I have one issue with the widespread use of psychiatric drugs.

As laypeople, we readily recognise the social and cognitive basis of much of what is called mental illness. We clearly see that when our friends are overworked and in debt, they become anxious. We see people lose their job and become depressed. Anecdotally, I struggle to recall a single instance of anyone I know experiencing significant distress with no clear social or cognitive reason.

As part of the medicalisation of our thoughts and emotions, we seem to have discarded the notion that we personally can change how we feel, by changing how we think and the way we live our lives. We have no model for how to think about our emotions in the broader context of our lives without involving someone with a certificate and a nice office.

To me it seems absurd that much of the medical establishment would regard the unhappiness a recently bereaved person as a chemical imbalance or a symptom of illness, but there are no shortage of references to the use of anti-depressants to treat "bereavement related depression".

I can't speak for anything beyond my own experience, but I have been diagnosed with a catalogue of mental illnesses by a variety of highly trained professionals. It turned out that my life was just really crappy and I needed to sort myself out. I felt hopeless because I really didn't have any reason to hope. I lacked energy because I had nothing to do. I felt nervous and restless because I was living in a shitty set of circumstances. A few significant but simple changes to my lifestyle and mindset suceeded where endless "treatment" failed.

It occurs to me that it is possible that we are treating symptoms without addressing causes. We rarely treat physical pain with painkillers alone, but usually act to resolve the cause of the pain wherever possible. It seems illogical to me that someone can become depressed as a result of a specific event in their lives, be prescribed antidepressants and continue to take those drugs for many months or years, without anyone thinking to address the issue that precipitated the negative thoughts and feelings in the first place.

I suggest that those advocating SSRIs as a cureall for anxiety and depression take a closer look at the recent metastudies into their efficacy. From the largest and most recent (JAMA. 2010;303:47-53):

""The magnitude of benefit of antidepressant medication compared with placebo ... may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.""

For all but the most severe depression, SSRIs are less effective than sunbathing or jogging. Given the quite substantial risk of side effects, especially amongst the young, I can't help but be dismayed at how widespread SSRI use is.

Looking at the healthcare debate in the US, the elephant in the room is that USians consume vastly more medicine than anyone else in the world but see no real improvement in their health as a consequence. From my perspective as a cynical Brit, USians seem to have an almost mystical faith in the power of medicine and seem to have medicalised a dizzying array of things which most of the rest of the world does not consider disease. British dentistry is often the butt of jokes amongst USians and considered substandard, but in fact it is of a very high quality. The difference is that British dental standards are based on function rather than aesthetics. We tend to perceive American dentistry as being vain and neurotic, the maxillofacial equivalent of spinning rims. What we would consider artificially straight and white, many USians would consider the lower bound of normal.

USians are literally bankrupting themselves on healthcare spending, but live shorter lives than Cubans, who spend 1/25th what USians do but lead healthier lifestyles. The United States has the world's highest rate of incapacity due to mental illness and the fastest growth in the rate of mental illness, despite prescribing more psychiatric medications than anywhere else in the world. I invite the reader to draw their own conclusions.