One of the great questions of psychiatry is the degree to which a diagnosis is valid - that is, whether a diagnosis leads to appropriate treatment. There are many factors that may influence the validity of a diagnosis.  Environmental factors can and should play a role in diagnosis – for example, aversive childhood experiences and social class. There are also stereotypes that influence diagnosis, especially when diagnosing someone from a different culture. It is important that psychiatrists are aware of these factors in order to increase the possibility of making a valid diagnosis.

Li Re-pac carried out a study to see how stereotyping may play a role in diagnosis. She compared the diagnoses of European-American and Chinese-American psychiatrists on both European-American and Chinese male patients. All of the patients had been diagnosed with mental illness. The researcher carried out an interview with each patient; the interview was videotaped. The psychiatrists were randomly assigned videos and asked to rate the patient for normality. Each participant watched four videos – two European American and two Chinese patients. The European American psychiatrists found the Chinese patients to be more depressed and lower in self-esteem than the Chinese psychiatrists did. They also saw the Chinese patients as less socially competent. The Chinese psychiatrists judged quiet European clients as having a more serious illness.  This shows that the process of diagnosis is influenced by cultural background and stereotyping.

An appropriate study is used to demonstrate how cultural biases may affect the validity of diagnosis. The aim, procedure, results and implications are clearly described.

However, this study has many limitations. First, the study has a very small sample size of only ten participants. The participants were all friends of the researcher, which may have introduced demand characteristics into the study. In addition, actual stereotypes about the out-group were not measured prior to the study.  Therefore, an assumption is made that it was cultural background and stereotyping that affected the diagnosis. 

Social psychologists also discuss the role of “vulnerability models” in psychology.  In other words, is the diagnosis due to stereotyping of a group or is a group, in fact, more vulnerable to mental illness due to environmental and social risk factors?  Brown and Harris carried out a study to determine how social risk factors may play a role in the diagnosis of depression in working-class women in London.  The study asked women to fill out a survey of depressive symptoms as well as a Life Events Scale which quantified the number of significant stressors they had experienced in the last year.  The findings were that women who were depressed were the ones that had the most stressors in the past year.  The researchers found that the most significant risk facts were the loss of one’s mother at a young age, more than three children at home and unemployment.  It appears that these factors play a key role in the development of depression.

Vulnerability models and the study by Brown and Harris are clearly explained and linked to the question.

The study by Brown and Harris is rather dated.  The study was done before the Human Genome Project and the role of gene expression on behaviour was not the focus of research.  Brown and Harris simply found a correlation between life stressors and mental illness, but they could not explain why stressors lead to depression. In addition, the study was only carried out on women from an individualistic culture.  The results of the study may not be generalizable to other cultures where social support is an important part of a collectivistic culture. In addition, cognitive coping strategies were not considered. The stressor alone may not lead to depression – but instead how the stressor is interpreted. Finally, the study is problematic in that depressive symptoms were self-reported, but there was not an actual diagnosis of depression.

However, does this justify the higher level of diagnosis of mental illness in the lower classes? The Midtown Manhattan study carried out over 100 interviews and found that the highest levels of mental illness were in the lower class.  Johnstone argues that this may be biased. He found that working-class patients were more likely to receive a more serious diagnosis.  He also found that when interviewing health professionals, they were more likely to prescribe drug therapy to working-class patients, arguing that they were less literate and would not benefit from psychotherapy. It may not be an either-or situation.  The lower class is more vulnerable to mental illness – and as a result of stereotyping, they are more likely to be diagnosed with a serious illness.

Nadine Burke Harris argues that we should not be asking “what is wrong with you,” but “what has happened to you?”  More research is showing the effect of adverse childhood experiences on mental health.  Children that are exposed to violence, abuse or poverty are more likely to have both physical and mental health issues as an adult.  It is important for psychiatrists to take into consideration these sociocultural factors in making a diagnosis. Modern psychology argues that it is the interaction of these factors with biological factors that may lead to disorders.  Knowing the background of the client with regard to environmental stressors may help doctors reach a valid diagnosis.

Sociocultural factors are an important consideration in psychology.  On the one hand, it is important that psychiatrists are aware of their own cultural biases and how this may affect their diagnoses.  On the other hand, social factors should be taken into consideration, recognizing the role that stress plays in disorders such as depression and anxiety disorders.

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