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Soldier, Elder, Prisoner, Ward: Psychotropics in the Era of Transinstitutionalization

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities

ISBN: 978-1-78560-403-4, eISBN: 978-1-78560-402-7

Publication date: 4 July 2016



This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.


This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.


This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Practical implications

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.


This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.



Hatch, A.R., Xavier-Brier, M., Attell, B. and Viscarra, E. (2016), "Soldier, Elder, Prisoner, Ward: Psychotropics in the Era of Transinstitutionalization", 50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities (Advances in Medical Sociology, Vol. 17), Emerald Group Publishing Limited, Bingley, pp. 291-317.



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