Abnormal - discuss cultural and ethical considerations in diagnosis Flashcards
problems with diagnosis
Caetano (1973):
- labelling theory: once a diagnosis has been made, it tends to stick
the problems with labelling:
- we don’t know whether the diagnosis is reliable or valid
- negative social backlash of diagnoses
ethical issues with diagnoses
- reliability and validity issues: both are necessary for correct treatment but there are no guarantees that a diagnosis is both reliable and valid
- maltreatment of patients: incorrect treatment may cause further complications
- biases in diagnosis: biases of the practitioner or of the diagnostic system (e.g. gender bias, ethnicity bias or age bias) may prevent correct diagnoses – confirmation biases may also occur in the practitioners
- normality and abnormality: ethically wrong to diagnose a patient if the patient doesn’t require treatment, but also ethically wrong not to make a correct diagnosis if a patient needs treatment
- social stigmas: psychiatric diagnoses generally have negative social connotations
ethical issues: social stigma
- Read (2007): attitudes towards those diagnosed in a medical context tend to be characterized by fears of dangerousness and unpredictability; also that knowing someone has a diagnosis of mental illness increases reluctance to enter into romantic relationships with them
- Sato (2006): Japan’s social stigma against schizophrenia is so heavy that less than 40% of Japanese patients who had been diagnosed with it were actually informed of the results of diagnosis, and the disorder had to be renamed
ethical issues: maltreatment of patients
- iatrogenesis: phenomenon whereby treatment for a condition causes other complications
- adaptation to life in an institution may cause mental patients to develop new behaviours which are then considered symptoms of their condition
- pseudopatients in Rosenhan’s (1973) study observed that staff-patient interactions lacked care and concern, and made the patients feel dehumanized, isolated, and abandoned
e.g. someone diagnosed with depression takes time off work → finds it difficult to return → ends up fired → increases feelings of isolation and worthlessness
ethical issues: biases in diagnosis
confirmation bias: Caetano (1973) noted that any suggestion that the subject is or has been mentally ill will be a powerful influence on diagnosis
ethnic bias:
- Morgan et al. (2006) found that Afro-Caribbeans and black Africans were 6-9 times more likely to be diagnosed with schizophrenia in UK than white British people – Morgan et al. believe that genetic differences cannot account for this disparity
- Read et al. (2004): ethnic minorities in Western countries are overrepresented in mental institutions
gender bias: Rosser (1992) argued that many psychiatrists are males whose perspective is situated within normative gender roles, and therefore prone to overdiagnosis
e.g. if an unhappy housewife and mother complains of stress and boredom, a male psychiatrist could diagnose
her with depression
cultural issues with diagnosis
Ballanger et al. (2001) notes that variations in diagnosis across cultures don’t necessarily reflect social or medical reality, because:
- stigmatization: different cultural groups have different attitudes to psychological disorders, influencing reporting
of symptoms and diagnosis (e.g. Sato, 2006: schizophrenia in Japan)
- cultural variability: certain diagnostic features such as methods of clinical assessment, classification, etc may not be suitable for all cultures (e.g. clinician doesn’t notice certain symptoms because they’re not familiar with the expression of distress in a particular culture)
- culture-bound syndromes: may be difficult for clinicians from other cultures to diagnose, preventing accurate diagnosis and treatment
cultural considerations: should diagnosis take an etic or emic approach?
- etic approach is based on the belief that disorders are
manifestations of universal underlying processes - emic approach is based on the belief that culture shapes symptoms and how people experience distress, along with their beliefs about the causes and consequences of their problems
- most clinicians take an etic approach (i.e. using universal classification systems)
Kirmayer (2001) on the etic approach: while DSM includes suggestions for a cultural interpretation of disorders, it still primarily represents Western concepts and may not be easily applied to other cultures
cultural considerations: misdiagnosis due to the etic approach
Zhang et al. (1998):
- people from traditional cultures may be unable to distinguish between emotional and physical symptoms
- the Chinese have lower rates of depression – this is because they either deny it, or express it somatically, which is difficult to diagnose with universal diagnostic systems
- neurasthenia is a common disorder in China that includes somatic, cognitive and emotional symptoms in addition to depressive symptoms
- could be Chinese culture’s version of depression, just explained in the context of Chinese culture – which explains disease as an imbalance in one’s Qi (life/energy flow)
- this alternative form of depression could have manifested due to the stigmatization of the Western idea of depression in Chinese society
main study: Kleinman (1982)
Kleinman (1982)
- interviewed 100 Chinese patients diagnosed with neurasthenia, using structured interviews based on DSM’s methodology
- found that 87% of the patients could be diagnosed with depression, but 90% complained primarily of somatic symptoms, contradicting DSM’s outline of a mentally depressed state as the main symptom
- neurasthenia could be a culturally-specific form of depression in somatic ways (as the majority of the patients in the study only mentioned physical symptoms)
- would be difficult to compare the data to Western data
because Chinese and Western patients made different complaints - highlights a concern of etic approach: somatization could be the Chinese cultural expression of distress while psychologization could be the Western expression
