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Implicit Bias in Mental Health


Is eighteen and was acting bizarrely. He wasn't coming home. He sat staring out the window for long periods of time and had angry outbursts. His mother finally got him to agree to see a psychiatrist. Who DIAGNOSED SCHIZOPHRENIA? His mother was tearful. She told me the diagnosis at Jamal's recent visit. She's a nurse and she knew a bit about schizophrenia. She didn't see any of the disease in Jamal. He was firmly connected to reality. His social relationships had become less desirable to him but he's still interacted normally with people. His thinking speech and his behaviors were organized. And he had no hallucinations. Psychiatrists like all of us can make mistakes. Unlike my practice where I can order lab tests. X-rays your scans to help me understand. What's going wrong psychiatrists don't have those tools? They see a person for a small amount of time. Ask a number of questions and then need to make a diagnosis and often star treatment. Usually a drug. There's no shortage of reasons that doctors can make mistakes in judgment including misinterpreting patients answers not asking appropriate follow up questions or implicit bias. Implicit bias is not unique to mental health. But it can play a role in how a diagnosis a patient implicit bias. Are those stereotypes or feelings that we have toward a group of people that are sub-conscious these biases can be either positive or negative. The important part though is that we act on these implicit bias involuntarily without any awareness or control these are not biases that we know we have that we subconsciously. Suppress these operate on a completely unconscious level implicit bias as affect every one of us. Even people who are supposed to be impartial like referees judges and doctors we know subconsciously. Many doctors have biases toward women. Ethnic groups sexual behaviors recreational behaviors and certain occupations textbook or classic descriptions of diseases often paint a picture the way a white man would experience them. Medical students may not learn how the disease looks and women or other subgroups. A recent study looked at about seventeen hundred men. Diagnosed with schizophrenia. It turned out that black men diagnosed with schizophrenia. Were four times more likely than white men to actually have symptoms of major depression. Could it be that racial implicit bias accounts for black men? Being misdiagnosed with schizophrenia rather than major depression the problem is of course. That depression requires a different approach in schizophrenia and it can have a very different prognosis but without knowing it doctors may be making misdiagnoses that have important negative consequences. Jamal was reevaluated. He was diagnosed as having depression treated with both anti depressants and therapy and his mother says with a big smile. He's nearly back to normal. Jamaa looks at me and gives me a thumbs up as for the psychiatrist. Not Bad doctor. She just jumped to conclusions. Perhaps based on implicit bias and failed to entertain alternative

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