From the jump, we learn that our speaker is having an internal conflict. It's not the kind of conflict about whether or not you should have that second helping of garlic mashed potatoes (you should—everyone knows that garlic mashed potatoes are the best). It's the kind of conflict in which you start to doubt whether your own sense of reality is, well, real. Of course, when you live in a country that constantly does things that profoundly bother you, it's a challenge to stay mentally fit.
I won't write my poem till I'm in my right mind. (7)
This is a tricky line. So, does the fact that the speaker keeps writing after this line show us that he is, in fact, in his right mind? Would someone who is not in his right mind just write something like this and then keep writing anyway? Which possibility gets your vote?
I'm sick of your insane demands. (14)
Sanity, it turns out, is a two-way street. It's not just the speaker who is struggling with his sanity. America, his country, is also insane. Perhaps, then, we get some insight into why our speaker is having his own mental challenges. In a world that has gone mad, can it be truly possible to remain above it all, and sane?
I refuse to give up my obsession. (23)
Does it help that the speaker acknowledges his own kinds of madness? It seems like we trust him more when he does admit that he's got his own mental issues. It's like he's not excepting himself from the madness that's around him, and yet he still manages to be sane enough to critique what he sees.
My psychoanalyst thinks I'm perfectly right. (34)
Well, then. By all means, carry on. Why does the speaker feel the need to add in this vote of confidence from his psychoanalyst? Is he worried that we won't believe him? Ironically, does the fact that he has a psychoanalyst cast doubt on his mental state as you see it?
I'm nearsighted and psychopathic anyway. (79)
This is an interesting admission, coming right at the end of the poem. On the one hand, it could be seen as just another joke the speaker is making. After all, nearsightedness and psychopathy are a pretty odd combination. On the other, he may be divulging to us that he is genuinely insane. The main point, we think, is that the speaker's mind is part of what sets him off from mainstream society. Once again, he reminds us that he doesn't fit in to the world that he's critiquing.