Cultural Factors Affecting Diagnosis

Question 1

Define ‘culture’.

Answer 1

The way of life of a group of people, sharing norms and values.

Question 2

Define ‘cross-culture’.

Answer 2

Culture varying between people from different parts of the world.

Question 3

Give an example of cross-cultures.

Answer 3

Western (USA) and Eastern (China) cultures.

Question 4

Define ‘sub-culture’.

Answer 4

Culture varying between different groups within the same region.

Question 5

Give an example of sub-cultures.

Answer 5

Different religious and socioeconomic groups.

Question 6

How does culture affect diagnosis?

Answer 6

The culture an individual belongs to affects likelihood of being diagnosed with a particular disorder and the treatment then received.

Question 7

What did Fernando (1992) say about culture and diagnosis?

Answer 7

That certain groups appear to be more prone to certain disorders - African Caribbeans being more likely to suffer from schizophrenia.

Question 8

Where did Fernando (1992) say the differences in diagnosis lie?

Answer 8

In the bias of the mental health system instead of different ethnic groups.

Question 9

What 5 key issues did Fernando (1992) identify from studies of ethnicity and mental health?

Answer 9

1) Over diagnosis of schizophrenia among West Indian and Asian British
2) Excessive used of compulsory admission for West Indian-British
3) More West Indian, African and Asian British is transferred to locked wards when hospitalised
4) Excessive admissions of ‘offender’ patients among West Indian-British
5) Overuse of electro-convulsive therapy among Afro-Caribbean and Asian British

Question 10

How do Fernando’s (1992) findings demonstrate a bias in the mental health system?

Answer 10

The fact that such high rates of mental illness are not seen in the countries of origin and such bias may include lack of recognition of differences in cultural beliefs.

Question 11

What did Casas (1995) find?

Answer 11

African Americans do not like to share their personal information with people of a different race.

Question 12

What did Sue and Sue (1992) find?

Answer 12

That African Americans don’t like to talk about their emotions and so are less likely to admit they have a problem.

Question 13

What did Banyard (1996) find that supports Fernando’s second key issue?

Answer 13

He found that 25% of patients on psychiatric wards were black, whilst they only made up 5% of the population and whilst in the hospital were more likely to be seen by a junior doctor instead of senior ones.

Question 14

What did Rack et al (1982) find?

Answer 14

That it is rare for Asian patients to present symptoms of depression due to believing that emotional problems is not something to go to the doctor for and so would more often report physiological symptoms.

Question 15

What 3 things does the DSM-IV-TR use in attempts to enhance its cultural sensitivity?

Answer 15

1) Including a discussion of cultural and ethnic factors for each disorder in the main body of the manual
2) Providing a general framework for evaluating the role of culture and ethnicity in the appendix
3) By describing culture-bound syndromes (CBS) in the appendix, such as Koro (Asian men fear their penis is retracting)

Question 16

Define ‘culture-bound syndrome’.

Answer 16

A disorder that appears confined to members of a particular culture and so does not occur elsewhere.

Question 17

Give 3 examples of CBS.

Answer 17

1) Pibloqtoq in Greenland and Alaska
- The uncontrollable urge to leave your shelter and expose yourself to arctic weather
2) Kuru in New Guinea
- Progressive psychosis and dementia among cannibals
3) Windigo in the Algonkian Indians
- Depression that leads to possession by a man-eating monster leading to cannibalism

Question 18

What is a potential problem with CBS?

Answer 18

Some people think that there are some culture-bound syndromes that the DSM ignores whereas other don’t believe that culture-bound syndromes exist at all and that different cultures use different terms for the same disorder.

Question 19

Define ‘cultural relativity’ in terms of CBS.

Answer 19

When the same disorder is described differently by different cultures and does not only occur in one place.

Question 20

What are the 2 ways cultural relativity could appear with culture-bound syndromes?

Answer 20

1) Having different terms for the same disorder
2) Having the same disorders existing in different cultures but the symptoms displayed are different due to different upbringings

Question 21

Give an example of a disorder that may be classed as ‘culturally relative’ due to use of a different term.

Answer 21

Amok in South East Asia

• When someone behaves like a wild animal and aggressive manner
• This has also been demonstrated in other parts of the world such as the Columbine school shooting

Question 22

Give an example of a disorder that may be classed as ‘culturally relative’ due to the same disorder existing in different cultures but with different symptoms according to upbringing.

Answer 22

Koro in China

• Severe anxiety that an individual’s genitals are retracting back into their body
• This may be equivalent of anorexia nervosa due to falling under body dysmorphia

Question 23

How might communication between the patient and psychiatrist affect diagnosis?

Answer 23

How patients explain their symptoms and how much they disclose to the psychiatrist.

Question 24

Give an example of research that supports this.

Answer 24

Casas (1995)
- Found that African Americans are less likely to share personal info and so may not provide sufficient detail such as psychological and physiological symptoms

Question 25

Give 3 strengths of cultural factors affecting diagnosis of mental health issues.

Answer 25

1) Much research supports
- Stereotypes w/ Banyard (1996), African Americans with Casas (1995) and Sue and Sue (1996), Clinicians social norms affecting with Cooper (1972)
2) The DSM is an objective tool and so reduces subjectivity of clinician (high reliability)
3) DSM includes culture-bound syndromes and providing framework for how to evaluate the role of culture

Question 26

Give 3 weaknesses of cultural factors affecting diagnosis of mental health issues.

Answer 26

1) DSM was developed in the USA therefore will be westernised and potentially ethnocentric to certain disorders
2) It is unclear whether CBS are actually culturally relative due to disagreement, meaning clinician may be subjective if believing one over the other (low reliability)
3) Clinicians may also be unaware of some culture-bound syndromes leading to misdiagnosis (low validity)