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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.

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 – 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.

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 – 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.

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 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association (APA), 2000), autistic spectrum disorders (ASD) are a collection of chronic conditions that include Autistic Disorder, Rett's Disorder, Childhood Disintegrative Disorder, Aspeger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified. Typically, ASD are often identified during infancy or the toddler years. Most individuals with ASD have some degree of mental retardation. According to Deisinger (2001), genetic factors, abnormalities in brain structure and biochemistry, and complications during pregnancy have been implicated as possible causes of these disorders. Generally, students with ASD have difficulties with daily activities such as language, self-care, mobility, and independent functioning. The focus of this chapter examines the many features that must be considered before diagnosing and classifying individuals with ASD.

Purpose – This chapter explores the changing definition of bipolar disorder, examining how debates within psychiatry actually construct the definition of mental illness, thereby creating the appearance of an emerging epidemic with increasing prevalence.

Method – I review the recent psychiatric and epidemiological research to reveal that the intellectual and scientific debates that occur in the psychological laboratory and in survey research are in fact falsely increasing the figures that show that an epidemic of bipolar is emerging.

Findings – For centuries, bipolar disorder was equated with severe psychosis and had a prevalence rate between 0.4% and 1.6%. As spectrum and subthreshold conceptions of bipolar disorder become established in official psychiatric diagnostic manuals, however, estimates of the prevalence of bipolar spectrum disorders have risen to almost 25%. I demonstrate that nearly all of this increase is a result of changes in the scientific and intellectual definition of bipolar disorders among psychiatric professionals, and that rates of symptoms are not in fact increasing.

Contribution to field – The arbitrariness of diagnostic thresholds naturally leads researchers to argue for lower thresholds. This allows more individuals who were previously considered psychiatrically normal to be reclassified as psychiatrically disordered. Lowering diagnostic thresholds increases the risk of confusing normal elation or sadness with disordered states, increasing the potential of false-positive diagnoses and the false impression of rising rates of disorder.

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.

The biomedical paradigm enjoys growing importance in our society. Biomedicine (e.g., Genetics) seems to occupy the position once held by religion and politics. In this context, every trivial problem of daily life is thought to require an appropriate remedy, and perfect health becomes a paramount value, especially within the upper class.

Medicalization is not only promoted by doctors. Today, other engines of medicalization are also available. These include pharmaceutical companies through marketing, advertising, and disease mongering; active consumers who seek a pharmacological solution – a magic bullet – to solve non-organic problems; technology, because highly sensitive diagnostic tools can now detect potential abnormalities even in very low quantities; and the culture of risk, which is connected to the evolution of diagnostic tools, because it is now always possible to be at risk of something.

The parts of life today considered pathological or quasi-pathological are ever increasing shyness, sadness, imperfect blood pressure, or glucose levels. Progressing editions of the Diagnostic and Statistical Manual (DSM) – the text from which diagnoses of mental illnesses are made – reveal a growing number of syndromes. These “diseases” are diagnosed on the grounds of certain symptoms and the number of weeks they last (quantification). Smartphones, with their tremendous capacity for data collection, contribute to a growth in self-diagnoses. For example, invited to log our every moment of sadness through a “trustworthy” avatar from our app (gamification), we can easily make too much of normal moments of discomfort, immediately seeing them – with a simple computation – transformed into something pathological in need of a cure.