The ability to categorize the state of your mental health into a single word or a few — to say “I am” or “I have” this diagnosis — holds a level of power. Receiving a formal diagnosis for mental disorders or illnesses may allow for the forging of new communities and connections, the access to proper care and the ability to better understand one’s own needs. A formal diagnosis is required in order to receive care, such as prescription medication and therapy paid for by insurance. As great as a formal diagnosis sounds, the process of receiving one is not as easy for some. This is especially true for communities of color that, over recent years, have been increasingly vocal about the stigma surrounding mental health.
However, even with the breakdown of stigma, attention has rarely been turned toward the access to and type of care available for communities of color in the mental health care system. The truth is, the mental health care system is lagging behind in its inclusion of cultural differences, which actively prevents people of color from receiving equitable care.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), responsible for the standardization of mental health diagnoses, has been widely regarded as the “Bible” of psychiatry. The DSM, although widely used by psychologists, has not been immune to controversy. For one, the DSM has a history of writing transphobia into science, with the potential of categorizing transgender individuals as mentally ill under the diagnosis of “gender dysphoria.” In addition, the DSM has received criticism for not only categorizing human experiences into science and recommending one-size-fits-all solutions, but also doing so by standardizing symptoms largely experienced by white patients.
In reality, racial and ethnic differences challenge the archetypal understanding of mental disorders and illnesses, whose symptoms manifest differently across various racial demographics based on factors such as cultural norms and socioeconomic conditions — all of which render nonwhite individuals more susceptible to misdiagnosis. For example, studies have shown that Black Americans experiencing depression are more likely to report symptoms pertaining to their physical well-being, while white Americans are more likely to report symptoms pertaining to their emotions.
While clinicians may have preconceived notions about a patient based on race, gender, socioeconomic class, etc., the process of diagnosis may also be heavily influenced by an inability to effectively word questions and understand answers through local idioms and culture. In the case of depression, one study from the Journal of Child and Family Studies suggests that non-Hispanic white patients are more likely to express the symptom of “two years or more depressed or sad most days” whereas Black Americans and Hispanics are more likely to use the terms “sad and blue,” leading to a higher risk of Black Americans and Hispanics being misdiagnosed. Moreover, the significance of culture in diagnoses is exemplified in the difference between social anxiety disorder, in which patients fear embarrassing themselves in social settings, and the Japanese cultural syndrome taijin kyofusho, in which patients fear embarrassing others and “disrupting social harmony.” While both disorders seem to have the same symptoms, misdiagnosis, fueled by a lack of cultural understanding, may prevent effective treatment.
It wasn’t until March 18, 2022, that the American Psychological Association (APA) released the DSM-5-TR, which sought to account for previous failures in representing nonwhite patients and to distinguish between differences in culture and genetics. In an effort to aid future diagnoses, the new DSM provides clarification and background information on higher rates of certain disorders in different communities, such as higher rates of schizophrenia for Black people. However, a disclaimer is unable to account for clinician bias and miscommunication that preempt accurate diagnoses. It is clear that praise of the DSM as the “Bible of psychiatry” only further standardizes mental health issues and does little to acknowledge the lack of diversity in mental illness symptoms, allowing racial disparities in diagnoses to continue to persist.
The mental health care system’s lack of inclusivity is only exacerbated by the lack of diversity in the field of psychology. In 2015, APA reported that 86 percent of psychologists in the United States were white, 4 percent were Black, 5 percent were Hispanic and 5 percent were Asian. While white therapists or therapists who are not of the same race or ethnicity of their patients are not necessarily less qualified, having a shared cultural background can have a lasting impact on mental health, whether it be through mutual understanding or the ability to discuss the complexity of intergenerational trauma.
A prototypical image of a single mental disorder does not exist — it presents itself differently across various communities. As we become more aware of and open to discussing the stigma of mental health, the need for a more culturally competent mental health care system becomes increasingly pressing.
Julie Ha is a freshman majoring in philosophy, politics and law.