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This study investigated disparities in dual diagnosis (comorbid substance use and depressive/anxiety disorders) among US adults by nativity and racial–ethnic origin and socioeconomic, cultural, and psychosocial factors that may account for the observed disparities.

The study drew on data from two waves of the National Epidemiological Survey on Alcohol and Related Conditions. Racial–ethnic categories included African, Asian/Pacific Islander, European, Mexican, Puerto Rican, and other Hispanic/Latino. Substance use and depressive/anxiety disorders were assessed per DSM-IV. A four-category measure of comorbidity was constructed: no substance use or psychiatric disorder; substance use disorder only; depressive/anxiety disorder only; and dual diagnosis. The data were analyzed using multinomial logistic regression.

The prevalence of dual diagnosis was low but varied by nativity, with the highest rates among Europeans and Puerto Ricans born in US states, and the lowest among Mexicans and Asians/Pacific Islanders. The nativity and racial–ethnic effects on likelihood of having dual diagnosis remained significant after all adjustments.

The limitations included measures of immigrant status, race–ethnicity, and stress and potential misdiagnosis of mental disorder among ethnic minorities.

This new knowledge will help to guide public health and health care interventions addressing immigrant mental and behavioral health gaps.

This study addressed the research gap in regard to the prevalence and correlates of dual diagnosis among immigrants and racial–ethnic minorities. The study used the most current and comprehensive data addressing psychiatric conditions among US adults and examined factors rarely captured in epidemiologic surveys (e.g., acculturation).

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 – This chapter critically examines efforts to destigmatize addiction through the creation of a diagnostic category and medicalization. It further critiques “realist” accounts of neuro-scientific knowledge, proposing instead a “biocultural” framework that enables a more multifaceted understanding of drug problems that leads back to questions of biopolitics.

Methodology/approach – After showing that medicalization is not always associated with destigmatization, this chapter reviews evidence suggesting that the social class of drug users is central to questions of stigma. A literature review concerning social constructionist approaches to bodies is then offered, culminating in an exploration of “biocultural” frames and their implications for psychiatric knowledge.

Findings – The material world can only be grasped through a cultural frame, an understanding that challenges “realist” accounts of knowledge. While making reference to brain functioning, psychiatric “disorders” in fact identify violations of interpersonal or psychic norms. These violations cannot be linked in a linear way to patterns of brain activity, even at a theoretical level.

Social implications – This chapter points toward a way of analyzing psychiatric disorders that allows for and highlights their political effects. Without ruling out medical interventions, it suggests that clinical and social understandings are an essential component of psychiatric understanding.

Originality/value of chapter – While “biocultural” approaches have been proposed by other social theorists, this chapter applies the frame in new ways to the psychiatric endeavor. In the face of increasing medicalization within the field of psychiatry, this chapter makes a strong theoretical case concerning the value of clinical and social knowledge concerning psychiatric disorders.

There is significant research describing how the development of neuroscience has affected the definition and treatment of neurological and psychiatric disorders, as well as brought about changes in research and care practices. Little is still known, however, about the ways in which these changes come about and on how they affect individuals’ – in particular, patients’ – experiences. In this chapter, I describe the changes imposed by neuroscientific practices not only on patients’ experience of their neurological or psychiatric disorder, but also on how they define themselves. In so doing, I draw on ethnographic research conducted among a neuroscientific team of a French hospital which has coordinated a research trial for the application of an experimental neurosurgical treatment – deep brain stimulation (DBS) – to patients suffering from obsessive compulsive disorder who are resistant to conventional treatments. This technology has been used since 1986 for treating various neurological and psychiatric disorders. My objective is to describe how the models of pathology conveyed by DBS and the experiences of patients suffering from a neurological or psychiatric disorder interact to constitute a form of personhood. I argue that, in certain situations, some of the patients attribute more significance to cerebrally orientated – or naturalistic – explanatory models and give a new value to their subjective experience: they ‘cerebralize’ and find inside the brain and its (dys)functions – or through an intervention on it – the source or the solution of a plurality of personal situations.

Purpose – To examine the influence of changing diagnostic tools and the pharmaceutical and health insurance industries' practices on perceptions of depression prevalence in the late 20th and early 21st centuries.

Approach – This is a general review of the sociohistorical shifts in depression diagnosis and pharmaceutical and health insurance industry practices during this time period as they impact professional and lay perceptions of changes in depression prevalence.

Findings – Shifts in the definition of depression to an increasingly medically oriented, social context-free definition along with the interaction of the pharmaceutical industry, health care, and health insurance industries in the U.S. system of mental health care have become major organizers of professional and lay perceptions of the nature of depression, its treatment, and prevalence. These sociohistorical and economic influences need to be factored into debates on depression prevalence.

Contribution of paper to the field – This chapter provides an introductory-level synthesis of basic psychiatric epidemiology concepts and social science critiques of professional and lay perceptions of depression prevalence as “epidemic.”

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

Post-traumatic stress disorder (PTSD) affects both civilian and military populations following wartime experiences. However, despite an abundance of research investigating civilian and military populations separately, much less focus has been given to synthesizing and integrating findings to describe how civilian and military war survivors are comparatively affected by PTSD. This review is broken down into three sections covering (1) risk factors associated with PTSD, (2) relationships between PTSD and mental health outcomes, and (3) protective factors that can attenuate PTSD and its effects. Each section covers findings for civilians and military personnel and highlights similarities and differences between groups.

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.