Advertisement

Ethnicity/race, paranoia, and psychiatric diagnoses: Clinician bias versus sociocultural differences

  • Arthur L. Whaley
Article

Abstract

Two contradictory assumptions underlie research on race differences in psychiatric diagnoses: (1) the “clinician bias” (CB) hypothesis, which assumes that Blacks and Whites exhibit symptomatology similarly, but diagnosticians mistakenly judge them differently; and (2) the “cultural relativity” (CR) hypothesis, which assumes that Blacks and Whites have different modes of expressing psychopathology but diagnosticians are unaware of or insensitive to such cultural differences. The purpose of the present study is to conduct a comparative test of the CB and CR hypotheses focusing on paranoid symptoms. The study examines race differences on the scales of Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs and Perceptions (FBP) from the Psychiatric Epidemiology Research Interview (PERI), which measure different types of symptoms ranging from relatively ordinary suspiciousness (i.e., mild paranoia) to the severe kind of paranoia often observed in schizophrenia, in relation to rigorous research diagnoses of depression and schizophrenia-like disorders. In effect, the CB and CR hypotheses become the null and alternative hypotheses, respectively, under conditions where the diagnoses are made according to research criteria. The present findings support the CR hypothesis over the CB hypothesis. The implications of these results for the psychiatric misdiagnosis of Black individuals are discussed.

Key words

Blacks clinician bias depression paranoia psychiatric diagnosis schizophrenia sociocultural differences 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adebimpe, V. R. (1981). White norms and psychiatric diagnosis: Overview.American Journal of Psychiatry, 138, 279–285.PubMedGoogle Scholar
  2. Adebimpe, V. R. (1982). Psychiatric symptoms in black patients. In S. M. Turner & R. T. Jones (Eds.),Behavior modification in black populations (pp. 57–71). New York: Plenum.Google Scholar
  3. Adebimpe, V. R., & Cohen, E. (1989). Schizophrenia and affective disorder in Black and White patients: A methodological note.Journal of the National Medical Association, 81, 761–765.PubMedGoogle Scholar
  4. Adebimpe, V. R., Klein, H. E., & Fried, J. (1981). Hallucinations and delusions in black psychiatric patients.Journal of the National Medical Association, 73, 517–520.PubMedGoogle Scholar
  5. Adebimpe, V. R., Chu, C. C., Klein, H. E., & Lange, M. H. (1982). Racial and geographic differences in the psychopathology of schizophrenia.American Journal of Psychiatry, 139, 888–891.PubMedGoogle Scholar
  6. Adebimpe, V. R., Hedlund, J. L., Cho, D. W., & Wood, J. B. (1982). Symptomatology of depression in black and white patients.Journal of the National Medical Association, 74, 185–190.PubMedGoogle Scholar
  7. Ashby, H. U. (1986). Mislabeling the black client: A reply to Ridley.American Psychologist, 41, 224–225.CrossRefGoogle Scholar
  8. Baskin, D. (1984). Cross-cultural categorization of mental illness.Psychiatric Forum, 12, 36–44.Google Scholar
  9. Baskin, D., Bluestone, H., & Nelson, M. (1981). Ethnicity and psychiatric diagnosis.Journal of Clinical Psychology, 37, 529–537.PubMedGoogle Scholar
  10. Bell, C. C., & Mehta, H. (1980). The misdiagnosis of black patients with manic-depressive illness.Journal of the National Medical Association, 72, 141–145.PubMedGoogle Scholar
  11. Bell, C. C., & Mehta, H. (1981). Misdiagnosis of black patients with manic-depressive illness: Second in a series.Journal of the National Medical Association, 73, 101–107.PubMedGoogle Scholar
  12. Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions.Behaviour Research and Therapy, 32, 331–341.CrossRefPubMedGoogle Scholar
  13. Bronstein, P. (1986). Self-disclosure, paranoia, and unaware racism: Another look at the black client and the white therapist.American Psychologist, 41, 225–226.CrossRefGoogle Scholar
  14. Collins, J. L., Rickman, L. E., & Mathura, C. B. (1980). Frequency of schizophrenia and depression in a black inpatient population.Journal of the National Medical Association, 72, 851–856.PubMedGoogle Scholar
  15. Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology.Journal of Consulting and Clinical Psychology, 24, 349–354.Google Scholar
  16. Dohrenwend, B. P., Levav, I., & Shrout, P. (1986). Screening scales from the Psychiatric Epidemiology Research Interview (PERI). In M. M. Weissman, J. K. Myers, & C. E. Ross (Eds.),Community surveys of psychiatric disorders (pp. 349–375). New Brunswick, NJ: Rutgers University Press.Google Scholar
  17. Dohrenwend, B. P., Shrout, P., Egri, G., & Mendelsohn, F. S. (1980). Measures of nonspecific psychological distress and other dimensions of psychopathology in the general population.Archives of General Psychiatry, 37, 1229–1236.Google Scholar
  18. Dohrenwend, B. P., Shrout, P., Link, B. G., Martin, J. L., & Skodol, A. E. (1986). Overview and initial results from a risk-factor study of depression and schizophrenia. In J. Barrett & R. M. Rose (Eds.),Mental disorders in the community (pp. 184–215). New York: Guilford.Google Scholar
  19. Fabrega, H., Mezzich, J., & Ulrich, R. F. (1988). Black-White differences in psychopathology in an urban psychiatric population.Comprehensive Psychiatry, 29, 285–297.CrossRefPubMedGoogle Scholar
  20. Fenigstein, A., & Vanable, P. A. (1992). Paranoia and self-consciousness.Journal of Personality and Social Psychology, 62, 129–138.CrossRefPubMedGoogle Scholar
  21. Gift, T. E., & Harder, D. W. (1985). The severity of psychiatric disorder: A replication.Psychiatry Research, 14, 163–173.CrossRefPubMedGoogle Scholar
  22. Grier, W. H., & Cobb, P. M. (1968).Black rage. New York: Basic Books.Google Scholar
  23. Hendricks, L. E., Bayton, J. A., Collins, J. L., Mathura, C. B., McMillan, S. R., & Montgomery, T. A. (1983). The NIMH Diagnostic Interview Schedule: A test of its validity with Black adults.Journal of the National Medical Association, 75, 667–671.PubMedGoogle Scholar
  24. Jampala, V., Chowdary, S., & Taylor, M. A. (1988). The use of DSM III in the United States: A case of not going by the book.Comprehensive Psychiatry, 29, 39–47.CrossRefPubMedGoogle Scholar
  25. Jones, B. E., & Gray, B. A. (1986). Problems in diagnosing schizophrenia and affective disorders among blacks.Hospital and Community Psychiatry, 37, 61–65.PubMedGoogle Scholar
  26. Khuri, R., & Wood, K. (1984). The role of diagnosis in a psychiatric emergency setting.Hospital & Community Psychiatry, 35, 715–718.Google Scholar
  27. Lewis, D. O., Shanok, S. S., Cohen, R. J., Kligfield, M., & Frisone, G. (1980). Race bias in the diagnosis and disposition of violent adolescents.American Journal of Psychiatry, 137, 1211–1216.PubMedGoogle Scholar
  28. Loring, M., & Powell, B. (1988). Gender, race, and DSM-II: A study of the objectivity of psychiatric diagnostic behavior.Journal of Health and Social Behavior, 29, 1–22.PubMedGoogle Scholar
  29. Malgady, R. G. (1996). The question of cultural bias in assessment and diagnosis of ethnic minority clients: Let's reject the null hypothesis.Professional Psychology: Research and Practice, 27, 73–77.CrossRefGoogle Scholar
  30. Maultsby, M. C., Jr. (1982). A historical new of blacks' distrust of psychiatry. In S. M. Turner & R. T. Jones (Eds.),Behavior modification in black population (pp. 39–55). New York: Plenum.Google Scholar
  31. Mirowsky, J. (1985). Disorder and its context: Paranoid beliefs as thematic elements of thoughts problems, hallucinations, and delusions under threatening social conditions. In J. R. Greenley (Ed.),Research in community mental health (Vol. 5, pp. 185–204). Greenwich, CT: JAI Press.Google Scholar
  32. Mirowsky, J., & Ross, C. E. (1983). Paranoia and the structure of powerlessness.American Sociological Review, 48, 228–239.PubMedGoogle Scholar
  33. Mitchell, J., & Vierkant, A. D. (1989). Delusions and hallucinations as a reflection of the subcultural milieu among psychotic patients of the 1930s and 1980s.Journal of Psychology, 123, 269–274.PubMedGoogle Scholar
  34. Mukherjee, S., Shukla, S., Woodle, J., Rosen, A. M., & Olarte, S. (1983). Misdiagnosis of schizophrenia in bipolar patients: A multiethnic comparison.American Journal of Psychiatry, 140, 1571–1574.PubMedGoogle Scholar
  35. Neighbors, H. W. (1984). The distribution of psychiatric morbidity in black Americans: A review and suggestions for research.Community Mental Health Journal, 20, 169–181.PubMedGoogle Scholar
  36. Neighbors, H. W., Jackson, J. S., Campbell, L., & Williams, D. (1989). The influence of racial factors on psychiatric diagnosis: A review and suggestions for research.Community Mental Health Journal 25, 301–311.CrossRefPubMedGoogle Scholar
  37. Neter, J., Wasserman, W., & Kutner, M. H. (1989).Applied linear regression models (2nd ed.). Burr Ridge, IL: Irwin.Google Scholar
  38. Pavkov, T. W., Lewis, D. A., & Lyons, J. S. (1989). Psychiatric diagnoses and racial biases: An empirical investigation.Professional Psychology: Research and Practice, 6, 364–368.CrossRefGoogle Scholar
  39. Ridley, C. R. (1984). Clinical treatment of the nondisclosing black client: A therapeutic paradox.American Psychologist, 39, 1234–1244.CrossRefPubMedGoogle Scholar
  40. Ridley, C. R. (1986). Optimum service delivery to the black client.American Psychologist, 41, 226–226.CrossRefGoogle Scholar
  41. Shrout, P. E., Lyons, M., Dohrenwend, B. P., Skodol, A. E., Solomon, M., & Kass, F. (1988). Changing time frames on symptom inventories: Effects on the Psychiatric Epidemiology Research Interview.Journal of Consulting and Clinical Psychology, 56, 267–272.CrossRefPubMedGoogle Scholar
  42. Simon, R. J., Fleiss, J. L., Gurland, B. J., Stiller, P. R., & Sharpe, L. (1973). Depression and schizophrenia in hospitalized black and white mental patients.Archives of General Psychiatry, 28, 509–513.PubMedGoogle Scholar
  43. Skodol, A. E., Williams, J. B. W., Spitzer, R. L., Gibbon, M., & Kass, F. (1984). Identifying common errors in the use of DSM III through diagnostic supervision.Hospital and Community Psychiatry, 35, 251–255.PubMedGoogle Scholar
  44. Snowden, L. R., & Cheung, F. K. (1990). Use of inpatient mental health services by members of ethnic minority groups.American Psychologist, 45, 347–355.CrossRefPubMedGoogle Scholar
  45. Steinberg, M. D., Pardes, H., Bjork, D., & Sporty, L. (1977). Demographic and clinical correlates of Black psychiatric patients in a private general hospital.Hospital & Community Psychiatry, 28, 128–132.Google Scholar
  46. Strauss, J. S. (1969). Hallucinations and delusions as points on continua function.Archives of General Psychiatry, 21, 581–586.PubMedGoogle Scholar
  47. Sussman, L. K., Robins, L. N., & Earls, F. (1987). Treatment-seeking for depression by Black and White Americans.Social Science and Medicine, 24, 187–196.CrossRefPubMedGoogle Scholar
  48. Terrell, F., & Barrett, R. K. (1979). Interpersonal trust among college students as a function of race, sex, and socioeconomic class.Perceptual and Motor Skills, 48, 1194.Google Scholar
  49. Terrell, F., & Terrell, S. L. (1981). An inventory to measure cultural mistrust among blacks.Western Journal of Black Studies, 5, 180–184.Google Scholar
  50. Toch, H., Adams K., & Greene, R. (1987). Ethnicity, disruptiveness, and emotional disorder among prison inmates.Criminal Justice and Behavior, 14, 93–109.Google Scholar
  51. Vinogradov, S., King, R. J., & Huberman, B. A. (1992). An associationist model of the paranoid process: Application of phase transition in spreading activation networks.Psychiatry, 55, 79–94.PubMedGoogle Scholar
  52. Westermeyer, J. (1987). Cultural factors in clinical assessment.Journal of Consulting and Clinical Psychology, 55, 471–478.CrossRefPubMedGoogle Scholar
  53. Zigler, E., & Glick, M. (1988). Is paranoid schizophrenia really camouflaged depression?American Psychologist, 43, 284–290.CrossRefPubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Arthur L. Whaley
    • 1
  1. 1.New York State Psychiatric Institute and Columbia School of Public HealthNew York

Personalised recommendations