Discuss cultural and ethical considerations in diagnosis

Diagnosis is the identification of groups or patterns of mental symptoms that reliably occur together to form a type of disorder. Diagnosing mental disorders is a very delicate process. Psychologists and clinicians must take precautions when making a diagnosis, as once a diagnosis is made, the life of the individual may be changed forever.

Concepts of abnormality differ between cultures, and this can have a significant influence over the validity of diagnosis. Behaviour that seems abnormal in one culture may be seen as perfectly normal in another, and therefore clinicians must take into account cultural considerations when making a diagnosis. They must take an emic approach to diagnosis.

For example, Koro is a culturally-bound syndrome in China where men believed that the penis is shrinking and that it will withdraw to the abdomen and cause death. Symptoms of this include fear and anxiety, and attempts to put weights on their penis to prevent it from retracting. Since this disorder is only found in China, some diagnostic manuals will not have it. The existence of culturally bound syndromes means that it is important for clinicians to consider the disorders found in many diagnostic manuals in order to make a fair assessment of the individual.

Cultural bias is also found in diagnosis. Sabin found cultural bias when clinicians were exposed to non-English speaking patients such as Mexican-Americans. The patient's emotional problems and symptoms were often misunderstood, which may explain why there is a much higher incidence of diagnosis made on ethnic minorities in the US and UK. Jenkins-hall and Sacco took Western clinicians and asked them to watch interviews with possible patients. There were four different conditions. The first condition was a Western-American woman that was not depressed. The second condition was an African-American woman that was not depressed. The third condition was a Western-American woman that was depressed. The fourth condition was an African-American woman that was depressed. The researchers found that the clinicians rated the non-depressed woman as the same, but that they were more likely to diagnosis the African-American woman depressed and less socially competent than the Western-American depressed woman. This shows that cultural bias exists, and therefore clinicians must take this into account. For a more reliable diagnosis, perhaps more than one researcher from a different culture should assess a patient.

Apart from cultural issues, diagnosis of abnormality can also follow some serious ethical issues, and these should be considered before making a diagnosis, as after making one there may be no turning back.

The labelling of people with mental disorder is called stigmatization. Rosenhan (1973) conducted a study where 8 normal patients would try to gain admittance to psychiatric hospitals. These patients claimed to be hearing unfamiliar voices in their heads. All but one were admitted with schizophrenia. The patients were told to stop displaying the symptoms, and they were all discharged after 19 days. However, they were stigmatized with the label "schizophrenia in remission". Had these participants been real patients, this label would follow them everywhere and may affect their ability to find a job or qualify for medical insurance. However, there are criticisms of this study. Firstly, the staff at the hospital are not entirely to blame as the participants admitted themselves and told the staff about their symptoms. The staff was simply just doing their job at identifying the symptoms and making a diagnosis. In real life, doctors are not normally confronted with people wishing to be admitted to psychiatric hospitals. The sample was too small, so there is a problem of whether it can be generalized. Even if a patient no longer shows any symptoms, the label "disorder in remission" still remains and this can affect the individual's self esteem and confidence.

The self-fulfilling prophecy states that when a stereotype or label is placed on an individual, they will internalise the role and thus conforming to the stereotype and start believing that they are abnormal. For example, if a patient is diagnosed with a mental disorder, the patient may start to believe that they are abnormal and start to behave similarly to the illness. Doherty et al found that patients who do not internalise the role of a mentally ill stereotype recovered much faster than those who exhibited the self-fulfilling prophecy. This finding emphasizes on the importance of taking in the ethical considerations before diagnosing patients.

Another ethical issue in diagnosis is confirmation bias, where clinicians tend to attribute a patient's behaviours to a disorder and looking for behaviours that confirm this disorder. This may be due to the assumption that if the patient is there in the first place, there must be something to diagnose. This is demonstrated again in Rosenhan (1973)'s study. Once the participants stopped exhibiting behaviours, they took notes on their experience. This was interpreted as a symptom of schizophrenia. When the participants were walking down the hallway, this was seen as a sign of nervousness. This shows that once a person is deemed mentally ill, any actions will be interpreted as symptoms of the disorder.

In conclusion, it is extremely important for clinicians to take into account the cultural and ethical considerations in diagnosis, as once a diagnosis has been made it is with the patient for the rest of their lives.