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Discuss Cultural And Ethical Considerations In Diagnosis Essay

 

D.

This is done along with a subjective evaluation.

E.

Encourages clinicians to use a more holistic diagnostic system.

F.

Each person is analyzed according to a bio psych- social frame work.

G.

Encourages on holistic observation of everything that could effect the person

H.

 Assumes clinicians are able to look deeper into a patient

I.

Up to date- Updated to make sure diagnosis is as easy as possible

J.

Multi axial approach, not only if they have symptoms. Includes medical conditions,psychological and environmental problems, and how well they are functioning.

V.

ISD - International Classification of Diseases

A.

More commonly used internationally than the DSM

B.

Originally intended by the WHO to be a means of standardizing recording of causes of death

C.

Covers a wide range of diseases and conditions

1.

Classification rather than diagnosis

D.

One chapter categorizes mental disorders

1.

Looks similar to DSM-IV System

E.

Strengths:

1.

Covers a wide range of diseases and conditions, giving a complete classification instead ofa diagnosis.

2.

More internationally recognized than the DSM

F.

Weaknesses:

1.

Some chapters look similar to the DSM-IV system

2.

With each revision, differences between the ICD and DSM are becoming fewer.

Discuss the cultural and ethical considerations in diagnosis

I.Confirmation Bias Phenomena: A.Confirmation Bias:Clinicians tend to have expectations about the person who consults them, assuming that if thepatient is there in the first place there must be some disorder to diagnose.B.It is the job of a clinician to diagnose abnormality so they may overreact and see abnormalitywherever they look.C.Link to Rosenhan: Participants in this study did not have any psychological disorder; howeverwhen describing their “symptoms” doctors searched for ones that correlated to schizophrenia. Also, when the participants in the institutions were admitted, any behavior from them wasconsidered to be a symptom of the disease.II.Institutionalization influences HOW the nursing staff views the patients: A.Define institutionalization:

To make into, treat as, or give the character of an institution.B.Explain how institutionalization can also be a confounding variable1.Once admitted, it was very difficult for the pseudo-patients to get out.2.This could be because once one is admitted, all behaviour is perceived as being a symptomof the illness.3.Powerlessness & depersonalizationa)Produced in institutions through lack of rights, constructive activity, choice, and privacy.C.Use examples from Rosenhan (1973) to explain how this occurs.1.All behaviours of Rosenhan’s participants were seen as being symptomatic of schizophrenia.a)Pseudo-patients would take notes, this would be recorded by the nurses as “patientengages in writing behaviour”b)Participants would never be asked why they were taking notes, but instead, the nurseswould take their behaviour as “paranoid behaviour”, etc. instead.III.Racial / Ethnic Issues: A.Jenkins-Hall and Sacco [1991] – AMPFPC and Brief Evaluation

 Aim:

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PSL.

Discuss cultural and ethical considerations in diagnosis. (22)

Discuss (22) – A considered and balanced review, including a range of arguments, factors or hypothesis. Opinions and conclusions presented clearly supported by appropriate evidence.



Classification/Diagnosis systems
  • Classification systems are suppose to be objective.
  • Traditional medical model in psychiatry is now assumed to be reductionist.
  • Most psychiatrists use a biopsychosocial approach in diagnosis and treatment.
  • Diagnose based on symptoms.
  • Affective (mood) symptoms
  • Behavioural symptoms
  • Cognitive (thought process) symptoms
  • Somatic (physical) symptoms
  • Based heavily upon abnormal experiences and belief reported by patients.
  • Agreed by a team of professionals.
  • Explains why Classification/Diagnosis systems are often updated and revised.

Strengths of classification systems

  • Statistical diagnosis
  • Quantifiable
  • Ability to identify disorders based on symptoms
  • Therefore suitable treatment can be applied

Weakness of classification systems

  • Ethical consideration is the main weakness of Classification systems
  • The effects of labeling
  • Leads to stigmatisation
  • Prejudice and discrimination
  • Self labeling can lead to Self-fulfilling prophecy
  • Person diagnosed with disorder act according to the label
Cultural considerations
  • An individual’s behaviour is governed to an extent by the culture they are brought up in.
  • There are likely to be different perceptions of behaviour in different cultures, different cultural norms.
  • A tendency to favor one’s own cultural view of the world.
  • Studies on psychological disorders originated from the west, hence the tendency that the diagnosis system favor the western culture.
Erinosho &amp Ayonrinde – Nigeria Yoruba Tribe study
[A]Investigate the cultural differences in criteria of normality and abnormality.
[P]
  • Participants were tribesmen from the Yoruba tribe in Nigeria.
  • Information of patients with schizophrenia were presented to people of the Yoruba Tribe.
[F]
  • Only 40% of the tribesmen from the Yoruba tribe identified the patients as mentally ill.
  • 30% of the tribesmen said they would marry such person.
  • This maybe due to the cultural differences between the tribesmen and the westernized world (see Binitie’s study).
[C]
  • Shows the importance of an emic approach in studies.
  • The ability to identify the definition of “abnormality” in different cultures can only be done in culture specific approach in studies.
Binitie – Schizophrenia in Nigeria
[A]Investigate the cultural differences in criteria of normality and abnormality.
[P]
  • Participants were Nigerians living in the city.
  • Information of patients with schizophrenia were presented to the participants.
[F]
  • Most participants correctly identified the patients as mentally ill.
  • 31% showed aggressive response to such patients e.g. suggesting that they should be expelled or shot.
[C]
  • Shows how western culture has influenced the judgement of normality (compared with Yoruba tribe study).

Overall conclusion

  • Seems that Schizophrenia is a western model, Tribal Nigerians did not see hallucination as something negative.
  • Cultural relativism suggests that abnormality is subjective cross culturally.
  • Hallucinations and cultural perspectives was also investigated in the Kasamatsu & Hirai – Monk Serotonin Study. Hallucination is seen to be a spiritual experience by Japanese monks.

DCM vs CCMD

  • Diagnostic and Statistical Manual of Mental Disorders (DCM) – Internationally recognised diagnosis system, westernised model.
  • Chinese Classification of Mental Disorders (CCMD) – China specific diagnosis system based upon the chinese cultural background.
  • The need for more than one classification systems suggests that culture has its effect on the criteria for abnormality and syndromes.
  • Uses different criteria in the different classification systems.
  • Takes care of certain Culture-Bound Syndromes.
Ethical considerations
  • Ethical concerns regarding diagnosis mainly surround the issue of Labeling and its consequences.
  • After diagnosis, the patient will inevitably be labeled with the diagnosed illness.
  • Labeling will cause Stigmatisation.
  • Where the patient will have a negative persona attached to them because they are labeled as mentally ill.

Depersonalisation and powerlessness

  • Removal of human rights, frequent verbal or physical abuse.
  • Usually seen in mental institutes.
  • Demonstrated in Rosenhan’s study.
  • Participants reported that cases of depersonalisation were observed in the institute.
  • This thereby worsens the mental illness.

Self-fulfilling prophecy

  • Patients may start to act according to the label they were given because they think they should act that way.
  • Demonstrated in Scheff’s Labeling theory.
  • “Scheff (1966) argued that receiving a psychiatric diagnosis creates a stigma or mark of social disgrace.” (Turner, 77)
  • Showed criticism toward the classification systems, in particular the diagnosis of schizophrenia.
  • Schizophrenic does not mean that they will break formal and obvious rules;
  • But residual rule breaking (basically breaking the norm i.e. talking to themselves).
  • He argued that many people breaks residual rules, but only those referred to a psychiatrist acquire a label, which influences their behaviour.

Prejudice and discrimination

  • Demonstrated in Rosenhan’s study
  • Stickiness of diagnostic labels
  • When an individual returns to society, their record of mental illness goes with them.
  • The pseudo-patients left with a diagnosis of ‘schizophrenia in remission’.
  • This can lead to stigmatisation, stereotyping and discrimination against those who have been mentally disordered.
  • Making reintegration back into the community difficult.

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