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Discuss issues of bias in diagnostic systems

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Introduction

Discuss issues of bias in diagnostic systems If we consider abnormality as deviating from the norm, then what would we consider being ?normal?? Certain behaviours are expected from us at certain times and in certain situations, and if those expectations are not met, then the behaviour and the person may be judged as being ?bad? or ?sick?. This is the issue with diagnosing abnormality, what may be considered normal to one person, may be consider abnormal to others. Will there always be bias when diagnosing abnormality, as there is not a clear definition of what ?normal? really is? The Diagnostic and Statistical Manual of Mental Disorders (DSM) group?s disorders into categories and then offers specific guidance to psychiatrists by listing the symptoms required for a diagnosis to be given. The DSM assumes that all symptoms can be grouped together to form a specific mental disorder. It lists around 400 disorders including clinical depression. However, there are problems with these two classification systems. Diagnosis is the process of identifying a disease and allocating it to a category on the basis of symptoms and signs. Any system of classification will be of little value unless psychiatrists can agree with on another when trying to reach a diagnosis and so they can have inter-judge reliability. Another problem is that they are reductionist as they are based on medical/biological models, and they assume that illness can be identified by a set of specific symptoms. ...read more.

Middle

A major issue with psychiatric diagnosis is that they result in labelling. For instance, a person becomes a ?schizophrenic? rather than a person with schizophrenia, a label that tends to stick even when the disorder has disappeared. An invalid psychiatric diagnosis has serious and lifelong implications. For this reason, many critics prefer to avoid the use of such labels. An alternative is to use a more ideographic approach that doesn?t require classification but emphasis analysing each patient?s problems individually. Different parts of the world and different ethnic groups have different ways of explaining their behaviour. It must be asked whether the DSM criteria are valid beyond the culture they were created in. Cooper (1994) has suggested that social consequences should be included when defining features of a disorder, since the social environment of individuals varies so widely between cultures. This is because the same symptoms and behaviour that are tolerated in one culture may cause severe social problems in another culture, and it is unreliable for diagnostic decisions to be determined by cultural and social definitions. Different societies have different views about the causes of mental disorders, and therefore, are likely to have different views about treatment. Certain cultural and subcultural groups are treated differently. For example, Cochrane and Sashidharan (1995) found that black Afro-Caribbean immigrants in the UK are up to seven times more likely to be diagnosed with schizophrenia then white people. In terms of subcultural bias, Johnstone (1989) ...read more.

Conclusion

In diagnostic systems, there may be apparent cultural bias. Systems such as the DSM may not consider that in some cultures what is considered normal may be considered abnormal in others. Therefore, If an individual from one culture were living in a society that had a different culture, they may be labelled as abnormal and start to think they actually have an illness. Can the DSM generalise across the world? It raises issues that there are a lot of wrong diagnoses due to the systems only relating to one type of culture, if perhaps the systems could generalise across the world and take into consideration ethnicity, race, religion etc. then there may be less ?cultural bias?. In terms of gender bias, it seems that in mental illnesses such as depression, a lot more women seem to be diagnosed. A common explanation for this would be that perhaps women suffer more from the condition due to having children. However, there is no evidence of a difference between men and women psychologically, e.g. men being stronger psychologically than women, this again may just be labelling. It should be taken into consideration that perhaps the reason for the high rates of diagnosis with women having depression, may just be down the fact they are open to speak to people about the problem, and men may be more likely to ?hide? away from the problem. Realistically, there may be just as many men suffering with the same conditions as women. Systems need to consider all factors, and not just diagnose on a set of symptoms or just assume that someone is depressed because they are ?unhappy?. Charlotte Barrow ...read more.

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