WJEC A2 Psychology PY4 - Issues Of Bias In Diagnostic Systems

Definition of Diagnosis: process of identifying the causes and nature of a disorder

Diagnostic System:

STEP 1 - recognition of abnormal behaviour by individual or family/friends

STEP 2 - see a GP/interview = to rule out physical disorders

STEP 3 - if physical disorders are ruled out, diagnosticians, community mental health team or psychiatrist uses DSM via interview

STEP 4 - Diagnosis

If a diagnostic system is valid/reliable, only symptoms should influence diagnosis not bias

3 Issues of Bias:

• class bias
• culture bias
• gender bias

1. Class Bias

• many critics have suggested that the lower the socio-economic class a person is, the more likely they are to be misdiagnosed with having a mental illness

(-) Umbenhauer + Devittle (1978)

• the higher the socio-economic class the higher likelihood that treatments like psychotherapy (talking cures) were administered, also given more favourable (less serious) diagnoses
• suggests that perhaps due to the potential discrimination the patient would face (job interviews, insurance, mortgages) the diagnosticians were reluctant to diagnose a serious condition to higher classes

(?) Socio-economic stresses

• one could argue that those of different socio-economic classes face different environmental stresses and pressures, and certain groups (poor/working classes) are more likely to experience more severe mental health problems than others

2. Culture Bias

• critics argue that if there are differences in the rate of mental disorders diagnosed in certain cultural groups over others, then these reflect the biases, ignorance and poor understanding of the cultural groups by the diagnostician

(+) Veling (2007)

• found that Turkish immigrants in Holland had higher incidence of psychotic symptoms than white Dutch people
• supports idea that incidence of psychotic symptoms in immigrant populations isn't based on bias but genuine symptoms

(-) Harrison et al (1984)

• black Afro-Caribbean immigrants = 4 and 12 x more likely to be diagnosed with Sz, and 17 x more likely to be sectioned than white people in UK = cultural bias
• could possibly be due to cultural differences in communication (English not first language) and spiritual belief systems being seen as symptomatic of psychosis

(?) HOWEVER...

• diagnosis difference could be genuine difference in Afro-Caribbeans than bias
• may be a higher genetic vulnerability in Afro-Caribbeans
• greater environmental triggers that lead to Sz (eg cannabis use in Rastafarian)
• being an A-C immigrant in England = cause mental illness = stress of racism

(?) Littlewood and Lipsedge (1989)

• argues many immigrants may have genuine psychotic symptoms due to racism
• found similar psychotic symptoms in Arab immigrants in France, Turkish immigrants in Germany and Eastern Europeans in Australia

(-) Blake (1973)

• found psychiatrists more likely to diagnose Sz if a patient was African American than white, suggests culture bias is, or was, a genuine problem HOWEVER...

(+) The Royal College of Psychiatrists (2005) believe bias is minimal as 1/3 of psychiatrists are an ethnic minority themselves, situation has changed since Blake?

3. Gender Bias

• critics of diagnostic systems argue that if there are gender differences in the rate of mental disorders being diagnosed between men and women, then these reflect the biases, ignorance and stereotypes by the diagnostician

(?) Gender of Psychiatrists

• data from the National Survey of Psychiatric Practice indicate % of female psychiatrists rose from 14.5% to 25% in 1996
• in 2007, approx. 60% of the Royal College of Psychiatrists are male
• suggests that even though female psych. are increasing, it is still a very much male dominated profession = affect diagnosis?

(-) Robins et al (1984)

• found women more likely to be diagnosed with depression and specific phobias
• critics suggest = stereotypes of women being weaker than men may influence diagnostician's diagnosis 

(?) HOWEVER...

• genuine difference in more females being diagnosed with depression than males?
• biological reasons (hormonal) or biological differences (childbirth, post-natal d)
• environmental (child care issues/greater pressure to be attractive)
• official statistics weighted towards females as men go to doctors less  (Nelson, 2008 = why men have higher suicide rates?) so incidence maybe same in m/f?

(-) Leeson and Gray (2008) found women more likely to get diagnosed with d. than men even with same symptoms and scores = gender bias in mental disorder diagnosis

(-) Broveman et al (1972)

• asked large number of psychiatrists (men and women) to describe qualities of mature, healthy, socially competent adult/man/woman
• psychs. equated 'men' with 'adults': mentally healthy man = mentally healthy adult
• untrue for women: mentally healthy woman not equiv. to mentally healthy adult
• suggests huge gender bias in how mental health professionals perceive a mentally healthy person to be (although was 30 years ago)

(?) DSM: diagnostic systems changing all the time, reflects the improving reliability/validity

(?) Classification systems: despite criticisms, all that is available at the moment for diagnosing mental disorders, until replacement system, they will continue to be used

(+) Diagnostic systems benefits

• can be incredibly useful in getting patients, suffering from anguish, some help/treatment and support quickly

(?) Diagnosticians

• if diagnosticians become too focused on not being biased in diagnosing, then ill people may be deprived of help and care and risk their own/other's lives
• important not to jump to the conclusion that just because a certain group of people suffer more mental illness than others, doesn't mean diagnosticians are biased
• nevertheless, also important to let symptoms alone govern particular diagnosis