PRACTICE PARTNER
How to Treat Stigma
People with mental health or substance abuse
issues can face barriers to care
DOC TALK
By Stuart Foxman
W
hen her son Stephen began
experiencing depression
and anxiety in high school,
Dorothy Bakker didn’t
realize it at first.
“People don’t always want others to know
that they’re struggling,” she says. “Maybe it’s
about stigma. He didn’t want to be labelled.
Or he didn’t want me to worry.”
Later, in university, Stephen was diagnosed
with a bipolar mood disorder, and also had
an alcohol and cocaine addiction. Yet a big
hurdle to his care remained stigma.
Bakker recognizes this not just as the moth-
er of a patient, but as a doctor herself. She is a
family physician at the University of Guelph’s
Student Health department, and an associate
clinical professor at McMaster University.
There are all sorts of ways stigma plays out,
from keeping issues secret to feeling marginal-
ized. Other manifestations may seem benign,
but reinforce the idea that patients are on their
own. Or that the problem isn’t really serious.
Dr. Bakker would like to see physicians be
more willing to engage in substantial conver-
sations about the mental health or substance
abuse issues of their patients. She feels they,
too often, honour an assumed reluctance to
disclose, so they don’t push. That’s stigma.
Just as troubling to Dr. Bakker is the pos-
sible minimizing of these issues. She often
accompanied Stephen when he saw health-
care professionals – to emergency after his
first manic episode; to an early intervention
psychosis clinic to see a psychiatrist and fam-
ily therapist; to an inpatient alcohol and drug
rehabilitation program for his addictions;
and to subsequent meetings with health and
mental health-care providers.
“Never once did they say my son had a seri-
ous disease. Never did they plainly lay out the
prognosis, as troubling as it may have been.
ISSUE 1, 2019 DIALOGUE
27