Video summary
The video explores how implicit biases in healthcare can lead to the misdiagnosis of mental and behavioral disorders by overlooking the profound impact of socioeconomic factors on a patient's symptoms. The speaker argues that behaviors often interpreted as resistance, non-compliance, or pathology are frequently rooted in external circumstances such as poverty, limited education, or language barriers. For instance, a client falling asleep during group therapy might be mistakenly labeled as unmotivated rather than recognized as sleep-deprived due to working night shifts, while individuals with low blood sugar from food insecurity may exhibit irritability and an inability to focus that mimics ADHD or depression.
Specific examples illustrate how diagnostic errors occur when clinicians fail to consider context, such as the case of children with dyslexia who are incorrectly diagnosed with oppositional defiant disorder because they struggle to read or participate in classroom activities. The speaker emphasizes that environmental toxins can cause confusion and brain fog that resembles early-onset dementia, while a lack of access to natural green spaces can trigger biochemical changes and behavioral symptoms similar to ADHD without the child actually having the condition. Furthermore, community violence and unstable housing create states of hyper-vigilance and chronic stress that manifest as defensive or acting-out behaviors, which are often misinterpreted as inherent personality disorders rather than survival responses to unsafe environments.
The core conclusion is that effective diagnosis requires healthcare providers to step back and ask what else might be contributing to a patient's symptoms before jumping to pathological conclusions based on superficial characteristics. The speaker notes that middle-class practitioners may not immediately recognize these environmental stressors because they do not personally experience them, yet it is crucial to understand the culture, experiences, and realities from which clients emerge. By examining behavior within its full context—including factors like thyroid issues causing pain, poor sleep quality affecting cognitive function, and the specific challenges of limited English proficiency—clinicians can avoid mislabeling vulnerable populations and provide more accurate, compassionate care that addresses the root causes of distress rather than just treating perceived symptoms.
Read the full video transcript
Think about
how the following may cause symptoms or
behaviors that are misdiagnosed
as a mental or behavioral disorder or
resistance to treatment based on
people's implicit biases.
You're working with somebody who lives
in poverty. What assumptions do you make
about them? What
treatment How might treatment plans
differ for this person?
What about [snorts] people with limited
education or limited English
proficiency?
How might your
diagnoses be a little bit different? And
when I worked in Florida,
I worked at a a community behavioral
health care center. Wonderful place. A
lot of the people that we work with were
impoverished and had limited education,
but that didn't mean they were
resistant. That didn't mean that they
were um necessarily had any particular
disorders besides obviously addiction
that they were diagnosed with.
It's important to look at behavior in
context. If a client is falling asleep
in group, if a client seems to be
um resisting doing what you ask them to
do or even become somewhat disruptive,
we want to examine what is that behavior
saying?
For people with limited education, it
may be saying, I don't understand.
You're going too fast. You're using a
lot of jargon. This is not useful to me
and it's very frustrating.
People with dyslexia
often are misdiagnosed as having
oppositional defiant disorder when
they're children because in school they
can't read uh as well as the other
children or maybe they
have difficulty with math and there's
another word for that um, that I can't
remember right now. But,
instead of asking,
"What is this behavior saying when this
child refuses to participate in
activities? When this child becomes
agitated when they're told to sit at
their desk and read an entire chapter in
their social studies book?"
What is that telling us? Um,
have we screened for other issues, or
are we jumping to the conclusion based
on certain characteristics they have
that they are being oppositional
defiant?
People who have shift or hourly work may
have difficulty participating in
treatment that's available during
banker's hours.
And if they are participating, maybe
they work midnight shift and they have
to come directly to group, then they
start falling asleep in group. Are they
being resistant? Are they unmotivated?
No, they're sleep deprived. We need to
step back and say, "What else could be
causing this besides
pathology?"
People with poor health care access may
have difficulty with a lot of things. If
their thyroid is low, if they are in
pain all the time, it's really hard to
concentrate and be in a good mood when
these things are going on. So, they may
be more irritable. Um,
environmental toxins can alter cognitive
abilities.
Um,
people may show evidence of confusion
and brain fog when exposed to
environmental toxins. Does that mean
they have early onset dementia?
No, not at all. It means that they're
having a toxic reaction.
Lack of access to natural spaces. The
research is just overwhelming that shows
that when we're out in natural spaces,
it helps regulate a lot of our
biochemical processes. It reduces
cortisol. It helps reduce blood
pressure. They found that children who
don't have access to natural spaces,
green spaces,
actually show more symptoms of
behavioral issues and ADHD.
That they don't have ADHD, they're
ADHD-like symptoms.
Um
as opposed to children who do have
access to those green spaces. And that
was when they compared children who are
in urban environments, even ones that
have access to a park, but a park with
no trees, no grass, no nothing, versus
environments in which there's grass and
trees and that sort of thing.
So, that's interesting, but let's think
about who lives in these really urban
areas, and could that be contributing
the the imbalance
in the child's
chemistry as a result of having a lack
of access to natural spaces.
Food insecurity. When you're hungry,
it's difficult to focus. It's difficult
to
have energy. It's difficult to be
motivated. If you're stressed about
food, there may be hoarding of food. But
generally, when we talk about food
insecurity, we're talking about the
result of being hungry. And think about
yourself, and ways your behavior changes
when your blood sugar is low. This isn't
just be having a grumbly tumbly. This is
having low blood sugar, not having
enough calories to fuel your brain to
help you do what you need to do.
Community violence
keeps people from feeling safe, keeps
people from sleeping well, may keep
people on edge and hyper-vigilant, which
eventually can lead to irritability,
um
resistant behaviors, acting out
behaviors. People become more stressed
and more defensive. They stay in that
stressed p- place and react from that
stressed place when
in general they feel like their
environment is unsafe.
And finally, unstable, crowded, or
unsafe housing.
If you can't get good sleep,
it impacts every aspect of your being.
It impacts you physically, it impacts
you emotionally, cognitively, it impacts
your relationships, your self-esteem,
and
can create a lot of other issues. People
need adequate quality sleep in order to
be able to function. When we are
assessing somebody who is presenting
with symptoms of depression or anxiety
or ADHD or cognitive dysfunction of some
sort, we need to back up and say, "What
else might be going on for this
individual that is contributing?"
As, you know, a person of the middle
class,
I may not experience these things, so
they may not be the things that first
pop into my head.
But it's important that we recognize the
environment, the culture, the
experiences
from which our clients are emerging.