by distant relatives? Is it financial poverty? Is it reliance on government assistance?

Well, I could write about any of these and make a case for all of them, but that’s not what keeps hitting me right between the eyes most days that I sit in my chair and talk to people via the Polycom screen.

The problem?

Lack of education.

One of my standard questions when taking a medical history is, “How far did you go in school?” I ask everyone this question because it is so very important in understanding someone’s frame of reference and their ability to assess a problem and deal with it realistically, be it a kidney stone or an episode of depression. I get answers to this question that are all over the map. I have seen teens who have graduated college already. I see old women who never graduated high school but raised entire families on their own. I see proud aging men who ply their trades, hard workers with calloused hands who had formal schooling up to the third grade and no further. I have seen professionals with decades of formal training and multiple degrees who are as psychotic as they can be, completely out of touch with reality due to drug use or mental illness.

Two things come to mind here of course. One is that mental illness is no respecter of educational level. I have written about this before and I will write more about it I’m sure. The other is that many people do not see the need, or are not given the opportunity, to further their education beyond the very minimal level that gets them by in the world.

This is not a prescription for growing a strong, healthy society.

Often, the answer to my question about education, “How far did you go in school?” is answered exactly like this:

“All the way.”

That person almost always means that they finished high school.

In many parts of our society, and among many sociocultural levels, finishing high school is the ultimate achievement. The peak. The holy grail. You are expected to make that level of education and then to get out, find a job, make your own living and support yourself in the world. Many of the families I see are more than happy to kick their kids out of the front door and onto the street the minute, the second they turn eighteen, never thinking twice about it.

The problem is that economic considerations, lack of parenting, lack of role models, early drug and alcohol use, the necessity of working to help support the family and other issues get in the way and take precedence over getting a good education. Kids are passed to get them out of one classroom and into another to avoid further negative behavior. They are still socially promoted, something that might eventually get them a degree but that might be worse than useless to someone who cannot read, problem solve or think critically.

When one thinks nowadays that getting a high school degree is going “all the way,” educationally speaking,  then we have a real problem. There are many other countries (Japan, China, and India immediately leaping to mind) who are producing generations of kids who are hungry to gobble up degrees from our colleges and universities and take high-level and high-paying jobs that Americans are not aspiring to at all any more. It is a sad state of affairs indeed.

It breaks my heart to see a hardworking middle aged man, my own age, in the emergency room, who has a third grade education and is embarrassed to tell me that he cannot read or write.

We have become a nation of people who value smartphones more than we value smart people.

I know that mental illness is a strange beast, hard to ferret out and even harder to diagnose and treat some times. I know that its causes and precipitants are multiple, some genetic, some economic, some cultural. I know all this. I also know, as surely as I know my own name, that if we do not pay attention to the education of our society in America, and our society globally, that we are going to slowly slide down the slippery slope of ignorance, class warfare and division that will be the end of us.

We must turn this around.

We must make it a priority, starting now, to educate our children.  We must teach them to see things as they are, think critically about problems, think creatively about solutions, invent new wonders, and leave the world a better place than they found it.

This is not a luxury for us in the twenty first century. It is a necessity.

Greg Smith is a psychiatrist who blogs at gregsmithmd.