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This study aims to assess the spread of environmental literacy graduation requirements at public universities in the USA, and to highlight factors that mediate the adoption of this curriculum innovation.

The author analyzed the undergraduate general education curriculum requirements at all 549 public BA-granting higher education institutions in the USA between 2020 and 2022.

The study found that only 27 US public universities out of 540 have an environmental literacy graduation requirement, which represents 5% of universities and is substantially lower than previous estimates.

First, this study provides a more complete, more reliable and more current assessment of the graduation requirement’s presence at US tertiary institutions, and shows the number of universities that have implemented this innovation is lower than was estimated a decade ago. Second, it draws from the scholarship on the infusion of sustainability into the university curriculum to provide a comprehensive discussion of factors that mediate the pursuit and implementation of the graduation requirement. As well, it identifies factors that played a key role in one pertinent case.

Since the beginning of the 20th century environmental health researchers have known about the association between toxicant exposure and disease. However, that knoweldge has not been well integrated into mainstream medicine. Shedding light on why is the focus of this chapter.

To shed light on this issue I analyze the 2011 American Academy of Pediatrics’ clinical practice guidelines for Attention Deficit/Hyperactivity Disorder (ADHD), focusing specifically on the omission of environmental health research pertaining to ADHD symptoms and exposures, such as lead and mercury.

I found that while environmental researchers have been documenting the link between lead and ADHD for over forty years, the American Academy of Pediatrics has completely omitted this research from its 2012 clinical practice guidelines. Moreover, I argue this omission can be traced to competitive pressures to protect medical jurisdiction, and a reductionist worldview that emphasizes treatment over prevention.

This is the first attempt to analyze the way clinical practice guidelines help reinforce and perpetuate dominant medical perspectives. Moreover, to shed explanatory light, this chapter offers a synthetic explanation that combines materialist and ideological factors.

Beyond the specific case of ADHD, this chapter has implications for understanding how and why environmental health research is omitted from other materials produced by mainstream medicine, such as materials found in the medical school curriculum, continuing medical education, medical journals, and on the medical association web sites.

Since 2016, the authors have been teaching an interdisciplinary module on the global clothing industry to students enrolled in an introductory psychology course and a second year chemistry course at the University of Auckland in New Zealand. In 2016, the module also involved third year chemistry students, and in 2017, second year sociology students and graduate students in English literature from the University of Stuttgart in Germany took part. The module has the following features: (1) it focuses on a complex industry with ramifications for social and environmental sustainability, (2) it involves an issue of direct relevance to the students, (3) students teach those from another discipline as “subject experts,” and (4) students are assessed on their learning within their home course. An evaluation of the 2018 iteration with psychology and chemistry students (N = 185) showed post-test decreases in participants’ materialistic values, increases in knowledge and concern about the social and environmental impacts of the clothing industry and reported changes to clothes buying practices. The authors discuss the institutional barriers faced and provide five recommendations for other university teachers considering integrating an interdisciplinary sustainability module into existing courses.

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 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.

Throughout the late 19th and early 20th centuries, one of the many techniques used by physicians and psychiatrists to diagnose patients involved external and highly public examination. Typically conducted as a lecture to other medical experts and students, the patient was placed in the center of a round room with onlookers arranged in tiered seating to guarantee an unobstructed view. As the lead physician detailed the list of symptoms, using the patient's body as an illustration, observers witnessed the behavioral signs for themselves and discussed the possible underlying conditions or pathologies. This process of consultation and naming worked to increase the relative reliability among experts and bolster the professional reputations of medicine and psychiatry alike (Conrad & Schneider, 1992; Gillis, 2006; Grob & Horwitz, 2010). As researchers have noted (Aronowitz, 2001; Foucault, 1973), this change from focusing on disparate, idiosyncratic symptoms as expressions of individual illness to a system that recognized disease states comprised of symptom clusters marks a historical turning point in the history of medicine. The shift toward a classification scheme that linked medicine with science and technology bolstered medical authority and the power of physicians. In addition to professional credentials, accumulated knowledge, and institutional legitimacy, the authority of modern medicine both rests on and is expressed by medicine's decisive power to name and categorize through diagnosis (Jutel, 2009). Even as medical prestige has eroded, ceding some of its power to other entities,¹ physicians remain the final arbiter of official medical categories (Pescosolido, 2006), judges of what is, and what is not, a “real” diagnosis. In the diagnostic process, one looks within to reveal the nature of disease from without – empirical observation becomes immutable fact. Of course, as critical perspectives on medicine have long pointed out (Conrad & Schneider, 1992; Zola, 1972), the scientific “fact” of one time and place is the mythology or ignorance of another. Diagnosis, as both category and process (Blaxter, 1978), is infused with all manner of things social, historical, and cultural. This volume explores some of these infusions. In so doing, it aims to clarify and contribute to the emerging sociology of diagnosis – an endeavor first called for by Brown (1990), but more recently revived by Jutel (2009).