How does culture affect diagnosis?

Culture can affect the diagnosis and treatment of mental disorders, as different cultures have different attitudes to mental disorders. In Morocco, for example, it is thought you can catch a mental illness accidentally by encountering some sorcery, such as stepping on it. They truly believe mental disorders come from sorcery and evil things. This affects treatment and how the mentally ill person is seen – they are often feared as there is a possibility the evil could spread. Culture can also affect how much information a patient is likely to disclose.

Casas (1995) found that a lot of African Americans do not like to share their personal information with people of a different race. Sue and Sue (1992) found that many Asian Americans don’t like to talk about their emotions and are more reluctant to admit to having a mental illness. Even when they do admit to being ill, they are not forthcoming in terms of discussing their symptoms with the therapist. This can affect diagnosis, as not all the symptoms may have been mentioned and so a suitable course of treatment cannot be easily formulated.

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One school of thought believes that culture does not affect diagnosis as mental disorders are scientific. The DSM was developed in the USA and is used widely in many other cultures. This is a valid use if mental disorders are clearly defined with specific features and symptoms.

Basically, mental disorders are scientifically defined illnesses that are explained in a scientific way. Research evidence comes from Lee’s study (2006).

This was conducted in Korea deliberately to see if the DSM-IV-TR was valid in a non-Western culture, and it was found that it was for ADHD. On the flip side, there are studies that have shown that culture can affect diagnosis. There are studies that have shown that culture can play an influential role in diagnosis. For example, symptoms that are seen in Western countries as characterising schizophrenia, such as auditory hallucinations, are interpreted in other countries as showing possession by a spirit, which render someone special in a positive way, not in a negative “disorder” way. Therefore, depending on cultural interpretations of what is being measured, the DSM is not always valid. A clinician from one culture must be aware that a patient from another culture is guided by their own frame of reference.

It does seem to be the case that there are actual cultural differences in mental disorders like schizophrenia. It has been reported that catatonic schizophrenia is on the decline and this could be because of health measures that prevent the development of this type of schizophrenia. Chandrasena (1986) reported more incidences of catatonia in Sri Lanka (21%) compared with 5% among British white people. However, it was also found that in Sri Lanka it was less likely that patients had received early interventions with drug treatment. This was not therefore a cultural difference in the attitude to the mental disorder, but a difference in treatment availability. After considering the pivotal role that culture plays in a person’s mental health, ideas have been put forward to overcome cultural bias in diagnosis. Ideas include: moving away from emphasis on first rank symptoms and interpretation as well as focus on more negative symptoms are they are more objectively measured.

On problem with schizophrenia is that, first rank symptoms tend to be weighted as more important when making a diagnosis. First rank symptoms include hearing voices, delusions and disorganised thinking. However, first rank symptoms are also more open to interpretation, which means that there might be cultural issues with regard to interpretation. Flaum et al. (1991) found a lack of reliability when using the DSM with regard to first rank symptoms and that was with a similar sample from one culture. Therefore, it is likely that such unreliability would be magnified if we used first rank symptoms across different cultures. Similarly, with regard to diagnosis there should be greater emphasis on symptoms that are objectively measured. Flaum suggests that negative symptoms (for example poverty of speech) are more objectively assessed and measured than positive symptoms, like hallucinations. Minimising first rank symptoms and placing more emphasis on negative symptoms would mean less unreliability with regard to diagnosis across cultures.

Culture-bound syndromes are mental health problems (or other illnesses) with a set of symptoms found and recognised as an illness only in one culture. Penis panic is an example. In some cultures males may think that their penis will retract into their bodies- and women may think the same about their breasts. This is known as genital retraction syndrome. Such panics have been found around the world but mainly in Africa and Asia. Another example is “Hikikomori”, a condition which has attracted concern in Japan recently, affecting mainly male teens that are otherwise perfectly healthy. The condition makes them withdraw completely, locking themselves in their rooms for long periods of time (years). The Japanese government have described “Hikikomori” as a social disorder rather than a mental disorder, and say it is representative of the economic downturn the country is going through.