EFFECT OF RACE AND SEX ON VARIATION OF DIAGNOSIS AND DISPOSITION IN A PSYCHIATRIC EMERGENCY ROOM

The present report is concerned with treatment decisions made in a psychiatric emergency room, and how diagnoses and disposition vary with the patient’s race and sex. On the basis of data descriptive of 2279 patients the following hypotheses were tested. a) Within a diagnostic group disposition was independent of race and sex and b) within a disposition group diagnosis was independent of race and sex. Hypothesis a was rejected for two diagnostic groupings and hypothesis b was rejected for all disposition groups. Outpatient department referral and neurotic diagnosis converged more for white than nonwhite and more for females than males. Nonwhites are more likely to be treated in the emergency room proper and not be referred out. Behavior that requires hospitalization of a female patient is more often perceived as neurotic when the female is white and as schizophrenic when the female is nonwhite. The processes of diagnosis and disposition converge when the behavior of patients is perceived as predictable from the clinician’s past clinical and social experience. The response set of the emergency room clinician is thought of in part as a predisposition to make decisions based on his own psychobiological, social and cultural experience. As the sociocultural distance between the clinician and his patient increases, diagnoses become less accurate and dispositions more nonspecific. Inasmuch as psychiatric symptoms and their sociocultural matrix present as fused complexes manifested by human suffering and human communication, reducing social distance might be more readily achieved as an interdisciplinary effort. We are of the opinion that psychiatric emergency room populations include data of substantial interest to social psychology and cultural anthropology as well as psychiatry, and that the complementary interaction of culture and psychiatric disease could be studied in patient populations. © Williams & Wilkins 1969. All Rights Reserved.