J Med Ethics. 2019 Apr;45(4):271-274. doi: 10.1136/medethics-2018-105042. Epub 2018 Nov 14.
Why are the diagnostic criteria of some psychiatric disorders standardised by gender while others are not? Why standardise symptom questionnaires by gender but not other personal characteristics such as ethnicity, socioeconomic class or sexual orientation? And how might our changing attitudes towards gender, born from scientific research and changing societal narratives, alter our opinion of these questions? This paper approaches these dilemmas by assessing the concept of diagnosis in psychiatry itself, before analysing two common approaches to the study of psychiatric diagnosis; the naturalist and constructivist views. The paper assesses the relative merits and significance of each, before turning its attention to the nature of gender and its relevance to psychiatry. The paper introduces a framework to approach gender-based diagnostic bias and concludes by drawing a distinction between qualitative and quantitative standardisation, arguing that gender standardisation of psychiatric diagnoses is ethically justified in the former but not the latter.
为什么一些精神障碍的诊断标准按性别划分,而另一些则不是?为什么要按性别标准化症状问卷,而不是按其他个人特征(如种族、社会经济阶层或性取向)?我们对性别的态度正在发生变化,这是基于科学研究和不断变化的社会叙述,这会如何改变我们对这些问题的看法?本文通过评估精神病学中诊断本身的概念,然后分析研究精神科诊断的两种常见方法;自然主义和建构主义观点。本文评估了每种方法的相对优点和意义,然后将注意力转向性别及其与精神病学的关系。本文引入了一个框架来探讨基于性别的诊断偏差,并得出结论,即精神病学诊断的性别标准化在前者是合理的,但在后者则不然。