While I agree with the author that psychiatric meds are too heavily relied upon and prescribed without much follow up, clear diagnosis, and seemingly based upon the wills and ways of "Big Pharma" (I hate that medications of all kinds are advertised on TV like candy) I had a tough time with what seemed like heavy editorialization by someone who does acknowledge he is not a psychiatrist nor has he suffered from mental illness himself... The book was thought provoking in that it really made me think about how mental illness is such a mixed bag on which doctors and scientists still do not have a firm grasp.
For full disclosure, I am doing a fellowship in neuropsychiatry (after training in psychiatry); neuropsychiatry is the treatment of patients with severe neurological conditions and mental health problems, and is by no means limited to just medications (in fact, I am just leaving a national conference on neuropsych as I type this, and CBT/other therapies were mentioned and discussed throughout.) Obviously, such a practice requires a strong knowledge of our current ideas of neurology and biology, but it is a completely different field that a general psychopharmacologist. It isn't so much the diagnosis as the severity that encourages treatment; for example, though I agree that anger isn't a psychiatric diagnosis, intermittent explosive disorder and uncontrollable, pathological anger is present in people with brain damage or other such conditions; it is still a weak diagnosis that doesn't tell much about the cause of the condition, (and thus requires work-up) but it isn't always "normal." As a side note, quoting the number of diagnoses in the DSM as proof that psychiatry is overpathologizing is not a good argument - though I'm not a huge fan of the DSM, the diagnosis count that people use is mostly accounted for variants on themes, in particular substance abuse disorders (5-6 diagnoses per substance class) and learning disabilities. Books like this are important, and the sections about the pharmaceutical industry, American culture, and lack of institutional support for appropriate diagnosis, psychotherapy, treatment, and the lack of recovery model by many mental health and primary care providers were good; overall, however, it didn't go far enough on those topics and, as mentioned above, was somewhat flaky on other topics.
In fact the SUV story and SSRI (selective serotonin reuptake inhibitor) story have remarkable similarities: both grew into iconic products of their age, and both represent in their respective industries the most extraordinary kind of overkill, or what marketers call "overperformance," the gap, or disconnect between a product's maximal capabilities and what is needed for everyday, real-world use. Granted, I guess I already knew that, but to read the ridiculousness of it, the glaring conflict of interests between the medical world and Big Pharma, the amount of money that is pumped into doctors pockets, that is pumped into marketing...it's disgusting. The second section was also very interesting, as Barber documents new(largely unfunded because there is no money to be made, no pill to market) therapy-based treatments for both (d)epression and (D)epression, and other major mental illnesses. Barber stresses his belief that there are no easy fixes to depression (or any major mental illness), and that there probably never will be, and that it takes hard work and commitment by the individual.
But the book is filled with oodles of common-grace insights into the human condition and the culture of Big Pharma in America. Barber even has some very insightful things to say about the goodness/propriety of depression (lower case d), since this world is full of hurt and sorrow.
Comfortable Numb How Psychiatry is Medicating a Nation also tells us how Big Pharma entices doctors to buy into their products claims at places called fun houses.
The book reads poorly, but I agree with most of Barber's criticisms of the overuse of psychiatric drugs for the worried well.
Americans consume 50% of the world's medications.
The idea behind Comfortably Numb is that the use of psychiatric medications (in the US, for the most part) is much higher than it should be, in general due to the influence of Big Pharma. In one extreme example (which made me want to throw the book across the room), he talks about a few women that he worked with who seemed to be very high-functioning, and that they were all on antidepressants, and how (in his opinion) they clearly didn't need to be on them, going to show that antidepressants are too heavily used and relied upon by the general public. You simply can't tell what a person is going through after a brief conversation or engagement, or heck, even after working alongside somebody for months or years. Maybe that was a minor part of the book, but considering the author's premise is to decrease the usage of psychiatric medication, it implies that somebody has to be the gatekeeper for the usage of meds. Obviously, change will be difficult and will have to rely on a mixture of changing all of the entities at fault, but the author doesn't discuss solutions.
I can remember quite well the cultural phenomenon of the 90s in which it was almost cool to have issues (not problems, but ISSUES, as Barber mentions), to the point where people either didnt believe you or looked down at you for daring to be happy. I wasnt; a few months later I was back to normal, if there is such a thing, without any kind of professional intervention.) Barber questions whether we as a culture are obsessed with happiness and fear that any time we feel sad about something we have somehow failed at life, a fear much easier to face if we believe it to be a biological failing rather than a personal one.
The author goes into a well researched telling of the affect mind altering drugs have had on Americans. Using these people based therapies often works better than a pill and the author has evidence from his practice in the mental helth field to back up what he claims.