Cultural Biases and Misdiagnoses

Cultural biases about health and illness, and beliefs about which individuals and/or groups are most susceptible to one or another disorder is key among these factors. Clearly, both health care practitioners and patients have cultural backgrounds through which perceptions of each will be filtered.

This discussion, however, is focused on the biases of practitioners when observing their patients. Biases are prejudicial points of view focused upon an object represented by selected perceptions framed by a particular sociocultural background, such as racist beliefs about differences between Blacks and Whites in the United States.

The influences of biases on decision making are often unintentional, expressed unconsciously, and as a consequence may be difficult to control in the doctor-patient relationship (Watson, 1982, 1984).

Biases regarding African Americans

The beliefs about the African Americans are as follows:

  • Inherent Racial Susceptibility. It was once believed that high rates of hospitalization for the treatment of selected mental disorders among African Americans was due to an “inherent racial susceptibility” to certain kinds of psychopathology (Thomas & Sillin, 1972; Williams, 1986)
  • Low Rates of Depression. Some psychiatrists believed that African Americans, as a group, tended to have low rates of depression because of their historical social and educational oppression. Somehow, being oppressed and deprived functioned as a social psychological shield against depression: Blacks were less vulnerable because they had less to lose (Prange, 1962)

Research and studies reveal the following:

  • Epidemiological and etiological research have subsequently shown that depression and other illnesses are much more complex disorders than that suggested by the foregoing statements and must be carefully studied, including cross-cultural variations in symptoms of disorders before drawing conclusions and formulating treatment plans
  • The two most comprehensive community based studies, the Epidemiological Catchment Area (ECA) Survey (1980–1985) and the National Co-Morbidity Survey (1990–1992) contained only several hundred ethnic minority older adults (African American, American Indian and Alaskan Natives, Asian American and Pacific Islanders, or Hispanic Americans). Numerous authors have reported that misdiagnosis and clinical bias commonly occur in the psychiatric assessment of African American patients of all ages
  • Though some studies report that African Americans are more likely than white older adults to be diagnosed as schizophrenic and less likely to be diagnosed with mood disorders, ethnic differences in the prevalence of these disorders is reduced (Baker, 1997)
  • Other studies suggest that the failure to accurately diagnose symptoms of depression, manic depression and other mood and anxiety disorders among African Americans sometimes results from preconceived notions that Blacks are “happy-go-lucky” people or some other stereotype (Adebimpe, 1981; Poussaint, 1983; Williams, 1986)

Cultural insensitivity and deeply rooted prejudices, along with a lack of cross-cultural study by professionals focusing on the cultural backgrounds of their clients/patients, contribute to risks of misdiagnoses and inappropriate treatment plans, especially but not exclusively in the care of Black older adults with mental disorders.