In preparation for his new study, Dr. Holstein observed several hundred commitment hearings in five widely separated jurisdictions. He then undertook a description of the interpretive practice under which the courts determined whether or not "candidate patients" should be committed against their will to institutions for the mentally ill. He has approached these hearings as a conversational analyst, examining the interaction among judges, lawyers, psychiatrists, and the patients themselves. He argues that decisions to commit are products of those conversations, that the ways in which patients are identified and responded to as concrete instances of "deviance" or "social problems" are constituted through such dialogue. (The book appends some useful transcripts of the actual hearings to illustrate its points.)

Holstein's book is also concerned with social organization and culture. He shows how legal interpretation at these hearings takes place within socially organized circumstances, and consequently is responsive to diverse contextual factors, fraught with collective representations and cultural images that serve as further interpretive resources for participants.

Court-Ordered Insanity addresses some serious questions: How do competence and incompetence emerge through the hearings? How do considerations about the patient's social status figure into the discussions? How do the actors' assumptions about mental illness shape what occurs? Thanks in part to the clarity and force of Holstein's presentation, the reader comes to recognize that much of the earlier sociological work on mental illness may have focused on the wrong issues.