Option - Abnormal 5.3 - cultural and ethical considerations in diagnosis

Question 1

Ballanger et al. (2001)

Answer 1

variations in diagnosis across cultures do not necessarily reflect social or medical reality diagnosis is also linked to cultural variation in the prevalence of disorders

    	- Ways in which culture may influence psychiatric diagnosis
   	- diff. attitudes to psychological disorders (stigmas)
                            	- Influence reporting
                	- Cultural bias in diagnosis - i.e.  lack of familiarity with the expression of distress in certain cultures
                            	- Culture- bound syndromes could be difficult to recognize

Question 2

Etic

Answer 2

Universalist approach – emphasizes cross-cultural equivalence of diagnosis; everything is a consequence of universal underlying processes
DSM-IV (most commonly used)

Question 3

Emic

Answer 3

Relativist approach – emphasizes role of culture; it shapes how people experience distress and their beliefs about causes and consequences of their problems
Culturally specific instruments

Question 4

Kimayer (2001)

Answer 4

DSM-IV is dependent on western norms; not easily applied to other cultures

Question 5

Bhui (1999)

Answer 5

Necessary to incorporate indigenous beliefs in diagnostic systems, define concepts of depression in accord with psychiatric and indigenous belief systems

Question 6

Misdiagnosis due to cultural differences

Answer 6

Jacobs et al. (1998)

Bhugra et al. (1997)

Zhang et al. (1998)

Tseng and Hsu (1970)

Question 7

Jacobs et al. (1998)

Answer 7

– found with Indian women in London, where doctors did not detect depression if women did not disclose all symptoms. (same found with cultural minorities in the USA and Australia)

Question 8

Bhugra et al. (1997)

Answer 8

– older Punjabi women used “weight on my heart” or “pressure on my mind” and described symptoms of “heat” and “gas” which is similar to Indian medicine models of hot and cold.

Question 9

Zhang et al. (1998)

Answer 9

– in China, depression rates are lower since some are diagnosed with neurasthenia instead, (includes somatic, cognitive and emotional symptoms in addition to depression) which fits well with traditional Chinese explanations as disharmony of organs and imbalance of life force. 4/5 of psychiatric patients were diagnosed with neurasthenia in the 1980s
12 regions in China - out of 19,233 people, only 16 people reported that they had suffered from a mood disorder at some point in their lives. –> a prevalence rate significantly lower than the US

Question 10

Tseng and Hsu (1970)

Answer 10

• the Chinese are very sensitive: tend to manifest neurasthenic symptoms (exhaustion, sleep problems, concentration difficulties and other symptoms similar to depression and anxiety)

Question 11

Neurasthenia

Answer 11

• is a Chinese diagnostic category signifying “the weakness of nerves”
• could be seen as the Chinese version of depression, with various bodily symptoms, fatigue and depression feelings
• the diagnosis of neurasthenia is much more common than depression in China, this could be because it is less stigmatizing in the Chinese culture
• another reason could be that the concept of neurasthenia fits better with the traditional Chinese medicine, in terms of disharmony of vital organs and imbalance of Qi.

Question 12

Kleiman (1982) Neurasthenia at a psychiatric hospital in China

Answer 12

• aim: investigate if neurasthenia in China could be similar to depression in DSM-III
• Structured interviews based on DSM-III diagnostic criteria, 100 participants
• 87% could be classified as suffering w/ depression, (90%= headaches, 78% insomnia, 73% dizziness, 48% pains), depressed mood was main complaint in 9%
• Neura. could be way of expressing depression in somatic ways - only physical symptoms
• Diff complaints between cultures= difficult to compare data with West
• Somatization (China) vs. psychologization (West)

Implications:
Western clinicians should pay attention to somatization when working with Chinese patients but not over diagnose depression

Question 13

Ethical Considerations in Diagnosis

Answer 13

• correct= reliability % validity
• many are not easy to identify correct because of the problem of comorbidity (other symptoms at the same time)
• biases in diagnosis: (ie gender, ethnicity, age) that prevent correct diagnosis
• Clinicians also suffer from confirmation bias
• ie may not perceive info that contradicts the clinicians diagnosis
• considerations of normality and abnormality
• it would be ethically wrong to incorrectly diagnose a patient
• Stigmatization: Rosenhahn (1975)

Question 14

-Stigmatization: Rosenhahn (1975)

Answer 14

• diagnosis is often associated with significant consequences in terms of being considered deviant (personal, legal and social stigma)
• demonstrated that diagnosis of serious mental illnesses (schizophrenia) could be based off of limited info

Question 15

Jenkins-Hall and Saco (1991) Ethnicity bias in diagnosis?

Answer 15

• a number of European American male and female therapists were presented videos of various patients (e.g. male or female, black or white, depressed or non-depressed)
• the results show that white therapists were more likely to make a false-positive diagnosis when the patient was black (for ex. a black patient would be diagnosed as depressed even in the absence of depressed symptoms)

Question 16

Boverman et al. (1970) Gender bias in diagnosis?

Answer 16

• Rosser (1992) argued that many psychiatrists are males with a normative gender perspective and a patriarchal culture. This means that if a woman is unhappy as a housewife, because she is stressed and bored, a male psychiatrist could diagnose her with depression. This would be an example of overdiagnosis.