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Thomas S. May, M.A.Medical Writer |
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Psychiatry's Diagnostic Bible Culturally Biased: Minorities Often Misdiagnosed
Thomas May, Medical Writer Introduction Some psychiatrists say mental illness is often misdiagnosed in members of ethnic minority groups because of cultural bias in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is psychiatry's "diagnostic bible" or main reference textbook. The DSM, now in its fourth edition, is published by the American Psychiatric Association and is used by most psychiatrists and clinical psychologists in the United States, as well as in many other Western countries, to diagnose and treat mental illness.
"The DSM IV is culturally biased, as is every other document
produced by human beings," says Edward Foulks, MD, PhD, a professor of
psychiatry at Tulane University Medical School in New Orleans.
According to Foulks, the textbook plainly states that the information is based on the experience of psychiatrists in North America. Cultural exceptions to the rule have been inserted in almost every category, "in order to recognize that the US and Canada--as well as most other countries-- are multicultural and diverse," which means that psychiatrists should keep cultural differences in mind when they diagnose a patient, Foulks claims.
Nevertheless, people are often misdiagnosed because of their cultural
background, according to Foulks. He cites examples from studies that
suggest
African Americans are sometimes wrongly diagnosed with paranoid
schizophrenia. Major depressive disorder may be overlooked in some
Asian
American patients who have been conditioned by their culture to talk
about their body to describe their emotions, according to Foulks. Illness or Ethnic Expression? In a 1999 Journal of Nervous and Mental Disease article, Foulks and his colleagues point out that North American psychiatrists tend to think that certain behaviors are evidence of mental illness, even though these behaviors are considered normal in the person's culture. For instance, many psychiatrists have diagnosed "dependent personality disorders" in Asians and Asian Americans who come from a culture that promotes submissive behavior towards authority. Also, people of Latin or Mediterranean descent may be loud and boisterous. This kind of behavior is quite common and accepted in their cultures. But based on the DSM criteria, they may be diagnosed with "histrionic personality," according to Foulks. What's more: "Members of racial minorities and former political prisoners who have suffered intense experiences of persecution and discrimination are at times diagnosed with paranoid personality disorders," Foulks claims. Members of some ethnic minority groups tend to be over-diagnosed, but others may not be properly diagnosed, even when they actually have a mental illness. The reason, according to an article in Clinical Psychology Review, is that the way people express how they feel differs among cultures.
For example, symptoms of depression may be "masked" in some Asians, the
authors claim. Many Asian cultures discourage open expression of emotion
and stigmatize mental illness: So, people of Asian descent often try not
to show their low mood. Instead, they play up their somatic (bodily)
symptoms, which means they are less likely to be diagnosed with
depression. Culture-bound Syndromes According to Jerome Wakefield of Rutgers University: In the 19th century, textbooks in the United States described a mental illness called "drapetomania." Drapetomania was said to afflict slaves who had escaped from their masters. Although drapetomania is not mentioned in the most recent edition of the DSM, a number of so-called "culture-bound syndromes and idioms of distress" are included in the textbook. Culture-bound syndromes are psychiatric disorders that are set apart from Western categories and are unique to a particular culture, according to the DSM, which includes 25 such disorders. One particularly interesting one is called ataque de nervios. Ataque de nervios or "attack of the nerves" is said to be common among members of Latino groups, particularly those from the Caribbean, says Steven Lopez, PhD, a professor of clinical psychology at University of California, Los Angeles. "Symptoms commonly associated with ataque de nervios include trembling, attacks of crying, screaming uncontrollably, and becoming verbally or physically aggressive. A general feature experienced by most sufferers of ataque de nervios is feeling out of control," according to Lopez.
Other culture-bound syndromes listed in the DSM include "amok" (a
sudden mass assault by a single person) among Malaysians and "taijin
kyofusho" (an intense fear of social interaction) among the Japanese.
Thomas S. May is a medical
journalist based in Toronto, Ontario, Canada. He has a master's degree in
psychology from Simon Fraser University in Burnaby, British Columbia. Source: Medscape Health
Reprinted from Medscape Health for Consumers.
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