Individual differences - Culture effecting diagnosis of mental health disorders affecting reliability and validity

Question 1

what can show that culture can change diagnosis in mental health disorders

Answer 1

• cultural stigma
• understanding symptoms

Question 2

cultural stigma

Answer 2

• every culture has a different way of looking at health
• for many there is a growing stigma around mental health
• mental health challenges are considered a weakness and something to hide
• this can make it harder for those struggling to talk openly and ask for help

Question 3

understanding symptoms

Answer 3

• culture can influence how people describe and feel about their symptoms
• it can affect whether someone chooses to recognise and talk about only physical symptoms, only emotional symptoms or both

Question 4

cross culture

Answer 4

• culture varies between people from different parts of the world

Question 5

sub culture

Answer 5

• culture varies between different religious groups in the same region
• different socio-economic groups
• men and women
• different age groups

Question 6

who devises most definitions of psychological abnormality

Answer 6

white middle class men

Question 7

why is abnormality being mainly caterogised by white middle class men an issue

Answer 7

• this may lead to disproportionate number of people from certain groups being diagnosed as abnormal

Question 8

example of a disproportionate number of people from minority groups being diagnosed as abnormal

Answer 8

• UK depression is more commonly identified in women
• black people are more likely to be diagnosed with Sz than white counterparts
• working class people are more likely to be diagnosed with mental illness than those from non manual backgrounds

Question 9

what does your cultural group influence

Answer 9

• your likelihood of being diagnosed with a particular disorder
• treatment you receive

Question 10

Fernando (1992)

Answer 10

• points out certain groups appear to be more prone to certain disorders
• this is not because mental illnesses are more common among ethnic groups
• it is due to bias in the mental health system

Question 11

example of certain groups being more prone to certain disorders due to bias

Answer 11

• Afro Caribbeans are more likely to suffer from schizophrenia

Question 12

evidence from Fernando - to show that diagnosis is due to bias in the mental health system

Answer 12

• high rates of mental illness are not seen in the countries of origin

Question 13

Issues from studies of ethnicity and health Fernando points out -

Answer 13

• over diagnosis of Sz among minority groups
• more ethnic minorities transferred to locked wards when hospitilised

Question 14

Fernando - over diagnosis of Sz in minority groups

Answer 14

• for the same symptoms a disproportionate number of individuals were diagnosed with Sz than those who were not a part of these cultural groups

Question 15

Fernando - more ethnic minorities transferred to locked wards when hospitilised

Answer 15

• over use of ECT among minority groups as appose to other methods of psychiatric treatment

Question 16

ECT

Answer 16

electro -convulsive therapy

Question 17

Banyard

Answer 17

• found in Britain 25% patients on psychiatric wards were black
• whilst they only make up 5% of the total British population
• when in a psychiatric hospital, black patients are more likely to be seen by a junior doctor than white patients

Question 18

Winter

Answer 18

• there may be a deliberate/unconscious bias
• this contributes to variations in diagnosis between groups
• suggests upbringing/training of western healthcare professionals may lead them to be biased/ insufficiently sensitive to the culture of ethnic / gender minorities / working class

Question 19

Casas - patients perception of clinicians

Answer 19

• African Americans do not like to share their personal information with people of a different race

Question 20

Sue and Sue - patients perception of clinicians

Answer 20

• African Americans do not like to talk about their emotions
• less likely to admit they have a problem
• once admitted, less likely to talk about it with their therapist
• the amount disclosed with a therapist may be due to communication troubles

Question 21

language barriers

Answer 21

• information can get lost in translation
• may be offensive in some cultures
• resulting in denial that the disorder is real in that culture

Question 22

Cultural beliefs

Answer 22

• effect diagnosis rates

Question 23

Rack et al - cultural beliefs

Answer 23

• rare for Asian patients to be present with symptoms of depression
• maybe due to Asian communities not seeing emotional problems as something to go to the doctor with
• they prefer to sort these issues within the family
• physiological depression symptoms may be reported but not the psychological ones

Question 24

ICD 10 - culture specific

Answer 24

• available in many different languages
• suits the cultural form for that group
• helping to reveal inconsistencies
• remove unclear dialogue and overlaps between disorders
• now it is clear, simple and logically organised
• so all cultures can interpret in the same way

Question 25

Previous versions of DSM have been criticised for lack of attention to cultural and ethnic variation in psychopathology - what amendments have been made

Answer 25

- by including a discussion of cultural and ethnic factors for each disorder in main manual - providing a general framework for evaluating role of culture/ethnicity - describing culture bound syndromes in appendix

Question 26

what are arguments against culture bound syndromes

Answer 26

- cultures use different terms to describe the same disorder - same orders exist in different cultures but symptoms shown differ according to an individuals cultural upbringing - disorders are culturally relative rather than culture bound - norms/values/lifestyles are just expressed differently

Question 27

suppression facilitation model

Answer 27

- does not recognise culture bound syndromes as separate disorders - sees them as the same disorders exist universally but symptoms shown differ due to individuals cultural upbringing

Question 28

example of suppression facilitation model

Answer 28

- anorexia - could be that there is an underlying disorder which is expressed in culturally different ways - in west it is expressed by not eating - in Malaysia it is expressed by concerns of genital retraction

Question 29

example of culture bound syndromes

Answer 29

- Pibloqtoq - Kuru - Windigo

Question 30

Pibloqtoq

Answer 30

- uncontrollable urge to leave your shelter - tear off your clothes - expose yourself to arctic weather - found in Greenland, Alaska, Canadian arctic - linked to environmental isolated conditions and to limited calcium uptake during sunless winters

Question 31

Kuru

Answer 31

- progressive psychosis and dementia among New Guinea cannibals - similarities to CJD symptoms - shaking - aching limbs - death - linked to the funeral practice of eating the brain

Question 32

Windigo

Answer 32

- used to deal with outcast among the Algonkian Indians - depression and anxiety followed by possession by a giant man eating monster - which leads to killing and cannibalism - treatment for sufferer is to kill them

Question 33

which disorder has different terms to describe the same syndrome

Answer 33

amok

Question 34

amok

Answer 34

- found in Southeast Asia - mental disorder where individual behaves in a wild and aggressive manner for a limited period - sequence of stages including dismal brooding, outburst of furious and lethal aggression against random victims

Question 35

where else in the world has amok been suspected

Answer 35

- Westermeyer - 18 young men in Laos who ran amok - though only one was eventually diagnosed with a mental disorder - schizoid personalities rather than amok would have been diagnosed - in different cultures different terms may be used to describe a similar syndrome

Question 36

Malgady

Answer 36

- said there is a difference in the interpretation of hearing voices - in Costa rica it is seen as talking to spirits - in USA it is a sign of Sz

Question 37

give examples of a disorder that are the same but exist in different cultures where the symptoms shown differe according to your cultural upbringing

Answer 37

- koro, dhat, anorexia

Question 38

koro

Answer 38

- Malaysia and China - Mainly among men - characterised by severe anxiety - and delusions that their gentials/nipples are retracting into the body - may lead to death

Question 39

koro - criticism

Answer 39

- argued it is a distortion of body image not a unique disorder - koro has been found outside of Asia - suggesting other factors e.g predispositional also may be underlying causes - koro may still be equal to anorexia which is also characterised by self image issues

Question 40

why may anorexia be prevalent in some cultures more than others

Answer 40

- some cultures may have societal standards - with an emphasis on thinness - people have access to social media where thinness is promoted - ledcs may not have access to this

Question 41

why may schizophrenia be prevalent in some cultures more than others

Answer 41

- could be a bias in the mental health system - to diagnose a certain culture more than others - as they have different cultural behaviours/norms

Question 42

how do communication issues present diagnosis issues

Answer 42

- language barriers - causes information to be lost in translation if patient and clinician speak different languages - translation can result in inappropriate treatment / no treatment

Question 43

how does communication issues affect the validity of diagnosis

Answer 43

- less valid - patient may misinterpret what the clinician is saying / vice versa - so behaviour is not accurately diagnosed

Question 44

how does the impact of being in a different cultural group affect diagnosis

Answer 44

- certain groups are more prone to be diagnosed with certain disorders - as healthcare professionals are insufficiently sensitive to cultural differences

Question 45

how does the impact of being in a different cultural group lower the reliability of diagnosis

Answer 45

- healthcare professionals are not consistent in their diagnosis - they are more geared to diagnosing minority groups with mental health problems

Question 46

how does bias in the health care system affect diagnosis

Answer 46

- over diagnosis of Sz across minority groups - so for the same symptoms a disproportionate number of individuals were diagnosed with Sz compared to those not a part of cultural minority groups

Question 47

how does bias in the health care system lower the reliability of diagnosis

Answer 47

- western healthcare professionals aren't consistent with their diagnosis across different cultures

Question 48

how does bias in the healthcare system for treatment affect diagnosis

Answer 48

- more ethnic minority groups are transferred to locked wards when hospitilised - given an over use of elector convulsive therapy

Question 49

how does bias in the healthcare system treatment lower reliability of diagnosis

Answer 49

- lack of consistency in treatment across different cultures - even if they are diagnosed with the same disorder

Question 50

how do different norms to the clinician affect diagnosis

Answer 50

- Winter 1999 - suggests training of western healthcare professionals may be biased towards culture and social situations

Question 51

how do different norms to the clinician lower the validity of diagnosis

Answer 51

- clinicians may not be accurately diagnosing the behaviour using their measures - as minority groups cultures and traditions may not fit these metrics

Question 52

how does disclosure of symptoms affect diagnosis

Answer 52

- some ethnic minorities more reserved - African Americans do not like to talk about their emotions - less likely to say they have a problem

Question 53

how does disclosure of symptoms lower the validity of diagnosis

Answer 53

- some patients who do not share personal information could be inaccurately diagnosed

Question 54

how do cultural beliefs affect diagnosis

Answer 54

- Asian patients will rarely present symptoms of depression - In Asian culture going to the doctor for an emotional problem is unheard of

Question 55

how do cultural beliefs lower the reliability of diagnosis

Answer 55

- number of Asian people who are actually struggling with a mental disorder is inaccurate

Question 56

how does the objectivity of the ICD affecting diagnosis

Answer 56

- ICD is available in different languages - suits the culture form of that groups - helping to reveal inconsistencies

Question 57

how does the objectivity of ICD increasing validity of diagnosis

Answer 57

- it has been adapted to different cultures and languages - it is describing treatments the way they were intended universally

Question 58

culture bound syndromes affecting diagnosis

Answer 58

- mental disorder that appears confined to members of a particular culture - does not appear elsewhere - some argue they are not real disorders - some argue they use different terms to describe the same disorder

Question 59

culture bound syndromes decreasing reliability of diagnosis

Answer 59

- disorders which have different names but are the same disorder may be treated differently

Question 60

Assess how far culture can lead to individual differences in mental health disorders - AO1

Answer 60

- there are cultural differences in how disorders are perceived - e.g for some religious groups hearing voices could be a sign of speaking to God - systems such as DSM tend to be culturally biased as they do not consider values of different countries - so people outside western cultures tend to be misdiagnosed - stereotypes held by clinicians of a different culture supported by phrasing of DSM could create bias - meaning some groups are over diagnosed with a particular disorder - there are proportionally more Afro Caribbean people of origin treated for Sz in UK than white people - suggesting other factors are playing a part - there may be issues with translation if the patient and clinician speak a different language - causing issues diagnosing a mental disorder

Question 61

Assess how far culture can lead to individual differences in mental health disorders - A03

Answer 61

- Malgady - Lopez - Cooper - Lee - Psychiatrists can over compensate for cultural differences and not diagnose a mental disorder when in fact there was one - subcultural differences may not have caused any difference in the disorders just in the diagnosis

Question 62

Malgady - A03

Answer 62

- demonstrated there is a difference in the interpretation of hearing voices - between Costa Rican culture where it is interpreted as spirits talking - In USA same thing is a Sz symptom

Question 63

Lopez - A03

Answer 63

- trying to dedress cultural bias in DSM by taking out cultural beliefs into account - lead to missing some diagnoses as symptoms are dismissed as cultural norms - makes it difficult to judge whether DSM is a valid tool outside USA

Question 64

Cooper - A03

Answer 64

- found NY psychiatrists twice as likely to diagnose Sz as London psychiatrists - when shown same video taped clinical interviews - suggesting cultural differences can impact diagnosis given and impact prognosis in treatment

Question 65

Lee - A03

Answer 65

- found using DSM in Korea for diagnosis of ADHD was valid - as using it in USA - so cultural differences has no impact on diagnosis