cultural effects in diagnosis: individual differences

Question 1

define ‘culture’

Answer 1

a set of beliefs and practices that characterise a group of people
- varies between different parts of the world
- varies between ethnicities and religious groups
- varies between socioeconomic groups

Question 2

does culture affect diagnosis?
- supports

Answer 2

culture does affect diagnosis
- DSM is a diagnostic tool used in western cultures
- Evrard found that hearing voices is because of a mental disorder classified as schizophrenia but in other cultures it is interpreted as possession by spirits
- culture blindness can be an issue

Question 3

does culture affect diagnosis?
- opposes

Answer 3

culture does not affect diagnosis
- DSM is valid if mental disorders are specifically defined with specific features and symptoms
- we use a scientific model
- Lee found that DSM was valid in non western cultures for ADHD
- Lin found that sz symptom similarities outweigh differences in different cultures

Question 4

state 4 cultural differences in the diagnosis of schizophrenia

Answer 4

• delusional in 1 culture eg witchcraft may be common in another
• visual or auditory hallucinations may be part of religious experience
• disorganised speech may be hard to assess in different cultures eg speaking in tongues
• assessment of affect requires sensitivity to differences in emotional expression and body language which differ cross culturally

Question 5

what are the 5 key issues identified by Fernando (1992)

Answer 5

• over diagnosis of sz amongst west indian and asian british, for same symptoms a disproportionate number are diagnosed
• black patients with sz 3x more likely to be hospitalised
• most west indian, african and asian british are transferred to locked wards
• excessive admission of offender patients amongst west indian british
• overuse of ECT among afro caribbean and asian british

Question 6

what do Fernando’s findings suggest?

Answer 6

differences are due to bias in the mental health system not due to mental illnesses being more common in ethnic groups

Question 7

how can culture affect communication between the patient and psychologist?

Answer 7

Casas - african americans don’t like to share personal info with someone of a different race

Sue and Sue - african americans don’t like to talk about emotions so less likely to admit they have a problem

Question 8

how can prejudice affect diagnosis?

Answer 8

banyard - 25% patients on psych wards are black but they only makeup 5% of population
- minority groups receive more diagnoses

Question 9

how does the DSM attempt to enhance cultural sensitivity?

Answer 9

• includes discussion of cultural and ethnic factors for each disorder
• provides general framework for evaluating role of culture and ethnicity in the appendix
• describes culture bound syndromes in the appendix

Question 10

how has the diagnosis of schizophrenia changed?

Answer 10

• move away from emphasis on first rank symptoms
• flaum et al found lack of reliability when using DSM in regard to first rank symptoms in one culture
• focus more on negative symptoms as they are more objectively measured
• flaum et al found poverty of speech is more objectively assessed

Question 11

how has the ICD improved cultural sensitivity?

Answer 11

• available in many different languages
• reveals inconsistencies and unclear dialogue
• clear, simple, logically organised for all cultures to interpret in same way

Question 12

what is a culture bound syndrome?

Answer 12

mental health problems with a set of symptoms found and recognised as an illness only in one culture

Question 13

why do some people argue that CBSs do not exist?

Answer 13

• different cultures merely use different terms to describe same disorder
• same disorders may exist in different cultures but symptoms differ according to cultural upbringing

Question 14

what is an example of a culture bound syndrome?

Answer 14

kuru
- progressive psychosis and dementia
- new guinea cannibals
- incurable brain disease so not a mental disorder but symptoms are similar

penis panics

susto - latinos in us/mexico believe their soul has left their body after a traumatic event

Question 15

state 2 strengths of culture affecting diagnosis

Answer 15

• DSM5 considers cultural issues by acknowledging symptoms and features, improves diagnosis validity
• DSM5 provides warning for focusing on bizarre symptoms acknowledging that these are open to interpretation leading to cultural issues

Question 16

state 2 weaknesses of culture affecting diagnosis

Answer 16

• first rank symptoms should receive less emphasis according to DSM5 but clinicians may not follow this, leading to subjectivity and reducing validity
• cultural differences in symptoms of schizophrenia so these should be considered separately