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 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".
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.
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.
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.
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.