Issues of the Bias in Diagnosis

Issues of the Bias in Diagnosis

1. Diagnosis = the identification of the nature of an illness / problem by examination of the symptoms

2. Culture Bias

   • appears to be a major bias in diagnosis with regards to people of African descent, particularly with schizophrenia
     • Cochrane and Sashidharan (1995) - Afro-Caribbean immigrants in the UK are 7x more likely to be diagnosed with schizophrenia than white people
     • however, doesn't give us any info about the nature of this bias; is there a bias in the diagnosing, or is there a genuine difference
   • over-diagnosis
     • bias is the diagnostic tools used
       • the diagnostic tool is culturally biased
       • may overemphasise a western concept of ideal mental health
       • 1. things that may be classed as symptoms of mental illness in one culture, may be regarded as normal in other cultures; leading to over-diagnosis of disorders
         • Ebigno (1986) - symptoms of depression vary from culture to culture. In Nigeria, people often complain of burning sensations in the body and crawling sensations in the head
       • 2. could lead to ignoring some genuine mental illnesses which don't occur in Western culture
         • Koro = extreme anxiety that the penis will recede into the body, and Ghost Sickness = excessive focus on death
     • bias in the person who is doing the diagnosis
       • Lewis (1990) - 139 psychiatrists were shown an individual written case history; asked to make a judgement on the treatment and predict whether criminal proceedings should take place; some were told it was a black patient, others were told it was white
         • found that the black patient was recommended drug treatment and was seen as a more violent criminal; suggests that mental health professionals can be biased in their judgement by social stereotypes
           • however, psychiatrists may have diagnosed patients in ways that we didn't know about before the experiments took place
   • genuine differences
     • stress of being a minority / immigrant
       • stress associated with being an ethnic minority leads to higher stress levels; could trigger off a mental illness
       • immigrants generally are of a lower social class, and have to adapt to living in a foreign culture, and may lack communication skills
       • however, the majority of immigrants to the UK in recent history have been white, yet the bias in diagnosis only applies to black immigrants
       • rates of serious mental illnesses are higher in British-born black people rather than their parents, or recent immigrants
         • however, this is because they have no home as they have mixed cultures
     • genetic factors
       • people of African descent may have a genetic vulnerability to developing certain types of mental illness
         • however, Nazroo (1997) found there is not more black people with schizophrenia

3. Gender Bias

   • Walker (1994) - women with depression outnumber men between 2 and 6 times
     • however, no gender bias for the occurrence of bi-polar or schizophrenia
     • this gender bias is quite recent
       • Cochrane (1995) argues that earlier in the 19th century, men were much more likely to be admitted to hospital than women
     • these statistics don't give us the cause of the bias
   • over-diagnosis
     • Worell & Remer (1992) - 4 possible reasons why there may be gender bias
       • 1. disregarding environmental context
         • focus in diagnosis is on the symptoms rather than the individual circumstances
         • female patients have to cope with more difficult circumstances
       • 2. differential diagnosis on the basis on gender
         • a patients's symptoms may be interpreted differently depending on their gender
         • therapists exaggerate the number of men and women with disorders which conform to the gender stereotype
       • 3. therapist misjudgement
         • sex role stereotyping may increase the chances that the therapist will detect symptoms of submissiveness in females and aggressiveness in males
           • Broverman (1981) supports the existence of gender stereotypes after health care professionals used similar words when describing a mentally healthy adult, a healthy male, and a healthy female
       • 4. theoretical orientation
         • therapist's theoretical biases may distort the process of diagnosis
   • genuine differences
     • cause of the high level of depression in women is hormones; the hormones fluctuate during the month, as well as childbirth and this may possibly explain why women are more prone to depression
       • however, Weissman (1977) - whilst there is some evidence of hormone contribution, it cannot completely account for the differences between men and women