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The world consists of a diversity of cultures and within these cultures, there are different definitions of what behaviour can be defined as normal or abnormal. Due to these different perspectives among different cultures, there can be a wrongful diagnosis of a patient with potential mental illnesses. These criteria, that are used to judge behaviour within each culture, are called clinical biases. Clinical bias can have an impact on the diagnosis of a patient due to the lack of knowledge of mental disorders from other cultures, cultural stereotypes, reporting bias, confirmation and symptoms that may vary across cultures. The two studies that I will be discussing, in which clinical biases are addressed, is Mendel et. al. (2011) and Naeem et. al. (2012). The study of Mendel et. al. investigated the role of confirmation bias in the process of diagnosing a patient with a mental disorder. The study of Naeem et. al. investigated the effectiveness of cognitive behaviour therapy in Pakistan because of the variety of ways that symptoms of depression can present themselves across different cultures.
Mendel et. al. focused on the influence of confirmation bias in mental health professionals. Confirmation bias is when you are more prone to search for information that confirms your beliefs or hypothesis. 75 medical students and 75 psychiatrists were assigned a decision task and found that 13% of the psychiatrists and 25% of the students showed confirmation bias when they searched for new information. This was after they already made an initial diagnosis. A large number of participants showed that they were less likely to change their initial diagnosis after searching for information that confirmed their diagnosis, than those who searched for contradictory information that challenged their first diagnosis. As a result, the participants who indicated confirmation bias misdiagnosed 70% of their patients. This led to prescribing different treatments from the participants who diagnosed their patients correctly. In conclusion, confirmation bias can lead to wrongful decisions building upon each other. Researchers or psychiatrists, in this case, should be aware of the impact of confirmation bias and search for balanced information during the diagnostic process.
The study of Naeem et. al. examined whether cognitive behaviour therapy would be effective to treat depression in Pakistan due to the variety of presentations of symptoms across cultures, specifically how depressive disorder symptoms present themselves among Pakistanis. The researchers interviewed outpatients that were diagnosed with depression at a university teaching hospital in Pakistan. The purpose of the interview was to determine the extent of the patient’s knowledge. Thus open-ended questions were asked about their general knowledge about mental illnesses, the health care system and their perceptions of the treatment they had been receiving. It resulted in the researchers noticing that the patients had very little to no knowledge about mental disorders or depression itself and were reluctant to discuss nonmedicinal treatments. This was possibly due to the difficulties of cross-cultural work, for the researchers stated that there were linguistic and interpretation issues. After an improved, second interview the researchers gathered that the Pakistani patients described their illness as a psychosocial problem that is caused by tension. Clinical bias in the form of cross-cultural variations of symptoms, for the patient has been treated with a universal treatment for their depressive disorder, namely cognitive behavioural therapy. This is not effective because of the cultural differences, therefore the treatment has been modified to fit the patient’s needs. In conclusion, the participants are more willing to accept medicinal treatments than therapy due to their perceptions of the illness. It is important for psychiatrists and doctors to know what the patient’s knowledge and perception are of the illness before diagnosing them to avoid clinical biases.
Clinical biases will always be present due to a person’s preconceived personal knowledge and beliefs. Thus researchers must be educated on how to eliminate biases as much as possible and use different techniques within an investigation. It should be a requirement to be educated on different cultures to eliminate misdiagnosed patients within a cross-cultured diagnosis. Mendel et. al. proved the severity of wrongful decisions in the diagnostic process that are caused by confirmation bias and Naeem et. al. thoroughly discussed the impact different moderations to cognitive behaviour treatment can make when people are more educated on the diverse presentation of symptoms within different cultures. When these biases are eliminated or reduced, researchers and psychiatrists are less prone to make inaccurate decisions.
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