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Purpose – This chapter has two central purposes. The first is to suggest that western, as well as non-western, illness categories are culture bound. The second is to elucidate the diagnostic and treatment implications associated with adopting a reductionistic diagnostic approach, including for psychiatric as well as nonpsychiatric illnesses.

Approach – A comparative approach is used to highlight the differences between American psychiatry's diagnostic system (i.e., DSM) and French child psychiatry's diagnostic system (CFTMEA). The analysis begins by identifying the overarching differences between the systems, then analyzes the differences between their respective versions of the Attention Deficit/Hyperactivity Disorder diagnostic category, and ends by tracing the diagnostic and treatment implications of those differences.

Findings – This analysis reveals that the systems differ in three significant ways: (1) theoretical orientation (biological vs. psychodynamic), (2) the view that symptoms should be counted as opposed to understood, and (3) the presence of symptom checklists versus their absence. Additionally, these differences encourage American clinicians to both administer the ADHD diagnosis to a greater number of symptomatic children and to treat these children with psychiatric medications.

Contributions to the field – The analysis makes three contributions to the field: (1) the comparative analysis highlights the limitations of the DSM's ADHD definition; (2) it strengthens the case for seeing western diagnostic categories in general, and the DSM categories in particular, as cultural artifacts; (3) it elucidates the profound relationship between diagnostic systems and both diagnostic rates and treatment practices.

Purpose – The purpose of this chapter is to theorize the relationship between diagnosis and medicalization through an examination of the medicalization of childhood gender variance and the Gender Identity Disorder of Childhood diagnosis.

Methodology/approach – The chapter examines textual data (published clinical and research literatures, and critiques of the diagnosis appearing in a range of venues) to track how childhood gender variance is medicalized over time and the role of diagnosis in that medicalization.

Findings – While diagnosis certainly plays a role in shoring up medicalization, this case study reveals the many ways in which diagnoses may also become key tools in attempts to curtail medicalization.

Research limitations/implications – As a case study, the findings are not generalizable to all diagnoses. As a study of an instance of the medicalization of deviance, these findings may be particularly applicable to analogous cases.

Social implications – These findings show the sometimes tenuous nature of medicalization processes, and the social uses of diagnoses in those processes.

Originality/value of paper – This chapter sheds light on a relationship that is often assumed to be unidirectional (e.g., that the formation of diagnosis results in increased medicalization), and answers calls for a more nuanced sociology of diagnosis, including greater attention to the relationship between diagnosis and medicalization.

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.

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

Purpose – This chapter discusses the proposed changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which eliminates Asperger's disorder (AD) and replaces it as “autism spectrum disorder.” Implications of these changes on the identity of adults with AD and the influence of everyday life experiences will be addressed.

Methodology/approach – This research is based on 19 interviews with adults diagnosed or self-diagnosed with AD. Central themes surrounding issues of identity and everyday life experiences were determined using grounded theory approaches.

Findings – This study demonstrates how the diagnosis and self-diagnosis of AD is fused with individual identity. It also shows how Asperger identity is positively embraced. The proposed changes to eliminate AD in DSM-V threaten these assertions of Asperger identity, which could potentially enhance stigma experienced by people with AD. Regardless of its removal, Asperger identity must be considered within the broader context of people's everyday lives and how experiences in social interaction and communication can be strong agents of identity construction.

Social implications – The proposed changes to eliminate AD in DSM-V is a social issue that will impact individuals with Asperger's and their families, as well as health-care professionals, health insurers, researchers, state agencies, and educational providers.

Originality/value of paper – This chapter offers a unique insight into identity construction based on the diagnosis and self-diagnosis of AD.

Purpose – To explore the ideological effects and social control potential of diagnostic biopsychiatry and encourage the sociology of diagnosis to retain key insights of early medicalization scholarship.

Methodology – As the sociology of diagnosis emerges from medicalization, it is imperative that the new sub-specialty retains the critical edge of the early scholarship. With this in mind the paper reviews key aspects of the medicalization thesis, emphasizing the links between medical definitions and social control processes (e.g. Conrad, 1992; Conrad & Schneider, 1992; Zola, 1972). Based on this review scholars are urged to be mindful of the “diagnostic imaginary” -- a way of thinking that conceals the presence of the social in diagnoses, and which closes off critical analysis of the existential-connectedness and political nature of diagnoses.

Findings – The paradigm shift from dynamic to diagnostic psychiatry in DSM-III opened the door to a new biomedical model that has enhanced American psychiatry's scientific aura and prestige. With the increased presence and ordinariness of diagnoses in everyday life, an illusory view of diagnoses as scientific entities free of cultural ties has emerged, intensifying the dangers of medical social control.

Social implications – By illustrating that diagnoses are cultural objects imbued with political meaning, the ideological effects and social control potential of diagnostic biopsychiatry may be mitigated.

The classification of psychological suffering stumbles on the challenge of quantifying the ‘un-quantifiable’ upon the systematic categorising and description of affective and mental states and their transformation into illnesses and disorders. In this chapter, the author will explore the affect of anxiety through a critical recent history of its diagnosis and treatment in the context of psychological care. By unpacking the strategies employed by mainstream psychiatry in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association since the mid-twentieth century, it is possible to unveil the dynamics of a reduction of the subject to a productive-biological body in the last decades. This chapter thinks through what happens to the equation ‘body-world’ through the critical genealogy of affect and its relation to diagnoses and treatments of anxiety and depression. It grapples with the ethics of techno-scientific global financial capitalism – heralded by pharmacological corporations and governmentality – which replicates a modern scientific view of the body, affect and suffering in a world of renewed paradigmatic demands. The author argues that by consistently pathologizing and working towards the elimination of anxiety, the hegemonic clinic erases the possibility of such ‘subjective truth’, reducing the subject to the status of ‘dividual’.

According to the Centers for Disease Control and Prevention (CDC), the number of children diagnosed with autism has increased dramatically, especially over the past decade. Most recently, the CDC estimates that an average of one in 88 children have an autism spectrum disorder (ASD). In terms of numbers, this translates into approximately 730,000 people between the ages of 0 and 21 who have ASD. While the primary cause(s) of increases in the identification of autistic students continue to generate debate school officials across the nation need to be prepared for the changing legal landscape associated with children diagnosed with ASD. The primary purpose of this chapter is to provide a detailed legal/policy update of the leading legal considerations and concerns involving K-12 students with autism. The chapter will discuss four specific legal topics involving the identification and eligibility of K-12 students with autism. These four legal topics include: Changes in the New DSM-5 Diagnostic Manuel and its Impact on Legal Definitions of Autism; Insurance Reform and Autism Coverage: A Comparison of the States; Developing Legally Compliant Individualized Education Plans (IEPs) for High-Functioning Students with Autism, and; Recent Legal Developments in Case Law Involving K-12 students who are autistic. The chapter will conclude with a detailed discussion of how today’s school officials can become more legally literate and better serve the legal needs of students with autism in their schools.

Child psychiatrist Leo Kanner (pronounced “Konner;” Feinstein, 2010, p. 19) published a ground-breaking paper in 1943 that introduced the world to the present-day concept of autism (Fombonne, 2003; Goldstein & Ozonoff, 2009; Roth, 2010). Prior to Kanner, however, several physicians described the condition of autism without identifying it as such. A textbook published in 1809, titled Observations on Madness and Melancholy, contained a description of a boy whose symptoms fit the modern definition of autism (Feinstein, 2010; Vaillant, 1962). The book's author, Dr. John Haslam, wrote about a 5-year-old male who was admitted to the Bethlem Asylum in 1799 with a medical history that included a case of measles when he was 1 year old. The boy's mother claimed that at age 2 years, her son became harder to control. She also indicated that he did not begin to walk until he was 2½ years of age and did not talk until he was 4 years old. Once hospitalized, the boy cried only briefly upon separation from his mother and was “constantly in action” (Vaillant, 1962, p. 376), suggesting that he was hyperactive. Hyperactivity is a characteristic commonly found in children with ASDs (APA, 2000; Wicks-Nelson & Israel, 2009). Although this child watched other boys at play in the hospital, he never joined them and played intently with toy soldiers by himself. The boy could not learn to read and always referred to himself in the third person (Vaillant, 1962). Grammatical errors in speech can be observed among individuals with ASDs (Roth, 2010; Wicks-Nelson & Israel, 2009).

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling theory, which highlights the conflict-based nature of diagnosis. The goal of this research is to examine the utility and benefits of diagnosis to psychiatrists' everyday work.

Methodology – Using institutional ethnography (IE), I undertook a small-scale interview-based study that documented the diagnostic processes of three psychiatrists in Calgary, Alberta, Canada. The IE-based goals of the study were to: (1) identify what texts were employed during the diagnostic process, (2) map sequences of action and text that coordinated psychiatric decision-making, and (3) theorize the utility of diagnosis for the everyday work of psychiatrists.

Findings – The analysis demonstrates how diagnosis can be understood as a valuable work process that produces a standardized diagnostic story in order to bring an individual's experiences of distress into relation with psychiatrists' daily practices, and institutional discourses more generally.

Limitations – Although IE-based research does not depend on large sample sizes for analytic accuracy, results from the current study need to be replicated because of the limited number of interview participants and to examine whether the diagnostic process is generalizable to other settings.

Social implications – This research challenges the idea that standardization through diagnosis is a negative process and highlights the value of diagnostic decision-making in the daily work of psychiatrists.