Li-Repac (1980)

One of the factors that affects diagnosis is a clinician's own biases. There are several biases that may affect an eventual diagnosis - including sick role bias (where a doctor assumes that because some has come in for advice, that s/he is really ill and needs a diagnosis), gender bias or bias based on socioeconomic status.

One area of psychology that started to receive a lot more attention in the 1980's is the role of cultural stereotyping. A psychiatrist's stereotypes about a culture may influence his or her diagnosis.

It may mean that a certain ethnic group is over-diagnosed because of stereotyping. it can also be the case that a therapist's bias may result in under-diagnosis of a person from a different cultural background in an attempt to be sensitive to cultural differences (Li-Repac, p 329).

The following study looks at the role of stereotyping in diagnosis.

The procedure

In order to test the role of stereotyping in diagnosis, Diana Li-Repac wanted to compare the diagnoses of both white and Chinese-American therapists of both white and Chinese male subjects. She hypothesized that the therapists would generally agree on the concept of normality as they all had similar training. She hypothesized that differences would exist in the actual diagnoses when diagnosing someone of a different cultural group.

There were ten subjects in the study - 5 white and 5 Chinese - all of whom had been diagnosed with mental illness. The subjects were controlled for age, socioeconomic status and level of pathology. Three of the Chinese were diagnosed with schizophrenia, 1 neurotic and 1 reactive depressive. Of the white subjects, 2 were diagnosed as schizophrenic, one as neurotic, one as character disorder and one as reactive depressive. All of the Chinese subjects were born either in China or Hong Kong.

The researcher carried out semi-structured interviews with each of the subjects. These interviews were videotaped. They were asked questions like "How have you been feeling lately?" and "How do you spend a typical day?"

The clinicians were 5 white and 5 Chinese-American males, all recruited through personal contacts with the researcher. The five white raters reported no previous contact with Asian clients.

Each "rater" (the clinicians) was first asked to describe an ideal, functioning individual using a 112 item test. There was no significant difference in the scores, showing that their training had lead to similar understandings of what constituted normality.

Then they were randomly assigned videos to rate for normality. Each rater would rate 4 videos - 2 of white clients and 2 of Chinese clients. They were asked to fill in an inventory to describe both personal traits and signs of pathology.

The results

The following two charts show the most frequently checked adjectives by the raters.

Looking at the two lists, can you see the difference?

When looking at personal traits, the Whites tended to see signs of lower self-esteem in the

Chinese clients. The Chinese tended to see the Whites as being more aggressive. When asked to rate the clients on pathology, there were three significant findings:

  • White raters saw the Chinese clients as more depressed and inhibited than did the Chinese-American raters. The result of the t test was p < .001
  • White raters saw Chinese clients as less socially competent and as having less capacity for interpersonal relationships than did Chinese-American raters. The result of the t test was p < .01
  • Chinese-American raters reported more severe pathology than did the white raters when judging quiet clients. The result of the t test was p < .05

Thinking about research

1. The aim of this study was to test the role of stereotyping on diagnosis. Do you think that this study accomplishes that? Why or why not?

It is difficult to establish the validity of this research. No test was done to determine the stereotypes and/or prejudice of each group before the study began. Because there are some differences between the white and Chinese American clinicians' responses, it is assumed that stereotyping played a role in the diagnosis - but it is not possible to determine from this study whether their diagnoses matched their stereotypes.

2. Why were the subjects to be videotaped "controlled for age, socioeconomic status and level of pathology?"

The researcher wanted to isolate the variable of cultural difference. If age, SES or the level of pathology was also significantly different among the clients, then those variables could have an effect on the diagnosis as well and it will not be possible to argue that cultural stereotyping alone is the reason for any difference in diagnosis.

3. Why is it important that all of the Chinese clients were born either in China or in Hong Kong?

It is important because the researchers want to make sure that they reflect Chinese culture. If they were born in the US, their education and peer groups would have had a significant effect on their cultural identity and behaviour.

4. What type of sample was used for the clinicians? Why do you think that this type of sample was used? Is there any problem with this sample?

It was a snowball (aka network) sample. This was probably used to simplify getting a sample. The researcher also was trying to find clinicians with relatively the same amount of experience. The problem with the sample is that it is not necessarily representative of white or Chinese-American clinicians.

5. Which of the three findings do you think is the most significant? Why is this important in a discussion of the findings?

The finding that is statistically the most significant is that the White clinicians found the Chinese clients to be more depressed. The probably that the results were due to chance increased with each of the findings. This is important especially because the sample size was small. It is important when discussing the findings because a 5% level of probability that the results are due to chance is the maximum that we accept in psychology. Having such a high probability emphasizes the need for this study to be replicated.

6. What do you think that we can conclude from this study?

It is difficult to conclude much from this study for several reasons. First, there was no pre-test on stereotyping. Second, the sample size was small. Third, the clients that were videotaped all had different types of disorders. In addition, there was significant variation in the number of adjectives checked by each rater. The findings of this study should be viewed very cautiously. So, although it does support the idea that there are cultural biases in diagnosis, more research needs to be done to support the findings.

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