cultural issues of diagnosis

Question 1

where was the DSM developed?

Answer 1

• USA
• widely used in many other countries

Question 2

what question is asked about DSM being globally used?

Answer 2

• whether a diagnostic tool developed in one culture is valid for use in another culture

Question 3

what is one cultural issue? (spiritual/scientific)

Answer 3

• some cultures are more spiritual and some more scientific
• DSM and ICD are scientific and use the medical model (scientifically defines and explained)
• however, in more non-Western cultures mental health issues can be linked to spirits (eg possessions)
• hearing voices in western cultures is a symptom of schizophrenia (suggested by DSM) whereas in another culture it might be a feature of being possessed by spirits

Question 4

how can cultural bias lead to different diagnosis of mental disorders?

Answer 4

• culture you belong to influences likelihood of being diagnosed with particular disorder and treatment
• therefore important to know what cultural group is most important to individual as their understand of their problem will reflect their particular culture
• cultural group one belongs to may influence how they view and express that illness to others

Question 5

how can mental health professionals misinterpret reported symptoms and what does it lead to?

Answer 5

• leads to inappropriate diagnosis and treatment
  1) psychiatrists in different countries will use same classification system but different ways - eg give different diagnoses for same symptoms
  2) mental illnesses included in classification system are not universal, and there are, what is called ’culture-bound syndromes’ eg Koro

Question 6

supporting evidence: Koro

Answer 6

• found in south Chinese men
• plagued by belief that their sex organs are shrinking and will disappear inside abdomen, leading to death

Question 7

supporting evidence: Dhat

Answer 7

• found in men from Indian subcontinent
• main symptoms are severe anxiety and obsessive concern over discharge of semen

Question 8

why is it important for a clinician from one culture to be aware of the cultural background (beliefs and customs) of their patient?

Answer 8

• patients may feel uncomfortable sharing to clinician as they may be from 2 different cultures
• to be able to give an appropriate and correct treatment according to behaviour
• what is deemed as normal and abnormal in symptom

Question 9

individual differences

Answer 9

• race and culture may affect diagnosis
• behaviour common in one culture may be misinterpreted in another as symptomatic
• if patient’s culture is different from clinician
• may be less likely to share (cultural shame)
• what is considered normal in one culture may be abnormal in another

Question 10

what can be done to overcome cultural issues affecting reliability and validity of diagnosis?

Answer 10

• less emphasis must be places on symptoms that show cultural differences
• more emphasis on symptoms and features that seem to be universal
• eg less emphasis on bizarre behaviour (judgment) - what might be bizarre in one culture (eg hearing voices) might not be in another culture
• emphasis should be on difficulties with social functioning or distress

Question 11

what did Flaum suggest?

Answer 11

• negative symptoms (eg apathy - lack of energy and absence of interest) are more objectively measured than positive ones (eg hallucinations) and so should be focus on more