Gender and Culture bias of diagnosis Flashcards
what are the key terms of culture bias?
Ethnocentrism: The view that our own culture should be the basis for judgments of other groups. The views, beliefs and cultures of our own group are ‘normal’ or superior and those of other groups are ‘strange.’
Emic approach: This is where one culture is studied in order to discover culture specific behaviour and they will only generalise their findings to the culture they have been studying.
Etic approach: This type of approach seeks to develop universal, ‘nomothetic’ theories about human nature and behaviour that span all cultures.
Cultural relativism: Cultural relativism is the principle of regarding the beliefs, values and practices of a culture from the viewpoint of that culture itself.
what are they key terms of gender bias?
Universality: Related to both culture and gender. This refers to when research assumes the findings can be applied to both genders equally, or to all cultures equally.
Gender Bias: This is when a bias is made towards one gender. Behaviour is then applied to the other gender. This is mainly caused by using a sample of just one gender in research, and then applying all the findings to all people.
Androcentrism: This refers to theories which are centred on males or focused on males only.
Alpha bias: Alpha bias occurs when the differences between men and women are exaggerated.
Beta bias: Beta bias occurs when the differences between men and women are minimised.
how can culture affect diagnosis?
Culture can affect the diagnosis (reliability and validity) of schizophrenia in many ways.
Some suggest that the American DSM and other manuals are culturally biased and do not take into account diverse cultural values and its impact on diagnosing schizophrenia.
For example:
- In native American cultures seeing visions is a sign of communicating with their ancestors
- In Asian cultures there is a stigma attached to being diagnosed with mental illnesses like SCH
- Clinicians may (unconsciously) diagnose those from particular cultures or nationalities based on their personal prejudices- esp if the clinicians are white
How can cultural interpretations of schizophrenia symptoms affect diagnosis of the disorder?
Some research shows that religious and cultural groups can have a marked effect on perceptions of schizophrenia, and what can be seen as ‘insane’ in one culture may be highly desirable (yet may be still seen as abnormal) in another. This can complicate a valid diagnosis of schizophrenia.
How can negative cultural attitudes to schizophrenia?
Psychological distress and mental health issues attract different levels of stigma in different cultures that will clearly affect the diagnosis of schizophrenia. This implies that without being diagnosed people with schizophrenia will continue to suffer needlessly and unable to access effective therapy.
How can the culture / nationality of the clinician effects the diagnosis of schizophrenia?
The actual nationality / culture of the clinician can create reliability and validity issues when diagnosing schizophrenia. For many reasons some nationalities diagnose schizophrenia in very different ways. Although the US and the UK are very similar in many respects, the US seems far more likely to diagnose schizophrenia.
How can race discrimination is evident in diagnosing schizophrenia?
Research has implied that some nationalities or countries have considerably more (or less) cases of schizophrenia than others. It is suggested that mental health professionals perceive diverse ethnic and cultural groups very differently, and hence discriminate. This implies to avoid misdiagnosis clinicians should be mindful of subtle prejudices.
There is a tendency to over-diagnose members of other cultures as suffering from schizophrenia.
African Americans and English people of Afro-Caribbean origin are several times more likely than white people to be diagnosed with SZ.
Cochrane (1977) reported that the incidence of SZ in the West Indies and Britain to be similar at around 1%. However, Afro-Caribbean men are several times more likely to be diagnosed with SZ when living in Britain.
This suggests that the validity of the diagnosis is poor because either it is confounded by cultural beliefs & behaviours in patients, or by a racist distrust of black patients on the part of mental health practitioners.
What are the positive evaluations of cultural bias of diagnosis?
- However there are important practical applications that have come from research into cultural biases of the diagnosis of schizophrenia.
Finding cultural biases allows for training for psychologists into the differences in interpretation of symptoms in cultures. This can improve diagnosis because by being aware of the biases, they can consciously try to avoid them and be more objective in their diagnosis process.
This implies that researching cultural biases has highlighted the problems and can lead to a reduction in these biases and lead to more valid diagnosis for people from different cultural background. - Another positive of understanding cultural differences allows us to come up with a ‘symptom pool’ (certain symptoms for each culture).
For example they may choose to describe only physical symptoms, only emotional symptoms, or both.
This can be very beneficial for the validity of diagnosis of schizophrenia as it helps understand differences in symptoms in different cultures & means that cultural norms can be taken into consideration when a diagnosis is made.
What are the negative evaluations of cultural bias of diagnosis?
- There is research evidence into cultural differences in interpreting behaviour which could impact accurate diagnosis
Malgady’s research demonstrated that in traditional Costrican culture, hearing voices is interpreted as spirits talking to the individual, whereas in the USA this is interpreted as a core symptoms of SZ.
This research implies clinicians have to be mindful of the cultures and beliefs people come from in order to ensure they are not imposing their own cultural bias when diagnosing people. - There has been further research evidence to support the claim that the culture or nationality of the psychologist or clinician can have an affect the rate of diagnosis.
Copeland found that US psychiatrists diagnosed patients with SCH 69 % of the time compared to 2% in British psychiatrists, when given the same description of symptoms.
This study shows that the background of the clinician and their own cultural biases can impact diagnosis and can lead to patients either getting the wrong treatment or no treatment at all.
How can gender bias affect diagnosis?
The gender of the patient (and clinician) can impact on whether or not they receive a diagnosis.
For example:
- Gender differences in SCH prevalence and recovery from SCH is not really considered. If they are grouped together without differences being recognised (Beta Bias)
- Research studies into female patients of SCH is limited
- Women are less likely to be diagnosed with SCH even though they may show similar symptoms to males but the onset and symptoms may present differently
How can unreported facts when diagnosing schizophrenia affect diagnosis? - gender bias
Men suffer more severe negative symptoms than women as well as suffering more from substance related disorders.
Men are more likely to be involuntarily committed to psychiatric wards than women. (Goldstein 1993)
For example Cotton’s (2009) research implies women recover more and suffer less relapse than their male counterparts.
How can biased research affect diagnosis? - gender bias
Some psychologists claim research into schizophrenia has neglected to use many female patients, questioning its usefulness and representativeness.
For example Nasser (2002) found that early research on SZ was conducted on men only.
How can underdiagnosing of female patients affect diagnosis? - gender bias
Some research has suggested that women actually go under-diagnosed in comparison to men.
This could have far reaching consequences as it implies many women could be denied access to treatment and have to continue suffering from deliberating symptoms of schizophrenia.
What is further understanding on how gender bias can affect diagnosis?
There is a tendency for diagnostic criteria to be applied differently to males and females.
Clinicians ignore that there are different predisposing/risk factors between males and females, which give them different vulnerability levels at different points in life. This can possibly explain the gender difference in the onset of schizophrenia.
If women are under-diagnosed then this suggests that the validity of the diagnosis of schizophrenia is poor, because the procedures for diagnosis work well only on patients of one gender.
What are the positive evaluations of gender bias of diagnosis?
- However research studies into gender biases does have good practical applications as it reduces the possibility of diagnoses being made according to gender.
Research can be used to help train psychologists to not misdiagnose females who have SZ symptoms with other disorders associated with females. This should result in more women receiving the correct diagnosis of SZ. It also means that male patients should not be overdiagnosed and should not receive a diagnosis of SZ that is incorrect.
This implies findings from studies, such as Loring and Powell, can help to show there are biases when diagnoses are made and improve the validity of the process moving forwards so the right diagnosis leads to the right treatment offered to the patients.
What are negative evaluations of gender bias of diagnosis?
- There is research evidence that identifies problems of not recognising differences in genders when diagnosing of SZ.
For example Cotton’s (2009) research implies women recover more and suffer less relapse than their male counterparts. Ignoring these facts would result in gender bias (a BETA BIAS) in clinicians not considering important factors in the diagnosis and recovery from schizophrenia. This could mean that key differences that might help treatment to be tailored to help the different genders could be ignored.
This implies that the diagnosis of SZ may not be valid if gender differences are not considered which limits full understanding of the unique experiences of SZ for the different genders and can impact treatment plans. - Further research evidence identifies problems with only focusing in one gender when diagnosing and ignoring another.
For example Nasser (2002) found that early research on SZ was conducted on men only. This meant that lots of research findings concerning treatments and explanations of the disorder may be inappropriate for women. When research focuses exclusively on men it can be assumed to be androcentric.
This suggests that such research limits our ability to generalise the finding to both males and females with this condition so can be detrimental to valid diagnosis and treatment. - Further research evidence indicates there may be a gender bias in the diagnosis of schizophrenia due to clinician’s preconceptions as to which gender the disorder is more prevalent in.
For example Loring and Powell (1988) conducted a study into this when 290 male and female psychiatrists read 2 cases & were asked to judge the condition, using standardised diagnostic criteria. When patients were described as male or no gender info was given, 56% were diagnosed as having SZ. However when patients were described as female only 20 % were diagnosed with SZ (but gender bias was less prominent with female psychiatrists).
This means the gender of the patient impacts and biases diagnosis as well as the gender of the clinician as women are more likely to be misdiagnosed with depression and anxiety as these disorders are more commonly identified in females. This leads to incorrect treatment , prolonging the illness.
