Cultural Differences in the Clinic
Posted on November 15, 2007
Eric A. Youngstrom (bio) talks about the impact that cultural differences among patients and clinicians can have on diagnosis and treatment.
One of the things that we’re finding, working with community members, is that bipolar disorder appears to be occurring fairly commonly in African American youth, but it’s very likely to be misdiagnosed. And this is consistent with what Melissa DelBello and Steve Strakowski and others have been finding.
But part of what’s exciting working with the families and also looking at the psychometric instruments is we’re starting to shed some light on why this has been getting missed, and it doesn’t seem like it’s so much that it’s bias on the part of the clinician as that it’s a cultural difference in what people will talk about as a problem with the clinician.
Clinician is sitting there thinking about, “Could this be a mood disorder or something else?” But talking about, “I’m having big changes in my feelings. I’m feeling too elated. I’m feeling sad or down.” That’s a very white, middle-class way of constructing things, apparently, and families are coming in and instead of talking about changes in their feelings, they’re focusing much more on changes in behavior.
And this is probably part of what is feeding into the clinician hearing more about the behavior and conduct and being more likely to misdiagnose the condition as a conduct disorder.
And so the cultural differences in language and what we ask for help with and what we’re willing to talk about and how we frame it are having an impact. The part which is neat to me as a psychologist is that I’m starting to see this in factor analyses: very quantitative approaches to data, changes in the way the particular symptoms are behaving in African American or Latin American versus European families.
And so, part of me is really excited about this as a researcher. My father, who’s a research chemist, teases me that things are scientific to the degree that they’re quantitative. And so when I talk about some of this with him he’s like, “It’s like you’re doing science or something, son.”
But it’s neat to me as well as a clinician, because it’s teaching me how to talk differently and how to ask questions differently with a family so that I have a greater chance of really understanding the issues and being able to make appropriate recommendations for treatment.
But part of what’s exciting working with the families and also looking at the psychometric instruments is we’re starting to shed some light on why this has been getting missed, and it doesn’t seem like it’s so much that it’s bias on the part of the clinician as that it’s a cultural difference in what people will talk about as a problem with the clinician.
Clinician is sitting there thinking about, “Could this be a mood disorder or something else?” But talking about, “I’m having big changes in my feelings. I’m feeling too elated. I’m feeling sad or down.” That’s a very white, middle-class way of constructing things, apparently, and families are coming in and instead of talking about changes in their feelings, they’re focusing much more on changes in behavior.
And this is probably part of what is feeding into the clinician hearing more about the behavior and conduct and being more likely to misdiagnose the condition as a conduct disorder.
And so the cultural differences in language and what we ask for help with and what we’re willing to talk about and how we frame it are having an impact. The part which is neat to me as a psychologist is that I’m starting to see this in factor analyses: very quantitative approaches to data, changes in the way the particular symptoms are behaving in African American or Latin American versus European families.
And so, part of me is really excited about this as a researcher. My father, who’s a research chemist, teases me that things are scientific to the degree that they’re quantitative. And so when I talk about some of this with him he’s like, “It’s like you’re doing science or something, son.”
But it’s neat to me as well as a clinician, because it’s teaching me how to talk differently and how to ask questions differently with a family so that I have a greater chance of really understanding the issues and being able to make appropriate recommendations for treatment.
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Excerpted from interview with researcher at the 2007 International Conference on Bipolar Disorder in Pittsburgh, PA.
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