Cultural bias in psychology
“To ignore these realities, or to trivialize them, is to contribute to a science while wearing blinders” (Lonner & Malpass, 1994).
A typical psychology text book contains hundreds of terms and theories to help explain human behaviour. Most of these texts appear to suggest that all of these fantastic concepts are universally applicable; we are all basically the same, and that is that. This is a very dangerous assumption to make. It has been estimated that over 90 percent of all psychologists who have ever lived are from the Western world (Lonner & Malpass, 1994). The majority of theories in counselling psychology have evolved primarily from the experiences of White, upper class men, conducting research on White, upper-class clients (Lee & Richardson, 1991). This article shall focus on the cultural biases that are clearly visible in much of the research conducted in psychology, with particular emphasis on the controversy over the resultant definitions and diagnosis of mental illnesses.
Culture can be defined as the “transmitted and created content and patterns of values, ideas and other symbolic-meaningful systems as factors in the shaping of human behaviour and the artefacts produced through behaviour” (Kroeber and Parsons, 1958, p583).
Psychologists and other social scientists have long been interested in the influence of culture on psychopathology, or abnormal behaviours.
We have been provided with the basic components and attributes of what constitutes a mentally healthy and ‘normal’ individual. Self-sufficiency, independence, competitiveness, confidence and an internal locus of control are all characteristics that are required to be deemed ‘mentally stable’ (Pederson, 1987). These are the stereotypical characteristics of [typically American, but can be generalised to those living in a Western Society] White, middle-class men (Ritchie, 1994). Individuals who exhibit connectedness, stability, cooperation and an external locus of control are therefore often seen as less psychologically healthy, even though these characteristics are viewed as positive and virtuous attributes in other cultures (Ritchie, 1994). Do definitions of normality and abnormality vary across cultures, or are there universal standards of normality?
Correct definitions of mental and emotional health are critical in psychology, as they guide counsellors and psychologists in the diagnosis, support and assistance of patients. If the definitions are narrow and biased in favour of particular cultural or social groups, it could lead to wrong diagnoses and unmerited assumptions about the mental health of certain individuals or groups (Richie, 1994). Pederson (1987) was passionate about the problems these assumptions cause, in fact, he claimed that “the consequences of these assumptions are institutionalized racism, ageism, sexism and cultural bias” (p16).
A plethora of research has discovered differences in the levels of mental illnesses present in people from varying ethnic and racial backgrounds For example, Hispanics have been diagnosed with schizophrenia 1.5 times more frequently than Whites, and African Americans are more likely than Whites to be diagnosed with schizophrenia, substance abuse, and/or dementia (DelBello, Lopez-Larson, Soutullo, & Strakowski, 2001). The essential question raised from these results is: are these differences in diagnostic rates due to cultural diversities, or the misdiagnosis from psychologists and counsellors due to their own personal biases? There have been similar concerns raised about cultural biases inherent in IQ testing, with the generalisations that Asian children have, on average, higher IQs than white children, and African children have, on average, lower IQs. Research in this field has indicated that there might be cultural implications inherent in the IQ test themselves, which lead to this perceived difference (Scarr, 1981). It is highly likely that such cultural differences could also manifest themselves in the diagnosed rates of mental illness.
A recent study by Hays, Prosek & McLeod (2010) aspired to explore how culture affects the clinical decision making progress, and cited selecting participants who were “culturally diverse”, with experience in clinical settings. But, of the 41 participants, 28 were White, 10 were African-American, 1 was Hispanic, 1 was multiracial, and 1 identified themselves as ‘other’. This is clearly still a very much Western world based sample. Even studies attempting to understand the influence of culture in clinical diagnoses can be culturally biased, with such a high number of White participants, the results cannot be generalised to every country.
The World Health Organisation (WHO, 1973, 1979, 1981) sponsored the international pilot study of schizophrenia to compare the prevalence of the disorder in 1, 202 patients, in several countries. The investigators were able to identify a set of symptoms that were present across all cultures in the schizophrenic samples, including: lack of insight, auditory and visual hallucinations and delusions of grandeur (Leff, 1977). But, it was found that the course of the illness was easier for patients in developing countries compared to those in highly industrialized countries. Patients in India and Nigeria, for example, recovered at faster rates than those in England, or the United States. These differences were attributed to cultural factors, such as the presence of extended family networks, community support, and the emphasis on returning to work in developing countries.
Cultures may differ in their tolerance for particular symptoms, the Nigerian culture as a whole is more accepting of the presence of voices. In cultures where Shamanism is prevalent, such voices, and indeed visions, are taken as a manifestation of power and of major religious significance, whereas in Western Culture, they would be taken as symptomatic of mental illness (Krippner, 2002). Even in the Western World, there are significant differences as regards how historical instances of “voices” and “a sense of mission” are viewed. Whilst English Professionals in the field might have their doubts about Joan of Arc, such a diagnosis would be very poorly received by French professionals, who have an all together different historical perspective on this individual (Allen, 1975).
In an early study of New York psychiatric cases, Opler and Singer (1959) found that Irish- American schizophrenic patients were more likely to experience paranoid delusions than Italian- American patients. The authors cited possible cultural differences in parenting and upbringing in order to account for the difference. Another possibility, which is not often discussed, might be genetic differences in the actual structure of the brain. There is increasing evidence that many forms of mental illness stem from subtle “mis-wiring” in the brain, it is quite plausible that there could actual be a genetic bias behind this (Phelan, 2002: in relation to schizophrenia). The prevalence of sickle cell anaemia amongst the African population, whilst very rare in the white population, has long been accepted. Indeed, there is a theory that genetic tolerance towards malaria (which isn’t prevalent in the Western World due to the mosquito disease vector not being present) has, as a side effect, increased the likelihood of sickle cell anaemia (Aidoo et al, 2002). Further research could well uncover similar predispositions towards certain types of mental illness in genetically different populations.
There are universal aspects of the symptoms and presentation for at least some of the major psychopathologies, such as schizophrenia. At the same time, however, many psychopathologies are thought to be heavily influenced by culture, especially in terms of the specific behavioural and contextual manifestations of the abnormal behaviour, and the perceived effect of the behaviour on the everyday lives of the individuals (Matsumoto & Juang, 2004).
Classification systems need to contain both etic and emic elements in order to display a rounded view of the symptoms and disorders in question. Where to draw the lines, and how to measure psychological traits and characteristics within this fluid and ever changing system, is the challenge that faces the area of psychology today. Although the field has made vast improvements in this area in the past few years, future research will need to elaborate further on these issues so that the classification and measurement can be made more precise, meaningful and relevant. Inclusion of more diverse populations in pluralistic countries such as England, the United States, and now more recently Ireland, is also needed in this area of research. If this can be done, proper understanding, assessment and diagnosis of mental disorders will in turn develop effective preventions and treatments that will improve and enhance people’s lives, all over the world.
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