Medicalising everyday life doesn't help anyone's mental health

When my anxiety was super bad (before therapy and medication), there were weeks when I was too anxious to go to the grocery store and started skipping dinner because there wasn't any food in the house. I hadn't seen a dentist in 8 years because my phone anxiety was too high to make an appointment - and my social anxiety was terrified that they'd be mean to me about my teeth.

I'm doing much better now, but there are still some times that my anxiety acts as a total blocker to something I have to (or sincerely want to) do.

Maintaining a "stiff upper lip" means learning to ignore unpleasant symptoms, which can both reduce their frequency and severity. There is usefulness in "manning up", to use an increasingly unpopular turn of phrase. I disagree with the increasingly common idea that suppressing one's negative emotions is generally harmful.

Agreed, and I would say that the answer to this is to have the licensed professionals guide the diagnosis. Don’t just self-diagnose or read a Wikipedia page and think you have an anxiety disorder. (It’s a good starting point and you can take your self-diagnosis to a psych{olog,iatr}ist and explain why you think you have a particular disorder.)

You hit the nail on the head with poor communication between generalists and specialists. This is why it looks like drugs are the first line of defense—because you went to the doctor first. If you had gone to a therapist first, the first line of defense would have been therapy. The doctor understands medication as a lever that they can pull, they can guide you through the process of finding a medication that alleviates your symptoms without bad side effects, and do it all safely. The doctor generally doesn’t understand the process of therapy or its outcomes because it’s not something they administer (except some psychiatrists). I would add that the side effects of modern antidepressants are surprisingly manageable.

This is reasonable to me. Like if you have complaints about your husband and talk to a divorce lawyer, you’ll get a different set of recommendations than if you go to your therapist, your best friend, some strangers online, or a priest.

Sleep problems in particular are troublesome, because so often they are caused by a complex set of factors that we have varying degrees of control over. The doctor’s ability to prescribe you medicine is one of the very limited number of ways that the doctor can help you get sleep. The other ways to help you get sleep might involve moving, modifying your house/apartment, changing your daily habits regarding exercise/eating/alcohol/screen use, therapy, accommodations at work, or a hundred other things.

I could just as easily diagnose myself with “having a crappy boss” and switch jobs, but the doctor (usually) won’t tell you to switch jobs. That treatment option comes with a hell of a lot of side effects, too.

> [1] Turns out it was the other way around: consistently not sleeping causes some pretty crappy psychological problems

That may be the case for you, but psychological problems do cause sleep problems for many people (including myself). There’s often some positive feedback loop / death spiral involved in any ongoing problem.