PRACTICE PARTNER
Quick to judge
Dr. Dorothy Bakker and her son Stephen.
All conversations were veiled reassurances
including that he was a ‘nice young man,’ ”
says Dr. Bakker.
That’s an aberration in health care, she
says. “I don’t think, as physicians, we simi-
larly minimize illness at a diabetes, cancer or
cardiac clinic. No, the disease, prognosis and
consequences of non-adherence to treatment
would be clearly explained. We’d offer rapid
access to a specialized clinic, no less. Instead,
in mental health, we often spare the person
and the family of the truth.”
Which is part of stigma too. Stigmatiz-
ing comes from judging and impugning (or
by people feeling they’re being blamed and
labelled), and assumes several forms:
• Social stigma , i.e. negative attitudes and
actions.
• S
tructural stigma , when institutions (and
institutionalized practices) don’t take the
problem seriously enough or provide the
appropriate response.
• Self-stigma , when people internalize social
and/or structural stigma.
All of it creates potential barriers to access-
ing care.
28
DIALOGUE ISSUE 1, 2019
So what would happen in a diabetes clinic?
Not this: someone telling you to just yell at
your pancreas until it secretes more insulin.
Dr. Diane McIntosh, a psychiatrist in B.C.,
was being facetious when she made the com-
ment in an article for the Huffington Post. But
she’s serious about what she sees as a significant
problem – the stigma perpetuated by some
health-care professionals around patients with
mental health or substance abuse issues.
It’s not surprising. After all, stigmatization
is a broader societal phenomenon. Many
patients self-stigmatize, and fail to share what
they’re going through or seek help. Oth-
ers can buy into myths, feeling that people
should just be able to will themselves into
wellness – and are weak if they can’t.
Of course, not all doctors stigmatize. Maybe
relatively few do. But there can be little dis-
pute that humans seem to be hard-wired to
judge (others and ourselves).
In one study published in Scientific Reports,
researchers had subjects read various scenarios
with negative and positive outcomes. They
were asked to determine the level of intent
in the actions described in the stories. When
subjects read the negative stories, they were
likelier to light up the amygdala. Not so when
they read the positive ones.
In short, people reacted to negative stories
more emotionally and to positive ones more
rationally. One conclusion: we’re quicker to
assume the good acts of others just happen,
while bad acts are deliberate. That can influ-
ence how (and if ) we seek and offer help.
See the person, not the label
Of course, many patients are eager for help.
And they’ll find many doctors who offer the
treatments, referrals and support needed.
If some doctors are less effective with
patients who have mental illness or substance
issues, the fault doesn’t always lie with stigma.
Training is one issue, as is a tendency by some
doctors to view treatments as more of an art