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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.

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.

Purpose – The DSM-III reflected American psychiatry's shift from a dynamic approach to a descriptive diagnostic approach. This chapter seeks to elucidate the implications of this shift for the diagnosis and treatment of mental illness.

Methodology/approach – To shed light on this issue I analyze the diagnosis and treatment implications of this shift for Attention Deficit Disorder (ADD).

Findings – The transition to the diagnostic approach has had three consequences for the handling of ADD, and later Attention Deficit/Hyperactivity Disorder (ADHD): first, it increased the number of children diagnosed with the disorder; second, it encouraged clinicians to treat the disorder with psychostimulants; and third, it expanded the pool of clinicians who could prescribe stimulants.

Contribution to the field – Beyond illuminating the specific cases of ADD and ADHD, this analysis contributes to the medicalization literature by demonstrating that there is more to be studied than merely the expansion or contraction of diagnostic categories. Researchers also have to analyze the implicit assumptions within the diagnostic definitions, which have implications for the prevalence and treatment of illness.

Chapter X of The Social System is often cited as the “charter” for the specialty field of medical sociology. A notable feature of its analysis is the argument that the physician is an agent of social control in relation to the patient. This argument grounds the application to medical practice of Parsons’ general conception that social control is an aspect of all social relationships. Parsons started by addressing the situation of a patient who assumes the sick role and then becomes the patient of a physician. The sick role involves a suspension of at least some of the performance expectations associated with a person's everyday social life, such as expectations of working productively at one's job, attending the meeting of a civic association, or caring for one's family members. But in assuming the sick role, an individual encounters new expectations that he or she should try to get well. For minor illnesses this may involve only resting, drinking fluids, and avoiding stress. For more serious illnesses, given our culture's valuation of scientific medicine, it typically involves placing oneself in the care of a physician. It then becomes the physician's duty to offer treatment and guidance to restore one's health and enable one to return to meet expectations of everyday roles. Thus the physician becomes an agent of social control.

Purpose – Over the last years, in the United States there has been significant increase in the consumption of pharmaceuticals for the treatment of mental disorders. More specifically, the number of clinical diagnosis of bipolar disorders in young people has increased by 40 times over the last 10 years. The purpose of this chapter is to analyse the growth of bipolar disorder diagnosis using a sociological frame.

Methodology/approach – The methodology is based on the concepts proposed by the ‘conflictualist’ perspective of medical sociology. Medicalization, that is, the extension of medical categories in everyday life, is the main concept on which the chapter is constructed. The ‘syndromization’ of the Diagnostic and Statistical Manual of Mental Disorders lowers the threshold above which someone may be diagnosed with bipolarism. Moreover, advertisements push people to seek for pharmaceutical treatment for conditions of ‘normal’ sadness.

Findings – This work shows the importance of the analysis of ‘medical’ phenomena by approaches taken from social sciences. Bipolar disorder can be a terrible and painful disease, but it seems that there is the possibility that it is over-diagnosed.

Contribution to the field – In this epidemics of diagnosis of bipolar disorder it is central to integrate the medical perspective with other dimensions: the classification of mental disease, the advertisement for drugs and the cultural aspects of a given society.

This chapter looks at the discourse in advertising for psychotropic drugs (N=200) in Scandinavian medical journals in 2005. The discourse in the ads displaying users (n=89) conveys a gendered image of mental health. The ads promote these drugs as life-enhancement drugs – for handling the lifestyle of a postmodern self – but draw on gendered scripts for promotion of a “healthy” self. This finding suggests that although the neurobiological paradigm prevails, the pictures of users in psycho-pharmaceutical advertising continues to depend on culturally fixed gendered scripts.

This chapter is a comprehensive discussion of autism spectrum disorder (ASD) across the globe (e.g., United States, China, Brazil, Japan and Turkey). Topics that are discussed include the following: diagnostic criteria and approaches; international perspectives of ASD; western and eastern assessment practices; cultural considerations of assessment of ASD; educational and medical interventions; behavioral and emotional interventions; complementary and alternative medical interventions; variations in educational services among countries; early intervention practices; adult services; national and international resources; and current needs and future directions.

In addressing positive general education teaching practices for use with students with or at risk for emotional and behavioral disorders (EBD), the chapter emphasizes teacher behavior change research that has been informed by applied behavior analytic (ABA) principles. Its central theme is that general education teachers can access research informed by ABA in developing prosocial instructional and management practices. Highlighted teaching practices include fostering correct academic responses from students, increasing active student response, and using contingent praise with regularity. The chapter also discusses functional behavioral assessment, positive behavioral interventions and supports, and controversial behavior change issues surrounding seclusion and restraints and medication, topics related to teaching students with or at risk for EBD in general education settings.