Discuss cultural & ethical considerations in diagnosis

By now, we know about… 3 Diagnostic systems (DSM V, ICD 10, GOS) Reliability/validity issues w/diagnosis How diagnosis relates to treatment

Ethical Issues Disclosure  Stigma You are applying for your first job at a legal firm. You are very eager, you respect this firm a lot, and you can’t wait to start making money for yourself. You get to the part on the application where it asks you to disclose any medication you are taking. You have been taking antidepressants for years and have been very stable. Do you disclose this on the app? Discuss.

Ethical issues Your thoughts on disclosure What’s the value of this info to an employer? Drawbacks to sharing? Read (2007) research summary on stigma Attitudes towards those with medically diagnosed mental illness characterized by fear of unpredictability Remember: we tend to like organization/predictability/schematic organization

Ogunsemi et al (2008) Labeling/stigma (See handout) Also, remember Caetano (1973)/labeling theory study; highly applicable here A label can affect how others interact with a person A label can contribute to social stigma & possibly mis/overdiagnosis

Iatrogenesis Theo has struggled with uni polar depression on his own w/o diagnosis for quite some time. He is worried about obtaining diagnosis for a few reasons, but mainly he’s not sure he wants to dedicate himself to therapy (time, $$, energy). He finally does seek help, received diagnosis, and starts drug therapy/CBT. But, the SSRI seems to be causing more complications than the disorder itself. He’s really tired, he can’t function at work, sleeps in a lot, takes more leave, and eventually is let go by the company. Discuss: What role did drug treatment play here?

Iatrogenesis When treatment itself can worsen symptoms, or create them. Diagnosis  Treatment  Worsening of symptoms can be troublesome/demoralizing

Cultural impacts on diagnosis Cooper et al (1972) American & British psychiatrists showed lack of inter rater reliability when watching the same videotaped clinical interviews. Americans diagnosed schizophrenia 2x as often British diagnosed depression 2x as often Discuss: How can American/British culture contribute to this finding? Confirmation bias?

Cultural impacts on diagnosis Manson et al (1985) Emic study & cultural bias What if symptoms reported don’t ‘fit’ w/ diagnostic criteria, or patterns in criteria? Dev. Of American Indian Depression Scale to combat this 5 Hopi illness categories reflected lived Hopi symptoms Hopi language does not have a word = ‘depression’ Bhugra et al (1997) also found older Punjabi women used ‘weight on heart’ and ‘pressure on mind’ – NOT ‘depression’. One’s culture & language impacts diagnosis. Remember Swiss article we read about prevalence across German, French, Italian parts of Switz.