Lifestyle drugs

I congratulate Joel Lexchin on his well-informed and thoughtful analysis of issues relating to lifestyle drugs.1 Producing a medical definition for “problems for living” and establishing boundaries for treatment represent major challenges. Many conditions uncomfortably straddle the medical–biological and environmental–social domains. Contemporary North American psychiatry, armed with a powerful tool in its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),2 presents a number of examples.

Under the banner of attention-deficit/hyperactivity disorder, the medical community has shown an ever- increasing tendency to use medications to “normalize” children whose behavioural and learning difficulties may, in an unknown proportion of cases, have as much to do with prevailing expectations and the resources available to today's families and schools as to neurobiology.3 Similarly, we increasingly use selective serotonin reuptake inhibitors to treat adults whose minor depressions and dysphoric moods may be as attributable to the subtle yet relentless pressures that are part of life in contemporary industrialized societies as to biological dysfunction.

Physicians who unquestioningly adhere to models of biological causation and medical treatment may be complicit in suppressing the need to question the effects of social and economic structures and values on people and may unwittingly obstruct needed social change.4