Discuss cultural and ethical considerations in diagnosis (for example, cultural variation, stigmatization).

Cultural considerations

--> Cultural differences in the display of certain disorders
- The way in which people perceive certain disorders may differ from culture to culture. People in various cultures define disorders differently, depending on their social and cultural backgrounds. In individualistic cultures, people may define disorders as a mental illness, because of their background of depending on themselves to solve their own problems. On the contrary, people in collectivistic cultures define disorders as something having to do with physical illness, because they are less willing to admit to having a mental illness.

CASE STUDY: Elialilia Okello and Solvig Ekblad (2006)

Method: Individual Interviews
Participants: Clans in Uganda (extended family, hierarchy, collectivistic)
Procedures: Use vignettes to explore perception of depression
Findings: see treatment as help-seeking behavior. Depression = “illness of thoughts” not emotional illness. Therefore, do not need medicine, unless chronic or recurring
Strength: High ecological validity because of researchers are able to gain insights directly from the locals without having to manipulate them.
Weakness: There could be extraneous/confounding variables. Participants may not answer truthfully.

--> Cultural variations in the prevalence of disorders
- Different cultures also differ in the widespread of these disorders. The statistics vary because of the willingness to be diagnosed with mental illnesses, and being labeled as abnormal. The statistics are much higher in individualistic cultures which have individuals whom are more eager to express themselves and have less fear of being different. They are more willing to admit to having the disease and seeking treatment. For collectivistic cultures however, the statistics are much lower, out of the fear of being different and dishonoring their families. People in collectivistic cultures are more afraid of being labeled as abnormal, and aren’t as willing to be diagnosed and treated.

CASE STUDY: Hwu and Compton

Method: Statistic
Procedures: Studied prevalence lifetime depression using Diagnostic Interview Schedule (DIS)
Findings: Korea 3.3%, Iran 6.24%, New Zealand 12.6%
Strength: The result supports the theory because Korea, a collectivistic country, has a lower report rate than individualistic country like NZ. This suggests that less people are willing to admit.
Weakness: The result differs for some countries. This could result from different sensitivity of the measurement tool.

Ethical consideration: labeling
Self fulfilling prophecies: People may act as they are expected to (similar to stereotype threat) Prejudice/stereotyping/discrimination: People with psychological disorders may be discriminated
Patient may think the “cure” is around the corner

STUDY: Rosenhan
Aim: Rosenhan conducted two studies, both of which tested acclaimed psychologist’s abilities to distinguish between sanity and insanity.
Procedure: In the first study, Rosenhan sent 8 pseudopatients, who were, in actuality, healthy associates, to 8 different mental hospitals across the United States; each pseudopatient had called beforehand and created a scenario in where they had been experiencing brief periods of auditory hallucinations – immediately certifying their places within these institutions as patients with schizophrenia. After their admission, the pseudopatients carried on with their lifestyle as normally as they could under the given environment. Weeks went by as the hospital staff failed to distinguish these pseudopatients from their real patients – with some of the hospital staff believing that all these pseudopatients were abnormal, though they were behaving normally, than the patients with the same mental illness. The pseudopatients were later then released, several weeks later, with the term that their mental illness was in remission. Ensuing the first study, a doctor from a mental institution, who felt the circumstances under which they had been deceived were unjustifiable, felt that he needed to disprove Rosenhan’s claim that psychiatrists could not distinguish the sane from the insane; he challenged Rosenhan to send more associates. After a few weeks, hospital staff falsely identified multiple patients as imposters, when, in actuality, Rosenhan had not sent any pseudopatients at all.
Findings: In mental institutions, it is difficult to distinguish the sane from the insane and that it is dangerous to label people with a mental illness as it dehumanizes them from society.
Methodological strengths:
High ecological validity- this experiment has a high ecological validity due to the fact that the participants, in this case, the pseudopatients, were in a natural environment – the mental institutions; they were expected to behave normally while under a realistic environment that patients with mental illnesses are placed in.
Methodological limitations:
Generalizability- this experiment has problems with generalizability because it is difficult to generalize the results of this experiment to persons of older ages as the symptoms of a particular mental illness may be more lucid that ones in patients of younger ages.