Transcript Cultural Ethical Gender in Diagnosis

DISCUSS CULTURAL AND
ETHICAL & GENDER
CONSIDERATIONS IN
DIAGNOSIS
(FOR EXAMPLE, CULTURAL VARIATION,
STIGMATIZATION)
CULTURAL
CONSIDERATIONS
CULTURAL CONSIDERATIONS
• Culture bound syndrome –
• abnormalities and disorders are thought to be culture-specific
• Contrary to popular beliefs that disorders may appear to be
universal (present in all cultures)
• Reporting Bias –
• Data is generally based on hospital admission which may not
reflect true prevalence rates for particular ethnic groups or
disorders.
• Culture Blindness –
• Culture blindness is the problem of identifying symptoms of a
psychological disorder if they are not the norm in the clinician’s
own culture
• Clinician is blind to other culture (blind to the patient’s culture)
CULTURE BOUND SYNDROMES - EXAMPLES
EXAMPLE 1: SHENJING
SHUAIRUO - (NEURASTHENIA)
• a culture bound syndrome
that accounts for more than
half of psychiatric patients in
China.
• It is listed in Chinese
classification system but not
DSM-4.
• Symptoms listed are similar
to mood and anxiety
disorder combination.
Example 2: Depression and
diagnosis • It is common in western culture, but
appears to be absent in Asian
cultures.
• Asian societies are collectivist and
they have lots of social support.
• Asian doctors say diagnosing
depression is just as common
among Asians but they visit doctors
about physical issues, not emotional
ones (Rack, 1982).
• Do not believe that it's the doctors
responsibility, but family's
• Seek help for physical symptoms
but don't mention mood
‘CRAZY LIKE US’ – ETHAN WATTERS
In his book Crazy Like Us Ethan Watters assesses the US’s global
influence on mental disorder diagnosis and treatment and how a
westernization of psychiatry is eliminating cultural differences.
1 – Introduction of Anorexia – Hong Kong
2 – Post-tsunami – Sri Lanka
3 – Shift in Schizophrenia – Zanzibar
4 – Marketing Depression – Japan
CRAZY LIKE US
ANOREXIA - HK
TSUNAMI – SRI LANKA
• Death of Charlene
Hsu Chi-Ying –
publicity turned to
western experts
• By 1997, fat phobia
had become the
single most important
reason given for selfstarvation
• Idea of anorexia was
imported from
western culture.
•
Most of the aid workers did not
speak the local language or
understand the culture.
•
One example is that the aid
workers felt that the locals
needed to acknowledge that
their family members were
dead so that they could move
on.
•
They were also unable to make
a distinction between the trauma
caused as a reaction to the
tsunami and the ongoing strains
of the social and economic
turmoil caused by that event.
•
Idea of PTSD was imported from
western culture.
CRAZY LIKE US
SZ -ZANZIBAR
DEPRESSION - JP
• Analyzed 3 families
with members with
Schizophrenia
•
The melancholic personality
type was admired and
aspired to.
•
Sadness is seen as a way of
tightening one's bonds with
family and the community.
•
One family sued work on
accounts of karoshi (death
by overwork) leading to
suicide.
•
Media connected mental
illness (depression) as the
cause of suicide.
•
Prozac came up with a
slogan that had cultural
resonance, "depression is
like a cold of the soul."
• Because kept with
families (Spiritual
notion), members
tended to do better.
• Western Culture
could learn from
this.
ETHICAL
CONSIDERATIONS
ETHICAL CONSIDERATIONS
What could be the
effects of being
labelled as having a
mental disorder?
Watch Video - Stigmatization
ETHICAL CONSIDERATIONS
• Confirmation Bias - when you pay attention to information
that agrees with what you already believe and discount
(ignore) information that contradicts it.
CONFIRMATION BIAS
TEMERLIN (1968)
•
Showed clinical psychologists, and clinical psychology graduate students a
videotape in which an actor portrayed an ordinary, mentally healthy
mathematician who had read a book about psychotherapy and wanted to
discuss it with a psychologist.
•
Before watching the tape, clinicians were informed by a prestigious psychiatrist
that the individual on the tape was “a very interesting man because he looked
neurotic, but actually was quite psychotic.”
•
After viewing the tape, participants selected their best-guess diagnosis from a
list of 30 choices: 10 psychotic disorders, 10 neurotic disorders, and 10
miscellaneous personality types, including “normal or healthy personality.”
RESULTS
•
A majority (60%) of the psychiatrists, along with 28% of the clinical
EFFECT
psychologists and 11%PRESTIGE
of the graduate
students, diagnosed the individual as
psychotic.
•
a patientinhas
been diagnosed
by someone
In contrast, none of thewhen
78 participants
fouralready
control groups
diagnosed this
individual as psychotic.respected in the field and a doctor confirms the
diagnosis based on limited information.
CONFIRMATION BIAS
MENDEL ET AL (2011)
METHOD
•
Researchers gave a case study to 75 psychiatrists and 75 fourth-year medical
students.
•
Participants were asked to choose a preliminary diagnosis of depression or
Confirmation Bias CHALLENGE
Alzheimer disease and to recommend a treatment.
•
The vignette was designed so that depression would seem the most
appropriate diagnosis.
The situations in which confirmation
is tested
is information.
not naturalistic.
Participants could then opt to view up to 12bias
pieces
of further
•
RESULTS
The situations are abstract and lack
•
For the preliminary diagnosis, 97% of psychiatrists and 95% of students chose
any personal contact with the person
depression.
•
they are being
asked
After looking at the further information, 59%that
of psychiatrists
and 64%
of to
students reached the correct diagnosis of Alzheimer
disease.
diagnose.
•
Psychiatrists who did not use information effectively to diagnose and only
looked at information that confirmed their original
diagnosis
were less what
This does
not represent
experienced.
happens in true diagnosis.
Participants were more likely to make the wrong final diagnosis if they
chose to view six or fewer pieces of additional information.
ETHICAL CONSIDERATIONS
Labeling Theory - Scheff's (1966) argues that if a person
is diagnosed based on symptoms of "deviant behavior,"
society's reactions to this label will produce additional
pathology or behavioral disturbance that causes mental
illness or makes it worse.
• Stigmatization: Extension of to Labeling theory, has
argued that labeling leads to the stigmatization - that is,
the social rejection - of people with mental illness.
• Self fulfilling prophecy - Scheff (1966) argued that
people may internalize the role of “mentally ill patient” and
their symptoms could increase.
LABELING THEORY
LANGER AND ABELSON (1974)
• Psychiatrists watched a video of a younger man talking to an
older man with the sound removed.
• Half the therapists were told that the younger man was a
patient; the other half, that he was a job applicant.
• After viewing the video, participants responded to a series of
questions about the interviewee.
RESULTS
• If the viewers were told that he was a job applicant, he was
described as attractive and confident; if they were told that he
was a patient, he was described as defensive, aggressive
and/or frightened.
AGAINST
LABELING THEORY
Labeling Theory CHALLENGE
•
•
The greatest challenge to labeling
Gove & Fain (1973) carried out extensive interviews with 429
theory is that psychologists are
former mental patients. The vast majority
stated that diagnosis
unable
to empirically demonstrate
had led to an improvement in their social relationships.
that social rejection is the result of
the diagnostic label rather than the
behavior
the individual.
Gibbons & Kassin (1982) found that
labels of
actually
lead to more
acceptance of behavior. They found that when children were
labeled with disabilities, they were blamed and punished less than
non-labeled children for the same negative behaviors.
•
Is there
evidence
thatthe
the
mentally
ill suffer
Doherty (1975) found
that people
who rejected
mental
illness label
from
social
stigmatization
and
tend to improve more
quickly
than rejection,
those who accept
it!
discrimination?
•
Link et al (1987) argues that a diagnosis may lead to social
withdrawal by an individual because they fear social rejection.
GENDER
CONSIDERATIONS
GENDER
• The double standard
• The LOA breakdown – Based on our previous information
in each of the three Levels, discuss what is different about
men and women (biologically, cognitively, socioculturally)
• What factors are different and influence their lives
differently.
• What reactions are different and influence their lives
differently.
• How might this impact diagnosis
Discussion: Why are more men diagnosed as abusing
alcohol than women?
More on gender later when we examine
Affective, Anxiety and Eating disorders in
specific.
RECOMMENDATIONS???
What can and should psychologists do to avoid cultural,
ethical and gender issues in relation to diagnosis?