Discuss cultural and ethical considerations in diagnosis
Culture may influence psychiatric diagnosis in several ways.
1. Different cultural groups have different attitudes to psychological disorders that might influence the reporting of symptoms and diagnosis (e.g. due to stigmatization).
2. Cultural bias in diagnosis (i.e. the clinician does not observe certain symptoms because he or she is not familiar with the expression of distress in a particular culture).
3. Culture-bound syndromes (disorders that are specific to a particular culture) could be difficult to recognize for clinicians. This could prevent people from being treated.
Emic or etic in diagnosis?
- The universalist approach (etic) to diagnosis emphasizes the cross-cultural equivalence of diagnostic concepts and underlying processes. Symptoms and disorders are manifestations of universal underlying processes.
- The relativist approach (emic) to diagnosis emphasizes a fundamental role of culture in psychopathology. Culture shapes symptoms and how people experience distress as well as their beliefs about causes and consequences of such problems.
- Clinicians could use universal clinical interviews and a classification system like the DSM-IV (i.e. taking an etic approach); or they could use culturally specific instruments that are developed to be used in a specific culture (i.e. taking an emic approach). In reality, most clinicians use the universal classification systems.
- Kirmayer (2001) argues that even though DSM-IV includes suggestions for a cultural interpretation of disorders, it still represents Western concepts of illness and therefore it may not be easily applied to other cultures.
- Bhui (1999) argues that diagnostic systems are necessary for comparisons between different cultures, and therefore it is necessary to define concepts of depression in accord with psychiatric and indigenous belief systems.