Issues of Bias in Diagnosis



A bias means that certain people are more likely to be classed as having a particular disorder than other types of people. 

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Cultural Bias

Appears to be a major bias against African people. 

Cochrane and Sashidharan (1995)- black Afro-Caribean immigrants were 7 times more likely to to diagnosed with schizophrenia than white people. 

Suggests that a bias does exist, but we don't know anything about the nature of this bias. 

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Explanation of cultural bias (1)

Over diagnosis due to inadequate diagnostic methods.

This could be a bias in the diagnostic tools such as DSM IV or ICD, which were both developed in the USA and Europe and so may over emphasis a Western concept of mental health, ignoring cultural factors. 

Leads to problems:

  • Things which may be regarded as symptoms of mental illness in one culture may be regarded as normal in other cultures. Psychologists may therefore misinterpret whats regarded as a social norm in one culture as a mental illness. 
  • The same illness could manifest itself differently in different cultures e.g, Ebigno (1986) said symptoms of depression vary in cultures. 
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Genuine mental illness which do not occur in Western cultures could be ignored.

Amok is a illness in Malaysian men, but the symptoms could be misinterpreted by Western psychologits unfamiliar with these culture-bound symptoms. 

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Explanation of cultural bias (2)

There may be a bias in the person doing the diagnosing. 

Lewis (1990)- asked 139 psychologists to make a judgement on treatments patients should be given. 

Also asked to predict whether criminal proccedings should be investigated. 

Some psychologists were told it was a black Afro-Caribbean patient, whilst others were told it was a white patient. 

The symptoms were identicial. 

Found that psychiatrists, based on reading of case studies, were more likel to recommend drug treatment if the patient was black, and also viewed the patient as being more violent. 

Suggess that mental health professionals can be bias. 

Issue= participants didn't see the patients, and so the study lacks mundame realism and ecological valdity. 

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Explanation of cultural bias (3)

Certain cultures have a genetic vulnerability to develop certain illnesses. 

Therefore exculding cultural or social status or stress.

However, the World Health Organisation conducted a study to see if black people were more prone to getting schizophrenia, expecting to see similar rates across all countries. 

But, Nazroo (1997)- rates were not as high in the uk, supporting a cultural bias. 

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Explanation of cultural bias (4)

It may also be that those of a lower social class are more vulnerable to mental illness due to their low self-esteem.

Littlewood (1980)- argued that mental health practitioners may judge people to be insane when they are actually reacting to disadvantage and racism. 

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Gender Bias

Psychiatry is male dominated meaning male behaviours are the standard by which all other behaviours are measured. 

There are clear differences with regards to mental illnesses. 

For example, 90% of anorexia nervasa sufferers are female and this shows a bias based on sterotypes (females are described as being hysterical/submissive) 

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Men V's Women

Robins et al (1984)- men are more likely to be diagnosed with alchohol abuse than women and women are more likely to be depressed or have phobias. 

Walker (1994)- reported that women with depression out number men between two to six times. 

However, Cochrane (1995)- claimed that earlier in the 20th century men were more likely to be admitted to hospital than women, but lack of evidence for this reduces it's reliability. 

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Explanation of gender bias

There are 4 possible explanations for gender bias in regards to over diagnosis due to inadequate diagnosis methods.

One explanation= disregarding of environmental context as focus in diagnosis is on symptoms rather than the individuals circumstances.

Another explanation= differential diagnosis on the basis of gender which states that symptoms may be interpreted differently depending on gender. 

Worrell and Remer (1992)- argued that men and women are diagnosed in different ways, by showing women react more to stress. 

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Genuine differences

There are other possible explanations for gender bias in regards to genuine differences in rates of mental illness.

It's often proposed that the high levels of depression is due to the hormones. 

Weissman et al (1977)- found some evidence for this but it doesn't explain the large differences in men and women. 

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Conclusion- differences in models

Worth considering the point of having a diagnosis system. 

The DSM and ICD do not agree with eachotheras they produce different descriptions and symtoms for mental illness, such as schizophrenia. 

This means that they lack reliability and validity.

These differences means that psychiatrists come up with a different diagnosis for each patient.

These diagnosis methods get reviewed periodically and re-written due to the changing world. 

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