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458 Canadian Family Physician Le Médecin de famille canadien VOL 48: MARCH • MARS 2002

letters

correspondance

VOL 48: MARCH • MARS 2002 Canadian Family Physician Le Médecin de famille canadien 459

letters

correspondance

Mental health care in aboriginals is neglected

I

enjoyed the December 2001 issue of Canadian Family Physician, particu- larly Dr Carol Herbert’s editorial,1 writ- ten with her usual insight and clarity, and the articles on aboriginal health.2,3

For more than 15 years, I have reg- ularly worked at Dease Lake, in the far northwest corner of British Columbia.

The Stikine Health Centre is the most northern, rural, isolated health care facility in the province. Until 2 years ago, I did family medicine locum tenens; however, for the past 2 years I have gone up on a monthly basis, mainly to do psychotherapy. I fly in on a Friday, work Friday afternoon in the Stikine Health Centre and Saturday and Sunday at Iskut (a First Nations reserve), return Monday morning to the health centre, and fly home Monday afternoon.

I could write reams about health care in northern, rural, isolated, and First Nations communities, but I won’t. Instead, I will comment on what appears to be, nationally, one of the most underappreciated aspects of mental health care in such areas—

mental health care itself being dis- gracefully neglected.

This part of our province, and of our country, is an area where “resi- dential school syndrome” is rampant, family violence is rampant, alcohol- ism is rampant, sexual abuse is ram- pant—and no one knows anything (or wants to know anything) about dissociation. People who have been traumatized, especially as children, develop incredible skills in compart- mentalizing their lives in order to survive, emotionally and sometimes physically. Of course this works, but it carries with it many difficul- ties, especially of emotional fragility, inability to trust, relationship prob- lems, and often poor coping skills.

Skills that work when one is a child

usually do not work when one is an adult. The consequence is often that personal and family life is fractured and unstable because of the dissocia- tive nature of the disorder.

The sadness is that these disorders are treatable. It isn’t even rocket sci- ence. It is just good, garden-variety psychotherapy that has the additional crucial component of knowledgeable attention to dissociative components.

It takes, however, a long time and trained personnel to achieve the best results—and also money.

What is more important and logi- cal: to find ways and means of offer- ing good therapy and helping people achieve control over their lives or to continue to use up resources by patchwork, Band-Aid crisis manage- ment of the “comorbidity” (disrupted families, addictions, poor mental

health, and the continuing cycle of family violence)?

The answer seems pretty clear to me. Why is it so difficult for govern- ments and regional health councils to understand?

—Marlene E. Hunter, MD, CCFP, FCFP

Victoria, BC Director, Labyrinth Victoria Centre for

Dissociation Past President, International Society for

the Study of Dissociation by e-mail References

1. Herbert CP. The fifth principle. Family physicians as advo- cates [editorial]. Can Fam Physician 2001;47:2441-3 (Eng), 2448-51 (Fr).

2. Smylie J. Building dialogue. Aboriginal health and family physicians [editorial]. Can Fam Physician 2001;47:2444-6 (Eng), 2452-5 (Fr).

3. Cole M. First Nations health. A perspective on aboriginal medicine [Letter from Nunavut]. Can Fam Physician 2001;47:2460-1.

...

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