Agents of social control

The courts and the police, as officially designated agents of social control, had to operate in terms of a socially sanctioned role. They could not opt out of this role they had to take some action. Their action was also limited to rule enforcement, rather than the creation of new rules. The fact that these limits were often exceeded, is attributable not to their absence, but to the perceived innovatory aspects of the behaviour itself, sensitization, symbolization and the whole belief system. Rationalizations such as new situations need new remedies accoimt for those elements exclusively directed at the particular deviance being controlled. 

The aim of this section is to describe some common elements of the control culture that developed around the Mods and Rockers. In response to what pressures did it operate How was it affected by previous stages in the sequence How did the established agents of control adapt to the deviance and what new forms of control were developed These questions will be answered by distinguishing firstly three common elements in the control culture diffusion, escalation and innovation. Then the reaction of three main types of social control will be described in detail (i) the police (ii) the courts and (iii) informal action at the local level, particularly in the form of action groups directed at forming an exclusive control culture. 

The so-called reversible MAOis, moclobemide and brofaromine, appear to obviate these problematic interactions, though the latter was never approved and the former is not available in the United States. Controlled studies of these agents in the treatment of social anxiety disorder have produced mixed results. 

Fluoxetine has been the subject of four reports in the treatment of social phobia. However, no double-blind, control studies have been reported. Preliminary results suggest that fluoxetine is effective in social phobia. Doses ranged from 10 to 100 mg/day. The onset of symptom resolution was variable among subjects. A justifiable approach to treatment with fluoxetine would be to implement an approach similar to that in the treatment of depression. One would start with a dose of 10-20 mg/day and titrate slowly upward over a period of several weeks. A duration of at least 6 weeks would be recommended as a minimum trial of this agent, with 12 weeks perhaps affording a better opportunity to assess the full measure of improvement. 

The results of these two open trials suggest that buspirone may at best have modest efficacy in the treatment of social phobia. These studies were limited by the open-label format and duration, given the findings of studies of other agents. Further studies are warranted to investigate the use of this agent in a controlled, blinded fashion. However, given the modest results and... 

The prior study by Davidson et al. was followed by a placebo-controlled study of clonazepam in 75 patients [Davidson et al. 1993]. Prior studies had been strongly supportive of the efficacy of the agent in social phobia but had... 

A larger set of placebo-controlled studies show conclusively that imipramine is also effective for the treatment of panic disorders. Other agents shown to be effective in panic disorders include the SSRIs paroxetine, sertraline, fluvoxamine, fluoxetine and citalopram. Generally, initial treatment of moderate to severe panic disorders may require the initiation of a short course of benzodiazepines e.g. clonazepam (0.5 1 mg twice daily), and an SSRI. The patient will obtain immediate relief from panic attacks with the benzodiazepine whereas the SSRI may take 1 6 weeks to become effective. Once a patient is relieved of initial panic attacks, clonazepam should be tapered and discontinued over several weeks and SSRI therapy continued thereafter. There are no pharmacological treatments available for specific phobias, however controlled trials have shown efficacy for several agents, e.g. phenelzine, moclobemide. clonazepam, alprazolam, fluvoxamine. sertraline and paroxetine in the treatment of social phobia (Roy-Byrne and Cowlev, 2002). 

It would, however, be an incomplete analysis of the control culture to look only at the official control agents. Social control is... 

Sertraline. Sertraline, the second SSRI to receive FDA approval for depression, has also been suggested as a treatment for social phobia. Katzelnick et al. (1994) carried out a double-blind, placebo-controlled, crossover study comparing sertraline and placebo. Twelve subjects were randomized to either sertraline or placebo for 12 weeks. The agent was then tapered and the subjects received no treatment for 2 weeks. They were then switched to the other treatment arm for an additional 12 weeks. Using the Liebowitz Social Anxiety Scale, analysis revealed statistically significant improvement with sertraline treatment but not with placebo. Forty-two percent of patients were rated as moderately or markedly improved while receiving the sertraline ther-... 

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