Aggression in the absence of any disorder could just be that – aggression – or in other words, bad or criminal behaviour. Why are we so keen to medicalise bad behaviour or any other behaviour that is not within the ‘defined’ or accepted norms?

I think it is good thing that ICD has not yet included diagnoses such as ‘intermittent explosive disorder’. Although we have come a long way from the time when modern medicine was accused of being a major threat to the world's health, ^{Reference Illich2} have we now gone too far in the opposite direction?

The problem of medicalisation is that it does not stop at that: it is only the beginning of a chaos that runs out of control. Once you make a diagnosis, you then have to treat the disorder. Often, behavioural problems are treated with medications that are not licensed for such indications, which in itself is bad practice in many cases. All treatments have their side-effects and many people are unnecessarily exposed to them. False hope is given to ‘patients’, their families and society. A culture is promoted in which people want medical solutions to all their problems, rather than taking responsibility for their actions. The cost of treatment adds up to a huge amount.

Also, costly research, including randomised controlled trials and meta-analysis, has to be carried out to establish the efficacy of these treatments. Often it reveals little or no evidence of efficacy. One simple reason could be that, for a treatment to be effective, there needs to be a real target illness.

In their meta-analysis, Jones et al conclude that the use of mood stabilisers resulted in an overall reduction in aggression. ^{Reference Jones, Arlidge, Gillham, Reagu, van den Bree and Taylor3} However, given the high level of heterogeneity between studies and the risk of publication bias in half of them, the results suggest that there is actually not enough evidence to support this statement.

In the end, the authors recommend further randomised controlled trials. I would like to ask whether there is enough evidence to justify the cost of such trials, in terms of money and of the time and efforts of highly qualified professionals. What about schizophrenia and depression, which remain the leading causes of morbidity across the world, yet for which there are still relatively limited treatment options?