Discuss cultural and ethical considerations in diagnosis.
Discuss - offer a considered and balanced review that includes a range of arguments, factors, and
hypotheses. Conclusions should be presented clearly and supported by appropriate evidence.
Introduction
Psychological diagnosis focuses on identifying and classifying abnormal behaviour based on the patient’s
symptoms, self-reports, observations, and clinical tests. However, to protect patients from potential harm
and increase the accuracy of the diagnosis and efficiency of the subsequent treatment, psychologists have
to take into account a number of cultural and ethical considerations. This essay will offer a considered and
balanced review of these considerations.
Cultural considerations
Culture has an immense influence on people’s understanding of the surrounding them world, which
consequently leads to a different understanding of the word ‘abnormal’ when assessing symptoms.
Therefore, it often impacts the validity and reliability of diagnosis. Culture may also influence psychiatric
diagnosis, for example different cultural groups have different attitudes to psychological disorders that
may affects the reporting of symptoms and diagnosis (i.e due to stigmatization), there may exist cultural
bias in diagnosis, and the existence of culture-bound syndromes (disorders that are specific to a particular
cultures).
The western, or etic approach is based on the Diagnostic and Statistical Manual of Mental Disorders
(DSM), published by the American Psychiatric Association, which provides set criteria for diagnosing
disorders. It is criticised, however, for its lack of consideration for cultural factors. This is perhaps, the
reason why there exist culturally-adjusted alternatives to the DSM, such as the Chinese Classification of
Mental Disorders (CCMD) which features a variety of syndromes that are not recognized by the DSM. It
includes disorders such as the Shenjing Shuairuo (or Neurasthenia) which signifies ‘a weakness of
nerves’. The diagnosis is a type of depression characterized by bodily symptoms, fatigue and depressed
feelings. One reason for the existence of neurasthenia could be rooted in the Chinese medicine which
explains disorders in terms of disharmony of vital organs. However, it is possible that this is an alternative
term of depression, since depression is a heavily stigmatized disorder in the Chinese culture.
Supporting study 1:
Zhang et al. (1998) investigated the cross-cultural differences in prevalence of depression in China. He
conducted a survey in 12 regions of China where only 16 out of over 19,000 people reported having a
mood disorder at any point in their lives, which is considerably less than in the West. He also concluded
that Chinese people may not distinguish physical and emotional pain which could be the reason why they
only consult doctors when they suffer from a physical pain. Therefore, in their culture depression is often
overlooked. However, Zhang reports that in the 1980s, 80% of psychiatric patients suffered from
neurasthenia, which as opposed to depression, also includes somatic symptoms (symptoms affecting the
cellular level of the human body).
Supporting study 2:
Kleinman (1982) wanted to investigate if neurasthenia in China could be similar to depression as
described DSM-III. He interviewed 100 patients diagnosed with neurasthenia using structured interviews
based on the DSM-III diagnostic criteria. He found that 87% of the patients could be suffering from
depression based on the patients complaints, even though only 9% complained about depressive mood.
Most patients in the study reported only physical symptoms. Chinese patients did not make the same
complaints as Western patients, therefore it could be deduced that the Chinese rely more on somatic
explanations of their well-being, while the Westerners more often refer to their mood. The main
implication of that is that Western doctors should employ the relativist approach (emic) when diagnosing
Discuss - offer a considered and balanced review that includes a range of arguments, factors, and
hypotheses. Conclusions should be presented clearly and supported by appropriate evidence.
Introduction
Psychological diagnosis focuses on identifying and classifying abnormal behaviour based on the patient’s
symptoms, self-reports, observations, and clinical tests. However, to protect patients from potential harm
and increase the accuracy of the diagnosis and efficiency of the subsequent treatment, psychologists have
to take into account a number of cultural and ethical considerations. This essay will offer a considered and
balanced review of these considerations.
Cultural considerations
Culture has an immense influence on people’s understanding of the surrounding them world, which
consequently leads to a different understanding of the word ‘abnormal’ when assessing symptoms.
Therefore, it often impacts the validity and reliability of diagnosis. Culture may also influence psychiatric
diagnosis, for example different cultural groups have different attitudes to psychological disorders that
may affects the reporting of symptoms and diagnosis (i.e due to stigmatization), there may exist cultural
bias in diagnosis, and the existence of culture-bound syndromes (disorders that are specific to a particular
cultures).
The western, or etic approach is based on the Diagnostic and Statistical Manual of Mental Disorders
(DSM), published by the American Psychiatric Association, which provides set criteria for diagnosing
disorders. It is criticised, however, for its lack of consideration for cultural factors. This is perhaps, the
reason why there exist culturally-adjusted alternatives to the DSM, such as the Chinese Classification of
Mental Disorders (CCMD) which features a variety of syndromes that are not recognized by the DSM. It
includes disorders such as the Shenjing Shuairuo (or Neurasthenia) which signifies ‘a weakness of
nerves’. The diagnosis is a type of depression characterized by bodily symptoms, fatigue and depressed
feelings. One reason for the existence of neurasthenia could be rooted in the Chinese medicine which
explains disorders in terms of disharmony of vital organs. However, it is possible that this is an alternative
term of depression, since depression is a heavily stigmatized disorder in the Chinese culture.
Supporting study 1:
Zhang et al. (1998) investigated the cross-cultural differences in prevalence of depression in China. He
conducted a survey in 12 regions of China where only 16 out of over 19,000 people reported having a
mood disorder at any point in their lives, which is considerably less than in the West. He also concluded
that Chinese people may not distinguish physical and emotional pain which could be the reason why they
only consult doctors when they suffer from a physical pain. Therefore, in their culture depression is often
overlooked. However, Zhang reports that in the 1980s, 80% of psychiatric patients suffered from
neurasthenia, which as opposed to depression, also includes somatic symptoms (symptoms affecting the
cellular level of the human body).
Supporting study 2:
Kleinman (1982) wanted to investigate if neurasthenia in China could be similar to depression as
described DSM-III. He interviewed 100 patients diagnosed with neurasthenia using structured interviews
based on the DSM-III diagnostic criteria. He found that 87% of the patients could be suffering from
depression based on the patients complaints, even though only 9% complained about depressive mood.
Most patients in the study reported only physical symptoms. Chinese patients did not make the same
complaints as Western patients, therefore it could be deduced that the Chinese rely more on somatic
explanations of their well-being, while the Westerners more often refer to their mood. The main
implication of that is that Western doctors should employ the relativist approach (emic) when diagnosing
