The finding that Whites are more likely than African Americans to receive a diagnosis of 
mood disorder and that Blacks are more likely than Whites to be diagnosed with schizophrenia 
has been interpreted as evidence of misdiagnosis.  DSM-III was seen as a solution to this 
problem because it made the much more criteria explicit, thereby guiding clinicians to make 
more "accurate" diagnoses of African Americans by impeding the intrusion of racial 
stereotyping (ethnocentrism) on the diagnostic process.  Thus while DSM-III implied that 
clinicians should treat Black and White patients similarly, the implication of equal 
applicability of diagnostic criteria across race was challenged because it contradicted 
empirical evidence that African Americans differed significantly from the middle-class 
European American patients upon which the DSM field trials were based.  The data needed 
to demonstrate the misdiagnosis of African Americans are elusive due to the absence of a 
gold standard.  Instead, the field must rely upon instances of diagnostic concordance 
(agreement and disagreement) and informed clinical opinion to gain an understanding of why 
clinicians implementing a similar set of diagnostic criteria often come to different 
diagnostic conclusions.  This paper reviews the literature on misdiagnosis to provide a 
basis for inspecting of the role of clinical judgment as influenced by the cultural 
recommendations contained within DSM-IV.  The paper argues that more studies that focus 
upon the manner in which clinicians experienced in working with African American patients 
implement DSM criteria across all five axes within the patient's sociocultural context are 
needed.  A serious consideration of culture underscores the importance of clinical judgment 
but to be culturally sensitive, clinicians must make cultural adjustments in the manner 
in which the DSM criteria are implemented.  Furthermore, truly embracing cultural relativity 
presents clinicians with a difficult challenge because there are positive and negative 
implications for generalizations made about patients based on racial/ethnic group membership.  
As a result, subjective clinical judgment should not be overly restricted because to do so 
would eliminate the application of those skills necessary for considering cultural context.  These issues underscore the importance of developing training programs that reduce the influence of ethnocentric bias while simultaneously maximizing the appropriate use of the contextual information necessary to employ DSM-IV's cultural formulation.  Permitting clinician discretion in diagnostic decision making appears to provide the best opportunity to solve the problem of misdiagnosis.