Women in Academic Psychiatry

Sophia Frangou Editor Women in Academic Psychiatry

A Mind to Succeed

123 Women in Academic Psychiatry Sophia Frangou Editor

Women in Academic Psychiatry A Mind to Succeed

123 Editor Sophia Frangou Department of Psychiatry Icahn School of Medicine at Mount Sinai New York, NY USA

ISBN 978-3-319-32175-2 ISBN 978-3-319-32177-6 (eBook) DOI 10.1007/978-3-319-32177-6

Library of Congress Control Number: 2016944473

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This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Preface

Barely a day goes by without a news or an academic article about the status of women in science and medicine. They paint a remarkably consistent picture of gender inequality that seems to transcend national and institutional boundaries. No matter what measure is used, from salaries to promotion [1], to grant funding [2, 3], and to academic publishing [4]; women fare worse than similarly qualified men. Not surprisingly, they are more likely to leave research and academic life. Although there has been progress, the gender gap stubbornly refuses to go away. The issue of the “vanishing women” is perhaps most acute in academic psychiatry. This is because for more than two decades, psychiatry has been among the medical specialties with the highest proportion of women entering residency programs [5]. The percentage of women in junior academic positions in psychiatry is also high and consistently higher than that of men. However, the number of women in positions of leadership remains disproportionally low. In the USA, for example, only 13 % of department chairs in psychiatry are women [1]. My personal journey from medical school graduate of the University of Athens to trainee psychiatrist at the world-famous Maudsley Hospital and to senior faculty, first at the Institute of Psychiatry, King’s College London, and now at the Icahn School of Medicine at Mount Sinai, has provided the impetus for this book. It has been a journey full of amazing encounters. I have had the privilege of meeting many extremely accomplished women, true trail blazers, both as scientists, clinicians and role models. I have also had the responsibility of helping younger women navigate their own voyage through the stormy waters of academia as a program director for academic trainees for over a decade and as a mentor to my graduate students, postdoctoral fellows, and junior faculty. The book reflects the duality of my experiences. The first part “They Did It Their Way” starts with profiling 15 women that hold positions of leadership within academic psychiatry. They have been very brave in their willingness to provide intimately personal, very honest, and extraordinarily moving accounts of their own journeys. Their stories are not just accounts of professional success. They are powerful tales of self-determination and empowerment. A striking feature they all share is their desire to pursue their dreams and remain true to their selves and their

v vi Preface generosity in opening up their lives to women everywhere. There is of course no single pathway to academic success but reading these stories can help distill useful lessons. The second part of the book therefore aims to signpost the “snakes” and to highlight the “ladders” of the academic world. Very few are gender specificin themselves but they affect women disproportionally and they prevent the gender gap from closing. I hope that the messages conveyed in these chapters will provide opportunities for self-reflection and inspiration for future action. Some may argue that writing a book such as this implies that the problem with the gender gap is women themselves. This was exactly what I was told early on in my career. A senior female colleague advised me to stay away from any women- centered initiative because these were only for women that were not “good enough” to make it on scientific merit alone. This was and is bad advice and a key example of how some women internalize and propagate negative societal attitudes about ourselves. Others may also argue that in order to close the gender gap we need to focus on societal and institutional barriers. This is of course true but meaningful change can only happen through the coordinated activity of a critical mass of likeminded people, women and men. This is why this book is not just for women. It is also for those men who, either as partners, fathers, brothers, mentors, or leaders, are interested in understanding the female perspective on the gender gap and are motivated to strategize change. I have met many men who declared that they had no idea about the problems and barriers women faced. Initially I tended not to believe them as these problems were both tangible and obvious to me. However, I now think otherwise. Male myopia when it comes to the gender gap is real and needs to be addressed if we are to transform our working environment. The hope with “Women in Academic Psychiatry: A Mind to Succeed” is that it will show to all readers, women or men, that change is possible. There are many more women than those contributing to this book that are engaged in this process of change. Success in closing the gender gap is a group process that also critically depends on individual efforts and achievement. Although this book is focused on psychiatry, it contributes to a wider societal effort to understand what underpins discourse on gender equality in leadership.

New York, NY, USA Sophia Frangou

References

1. American Association of Medical Colleges. The state of women in academic medicine, the pipeline and pathways to leadership. 2014. https://www.aamc.org/ newsroom/aamcstat/,a=418758. 2. Rockey S. Women in biomedical research. 2014. https://nexus.od.nih.gov/all/ 2014/08/08/women-in-biomedical-research/. Preface vii

3. European Research Council. Gender statistics. 2014. https://erc.europa.eu/sites/ default/files/document/file/Gender_statistics_April_2014.pdf. 4. Filardo G, da Graca B, Sass DM, Pollock BD, Smith EB, Martinez MA. Trends and comparisons of female first authorship in high impact medical journals: observational study (1994–2014). BMJ. 2016;352:i847. 5. American Association of Medical Colleges. Report on residents. 2015. https:// www.aamc.org/data/448474/residentsreport.html. Contents

Part I They Did It Their Way 1 Lynn E. DeLisi ...... 3 2 Judith M. Ford ...... 11 3 Ellen Frank ...... 17 4 Sheila Hollins...... 23 5 Hilleke Hulshoff Pol ...... 31 6 Eve C. Johnstone...... 37 7 Shaila Misri ...... 47 8 Antonia New ...... 55 9 Mani Pavuluri ...... 63 10 Mary Phillips ...... 69 11 Natalie Rasgon...... 75 12 Marcella Rietschel ...... 79 13 Nina Schooler ...... 87 14 Patricia Suppes ...... 93 15 Carol A Tamminga ...... 99 16 Danuta Wasserman ...... 105

Part II Plan Your Way 17 The Pursuit of Happiness ...... 117 18 External Barriers: Societal Attitudes ...... 121 19 Internal Barriers ...... 125 20 Putting Yourself First ...... 129

ix x Contents

21 Putting Yourself Forward...... 133 22 Project Conﬁdence ...... 137 23 Be Visible...... 141 24 Be Memorable ...... 145 25 Be Connected...... 149 26 Be Persistent ...... 153 Index ...... 157 Contributors

Lynn E. DeLisi VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, Brockton, MA, USA Judith M. Ford Department of Psychiatry, San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA, USA Sophia Frangou Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Ellen Frank Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, USA Sheila Hollins St. George’s University of London, London, UK Hilleke Hulshoff Pol Division of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands Eve C. Johnstone Royal Edinburgh Hospital, University Department of Psychi- atry, Scotland, UK Shaila Misri Department of Psychiatry, Obstetrics, Gynecology, University of British Columbia, Vancouver, BC, Canada; Department of Reproductive Mental Health Program, BC Children’s & Women’s Hospital, Vancouver, BC, Canada Antonia S. New Icahn School of Medicine at Mount Sinai, New York, NY, USA Mani Pavuluri Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA Mary L. Phillips Department Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA Natalie L. Rasgon Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA Marcella Rietschel Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Baden-Württemberg, Germany Nina R. Schooler SUNY Downstate Medical Center, Brooklyn, NY, USA

xi xii Contributors

Trisha Suppes Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA Carol A. Tamminga Translational Neuroscience Division in Schizophrenia, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA Danuta Wasserman Head of the National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden Part I They Did It Their Way Lynn E. DeLisi 1 Lynn E. DeLisi

1.1 Dr. Lynn E. DeLisi, M.D.

L.E. DeLisi (&) VA Boston Healthcare System, Department of Psychiatry, Harvard Medical School, 940 Belmont Street, Building 2, Brockton, MA 02301, USA e-mail: [email protected]

Dr. Lynn E. DeLisi, M.D. is an Attending Psychiatrist at VA Boston Healthcare System and Professor of Psychiatry at Harvard Medical School in Massachusetts, USA. She has been at the vanguard of schizophrenia research throughout her career, most notably in her use of neuroimaging and genetics to investigate the longitudinal biological outcomes of schizophrenia. She currently serves on the advisory committee of the Schizophrenia International Research Society, is President-elect, and is a founding editor of one of the society’s journals, Schizophrenia Research, which is the largest scientific journal reporting findings exclusively in the field of schizophrenia research. She has authored a best-selling book entitled “100 Ques- tions and Answers about Schizophrenia: Painful Minds,” which provides practical answers to patients with schizophrenia and their families.

1.2 What Was Your Earliest Ambition?

Curiously, although this is certainly a common vocabulary word, my first task in writing this essay was to “Google” the word “ambition,” just to make sure I was thinking about it correctly. Ambition is “an earnest desire for some type of achievement or distinction, such as by power, honor, fame, or wealth, and the willingness to strive for its attainment.” Quite possibly my earliest glimmer of ambition came with my first encounter at age 8 with the mortality of a close family member, my grandfather. At age 8, one really cannot fathom what it is like to be dead, but my earliest memory is telling myself that I must leave a “mark” on the earth before I go so that I will be remembered forever. The death of my grandfather was the beginning of my quest for immortality and a significant earliest turning point in my life. It was only a few years later when I read a child’s version of the biography of Marie Curie that I knew that I wanted to be a scientist. My father would take me to the town library each week to borrow books that I devoured easily at a rate of one a day. I read every biography of all kinds of famous people I could find on the shelves. Marie Curie was by far my most revered idol and her biography was the most important and treasured one that I read. What I learned from her life is that despite poverty, hardship, and prejudice against women in the workplace, perseverance and persistence were the traits that led to success. I also learned the obvious, that marriage to a scientist with whom one could uncover the truths of science, was the only way to go.

1.3 What Attracted You to Psychiatry?

It must have been in my sophomore year of high school that my biology teacher showed us a movie all about cancer and the researchers in white coats pursuing its cause. There was a boy in my class at the time that I had an intense crush on and he too wanted to be a cancer researcher; thus, we would spend hours on the phone not only checking homework answers, but dreaming together about how we would solve the riddle of cancer. 1 Lynn E. DeLisi 5

That led me to medical school, which was the ﬁrst step certainly that would lead me to psychiatry. My goals upon entering medical school were to go into research through internal medicine, endocrinology, or neurology. So how did I happen to choose psychiatry? It is quite embarrassing to say, but at the time, I had two infant children, as well as a need to do a residency. My husband was quite old-fashioned and believed the changing of diapers was up to women, and thus, I had no choice but to look for a residency in a specialty that had the least amount of night-call. To be honest, that was how I was led to psychiatry. At the time of my residency, however, departments of psychiatry were all run by psychoanalysts and biology generally became buried by my preceptors’ devotion to Freudian principles. My rebellious nature then led to many arguments in classes in which I would insist that biology underlies all of human behavior. I particularly fought the suggestion my child psychiatry teacher endorsed that full-time mothering during the very early years was necessary for all children in order to avoid later psychopathology. Later on in the program when decisions had to be made about where to go upon graduation, I was awarded the chance to be a clinical associate (postdoctoral trainee) at The National Institute of Mental Health (NIMH). See below as to how I managed to get in through “the back door” without putting in a formal application. Since I was very proud of this opportunity, it was with much dismay that I took to heart the interpretation by the director of my residency that I was surely exhibiting “countertransference to my patients” by choosing to do a fellowship in biological psychiatry in the NIMH intramural program rather than going to one of the schools for training in psychoanalysis. The year was 1978. In summary, my choice of psychiatry was one of convenience due to the pressures of motherhood and marriage in the 1970s, a time when women’s liber- ation had only just begun. Once in the ﬁeld, however, I became fascinated particularly with the symptoms of schizophrenia, having read and viewed the movie “I Never Promised you a Rose Garden” and read many of Frieda Fromm-Reichmann’s volumes on the psychoanalysis of her patients with schizophrenia—an illness to which I devoted my biological pursuits in years to come.

1.4 What Do You Enjoy Most in Your Job Now?

It has now been 40 years since I began my residency in psychiatry. I had high hopes for my career and saw myself as someone who was going to, and must, rise to the top, even despite the “glass ceiling” that was always placed directly above my head as a woman. I envisioned myself simply solving the enigma of schizophrenia, perhaps even awarded the Nobel Prize or at least the “Nobel” of schizophrenia research. That never happened and so in that, and many other ways, I have considered myself a failure. I failed at negotiation for top positions and often considered family ahead of profession in choosing the paths I took. The few times I chose to follow my career aspirations before other considerations, the choices led to the eventual dissolution of my marriage and to personal hardship. The job I currently have is one in which I accepted in order to be close geographically to my 6 L.E. DeLisi family. It was not and is not a position of leadership, nor one that gives me a broad impact on the alleviation of mental illness that I would have liked; nor is it one that allows me to think about science, develop hypotheses, and pursue them with sci- entiﬁc rigor. I have a heavy load of patients mainly with very acute and life-threatening mental illness. What I do like about this current job is that I am helping my patients each day to recover from debilitating symptoms and to be able to go back to life to pursue their dreams. It gives me great satisfaction to see them improve as a result of my care. I also enjoy being able to teach a new generation of young psychiatrists, such as the excited and eager residents who rotate through our program. Perhaps by being a role model for them, I will inﬂuence their careers and have a lasting effect on their life choices and goals. These will certainly outlive me and in that sense I will have achieved the immortality that I pined for as an 8 year old.

1.5 Who Do You Consider Your Mentor(S) During Your Career?

My first real mentor, and one who influenced my life in so many ways, was Richard J. Wyatt. When I first met Richard, he was giving incredibly inspiring psychopharmacology lectures to my residency class, although he ran a large, successful research laboratory in the intramural program of NIMH at St Elizabeth’s Hospital in Washington, DC. He was a very dynamic and energetic teacher, and so it was no surprise that I would get up enough bravery to make an appointment to see him for career advice during my 2nd year of residency. Much of the details of that meeting 39 years ago are still very clear in my memory. He cautioned me about becoming a researcher and even applying for the coveted NIMH Clinical Associate Fellowship for those first years beyond my residency. “You would never get in,” he said. “You are a woman with 2 young kids and no one would believe you could do it…Research requires long hours of devotion to succeed…No,” he said. “You can’t possibly do it.” I remember going home crying that night, but also vowing to persist. I went back to him again and again, and finally, during my last year of residency, he found discretionary funds to bring me in as the first woman clinical research fellow in his laboratory. What I did not realize was that it would take 2 more years of my working hard and succeeding to uncover something important to have him take me seriously and smile with amazement at me, saying that I “had surpassed the men in the laboratory.” Eventually, I went on to work at other NIMH laboratories, although from time to time Richard kept up with me and continued to advise me in career decisions until his untimely death in the early 2000s. Dan Weinberger and I organized a festschrift in his honor the year before he died. In the process, I sent personal invitations to all the mentees he guided, surprisingly finding that they numbered over 100. This too made me reflect on how much Richard J. Wyatt achieved immortality by living on in every one of us and our mentees as well. 1 Lynn E. DeLisi 7

My mentors that followed were Monte Buchsbaum, Elliot Gershon, and Fritz Henn. Notably, there were no women who mentored me, which was quite significant, as I was alone in trying to find and fight my way through many obstacles placed in front of me in what was, particularly in my early years, “a man’s world.” Marie Curie continued to be a mentor of sorts in that her career and life served as the only role model I saw myself following. While I did not have female mentors per se, I did have somewhat older women colleagues I could look up to and want to emanate in some ways. Nancy Andreasen was a strong force in my career always giving me critical advice and spurring me on to do better. Paula Clayton exemplified the woman leader that I wished I could be and so I was so outraged many years ago that I wrote a protest letter to the Board of Biological Psychiatry when she was president because one of the men introduced her by saying “what I like about Paula is her new hairdo.” Part of me also wanted to be like Myrna Weissman, who too was a leader in our field who has accomplished so much. There were, however, other women in the course of my career, who particularly attempted to block my success, with a curious bias against my grants, award nominations, and anything that brought me personal success. Sometimes, I found that some women colleagues facilitated my career, while others hindered it and could be my worst enemies of all.

1.6 What Was Your Best Career Move?

This is a difficult question to answer because as I look back on the moves I made from the NIMH-IRP, to SUNY Stony Brook, to NYU, and then to the Boston VA, each were made with other considerations in play rather than advancement of my career. However, if a move could be considered some projects with which I achieved success, it was first, with my development and establishment of the journal Schizophrenia Research and of the two societies I worked so hard to develop and administer: The International Society of Psychiatric Genetics and The Schizophrenia International Research Society. The field of biological psychiatry goes on now for the better with each of these 3 things in place for which I have enormous pride.

1.7 What Were the Key Obstacles You Had to Overcome?

The obstacles I overcame have become the story of my professional life and career. All of them I see being related to my being a woman and thus a wife and mother as well. When I applied for medical school, I was asked whether I planned on marriage and I was advised by the male professor who interviewed me to “make sure I used birth control.” Another interviewer at a different school asked me which I would put ﬁrst: my career or my husband and family, to which I replied it would be the latter. I was rejected from that school soon after the interview. 8 L.E. DeLisi

When my husband took a postdoc at a major university in Connecticut and I was in medical school in Philadelphia, I was forced to drop out for a year, but overcame this obstacle by negotiating a special arrangement with my understanding female Dean to finish medical school at my husband’s postdoctoral institution. But then when my husband obtained his first job in a remote region of northern New Mexico where I had no opportunity to complete a residency, I managed to pass examinations to obtain a medical licence in New Mexico and to perform general practice in rural clinics until the time we moved a few years later to an urban area with lots of opportunities. My writings above about how I became “interested” in psychiatry tell of other obstacles I had to overcome in my personal life. But perhaps the most memorable obstacle to achieving advancement and success in my career came when I was a fellow in the intramural program and was asked to leave, not because I had not accomplished some important things, but simply because I was not part of the “all boys network” that existed at the time. This obstacle was not overcome by me personally, but rather by someone else, a woman in my same situation, who filed a class action suit against the institution for sexual discrimination. While this suit was active and she was calling in witnesses, naming me in writing as another colleague who clearly was discriminated against, I was called to a special meeting of the director. I was told the details of the lawsuit and how it was not in my best interest to support it and in turn was given the option “because of my outstanding work” to become a permanent senior member of the NIMH-IRP and to become a member of any of the existing laboratories I wished. That certainly was an opportunity I could not turn down. When I finally did leave NIMH in 1987, I did this by my own choice.

1.8 What Kept You Going During Difficult Times?

I have had many difﬁcult times. Research that did not go as planned, despite months of gathering data, grants written well that never got funded, failures in my personal life, and failures obtaining advanced positions and achieving awards and prizes for my work. What has kept me going most of all is persistence, focus on goals with energy and hard work, and a desire to achieve that outweighs all the failures combined.

1.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

Being a woman meant invariably that I was noticed more. I stood out at meetings because of my minority status and so that made me more visible, particularly if I did well. Women also, and I think this includes me, are more collegial and willing to share data and ideas with others than men. I have also been more sensitive to issues 1 Lynn E. DeLisi 9 speciﬁc to women and have fought hard for others if I thought they were being discriminated against because they were female. I have had, on the other hand, mentioned above, many obstacles that did have a negative effect on me because I am a woman. These are just facts that I live with. Currently being an “older woman” is no fun. Postmenopausal women are seen as “over-the-hill,” whereas similar aged men give the appearance of being more distinguished and endowed with leadership qualities that people often do not think of women as having.

1.10 How Did You Deal With the Issue of Work–Family Balance?

Much of this question is answered above when I wrote of the obstacles and other personal challenges in my life. However, while achieving a successful work–family balance was a challenge, I did manage it by obtaining special permission to take longer to graduate medical school, to do residency 3/4 time (yet finishing on time by sacrificing lunch and working twice as hard as the others in the time I had), by accepting positions in my career that were convenient for my family, by having homes in two different states or halfway between my husband’soffice and my own, but most of all, by spending my money on full-time housekeepers, and by analyzing data in hours way after all others in my household had gone to sleep. I am a grandmother now and see these same issues being dealt with by my daughter and daughter-in-law, each very differently. The latter sacrificed her own career for my son’s and so she stays home and manages the children and all their activities. My daughter struggles with a full-time career, but manages because her husband changed diapers, drives kids to endless activities, and has done his share of the family chores. How one balances career and family is the essence and challenge of life and it differs by stage of life for sure.

1.11 What Would You do Differently If You Were to Start Your Career Now?

This is a question that can only have a theoretical answer, as times have changed and the challenges and obstacles in my 40-year career would not be the same if I now had the opportunity for another 40. However, there are things I could have done differently: (1) I could have devoted myself more to raising my children in those crucial years when they needed me and were growing up. Those years did not last very long, but those were the years that I was climbing the academic ladder and because of that always so stressed by the need to succeed. (2) I would have had more confidence in myself so that I would have been able to develop a strategy for negotiating for what I deserved as I advanced. Perhaps formal training in leadership and negotiation skills would be something I should have pursued. (3) I never would 10 L.E. DeLisi have taken a job that was a parallel or even worse, a step-down move. And (4) despite my focus on a full-time research career in my early and middle years, I should have foreseen the power of being board certified in my specialty and pursued “Boards” despite my feeling that they were a waste of time. At the moment when I finally realized this, it was too late, as all my close colleagues were board examiners and they had too much difficulty finding anyone to interview me for the orals who did not know me.

1.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

Always strive for excellence, be persistent, work hard, and be the best you can. Never take advantage of your status as a woman to expect special favors or priv- ileges. Know that you are equal to men, but also different in many ways. These differences can either help or hinder you, depending on how you use them. Most of all, remember to be compromising and sharing with both your male and female colleagues, negotiating with kindness and respect for them, as you would like them to do with you. Judith M. Ford 2 Judith M. Ford

2.1 Dr. Judith M. Ford

Dr. Judith M. Ford is a Professor of Psychiatry and Co-director of the Brain Imaging and EEG Laboratory at the University of California, San Francisco, USA. She is at the forefront of efforts to bridge the gap between neuroscience and

J.M. Ford (&) Department of Psychiatry, San Francisco VA Medical Center, University of California San Francisco, 4150 Clement Street, 116D, San Francisco, CA 94121, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 11 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_2 12 J.M. Ford psychiatry. Her research focuses on integrating data across imaging modalities and EEG to characterize the neural correlates of symptom expression in psychosis. Dr. Ford is committed to promoting mentoring in her ﬁeld and in particular to fostering the next generation of translational psychiatrists through her role as Director of the VA Schizophrenia Research Fellowship Program.

2.2 What Was Your Earliest Ambition?

I had a series of early ambitions. As a tall 4 year old, I dreamed of being the tall lady in the circus. Several years later, I dreamed of being a movie star—not an actress—just a star. In high school, I was the ﬁrst girl ever to run for student council president and dismissed questions of whether it was “against the rules” for a girl to run. I failed at all three dreams. When I got to college, there were not many women role models on the faculty, and instead of dreaming of being a college professor, I dreamed of marrying one. I succeeded at that, but only after I became a professor myself.

2.3 What Attracted You to Psychiatry?

During my ﬁrst (and only) year in the PhD program in cognitive psychology at UC Berkeley in 1970, I studied human memory. Historical scholars may remember that UC Berkeley closed its doors in the spring of 1970 following the invasion of Cambodia. This was a time of great political and social upheaval and, for many, a time of personal introspection. I decided to “take a break” from memory research to ﬁnd a socially responsible job. My quest led me to the laboratory of Dr. Bert Kopell of the Department of Psychiatry at Stanford Medical School, located at the VA hospital. Dr. Kopell was studying schizophrenia, using methods at the “interface of psychology and physiology.” Not only did the prospect of learning about psychiatric illnesses seem ecologically valid, but I was also intrigued by the possibility of learning how to record evoked potentials—a “window on the brain.” Although I was surrounded by veterans with schizophrenia, initially I was not particularly interested in their symptoms or illness and focused instead on basic human neuroscience. A product of the sixties, I believed schizophrenia was a “choice,” not a brain disease, and wondered why my colleagues were wasting their time. In spite of my biases, in the mid-1980s, I worked on a schizophrenia brain imaging project with Dolf Pfefferbaum and quickly realized what others already knew: People with schizophrenia have a serious brain disease, manifested in abnormalities in brain function and structure. I came to appreciate the power of clinical neuroscience research in promoting our understanding of the mechanisms of psychopathology and giving patients and families a biological explanation for the symptoms of the illness. 2 Judith M. Ford 13

2.4 What Do You Enjoy Most in Your Job Now?

I enjoy interacting with patients in our studies and listening to them talk about their lives and experiences. This is personally rewarding, and it also informs my efforts to understand the neural mechanisms responsible for the hallucinations and delu- sions they describe. I enjoy interacting with my colleagues locally, nationally, and internationally. This happens in the course of running a laboratory full of young scholars, in serving on and chairing committees and in presenting research data at conferences around the world.

2.5 Who Do You Consider Your Mentor(s) During Your Career?

I was an “early adopter” of the EEG-based evoked potential method. Its utility in human neuroscience led me to pursue a PhD in Neuroscience at Stanford. Although there was local expertise, there was only one other neuroscience student interested in human neuroscience, making it a lonely enterprise. Steve Hillyard, at UC San Diego, was an even earlier adopter of the method, and I was lucky enough to spend a summer in San Diego working closely with him and all the other graduate students in his laboratory. It was a rich educational experience that I could not have had at Stanford. Steve agreed to remotely guide my PhD dissertation on human attention and evoked potentials. After getting my PhD, I continued to work closely with Tom Roth and Dolf Pfefferbaum, psychiatrists and human electrophysiologists at Stan- ford. They were important scientiﬁc and career mentors and worked hard to get me appointed to the psychiatry faculty at a time when PhDs were not exactly welcomed.

2.6 What Was Your Best Career Move?

The best move I ever made was my move to Yale. The Yale Psychiatry Department valued PhDs and welcomed me. About a month after I arrived, I got a call from the chair’sofﬁce inviting me to the “tenured faculty” meeting. I gasped, “I have tenure?” Tenure was something I had never dreamed of having nor thought to ask about.

2.7 What Were The Key Obstacles You Had to Overcome?

Before moving to Yale, where the culture welcomed PhDs, the biggest obstacle I faced was being a PhD in a department full of MDs. PhDs could not get a faculty appointment without grant support and could not get grant support without a faculty appointment—an impossible situation. To work around this and stay in the research 14 J.M. Ford game, I had to ﬁnd colleagues willing to serve as principle investigator on grant applications I wrote. I did this for decades, until the culture softened and I joined the faculty. However, even after I was on the faculty and had risen to the rank of full professor, I continued to face obstacles in the workplace. One Sunday afternoon before a Monday morning MRI scan of a research participant, an MD in my department questioned whether I was qualiﬁed to do MR scanning because I was not an MD. He tried hard to shut me down. My department chair came to my rescue in the nick of time, and I scanned early Monday morning.

2.8 What Kept You Going During Difficult Times?

Occasionally, over my long career, I have wondered whether it is all worth it— feelings of inadequacy fueled by negative reviews of papers, difﬁculty balancing work and family, and internecine warfare in the department. At those times when I got close to quitting, I realized I would miss all the friends and colleagues I had gotten to know over the years. Although I only saw them once or twice a year, I had developed strong attachments to them, because we had “grown up together” in the ﬁeld. If I quit, I’d never see them again.

2.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

As an older woman, I recently realized that I am “invisible.” My equally old friends from high school agree—it does not matter what we do, what we wear, what we say—we go unnoticed. We are all OK with it, and it is strangely liberating. However, in thinking about when this “invisibility” started, I realize that even young women are often unheard, or if heard, they are not given credit for what they have contributed. The universality of this was apparent when I saw a New Yorker cartoon, depicting a board meeting with the chairman saying, “That’s an excellent suggestion, Miss Triggs. Perhaps one of the men here would like to make it.”

2.10 How Did You Deal with the Issue of Work–Family Balance?

I balanced work and family by working part-time and raising my daughters full-time—a 150 % FTE. I worked part-time for 22 years, from the birth of my older daughter until my younger daughter left for college. I worked whenever they were occupied with friends, lessons, sports, music, school, or asleep. When they were little, struggles at work could not bring me down because of their pervasive 2 Judith M. Ford 15 positive energy and my love for them. When they were in high school, I learned that I was a role model for them. Although it was terrifying to have such an elevated position in their lives, it made me glad that I had never given up my career, even when the work–family balance seemed impossible. Going forward, if I ever thought of throwing in the towel, I could not because I did not want to let them down.

2.11 What Would You Do Differently if You Were to Start Your Career Now?

Two words: day care.

2.12 What Advice Would You Give to a Young Woman Starting her Career Now?

Young women are always advised on how to successfully negotiate with their department chair, but I think it is just as important for women to ﬁgure out how to negotiate with their husbands for a fair distribution of household and family responsibilities. Of course, the biological realities of childbirth and infant care can derail the best-negotiated balance between work and family; it will need to be renegotiated as soon as it is emotionally and biologically possible. Ellen Frank 3 Ellen Frank

3.1 Dr. Ellen Frank

Dr. Ellen Frank is Distinguished Professor Emeritus of Psychiatry and Psychology at the University of Pittsburgh School of Medicine in Pennsylvania, USA. Dr. Frank chaired the U.S. FDA Psychopharmacologic Drugs Advisory Panel and

E. Frank (&) Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 17 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_3 18 E. Frank was elected to the National Academy Medicine in 1999. She is internationally recognized for developing the Interpersonal and Social Rhythm Therapy for Bipolar Disorder. She is Chief ScientiﬁcOfﬁcer of HealthRhythms, a health technology start-up that uses MoodRhythm, a smartphone application based on her research, to track the mental state of patients in a naturalistic manner.

3.2 What Was Your Earliest Ambition?

I do not know that I actually ever thought of myself as ambitious; in retrospect, though, I always was… and other people saw it. A year or so after my husband and I got married, he mentioned that he had been voted ‘Most Likely to Succeed’ by his high school class. We did not do that at my high school. Instead, there was a section of our yearbook entitled ‘The Perfect Senior’, with separate lists for the perfect boy and girl in terms of the best hair, eyes, smile, athletic ability, etc. I remembered I’d been on the girls’ list, but I could not remember for what so I went in search of my yearbook. The answer: Ambition. When I saw that, some 14 years after graduating, it rang true. Throughout grade school and high school, I’d always looked for some new mountain to climb, a new objective to achieve, whether it was editor of my grade school newspaper, president of my high school sorority (yes, we did that back in the late 50s) or acceptance at a Seven Sisters college. Ambition was so intrinsic to my nature that it never occurred to me that there was another way to be. My earliest ambition? Probably to become a bal- lerina; but, by 13 I knew I had neither the right body nor the willingness to give up every other part of my life, which was looking like what becoming a professional dancer would require.

3.3 What Attracted You to Psychiatry?

Maybe the question should be what attracted psychiatry to me. In 1973, becoming a psychiatric researcher was probably the last thing I’d ever thought I would do. Then, Thomas Detre brought a team of 27 people from New Haven to Pittsburgh to form a new, scientiﬁc department of psychiatry. At the time, I was hosting a talk show on women’s issues on a local television station. I invited Carol Anderson, part of the Yale onslaught, to appear on the show to talk about gender roles in families. She went back to Tom and said she thought she’d found the replacement for the research assistant they had been unable to persuade to come to Pittsburgh (who, by the way, had a talk show on women’s issues on the radio in New Haven). What they saw in me, I’m not sure, but the rest, as they say, is history. I was completely and immediately fascinated by the science of psychiatry. Again, in retrospect, that psychiatry was where I belonged should have been pretty obvious. My very best grades as an undergraduate drama major were in the 3 Ellen Frank 19 only three psychology courses I took simply to fulﬁll our science requirement. Once landed in psychiatric research, I found myself totally in my element. I loved the patients, the questions, the grant writing, the carrying out of studies, the analysis of the results and the writing of papers.

3.4 What Do You Enjoy Most in Your Job Now?

I have just moved to emerita status, so I don’tofﬁcially have a ‘job’ anymore. Nonetheless, I ﬁnd that what I enjoy most has not changed very much. I am still involved in a good deal of mentoring of young people and enjoy talking with them both about research design and analysis issues and about research career survival skills, including how best to use their time, what to accept and what to turn down, how to negotiate for what they need to be successful and, yes, how to balance career goals and personal goals.

3.5 Who Do You Consider Your Mentor(s) During Your Career?

When asked about this, I always make the distinction between mentors and role models and emphasize how important both have been for me. It is possible for the same person to be a mentor and a role model, but not at all necessary. Myrna Weissman has served as a critically important role model since the very ﬁrst days of my work as a research assistant and graduate student in the mid-1970s. I saw a woman who was perfectly and elegantly put together and presented her work with absolute command of her topic and knew I wanted to be like that. Although Myrna has never been my mentor in the strictest sense of the word, I have learned volumes about how to be a woman scientist by staying in close touch with her and watching how she did things. As to who taught me what to do, much of the credit has to go to the man who became my husband, David Kupfer. Pretty much everything I know about study design, grant writing, project and personnel management, negotiating with journal editors, local and national committee service, I learned from him. Helen Kraemer has been another key mentor. She continues to teach me how to think through a research question so that one comes up with the right analytic strategy and that, if that strategy does not exist, one either needs to rethink the question or invent a new analytic strategy. Most important, Helen gave me—someone who is seriously mathematically challenged and cannot think in symbols to save my life—the conﬁdence that I knew how to do that. 20 E. Frank

3.6 What Was Your Best Career Move?

My best career move was more a gift than a move. When David Kupfer became chair of psychiatry at Pittsburgh, he asked me to take over as PI of the long-term maintenance study of depression that we were conducting. It was not where I was thinking of putting my energy at the time, but it proved to be the starting point for the series of studies of maintenance treatment for unipolar and bipolar disorders that have pretty much deﬁned my career. My best move? Not saying ‘no’ to that gift.

3.7 What Were The Key Obstacles You Had to Overcome?

I got a late start, entering graduate school at 31, but that was a blessing in some respects, allowing me to develop as a person and a thinker before I had to compete in the academic marketplace. If there was an obstacle, I suppose it was people assuming that I had not really made a meaningful contribution to the studies that my husband and I had carried out together. Indeed, when I was being considered for tenure, I received a call from the departmental promotions committee chair asking me to ‘document my independent contribution’ to those studies. Initially, I felt insulted. Later, I realized that he and the committee were trying to protect me from questions that were likely to come up when my promotion went over to the medical school. In fact, completing that documentation was one of the most satisfying experiences of my career. It helped me to see with exceptional clarity how critical my role had been in designing, carrying out and publishing those studies.

3.8 What Kept You Going During Difficult Times?

Avoidance and denial: two great defence mechanisms. And, occasionally, ﬁghting back. When things did not go as I’d hoped, I typically just looked around for the next thing to take on. Becoming involved in whatever that new challenge was took my mind off whatever had not gone my way. I can, however, think of a few rejected papers that turned into publications when I called—not wrote; some things are better not put on paper—the journal editor and pointed out the clear errors or bias in the reviews. Once, when I was studying interventions for female rape victims, the government informed me that they were cutting my grant by some 35 %. I wrote back to say that I doubted that a similar cut would have been taken from a grant focused exclusively on men and that, since it would be impossible to carry out the study with 65 % of the budget, I was returning the money. I was scared to death the government would actually comply, but my mentors reassured me that it was much too complicated for them to take back money. It took about a week for them to restore the cut. 3 Ellen Frank 21

3.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

I loved what Cambridge Professor Mary Beard said, ‘It would be a lie to say that gender has held me back in my career; but, it has sometimes been a case of feeling in a foreign country’. Mostly, though, in the department that Tom Detre and David Kupfer built, women did not need to feel that way. There were lots of other women around and they were given a great deal of responsibility and respect. It was when I left our fairly unique environment that it sometimes seemed that I was in a foreign country. Still, I do not think I felt a need to behave differently there. The conﬁdence that was instilled in the women in our department served us well when we found ourselves in those strange lands.

3.10 How Did You Deal with the Issue of Work–Family Balance?

A lot of things helped me in this regard: not needing much sleep, enough resources to have help in our home, an ex-husband who was devoted to his daughters and highly collaborative in their upbringing, a husband who encouraged me in all my career goals and being clear in my own mind that, unless there was an absolutely incontrovertible deadline, my children came ﬁrst. In retrospect, for one of my daughters, this worked out ﬁne. My other daughter really would have liked to have had a different kind of mother who did not work outside the home, did not travel and was not so focused on her own goals. It is the one great sadness of my life.

3.11 What Would You Do Differently if You Were to Start Your Career Now?

If I had understood how hard my career was on my younger daughter, I would have tried to ﬁnd ways to be more of the kind of mother she wanted. I’m not sure how well I would have succeeded, but at least I would have tried to be home more often when she came home from school and to travel less until she had gone off to college.

3.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

I spend a lot of time doing this these days, so what is it that I say? And is it any different from what I say to the young men I mentor? I tell young people to figure out what they are passionate about and to pursue those ideas. If a grant application 22 E. Frank you’re writing is boring you, write a different one. If you really can not muster the enthusiasm to respond to the critiques on a paper, just drop it and move on to a paper you’re excited about. Be as thoughtful, careful and kind in your relationships with clerical support and cleaning staff as you are with senior faculty members. These people can often be as critical to your success as your department chair. Work on forming personal relationships with those who can shepherd your work along: journal editors, granting agency staff, etc. This may seem an intimidating prospect, but even these ‘powerful’ people are generally interested in getting to know those who are intrigued by their work. Go up to them at meetings and introduce yourself. Start an email dialogue about a question you have about their work. And to women, specifically? If you are about to have a child, especially a first one, plan to ease back into work. Nothing can prepare you for how hard it will be to leave that baby, so do not take all your maternity leave in one continuous lump. Come back to work earlier than you’d planned, but only two days a week, then go to three and then finally to five. Sheila Hollins 4 Sheila Hollins

4.1 Professor Sheila, Baroness Hollins of Wimbledon and Grenoside

S. Hollins (&) St. George’s University of London, London, UK e-mail: [email protected]

Baroness Hollins is emeritus professor of psychiatry of disability at St. George’s University of London in England, UK. In 2010, she was appointed to the House of Lords as a cross-bench peer for her innovative research and policy advocacy on the mental and physical health of individuals with learning disabilities. She is also founder and chair of Beyond Words, a charity that designs picture books to aid communication in people with intellectual disabilities. Dr. Hollins chaired the Board of Science at the British Medical Association until 2016 and is currently president of the College of Occupational Therapists. She holds an honorary chair in the Department of Theology and Religion at the University of Durham and has also served as president of both the British Medical Association and the Royal College of Psychiatrists.

4.2 What Was Your Earliest Ambition?

An early ambition was to be a nurse—I remember the home birth of my younger brother and the role of the midwife who came to support my mother. I was very impressed. My parents let me join the St. John’s Ambulance Brigade cadets when I was still at primary school and I took the exams seriously. When I was 15 my biology teacher encouraged me to consider medicine instead. I also wanted to be a musician and to play in the Halle Orchestra. My favourite activity as a young teenager was to sit behind the orchestra in the choir, watching the conductor closely and listening to a concert in the Shefﬁeld City Hall! I learned jazz clarinet as well so would have been thrilled to be in a jazz quartet.

4.3 What Attracted You to Psychiatry?

I was curious about other human beings, their decisions and relationships and clearly remember wanting to know why people are the way they are. In fact I studied very little psychiatry at my Medical School, St. Thomas’, as I chose to get married during the psychiatry ﬁrm and it was not examined in clinical ﬁnals. But as a general practitioner in South London, I felt ill equipped to respond to my patient’s emotional and social problems so I took a psychiatry training post for 6 months thinking I would return to general practice later. Instead I fell in love with the subject, encouraged by one of my teachers who said my common sense would be useful.

4.4 What Do You Enjoy Most in Your Job Now?

In 2010 I was appointed ‘Baroness Hollins’—an independent ‘cross-bench’ peer in the House of Lords—where I speak mainly on mental health and disability. It involves me in trying to explain mental health and developmental disability to the 4 Sheila Hollins 25 public, to politicians and policy makers and to those responsible for commissioning and delivering services that will make a positive difference to people’s lives. I work strategically with organisations as diverse as the Vatican, Health Education Eng- land, and Beyond Words. My work brings together many years of clinical and academic experience as a psychiatrist, with my personal and family experience. The work I enjoy most and feel proudest of achieving is co-researching and co-creating picture books with people who ﬁnd pictures easier to understand than words. We all know the expression ‘a picture tells a thousand words’. What the pictures in my books achieve is to unlock a mode of communication that enables us to recognise the universality of feelings and relationships, independently of the ability to express them in words. Books Beyond Words is a tool for professionals to use with people in many different teaching and counselling situations, to increase empathy and to provide a glimpse into people’s inner worlds. Our books use pictures to tell stories that engage and empower people, on themes such as love and relationships, health, death and dying, and crime. www.booksbeyondwords.co.uk.

4.5 Who Do You Consider Your Mentor(s) During Your Career?

Most of my mentors would have considered themselves outsiders in some way, rather as I felt myself to be something of an outsider as a woman at that time, especially as a married woman working part-time. Thinking now about their qualities, they were generous people who would do anything to encourage and support others. Maybe they were perceived as being different, were thought not ‘clubbable’, or perhaps they experienced having to work very hard to belong because of their nationality, gender, race or sexual orientation. All issues that I hope are becoming a distant memory. They included my psychoanalyst who helped me with work/life balance issues but most importantly to gain insight into the contribution my own personality makes to any relationship whether professional or personal.

4.6 What Was Your Best Career Move?

My best career decision was probably to enter analysis when I was a trainee—at my own expense and in my own time! In the more traditional understanding of a career move, it is hard to choose. My three years as a GP were an essential foundation for the way I have practiced psychiatry. Higher training in child and family psychiatry profoundly inﬂuenced my later career working with adults with developmental intellectual disabilities. Leaving child psychiatry in 1981 to be a senior lecturer with Joan Bicknell, the newly appointed ﬁrst ever professor in psychiatry of intellectual 26 S. Hollins disability (mental handicap as it was called then) felt incredibly brave. One of my former consultant trainers commiserated with me: ‘My dear, I am so sorry—I hear you are going into subnormality’! I began to understand just how brave or foolish I was about to be! When I was offered the position, Joan introduced me to some of her (all male) colleagues at the University and said how glad she was to be appointing a psychotherapist. This encouraged me to think that my skills would actually be as relevant as I had hoped they would. The job description looked impossible and was seemingly unachievable. But I was inspired by an extraordinary woman and instinctively drawn to the work because of my experience with my young disabled son. I have always been highly motivated by my passion for my work, but I wasn’t career-focussed. I didn’t set out to become a consultant or professor—I think I wanted to understand my ‘patients’ as human beings and to be good at what I did. I was motivated by a desire to learn and to make a difference. Personal ‘success’ was a by-product, never a primary motivation.

4.7 What Were The Key Obstacles You Had to Overcome?

Finding a training post as a part-time clinician was a challenge. A senior professor said I wasn’t suitable for a training post at his prestigious institution unless I was prepared to work full time. Years later, during my presidency of the Royal College of Psychiatrists, he reflected that his hospital’s pressurised training programme could have destroyed my creativity. I know what he meant—too much guidance, too many rules about what you ‘must’ do to ‘get on’ are unnecessarily restrictive, perhaps even more so if you start off being different in some way. Secondly my academic career began rather unorthodoxly. I had published very little—but it included a paper about introducing one of the earliest home computers to my son to try and stimulate his language development. I understand that the rules have changed and the dreaded publish or perish has been replaced with one’s value and success being judged by the level of grant income obtained. My citations, impact score and grant income could never achieve the dizzy heights achieved by researchers with laboratories. My area of research is the least ‘sexy’ and the least medical and the last to need a laboratory. There is so little interest in my field that there are few grant opportunities. Have a look at the latest call for applications from any mental health or public health grant giving body and see how many such calls even mention my ‘patient’ group. My focus was on impact and making a difference. This too is now recognised, but making an impact can take a long time. Research I completed in the early nineties took several years to publish because it wasn’t considered of interest to physicians and GPs (it was about life span and cause of death in people with intellectual disabilities), but is at last having the kind of impact I hoped for. My finding that adults with developmental intellectual disabilities were 58 times more likely to die before the age of 50 was replicated in a 4 Sheila Hollins 27

Confidential Inquiry published two years ago, leading to the establishment of the first National Mortality Review for this client group worldwide—just 25 years after I completed my data collection! As for picture books with no words as a tool for communicating best practice, emerging from co-produced research with my client group—that was definitely not considered ‘academic’!

4.8 What Kept You Going During Difficult Times?

My husband! I am married to an unusual and wonderful man who shares my values and interests, although not at all in medicine, and who was more than content to share childcare, food shopping and so on. For many years he was a schoolteacher and was at home during school holidays. He has always been a great listener and comfort after a difficult day. My children are good company and I share different interests with each of them and their children. Grandchildren are a joy, and I have more time to observe them and ponder their futures. My spirituality is grounded in the Catholic Church and in a dispersed lay Benedictine community, not in a ‘blind’ adherence to a religious faith, but through finding a space for reflection in a global community with a shared culture and shared values. Of course we all have difficult times. One such time for me was when my youngest daughter was stabbed and became tetraplegic. Family, friends, colleagues and our faith community all gave us the strength to confront the resulting challenges, including having to deal with unwanted press intrusion and harassment.

4.9 What Role (Positive and/or Negative) Did Being a Woman Played in Your Career?

In some ways being a woman made my career easier because few of my teachers seemed to have any significant expectations of me! Nobody was pushing me to achieve, so I could just get on with doing what I enjoyed and found satisfying, without having to explain myself all the time. On the other hand, nobody thought my priorities and choices were particularly wise ones. Occasional advice to work full time if I wanted to be taken seriously was easy to ignore. With 4 children, one of whom had a developmental disability, full time was just not an option. So firstly as a trainee, then as a salaried GP, and later as a trainee psychiatrist, I was able to work part-time. I benefitted from the super- numerary part-time training programme established for women like me by the visionary Dr. Rosemary Rue. I chose a hospital that had a workplace nursery and fortunately it also offered excellent psychiatric training! The nursery was the priority for me, and running a campaign to save the hospital crèche from closure introduced me to the importance of understanding NHS management and the power of using broadcast and print media to gain support. 28 S. Hollins

I found that my voice was not ‘heard’ in meetings where I was the only woman. What I said was ignored, although the same idea voiced 5 minutes later by a male colleague might be received with acclaim, without any acknowledgement of my contribution! Many women report similar experiences. I learned a few tricks in my early days as an academic. For example, if I needed to leave a meeting before the end, I realised that everyone was sympathetic if I said I was going to collect my car from the garage, but they were not at all impressed if I said I was leaving to collect a child from school. As my conﬁdence grew I simply told the truth.

4.10 How Did You Deal With the Issue of Work–Family Balance?

My family has always and will always be my absolute priority, but I would never have been completely fulﬁlled by being a stay at home mother. I have always needed the intellectual stimulation and the personal rewards that came from clinical work, teaching and research. My personal analysis helped me to understand my own needs and to be conﬁdent in my own potential. I know that my family might consider my work to occupy too much of my time, especially since I retired from paid employment. But retirement simply means that with the luxury of a pension, I am free to choose which challenges I engage with and which I feel free to say no to. Another way I have tried to deal with work/life balance is to involve my family, especially my husband in opportunities that arise from my work. So we often travel to conferences together and then have a holiday afterwards. My aim has been to view my life as an integrated whole rather than to try to separate different roles and activities. The Benedictine charism is one of balance and stability and I have learned much from the monastic tradition, which encourages a rhythm of work, rest and contemplation within a community. My primary community is my family.

4.11 What Would You Do Differently if You Were to Start Your Career Now?

I wouldn’t want to do things very differently today from a career point of view, although I might have to. For example, to gain a clinical academic position, I would probably have to do a doctorate, rather than gratefully and graciously accept honorary doctorates in all manner of disciplines, which seems to be my good fortune now! Perhaps I would have studied something else before going to medical school. More importantly, I would be able to take advantage of maternity and paternity leave arrangements. When my ﬁrst two children were born, there was no such provision. I was unemployed for 4 months after my daughter was born, having worked more than 100 hours a week up until two days before her birth so that I 4 Sheila Hollins 29 could ﬁnish my house jobs (residency), and had to go back to work to help pay for the mortgage. Later as a GP when my son was born, the senior partners expected me to go straight back to work—I only managed to negotiate 4 weeks completely off after his birth. That was an exhausting time but fortunately, I was working part-time.

4.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

Be conﬁdent. Remind yourselves that since ﬁfty-one percent of the population is female, your ideas and interests are just as valid as any of those presented by your male colleagues. Ignore muttered predictions of the downfall of medicine because of its femini- sation. Women may choose to do things differently and have a differently shaped career than a man, or they may choose the traditional route, which was, frankly speaking, designed by men for men. Women may indeed have different priorities in terms of work/life balance but also in the way we see the world, the issues that we think most important, the methods we choose to progress our ideas, and our approach to collaboration. One of the principals of the medical school where I am still an emeritus professor of psychiatry told me that he liked to appoint people who had had zigzag careers. People who had obviously followed their own interests rather than trying to copy someone else’s. My advice to young women is to do just that. Hilleke Hulshoff Pol 5 Hilleke Hulshoff Pol

5.1 Dr. Hilleke Hulshoff Pol

H. Hulshoff Pol (&) Division of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands e-mail: [email protected]

Dr. Hilleke Hulshoff Pol is Professor of Neuroscience at the Brain Center Rudolf Magnus at the University Medical Center Utrecht, the Netherlands. She leads a research programme on structural and functional brain plasticity throughout life in health and in psychiatric disease, in particular in relation to genetic and environmental inﬂuences. Much of her research has utilized the twin design based on the Netherlands Twin Register. Dr. Hulshoff Pol chairs the Scientiﬁc Advisory Board of the Dutch Brain Foundation (Hersenstichting Nederland) and has spearheaded several international initiatives and consortia in psychiatric neuroimaging.

5.2 What Was Your Earliest Ambition?

This is an interesting exercise into my earlier memories. It feels like opening doors that have long been closed. It also feels tough to be so honest, and sobering to compare the early envisioned ambition with the outcome so far. Well, from an early age on, I alternated between my wish to be a scientist and my dream of becoming an artist. This early ambition seems a strong underlying driving force even today. I remember listening to music as a young child and imagining myself as an orchestra conductor, receiving the audience’s loud applause at the end of a great concert. Indeed, when I was young, there was no lack of ambition or shyness.

5.3 What Attracted You to Psychiatry?

I have always been fascinated by the brain. At school my favourite subjects were biology and mathematics and when lessons on neurons started I thought this was all very fascinating. My attraction to psychiatry came later. My mother, Eef Hulshoff Pol-Kars, was a child psychologist with her own clinical practice. I have very fond memories of discussions about brain and behaviour at home. My father, Dirk Hulshoff Pol, is a physicist who also enjoyed having lively dinner time discussions with my two sisters, Annekee and Fenneke, and me. So, our skills in logical argumentation were sharpened from an early age. I wanted to go to medical school but was strongly advised against it in light of difﬁculties combining the heavy working load with a future family life. Also, I, myself, was worried that I may not have the stamina required for this. So, I went to study psychology instead. This had the advantage of providing a short cut to studying the brain. Throughout my university education I was attracted to the biological basis of human behaviour. I managed to join courses on brain anatomy at medical school outside of the required curriculum. After specializing in neurophysiology and neuropsychology and completing a PhD in neuroscience, I got a great job offer in psychiatry to set up a brain imaging research programme. I said yes and have not regretted it since. 5 Hilleke Hulshoff Pol 33

5.4 What Do You Enjoy Most in Your Job Now?

I enjoy working with the highly motivated and highly talented young and senior researchers in my research group, in the department, in our hospital at large and beyond nationally and internationally. Since the advent of the Internet, science has no borders. This allows me to reach colleagues around the world from behind my desk and to join forces to improve (psychiatric) health. I consider this a gift to cherish. I also enjoy the sheer beauty of the outcome of a study, when after years of following an idea, empirical work from many researchers and loads of calculations, a conclusion can be drawn into a few sentences. In research it is the freedom to express and implement new ideas that I consider to be crucial for great science and for groundbreaking the translation in new health solutions. However, the current climate emphasizes rule making and rule following. Running science as a business improves management and accountability, but runs the danger of stiﬂing freedom and creativity. So we have to be careful not to throw out the baby with the bathwater.

5.5 Who Do You Consider Your Mentor(S) During Your Career?

There has not been just one mentor in my career. Instead, I would consider several to be mentors and examples during my career. I learned from my intern supervisor, Professor Nelson Butters at the University of California San Diego, to think independently, from my PhD supervisor Professor Jan van Ree to think out of the box and from the head of our department, Professor René Kahn, to think big. All males, but often males have no problem in promoting women. With women in psychiatry being much better known in the United States than in Europe at the time, it may not have been a coincidence that my first and most important female example in psychiatry was Professor Nancy Andreasen. I had read her seminal book on biological psychiatry when she came to visit our hospital in the very early days of our studies in schizophrenia and commented on our first structural brain images. Professor Judith Rapoport has also been a great example to me, with her wonderful developmental imaging studies in children, reaching out towards new scientific fields. Last but not least, I learn from and am grateful to my great female colleagues today, such as Professor Dorret Boomsma, who inspires by her great work, and the director of our Brain Center Rudolf Magnus, Professor Marian Joëls, who is not only a great scientist but also paves the way for other women’s careers in science.

5.6 What Was Your Best Career Move?

There have been two decisions that have been crucial in my career. My ﬁrst great move was my internship at the Veterans Administration Medical Center of the University of California, San Diego, after having completing my master’s degree in 34 H. Hulshoff Pol the Netherlands. It gave me the opportunity to learn new ways of thinking in a booming neuroscience environment. It was inspiring and gave me a solid basis in research and clinical practice in neuropsychology. On a personal note, it showed me that I could handle life on my own and I hope other young women take the time for such an experience. My second important career move was to seek a stable academic environment in which to develop. While building cohorts and developing new methodology in my growing neuroimaging lab, stability of location has been an asset.

5.7 What Were the Key Obstacles You Had to Overcome?

The key obstacle I have had to overcome was probably to trust myself that I was good at what I do. Uncertainty requires a lot of energy that can be put into more pressing matters. And you need to trust yourself in real time since the world outside is not waiting for you to start. Also some things are not explicitly obvious, such as that I wanted a career. For me this was so obvious but apparently to the outside world it was not. It has also been challenging to get across that I like technique. Being a woman, that was probably not considered natural. Once, a grant committee asked me where I intended to have the imaging data in my project analysed, after having explained for 20 minutes the new image analysis procedures I was going to develop in my research lab. Since that day, I always make sure to show a slide with impressively large computer systems.

5.8 What Kept You Going During Difficult Times?

I have been brought up with the view that women should be ﬁnancially independent and must therefore work. I have always been aware that this was easier for my generation than for my mother’s generation, who worked full time but also did all housekeeping chores. It was deﬁnitively easier for me than it had been for my grandmother, who was not allowed to go to university. What kept me going was an internal drive to do science, to make a difference by going forward and putting my weight behind ambitious plans.

5.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

For the most part, I would say it did not play a major role, but that is probably a lie. A new report came out this week (November 2015) on the number of females in universities in the Netherlands. The numbers are quite sobering with only 17 % of 5 Hilleke Hulshoff Pol 35 all professors being female, despite years of campaigns to hire more. Overall, when starting my career, I did not notice many issues in being a woman. However, when I became more senior and the competition grew more ﬁerce, it became clear that being a female plays a role. There have been times when being the only woman in a meeting of 20 made me wonder what was wrong with me. Next, I wondered what on earth made me have that thought. You get used to it however, and today there are fortunately more women around. To overcome the present bias against beta-oriented capacities of women sometimes requires a bluntness that seems not natural but that can be learned. Growing some elephant skin helps and this is what I tell young female researchers today. These young female researchers, as talented as they are, seem to struggle more than my generation has, despite seeing improvements in gender differences at work. As strange as it may seem, being underesti- mated because of my gender has also played a positive role since it allowed me to grow in tranquillity. It can thus be applied positively.

5.10 How Did You Deal with the Issue of Work–Family Balance?

Having a family has kept both my feet on the ground. My husband, Pieter Vos, is a neurologist who also has a very successful career. He has been very supportive and we have raised our family and children, Belainesh and Ashebir, together. Although I think that children benefit much from having input from many different people along the way, it is important that parents serve as the primary caretakers and teachers and should always be there for them. When our children were young, I wrote grants during the night to make-up for time spent with them during the daytime. It was fruitful but not healthy and I would advise against it. Also, having young children meant skipping conferences and meetings, which was a problem because it meant missing out on relevant information and passing up crucial opportunities for visibility. It is good to be aware of this. Flexibility in your agenda helps. Modern technology, such as the Internet, is a tremendous help. Talking to other women helps. Someone once gave me the great advice to always have your children at a primary school with other women with careers, since they know your situation and help out, all so true. It is not wise to live two lives, it is better to combine work and family in one. Yes, I have been in telephone conferences while walking with my kids or while cooking. No, I do not find that women are good at multitasking—Idefinitively am not—but it helps. Is it efficient? Yes, I think it can be as long as you can think fast on your feet and shift between homemaking and networking. Finally, when at times you wonder why you ever started a career, it helps to think that if you have to be stressed about something, you better be stressed out about something important. 36 H. Hulshoff Pol

5.11 What Would You Do Differently if You Were to Start Your Career Now?

To my surprise and joy, I have found out that I have no regrets and would not do things differently. Maybe, if I were to start my career now, I would follow my gut feeling even more strongly whenever possible. Also, I would try to keep even more focused, and to avoid letting myself get dragged away by details that take up time that could be better spent. Following your heart, also in your career, is a wise thing to do.

5.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

This is a tough one since each generation has its own setting. Be sure of yourself and keep that in mind when times are tough. Also, have a clear goal and keep that in focus along the way. Be aware that there is competition and that this will get stronger. Be proactive: High quality of work is a prerequisite for your career but other skills are also needed. You have to take opportunities when they arise. Be realistic: While you may be capable of many things, all of these require time and practice. Sometimes it is better to skip a few and to do what you can do at a high level. When you are a homemaker, just putting in the hours required of a full time job may not be enough, and it is hard to ﬁnd the extra time to keep in the forefront of the ﬁeld. Be aware that other women have the same issues as you. Work together with them to pursue changes in the workplace that can empower all of us. I have also found other women to be a source of inspiration when it comes to the work–life balance. My two sisters have great careers and I really admire them. I also admire my dear friend and colleague, Professor Chantal Kemner. She recently started a female network where business meets academia and it works! This book, initiated by Professor Sophia Frangou, is a wonderful effort to support other women. My last piece of advice to younger women is to lead rather than follow, so you can change your environment and set new standards. You can make a difference! Eve C. Johnstone 6 Eve C. Johnstone

6.1 Dr. Eve C. Johnstone

E.C. Johnstone (&) Royal Edinburgh Hospital, University Department of Psychiatry, Morningside Park Edinburgh, Scotland EH10 5HF, UK e-mail: [email protected]

Dr. Eve C. Johnstone, CBE, is a professor of Psychiatry and an honorary Assistant Principal of Mental Health Research at the University of Edinburgh, Scotland, UK. She is a pioneer in schizophrenia and psychosis research and revolutionised the ﬁeld of psychiatry by using neuroimaging to understand the neurobiology of schizophrenia. In 1994, Dr. Johnstone initiated the Edinburgh High-risk Study, one of the most successful longitudinal high-risk cohorts in the world. Dr. Johnstone is an inspirational mentor and has trained many heads of departments and professors of psychiatry across the UK.

6.2 What Was Your Earliest Ambition?

I remember when I changed schools at the age of nine being asked what I wanted to do when I grew up and I said that I wanted to be a doctor and subsequently I rarely deviated from that idea. People tended to think when I said that I wanted to be a doctor I wanted to be a General Practitioner but I didn’t—I wanted to be a hospital doctor and I wanted to be a success and make an impact. I liked hospitals, in particular the hospital where my father worked. He worked as a dentist, his practice being in our house, but he also worked at Killearn Hospital, a neurological hospital which had been established to treat head-injured soldiers in the Second World War but later also treated other neurological cases, in particular polio victims. My father made inlays to repair skull and facial defects in people with head injuries. At Christmas, I went to see patients and hand out presents to them (this was a normal practice for the children of hospital staff at the time). I thought it was wonderful. I was fascinated by people on machines and with tubes coming out of their heads and especially by the polio victims in iron lungs. I remember two girls in their late teens with their beautiful hair brushed out over the pillows and with mirrors suspended over their heads so that they could see behind them as they could not move at all. A year or two later the “sugar lump” polio vaccine was introduced and I realised that never again would anyone I knew have to suffer polio. This was important to me as every summer there had been epidemics. A boy in my brother’s class at school died from it and a girl at school with me went off for the summer break, running about like the rest of us, and came back with her legs in iron calipers and the same thing happened to the mother of one of my close friends. The importance of this preventative treatment was thus extremely obvious to me and at around the same time I became aware that successful treatments for tuberculosis, widespread and greatly feared in the west of Scotland at the time, were being introduced. It therefore seemed to me that fantastic developments were taking place in medicine and that maybe, just maybe, I could be part of this. I continued to think like this as a teenager except for a brief blip when I learned that Rose Heilbron, who had been the first lady Queen’s Council in England, had become the first female Judge. She was a glamorous figure, good looking and always very well turned out and I wondered if this might be a good idea for me. My father asked his cousin, a lawyer, to have a word with me and he explained that while I could certainly study law I would have no future as an Advocate (the Scottish equivalent of a Barrister) as the solicitors 6 Eve C. Johnstone 39 would be reluctant to engage a woman. I would be able to come into the family firm as a solicitor. The idea of sitting in an office drawing up wills had no appeal for me and so I returned to my first idea of medicine but it had of course been made very clear to me that there was no point in thinking about being a neurosurgeon.

6.3 What Attracted You to Psychiatry?

In 1961 at the age of sixteen I left school and went to the University of Glasgow to study medicine. I liked it from the beginning. I enjoyed the pre-clinical studies and fit into hospital life just as I had hoped I would, but I did have concerns. Polio had been eradicated, TB was less of a problem than it had been, antibiotics meant that people survived pneumonia and that rheumatic fever was becoming less common, but, for many of the patients I saw, things were not so sunny. For people with coronary artery disease and heart failure, strokes and in particular cancers, treatments were not successful. The mustine drips and newer cytotoxic agents used for lymphomas and leukaemias put people into remission, but there was always going to be recurrence, which would ultimately be fatal, and this of course was also often true of the life-changing surgery used to treat other cancers. Sometimes at least, we were extending the lives of people that had pretty serious and unpleasant ill health by months to a year or two. I wondered whether this was really what the patients would have wanted had they known what was in store for them. I often asked myself whether it would have been better, at least for some of them, if they had never met us at all and had instead died without prolonged suffering? But then, no one can foretell the future, and of course some patients did do well even against expectations. It was during this time, when I was struggling with these thoughts, that I was introduced to Psychiatry. I had not expected to like it—my idea of the subject (probably influenced by the cinema) was of a doctor talking to an individual troubled by fears and relieving their anxieties. I had never seen anyone psychotic and when I did I was fascinated. The first patient I ever saw with schizophrenia was a girl called Eileen and she was twenty one just like me. Three weeks before she had been working, evidently effectively, in an accountancy office in the city and when I met her she was agitated, deluded and continuously hallucinated and no one could give me any sort of explanation that was remotely reasonable as to how this transformation had occurred. She improved greatly on antipsychotic drugs and I learned that while they had been introduced on an empirical basis and the mechanism of action was not understood, there was evidence that they worked and this was not just due to sedation. I learned that similarly, anti-depressant drugs had also recently been introduced. Patients I saw in psychiatry, gravely and indeed spec- tacularly ill as they were, did not, in general, have the option of death without our intervention and I felt that here I would perhaps be able to clarify some important questions and make a real difference, as I had always wanted to do, without having to worry that in trying to make things better I was actually making them worse. Female role models were few in psychiatry, as in the rest of medicine, at that time 40 E.C. Johnstone and in my native land, but I thought that it might be a better prospect than neu- rosurgery or neurology which also interested me.

6.4 What Do You Enjoy Most in Your Job Now?

I don’t do much work now—I retired from full-time work five years ago and I just do bits and pieces on an honorary part-time basis but I very much enjoy what I do. Rather more slowly than in the past, I have continued to work on our cohort of young people vulnerable to schizophrenia because of borderline intellectual disabilities. The tried and tested method of careful serial clinical assessments over time related to imaging variables still seems to work well and I am very pleased that we are deriving findings relating to the development of negative symptoms. I would be very pleased to clarify issues relating to these disabling, poorly understood and essentially untreatable features. I am also involved in the administration and organisational aspects of a recently developed centre, the Patrick Wild Centre, at the University of Edinburgh which combines basic neuroscience with clinical studies of autism, intellectual disabilities and related conditions. While I do not (and could not!) do any of the laboratory work myself, the microscopy work with the multi-photon microscopes where you can visualise not only individual neurones, but dendrites and synapses in living animals, seems absolutely amazing to me and the stem cell work where neurones can be grown from skin or blood of people with psychosis or intellectual disability associated with specific genetic anomalies and are available for study is fascinating. I understand that it may become possible to examine the effects of relevant drugs upon them. This seems a very hopeful possibility which interests me a lot but I am, of course, well used to false dawns!

6.5 Who Do You Consider Your Mentor(s) During Your Career?

My original mentor was Alec Brown, a specialist in lymphomas and leukaemias to whom I was house physician. He taught me how to talk to patients and relatives when you don’t really have any good news for them and this is a skill which I have continued to find is well appreciated. My two main mentors in psychiatry in Glasgow were Reg Herrington, an academic, and Malcolm Ingram, a clinician. Reg taught me that what is generally accepted may not be true and to question everything and Malcolm taught me how to make sense of the most disorganised mental states. Once I went to the Clinical Research Centre at Northwick Park in London, Tim Crow was my mentor. He taught me that the sky was the limit. I remember suggesting a small project to him and he said “well you are not going to get the Nobel Prize for schizophrenia out of that” and I was amazed that anyone thought in these terms. Later when we were studying the entire population of patients with 6 Eve C. Johnstone 41 chronic schizophrenia in Shenley Hospital, I said to him “there are 524 who fulfill the criteria what sort of sample do you think we should take” and he replied “do all of them”. I had been so accustomed, in my cautious homeland, to being told not to go too far, not to be over ambitious, to keep things within achievable limits that this seemed extraordinary to me and it was certainly easier said than done, but it worked, and the idea of getting as many as possible and not cutting down your sample at all has served me very well. While I was at Northwick Park, Chris Booth, the Director, a gastroenterologist gave me great confidence. Sometimes I had felt that physicians and surgeons did not take psychiatry seriously, they perhaps thought us lightweight and a bit zany—not really proper doctors. Chris Booth would say “this work is wonderful, psychiatry is our Jewel in the Crown”. Once I got back to Edinburgh I felt that I could fly on my own. There were no other women around to provide mentorship. This is why there are no women in this list and I cannot think of a single one I could even squeeze in. When I was a medical student, there was, as far as I know, one woman on the staff of the University who taught medical subjects, Dr Anne B McNaught in physiology. She was a very good lecturer, indeed. There were few female clinicians beyond the very junior grades. In those days, they kept low profiles, and I cannot say that I found them to be very charismatic. When I got to Northwick Park, there were very few clinically qualified women on the staff and none in subjects relevant to psychiatry. In all of these places, of course, things are rather different now.

6.6 What Was Your Best Career Move?

There was no one “best move” and I really only moved twice. I moved from Glasgow to the Clinical Research Centre at Northwick Park in London to work for the Medical Research Council and this was an excellent move. It let me see what was possible in research terms and to work with some wonderful collaborators, some of whom I have now worked with for many, many years. It let me understand that it was possible for me to stand at the cutting edge and I do not think that I would ever have developed that conﬁdence if I had not left Scotland. Scottish medicine has great strengths but certainly at that time they had a tendency “to cut down the tall poppy” regardless of gender. My return to Scotland after 15 years this time to Edinburgh was also an excellent move. I had thought it might be a good idea to get into a post which would allow me to move sideways into teaching or administration if my research ideas began to fade. At that time, the view that most people did their best research before they were forty was widely held. I do not really think that that has happened to me and it has been wonderful to drive forward a programme of research demonstrably based on my own ideas and endeavours and to train others to take things forward. 42 E.C. Johnstone

6.7 What Were the Key Obstacles You Had to Overcome?

Early on, I felt it was difficult to get people to take me seriously, to believe that I really wanted to have a research career and that I was going to persist with this. After a while of course this became less of a problem. Other difficulties related to the tension between clinical and research responsibilities and the need to obtain research funding. My research has always been very clinical and it depends upon the cooperation of the patients and their relatives who have to believe that you really are deeply concerned for the patients’ welfare and that you will do your absolute best for them. They are not being asked to believe any more than the truth but they have to see that this is the case and that can take a lot of time. Similarly, the nurses and paramedical staff have to be convinced. They may well consider that the research is exploitative of the patients and that those involved are motivated by a desire for personal glory. You can certainly persuade them that this is not true of you but to gain their full cooperation they need to see you, in clinical terms, as at least as good as the non-research clinicians and preferably as better. This means long working hours. You can only maintain the necessary large clinical cohorts with the support of clinical colleagues and general practitioners and on the whole they have been just wonderful and I owe them a lasting debt of gratitude, but one or two have not always been quite like that and patience and forbearance are required. I cannot really complain with regard to research funding because I have always been very fortunate in that respect but it is a constant struggle. I have tended to think that the fact that clinical research and basic research are generally considered in the same committees is a problem. Basic experiments can often be elegantly described, they usually finish on time and are frequently cheaper than clinical studies where it may be difficult to achieve the suggested numbers, there is often time slippage and things are altogether less cohesive. The facts are of course that there is nothing very elegant about schizophrenia and you cannot take 100 Sprague Dawley people. When the funding situation is tight however, committees favour greater certainty. To have success you have to be involved in relevant bodies and committees and you have to stay until the end when the decisions will be taken. If you come from Edinburgh, you will be going home on the night sleeper train—get used to it!

6.8 What Kept You Going During Difficult Times?

I have had the great fortune always to work with people who have become (and remain) close friends, although of course as time went on some of us would live and work hundreds of miles apart. Nonetheless, we all understood the nature and dif- ﬁculties of the work and the personalities involved. In difﬁcult times, long supportive phone calls have been invaluable. 6 Eve C. Johnstone 43

6.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

Early on, in Glasgow I think that my senior colleagues did not believe that I really wanted to pursue an academic clinical career and indeed some of them, from kindly motives, expressed the idea that it would be too hard for me. In the context of the times, this was more reasonable than it seems now because of the women who trained with me a definite minority have pursued any level of medical career on a full-time basis for many years—times were different. On the other hand, as even a junior clinical academic I was unusual because of my gender—I stood out from the crowd and people did not forget me. This was a definite advantage which continued for a long time. Nonetheless, it was quite difficult to break into the kind of meetings and discussions where decisions were made. I remember the first distinction award committee I attended many years ago. I was the only woman there and everyone was very polite and kind to me but they seemed to go out for very, very long breaks—it must have been very crowded in the gentlemen’s lavatory. Similarly, in Edinburgh, for a few years when I joined the other senior academics at functions and meetings (initially as one of only two women) the conversation always seemed to turn to golf. A game I do not play. In any case they were talking about affairs at their golf clubs which women are not permitted to join. Mildly irritating as this was, this “special treatment” tended, I thought, to mean that it was felt that my interests could not be ignored. When it came to the actual circumstances of my clinical work in which my research work was embedded, I think that being a woman was an advantage. In the kind of work that I do, it is important to gain the confidence and support of the patients’ relatives, especially their mothers. Necessary long discussions in their homes were easy for me and for at least some male clinical scientists I think it might have been a bit more difficult. Overall therefore, although there are negatives as well as positives I don’t think my gender has really been a disadvantage. Furthermore, I remember a conversation from long ago with a couple of male colleagues where one of them said, “it is all too easy, if there is something about you, in terms of religion or ethnicity or gender, which could be perceived as a disadvantage, to put every little reversal down to that cause and this will do you no good at all”. I thought then and I think now that he was absolutely right about that.

6.10 How Did You Deal with the Issue of Work–Family Balance?

This has never seemed to me to be a serious problem. I think I have a good work life balance though I realise that others might disagree, but then I like working. I am sure it is easier if like me you do not have children. I think the key is to realise that there are going to be a lot of demands on your time and that there are only 24 hours in everyone’s day—you can’t do everything (except perhaps for short periods!). You are not Superwoman. Planning is the key. If possible get a manageable home a 44 E.C. Johnstone short stress-free journey from your place of work. You will get an hour at the beginning and end of each day that most people don’t have. Get domestic help—I have employed domestic help since I was in my twenties, you do not need to clean and if you hate ironing you can get that done as well. You can buy a lot of services —in my mother’s ﬁnal illness, I had her looked after in my house by private nurses. It was expensive but well worth it. She was happy there as she hated hospitals and it was a lot easier for me than going backwards and forwards to visit her in a hospital or hospice. However busy and preoccupied with work you are, maintain outside interests in sports or music or whatever and social contacts with people who are not involved with your area of work at all—it keeps things in proportion and it makes you less boring. A plan like this may not work for everyone, but it has worked for me.

6.11 What Would You Do Differently if You Were to Start Your Career Now?

Looking back I think I have been enormously lucky and there is very little that I would like to change. I am sorry that I have never worked outside of the UK. I would have liked to have worked perhaps in continental Europe for a year or two but the opportunity never really arose and I didn’t make any effort to create it. I would have been a bit apprehensive that I would lose momentum if I did that and I probably would have. If I were starting now it would be in a very different world, but I would still be keen, in the midst of the scientiﬁc advances that I hope would occur during my working life to maintain my clinical skills which are the bedrock of what I do and which are the aspect of clinical science that I am best placed to address.

6.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

If you want a 9–5 job where you put your coat on at the end of the afternoon and don’t have to think about work until the next morning, this is not for you. It is a great help if you are fascinated by the tragedy and pathos and non-understandability of mental illness in its great variety and if you are, you will probably find a career in academic psychiatry enormously enjoyable. In my career, I have seen a lot of false dawns and I expect that you will too. I am extremely fortunate that the technique of psychiatric imaging, in which I first became involved 40 years ago, is still pro- ducing cutting edge results after all this time. That doesn’t happen to many people. It is important not to be beguiled by extravagant claims and keep your options open. What looks like a wonderful advance may turn out to be nothing of the kind and you do not want to find yourself out on a limb. Remember that everyone has to 6 Eve C. Johnstone 45 make compromises from time to time during their career and you need to accept responsibility for your own advancement and stand on your own two feet. Try to avoid complaining—it is much easier to get your own way if you are pleasant. And finally just enjoy it. It is fascinating, exciting at times and although of course associated with great distress for sufferers and their families, for you it may be a very rewarding way of life (although not necessarily in the financial sense!). Shaila Misri 7 Shaila Misri

7.1 Dr. Shaila Misri

S. Misri (&) Department of Psychiatry, Obstetrics, Gynecology, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] S. Misri Department of Reproductive Mental Health Program, BC Children’s & Women’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada

Dr. Shaila Misri is the clinical professor of psychiatry and obstetrics and gynae- cology at the University of British Columbia in Vancouver, Canada. Dr. Misri is internationally recognized as a pioneer in women’s mental health and reproductive medicine. She is the founder and research director of Reproductive Mental Health Program at St. Paul’s Hospital and at the British Columbia Women’s Hospital and Health Centre in Vancouver. She has also authored two classic books on the mental health of expectant and new mothers entitled “Pregnancy Blues” and “Shouldn’tI Be Happy?”

7.2 What Was Your Earliest Ambition?

I grew up in post-independent India. This was an era when the country was grappling with establishing cultural identity, changing societal norms, and challenging gender inequality. In the context of this rapidly evolving environment, I was in the midst of establishing my identity. To me this process symbolized personal empowerment, and fostered a sense of independence and self-worth. During my teenage years, I looked up to my aunt, an obstetrician who dedicated her life to alleviating human suffering with relentless self-sacrifice. A true humanitar- ian, she was devoted, with undeniable commitment to her patients. I was in awe of her. Actively spending time with her over the next few years sealed my own ambition to become a doctor. This aspiration was endorsed by my parents, who gave me their blessings to follow a path in medicine. Reflecting on those crucial years of my life, which were filled with uncertainty and fear of “not making it”, it seems surreal that I am now in this privileged position of honour and acclaim. It humbles me.

7.3 What Attracted You to Psychiatry?

As a first-year surgical resident, I was expected to explain the anaesthetic procedures to presurgical patients in an empathetic manner. I was supervised by an anaesthesiologist, Dr. Kochak—a gentleman filled with kindness and warmth. One day, he made a suggestion in passing, “Shaila, have you ever thought of becoming a psychiatrist?” I did not give his remark much thought at the time; however, his comments got me thinking. I became genuinely curious about this specialty and decided to apply. I viewed my psychiatry residency as a trial period of six months, at the end of which I had a choice to train in OB/GYN. I always wanted to be an Obstetri- cian. Simply put, I never left. Although persistent mental illness is fraught with challenges, providing hope and optimism to patients struggling with stigma, fear and despair makes me feel that psychiatry was the right choice for me. Forty-one years later, the attraction to the field of mental health has not ceased. 7 Shaila Misri 49

7.4 What Do You Enjoy Most in Your Job Now?

I have been very fortunate to be able to work in the subspecialty of perinatal mental health since 1983. I work with nine other psychiatrists, a nurse clinician, a social worker, counsellors and research staff who are like my family away from home. This environment, which embodies collegiality, mutual respect and a common vision, makes me want to come to work every day. It is exciting to be among associates who share a collective goal despite diverse backgrounds and experiences. We not only come together for crisis intervention, but also enjoy spending time with each other at dinners and retreats. I feel this unique milieu has contributed to my professional growth and has allowed me to develop personal friendships which have spanned decades.

7.5 Who Do You Consider Your Mentor(S) During Your Career?

As I write this answer, it comes as a surprise to me as to what my conception of fun was during my high school years. Aside from doing exciting activities with family and friends, I used to spend my summers with my aunt and uncle who were busy doctors. What stands out most to me today is the meaningful mentorship both of them offered when I was trying to make career choices. Many nights I would volunteer to accompany them and observe childbirth, always curious and nervous at the same time. I was fascinated by the intricacies of labour and motherhood. The memory of a joyful mom holding her baby stayed with me forever. It was not surprising then that I would later seek to incorporate this aspect of medicine in my professional life. Another influential mentor was Dr. Vallance, one of my supervisors at the beginning of my psychiatry residency. Aware of my interest and background in OB/GYN, he was an important driving force who propelled me to pursue my specific career interest in reproductive mental health. At the time, during the 80s, this was an unknown field; it was unexplored territory. He saw in me the potential that I obviously could not see in myself. I had his unconditional support in materializing my professional aspirations. He has been one of the finest teachers and a visionary. I remain eternally grateful and indebted to him. To this day, I can pick up the phone and ask him for any professional guidance. He is always there for me.

7.6 What Was Your Best Career Move?

While working on the consultation liaison service during my final year of psychiatry training, I had the opportunity to look after pregnant and post-partum mothers with psychiatric illnesses, a patient population I had never set my eyes on 50 S. Misri before. Seeing a pregnant, psychotic patient from Sierra Leone had a significant impact on me. I soon realized that these women were falling through the cracks due to a lack of appropriate medical intervention. There were no dedicated clinics in Vancouver where such patients felt heard or validated. In fact, they often went undiagnosed and untreated. I became passionate about advocating treatment for this population who needed specialized care and attention. I was determined to create awareness among my medical colleagues and endeavoured to fill the obvious gaps in the system. Single-handedly, I started providing services in the maternity hospital to patients with complex psychiatric illness during pregnancy and after childbirth. I felt as though it was my calling. It was the best career move I made and I have never regretted it.

7.7 What Were The Key Obstacles You Had to Overcome?

When I reflect on my journey of establishing the Reproductive Mental Health Program at BC Women’s Hospital, Vancouver, in 1993, I recall that a key obstacle I faced was convincing the various stakeholders of the urgency of starting such a service. In the beginning, my colleagues kept asking “What is a shrink doing in a maternity hospital?” These sort of questions evoked feelings of uncertainty and dismissal; I often felt judged and undermined. My clinic was born in a tiny office that housed a resident on-call at night; it consisted of a Murphy bed and toilet. During the day, two small chairs were brought in for me to see my patients. This is where I began my career as a perinatal psychiatrist. Acceptance of psychiatric services in a maternity setting was unheard of. However, I was convinced that my presence was much needed. I knew it was not going to be easy until I proved myself. Within six months of countless hours of toiling and being available day and night, the waiting list was full! The rapidly expanding clinic posed insurmountable hurdles over the next few years. Thoughts of worry and uncertainty would haunt me. “How would I deal with the wait list? Where would I get my funding for support staff? Where would I find another colleague?” Belief in my work, consistent patience and the ability to move beyond frustra- tions have kept me ploughing through the fields of disappointments and trepida- tions. It was worth it to persist and create a “safe space” for my patients despite a series of obstacles.

7.8 What Kept You Going During Difficult Times?

It was my first time on-call in psychiatry at UBC hospital. A young woman was brought in by her family having slit her wrist because of being acutely suicidal. My immediate response upon seeing this patient was to reach for the suture box and administer seven stitches. The next day, my supervisor reminded me of my 7 Shaila Misri 51 responsibilities as a psychiatry resident and what the safety procedure for this particular patient entailed. I realized in a flash that I had not quite made the transition from a surgeon-in-training to a psychiatrist-in-training. This particular inci- dent had a profound impact on my ensuing year; I continued to wonder how long I would last in this residency. These feelings were also paralleled by my continued realization of the unmet needs of mental health patients. The huge dearth of resources for mentally ill patients, be it those with personality disorders, addiction issues or chronic depression, began to haunt me. I felt passionate about advocating for this population and gave myself the time and energy to make the commitment needed to finish the residency. At the end of one year, my choice was made. Interestingly enough, my family back home who were familiar with surgeons, obstetricians, cardiologists and so on did not have a clue about what it was to be a psychiatrist. For the fear of not hurting me or embarrassing me, friends and family would skirt around my job issues in a polite manner, not ask me too many questions and wonder in their minds, “what was psychiatry all about”? It was only when a cousin of mine became really ill with a psychotic break that I felt that I had my own “break” with my family. They began genuinely accepting and appreciating my career choice. The rest is history. When I published my first book, I still remember to this day the pride and joy in my mom’s eyes. Persistence, belief in myself and being clear about my motivation behind my choice of this specialty keeps me going even today.

7.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

For me, being a female psychiatrist in the subspecialty of reproductive mental health has been marked with positivity. I have found that my patients feel more at ease in the presence of a female physician. Specific issues, such as breastfeeding during a session, talking about partner conflicts, disclosing sexual difficulties and describing medical details pertaining to their genital areas, are disclosed and discussed with fewer inhibitions. Women in general appear to feel less judged and safer in the presence of a female healthcare provider. Some female patients have also openly expressed concerns over sharing their intimate, emotional stories in front of male trainees in my office. Furthermore, on occasion, young male trainees have expressed to me their sense of discomfort when a young woman starts nursing to soothe her wailing baby in order to continue her session. At times, this issue has been a challenging matter to deal with. On the one hand, we are a university- affiliated teaching hospital where I am mandated to fulfill my obligations of teaching, but on the other hand, I have to respect the comfort levels of my ailing patients. Overall, this is a fine balance to contend with. Being a woman psychiatrist in reproductive mental health has allowed me to connect with many female patients and make them feel comfortable during our interactions. 52 S. Misri

In every role, there is always a mix of both pleasant and unpleasant experiences. During my residency, unwanted sexual advances were not uncommon. Such dis- turbing encounters produced a sense of fear, guilt and rage within me. There was no education provided to residents around this topic. Therefore, discussing it in public was taboo. Many years later, as I reﬂect on the lax boundaries around sexual indiscretion in the 1970s, it has been heartening to see immense strides that have been made with regard to respecting and empowering female colleagues, maintaining equality and refraining from unforgiving behaviours.

7.10 How Did You Deal with the Issue of Work–Family Balance?

I thank all the nannies who looked after my two young sons while I worked part-time. I fulfilled my maternal responsibilities and managed my household while maintaining my marriage. Unfortunately, there is no school for parenting. Juggling motherhood and practicing medicine is a daunting task. I knew very early on that I did not want to make a choice between being a full-time physician or a mother. I had to find a way to do both in order to protect my sense of identity. Delegating tasks, trusting a caregiver and being realistic about family expectations was a steep learning curve. Motherhood changed my life, a different reality from my male physician colleague who lived two houses down. His life continued without any hindrance upon his entry into fatherhood. I, on the other hand, had to prioritize, make choices and learn how to say no—whether at work or at home. While my focus in life, both as a mother and a physician, began to change, retaining female friendships proved to be an interesting exercise. I'm glad that I value my female friends. With regard to work–family balance, I feel strongly that there is no one glove that fits all; it is an individual choice, unique to each person.

7.11 What Would You Do Differently if You Were to Start Your Career Now?

I would be kinder to myself. This includes taking more time off work and feeling less concerned about professional opportunities. I had no choice but to meet my on-call schedule and my research obligations during pregnancy and after childbirth. I did not have the luxury of taking maternity leave as my younger, female colleagues do today. Although looking back, I could not have done anything differently for myself, I now promote and encourage the new generation of physicians to own their choices without fear. 7 Shaila Misri 53

7.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

With increasing enrollment of women in medicine, female and male roles have blurred. There is more openness towards having a dialogue with a young woman who is aspiring to be a successful doctor. This raises an important question. What does the term “successful” really mean? Thirty to forty years ago, success resonated with being a doctor who dropped everything else in his or her life in the name of medicine. Today’sdeﬁnition of success is much different. It embodies maintaining work–family balance, keeping a certain level of ﬁtness, enriching life beyond medicine and valuing leisure time. A young doctor who is going to contribute in a meaningful manner and make a difference in the lives of her patients would ideally aim for these trying, but attainable goals. Antonia New 8 Antonia S. New

8.1 Dr. Antonia S. New

A.S. New (&) Icahn School of Medicine at Mount Sinai, New York, NY, USA e-mail: [email protected]

Dr. Antonia S. New is a professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City, USA. Dr. New is at the forefront of research on borderline personality disorder and uses brain imaging and genetic techniques to explore neurobiological responses to pharmacological treatments. In addition, Dr. New’s commitment to furthering education is unparalleled. As vice chair for education at the Icahn School of Medicine, she has established novel educational programs to train medical students and residents to become the new generation of young researchers and medical professionals.

8.2 What Was Your Earliest Ambition?

If I am to be truly honest, my earliest ambition was to be a doctor. As a child, I loved the idea of taking care of people, of knowing a lot and of having authority. This did not come out of nowhere for me. My mother was (and is) a very accomplished academic physician. My father too was a physician, and, as it turns out, so are my sister, my brother and I. While the idea of being a doctor was my childhood ambition, my adolescent aspirations took a different turn. I became absorbed in novels and poetry. I had a special love for the Bloomsbury period and imagined myself with a “room of (my) own.” I fell in love with the poetry of W.H. Auden in college and, in retrospect, looked to poetry to get a glimpse into the emotional life of others. I found the resonance of poetry more satisfying than reading dry psychological explanations of the human experience. And so, how did I end up in medical school? I resisted the pre-med track and studied English literature in college; yet, when it came to making a concrete career plan, I was drawn back to medicine. The reasons for this were myriad. One important consideration was that I wanted to have a skill set that enabled me to make a living; medicine was attractive because it was challenging, demanding and productive. It allowed me to make a contribution to helping others. It also happened to be the family religion. I confess that a part of me still imagines writing stories when I have more time, but I did recognize that, for me, science came much more easily than creative writing. I was no W.H. Auden.

8.3 What Attracted You to Psychiatry?

I went to medical school imagining that I would be an internist. I loved medical school and was voracious in my wish to learn all of medicine. Cardiology seemed especially attractive. What could require a more concrete skill set? I actually loved the coronary care unit, but soon realized that what I loved about it was the adre- naline high and I realized that this would be hard to sustain over a career. Medical school was absorbing because there was so much to know, so many answers to my questions. I discovered over time, however, that this was not enough. I became 8 Antonia New 57 more drawn to unanswered questions, revisiting the more intellectual and curious approach to learning that I had taken in college. Psychiatry was then the obvious choice. It satisfied two different streams of my interest: the humanist and the scientist. As a field, psychiatry values humanistic thinking. On the other hand, it seemed to be on the brink of a major transformation, brought about by advances in neuroscience. With the rapid growth of neuroscience, it seemed inevitable and wonderful that breakthroughs in neuroscience would massively alter and bring forward the field of psychiatry. I was drawn to the challenge.

8.4 What Do You Enjoy Most in Your Job Now?

I had not appreciated early in my career how much I would enjoy teaching, discussing my ideas with younger people and listening to theirs. I found myself eager to help make things clear, share my thoughts, answer their questions and make suggestions about how to approach problems. I found this rewarding whether it was mentoring young research assistants who had just graduated from college, teaching medical students and helping them to imagine themselves as psychiatrists, mod- elling practice for residents or indeed, helping young postdocs get their ﬁrst grant. The other aspect of my job that I really love is that it is varied, challenging and permits me always to learn new things. It is simply never boring.

8.5 Who Do You Consider Your Mentor(S) During Your Career?

This is a very hard question for me. Certainly Larry Siever was a mentor to me. His style was to provide the opportunity for me to develop my ideas and to give me complete freedom to carry them out. I have come to appreciate that this laissez-faire approach and his confidence in me helped to make me very self-reliant. I have not, however, had mentors who help me to reach each step and to strive to move my career forward. The person who comes closest to this in my life is my husband (now of 32 years). He is not a physician, but instead is a law professor. Nonetheless, he has always encouraged me to find my path and to be confident about my work. What I lacked was female mentorship. I think that the relative absence of women mentors was in part due to the fact that there simply were no women physicians in my department who rose in the ranks to professor before I did. It is also, however, that I am not great at taking advice. I had a powerful mother who was very single-mindedly focused on her own success, a single-mindedness that enabled her to be a groundbreaking leader. However, this experience did not beckon me to put myself in the hands of very accomplished senior women. I now recognize that this was an error on my part; I think my career would have been more enjoyable and I might have risen more quickly if I had sought out and trusted mentors more. 58 A.S. New

8.6 What Was Your Best Career Move?

I have been fortunate in the timing of my decisions about shifts in my own career. I spent years doing NIH- and VA-funded research and shifted to education rather late, not because I felt unsuccessful in research, but because I felt that the discoveries being made in neuroscience were not being shared adequately with clinical psychiatrists and physicians more generally. I was fortunate that I made that move before NIMH funding became extremely challenging and so I did not have to experience the frustration of applying for grant after grant with low likelihood of success. I would like to think that my move was prescient, but in reality, I think it was lucky. How can I pass along advice to young women to be lucky? I can’t. I would say, however, that you should not be afraid to change and to challenge yourself to do new things. This will leave you in a position to be the agent of changes in your own career.

8.7 What Were the Key Obstacles You Had to Overcome?

I have such a humdrum response to this and so many women have written about this so eloquently. The major obstacles in my career have related to being female and they fall into two main categories. I have clearly experienced what has been written about over and over again that when a woman has an idea and contributes it to a discussion, she is at risk of being thought brash. When a man articulates the same idea, he is simply thought to be smart. I see this as a steady feature of my own experience, but it smacks me in the face when I see it done to my junior women colleagues. I must say that this has gotten better in my own experience as more women have taken on leadership roles around me and I have risen to a leadership role myself. The other part of the challenge of being female is that I am the mother of three children (now one teenager and two young adults). My husband is also the parent of these same children, but when he takes time away from work to attend a school event or calls a neighbour for a play-date, he can view himself as the world’s most amazing dad. When I do those things, I often feel (and hear) about how much less I am doing of that than the women around me and ﬁnd myself feeling guilty and left out. I do not have a great solution to this except self-compassion. I am very close to my girls and they are wonderful. Do I wonder when they struggle with something if my busy work life played a role in engendering it? You bet.

8.8 What Kept You Going During Difficult Times?

“Difficult times” is a broad category, but my coping strategies are fairly consistent across domains. My primary coping strategy is to turn to people I love for support. For me, this is first and foremost, my husband, and I recognize how lucky I am to 8 Antonia New 59 have him. However, I was recently asked by a first-year medical student how I handle all the sorrow that I encounter in my patients and how I avoid bringing it home. I answered that I appreciate having something of a commute so that there is a period of about 45 minutes in which I am in transition. This gives me a chance to regroup and to recall that my children are entitled to a mother who is emotionally present for them. They did not sign on to thinking about suicide, depression and other serious symptoms on a daily basis; I did. My role in my family helps keep my world broad and vital outside of work. For a different sort of stressor, feeling overlooked at my work because of my gender, I turn to my female peers. Lacking senior women mentors, I found that getting together with women who are my peers was an enormous source of support. It helped particularly to have a group of women to meet and to contemplate how to support women junior to us to reach their goals. This exercise was not only about helping them, but also about supporting our own identities. The young people I have mentored have helped to make me find my own career satisfying.

8.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

I think I answered this question above. I could add that there were more concrete ways that being a woman played a role, like finding out that a man hired after me for a less responsible job had a higher salary than I did and than all the women at the equivalent level. That was cleansing in a way. At least it was clear. I happened to be working at a VA at the time and was able to go to the proper authorities to get it rectified for all of us. I do notice that I am a much better advocate when others are involved. Had it just been a comparison between my male colleague and me, I likely would have thought myself deficient in some way. I would have justified his credentials in some way, even though I was the one with the Ivy League education, the AOA credentials and the greater number of publications. Even as I write that, I am deeply troubled by describing myself in that way. I eschew the notion that I am placed on the academic mattering map based on such superficial facts as my medical school grades. What about my collegiality? My compassion? Are those attributes not more important? I actually think they are, but find that in the world at large, they are, to say the least, not enough.

8.10 How Did You Deal with the Issue of Work–Family Balance?

This notion of work–family balance has been a thread woven through everything I have written on these pages. I don’t think that I know any women who feel that they have reached that. Indeed, young men approaching the age of starting a family also 60 A.S. New

find themselves deeply torn. The simple model of a man who supports the family financially, married a woman to manage the home and raise the children, is largely a thing of the past, for better or worse. At least this model made sense in that two people accomplished two jobs. Nowadays, lucky families have three jobs for two people (two careers and homemaking). Less affluent families often have a worse ratio; there might be only one parent and that parent often has to work more than one job. I don’t have a good solution, but politics certainly is involved. I do not advocate a return to a time when women’s options were foreclosed by parenthood. If we look to other countries, modest improvements appear. More generous and paid family leave would help, a culture that does not value putting in long hours so highly would be better, widely used and subsidized day care would help. Nonetheless, none of this would have solved my problem. I was able to hire proper help, but no one can quite substitute for a parent. I wanted our children to be raised by their parents. They are now almost grown up and we remain a very close family. The cost has been having parents who are exhausted, a sense that we each would like to have been able to pour ourselves more completely into our work and remaining very distant from my adolescent fantasy of a “room of (my) own.”

8.11 What Would You Do Differently if You Were to Start Your Career Now?

If I were to start my career over again, I think I might have chosen to work in a slightly less challenging area. It is an uphill battle for people to take the illness I study, borderline personality disorder, as a “real disease.” This reflects the stigma against this serious illness and I am involved in advocacy to help encourage funding for research and treatment for these patients. Nevertheless, I find myself advising young people to choose to study a field that is more accepted as fertile ground for translational research, such as substance abuse. Early in my career, I felt that I had a limitless supply of energy to fight the challenge of this stigma. I’m not sure I needed to set myself such a formidable challenge.

8.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

My advice to young women starting a career is fourfold: (1) find the work you love and become very good at it; (2) learn to advocate for yourself. People will underestimate you and you need to make sure you surround yourself with people who will help you keep setting the record straight; (3) find mentors and advocates for yourself. Look for people who align their own needs with yours so that when you succeed, they also succeed. Find mentors who are generous enough to give you 8 Antonia New 61 the credit; (4) and finally, pay attention to your personal life. My father, while spending the last days of his life in a hospital, said to me that, in his situation, “I will not look back and wish I had written that one extra paper. I will look back and cherish the casual (not the ‘quality’) time spent with the people I love.” Mani Pavuluri 9 Mani Pavuluri

9.1 Dr. Mani Pavuluri

M. Pavuluri (&) Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA e-mail: [email protected]

Dr. Mani Pavuluri is Professor of Psychiatry and Berger-Colbeth Chair in Child Psychiatry at the University of Illinois at Chicago, USA. Dr. Pavuluri has dedicated her impressive research career to studying pediatric mood disorders. Her speciﬁc research aims are to identify key biosignatures of pediatric mood disorders that could be used to develop treatments and personalized interventions. She is the founding director of the now nationally recognized Pediatric Mood Disorders Clinic Program, which has drawn patients from many US states. This program also serves as a model for many similar programs across the world.

9.2 What Was Your Earliest Ambition?

This is a story influenced by three women. My earliest memories date back to when I was five, embedded in the thematic play, in India. After visits to our female obstetrician-cum-family doctor, I would set up a make-believe hospital with used glass injection bottles paired with toothpicks serving as injection needles. On reflection, my ambition was ignited by this powerful woman who gained the respect of the whole community and delivered almost my entire cohort in town. I wanted to be like her. Then, there was our school principal, our city’s icon and a great orator (incidentally the grandmother of Nina Davuluri, Miss America, 2013). I was cap- tivated by her audacity. I covertly wielded my limited power through elocution competitions—I actually won the first prize for the prompt that asked us to talk about career ambition in 9th grade. Mine was to be a government administrator. I recall receiving the prize and standing on the stage with my head bowed down, consciously wanting to look submissive, “as a girl should be.” It was a clear paradox of ambition and the need to simmer it down. Then, there was my mom, a professor in English literature who handed me the torch to think critically and not flinch with words. These elements in the making slowly molded me to be an academic physician. I needed the powerful trio to fight my own strong inner critic that told me being feminine meant being docile.

9.3 What Attracted You to Psychiatry?

I was placed as an intern in psychiatry at the Auckland Hospital, New Zealand. I was utterly fascinated by the intimacy of being invited to join in solving people’s problems. I clearly remember Drs. Robb Kydd and Jim Wright who handpicked me to consider psychiatry as a career. Being that I initially struggled to make the radical cultural transition into the Western world and barely understood the NZ accent, it was comforting to be ensconced by my attendings. I often wonder what prompted me to write about child temperament in our Medical School Yearbook ﬁve years prior. I am reminded of Steve Jobs’ quote about how we connect the dots by looking back into the past. I see an emerging intuitive passion. I originally joined 9 Mani Pavuluri 65 the department of obstetrics and gynecology prior to psychiatry, but did not like it one bit. I asked to change departments to avoid becoming a character in a Tolstoy novel. A psychiatry internship was offered as a fortuitous, immediately available option. Some things are meant to be.

9.4 What Do You Enjoy Most in Your Job Now?

Many years of an adventurous journey lead to where I am “now.” I was taught phenomenology, psychodynamics, and psycho-biosocial models in Australia, three ﬁelds which led to developing measures and neuroscience-informed psychotherapy models of treatment in the USA. My greatest joy was learning about medication effects on developing brain function through research using pediatric bipolar disorder as an illness model and fMRI and diffusion tensor imaging as technical tools. I learned that cognitive domains are intricately linked with emotional domains, with multidomain dysfunction being common in early onset disorders. What I enjoy most now is translating the science toward serving the youth impacted by mood disorders who have come with hearts full of hope from all corners of our country. I am also engrossed in perfecting the development of two programs: I. Precision Neuropsychopharmacology in Developing Brain and II. Feeling BETTER (Brain and Environmental Training Towards Emotional Resilience), through which I hope to help young trainees as well as affected youth. I enjoy having a purpose in my life.

9.5 Who Do You Consider Your Mentor(s) During Your Career?

The thought process went like this for me. I needed the gurus with brilliant minds and the generosity to invest their time in teaching me. I was one hungry student swirling around my teachers, and there were countless mentors. Gender of the mentor did not weigh into my equation. My ﬁrst mentor in NZ was Dr. John Saxby who was Dr. Frank Fish’s student from UK. He used to keep butterscotch toffee in his ofﬁce, which I enjoyed eating each week I went for supervision. He taught me to think fresh. Then, there was Dr. Gabor Ungvari, also in NZ though originally from Budapest and Munich (Kraepelin Clinic), who taught me phenomenology directly from Jaspers. My child psychiatry and research mentor both in NZ and Australia was Dr. Siu Luen Luk, a student of Dr. Eric Taylor and Sir Michael Rutter. Then in the USA, there was my research mentor and the Czar of fMRI studies, Dr. John Sweeney, who taught me all about the brain like a child’s play. Ten years of intense mentoring was like a joy ride—I picked cherries and apples wherever I was and was fortunately never disappointed. Every single mentor has become a dear family 66 M. Pavuluri friend. I especially made sure that my husband got to know them and that I became friends with their wives, an important detail as a female mentee.

9.6 What Was Your Best Career Move?

Coming to America. I loved the idea. I read about all the prominent researchers in child psychiatry here. Though I was a consultant with my FRANZCP degree in Australia, my husband and I decided to move to the USA. That meant I had to take my USMLE I, II, III examinations, repeat my child fellowship, and also take the American board certiﬁcation examinations for general psychiatry and child psychiatry. I did them all over again. Then, I founded the ﬁrst pediatric mood disorders clinic in the Midwest in 2000, which I still direct. I applied for the National Institute of Health’s training grant to learn fMRI research in 2002. It all happened from there. My motto was “dream it and do it.”

9.7 What Were the Key Obstacles You Had to Overcome?

My one and only obstacle came rather late, a couple of years ago. My success meant I was the principle investigator of several large, federally funded grants. I had nearly thirty people working in the laboratory and was mentoring around eight junior faculties and postdoctoral students launching their careers. We were sub- mitting ﬁve to six grants each cycle and writing and revising grants and manuscripts. I had a thin clinically trained staff in the laboratory, which meant I had to attend to almost all things clinical. I tried to keep up with the three-ring circus. But I could not attend to some IRB amendments that were due or problem-solve the nuances in the large laboratory. No matter how angelic I was with my research subjects, or how hard I worked day and night, things crashed. Here, I learned my main lesson, which is the need to have a tight grip on research supervision. No work is done till the paperwork is done.

9.8 What Kept You Going During Difficult Times?

I nurture a strong sense of spirituality. I believe that adversity and failure are great teachers. I have to practice what I preach. I keep telling myself that each day is a treasure box and to live fully and appreciate what it brings. My husband and our two sons are a gift to me. The Bergers and Colbeths who endowed my chair in child psychiatry are relentless supporters. I also thrive among a large group of true friends. I do not lose sight of my assets—my relationships. I practice being grateful. Our son Rohan says that “the ultimate meaning of life is utility to the world.” 9 Mani Pavuluri 67

I embrace that principle with humility. I immerse myself in giving in anyway possible to help others and be the best I can be, minute by minute. I am mindful in this moment. I foster my vision for tomorrow, keeping in mind that I do not need to hustle.

9.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

In my specific case, I had all the characteristics that define me as minority—short, foreigner, woman, brown skinned and to top it all, in psychiatry. While none of them are really negative, my Chair Dr. Paul Mullen in Dunedin, who hailed from Maudsley remarked that I had shock value every time I opened my mouth. People were not expecting the intuitive string of sentences. Ultimately, the power is within you. It is common knowledge that being a woman means we tend to manage the household, décor and relationships, nurture, serially multitask, and be the pillar. This has helped me enormously in defining my strengths. Furthermore, I unapologetically enjoy style and I am a self-confessed francophile. Women can be sophisticated, charming and disarming. It was my way to defy being a minority. I think that just like how we women do not like men to join “girl’s night out,” men may not like us to join them at ball games or, many times, in the administration. I experienced the invisible glass ceiling. It gets much tougher actually at the top and especially if you are a minority. My conscious strategy was to not buy into these obstacles and to nonchalantly keep my eye on the next achievable prize (i.e., find the next good purpose and keep at it). I do not want to sound conceited, but for your sake, let me underscore that no one can steal your brilliance.

9.10 How Did You Deal with the Issue of Work–Family Balance?

I had four rules: (1) I had a full-time live-in nanny to reduce stress since I travelled a lot, especially when our boys were young. Mind you, your hardest work life coincides with the phase when your kids are younger. (2) I left work at 5:00 p.m. religiously, even if it meant I would work late at night after the boys went to bed. I was there for them. (3) I compartmentalized work and home in my head and said to myself, “my story is mine.” (4) We sent our boys to a private school where resources were sky-high, and I did not have to run around taking him to soccer or swimming. It was a one-stop shop and had bang for its buck. I still failed to watch a lot of their games, but they knew I would appear at every performance and function at school. They knew parents had to work hard. I actively taught them to understand life. 68 M. Pavuluri

9.11 What Would You Do Differently if You Were to Start Your Career Now?

Honestly, not knowing how tough it could be at the outset was a blessing in disguise. If I knew I would have had to go through all that I did, I would have recoiled. I may not have braved to walk the highly complex fMRI research path. But now that it has been accomplished, I would appreciate the exact same life peppered with the same rich experiences. My advice is that sometimes you just have to dive in. This takes me to answering the next question of giving it forward.

9.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

I mentored mostly all women faculty in my laboratory and felt it was important for me to rise up to the challenge since I personally lacked a female mentor. I have specific advice for young women starting their careers: (1) Seek the mentor who has the track record of success and is invested in you. (2) Look for peace in equal proportion to stroking your ambition; in other words, less is more to maintain quality of work. (3) Do not run to just anyone to expound your saga in crisis as most people cannot help. In other words, be careful in thinking through things first and do not become prey to their misinterpretations. (4) When others ask how you are doing, don’t just focus on work alone. (5) Be mindful of nutrition, sleep, body, work, and family. (6) Enjoy the routine. (7) Never lose sight of compassion. (8) Be eager to help, yet do not overextend and dilute time for your own investments. (9) When you see a tall man in jacket and tie or see any man talking assertively, don’t be conditioned to think he is smarter or more powerful than you, as it is most often—untrue. (10) While you should always remain free spirited, try to add value when you speak, rather than speaking for the sake of it. (11) Show confidence in tolerating and accentuating others’ success around you, as it demonstrates your security, and let go of pesky friction that comes your way. Mary Phillips 10 Mary L. Phillips

10.1 Mary L. Phillips

M.L. Phillips (&) Department Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA e-mail: [email protected]

Mary L. Phillips is Pittsburgh Foundation-Emmerling Endowed Chair in Psychotic Disorders in the Department of Psychiatry at the University of Pittsburgh in Pennsylvania, USA. Dr. Phillips was honored with a membership at the American Society for Clinical Investigation in 2014. She has played a pivotal role in developing neuroimaging techniques for the study of emotional processes, which have transformed our understanding of mood disorders. Dr. Phillips is passionate about promoting young investigators and clinicians in the ﬁeld and currently heads the Women’s Leadership Group for the Society of Biological Psychiatry.

10.2 What Was Your Earliest Ambition?

Right from an early age, which was probably around five years old, I wanted to be a doctor. I think that this came about because of significant exposure to the medical profession at the time, in the form of general practitioner visits and television dramas, and the perception that being a doctor would allow me to help other people and earn me the respect of my peers. In those days, I remember telling everyone that I wanted to be a “lady doctor.” Remarkably, this was never met with derision. This may have been because of the use of the word “lady” as a qualifier. I was also rather academic and was fortunately encouraged by teachers and parents to succeed in academic pursuits at school. Thus, the progression to “lady doctorhood” seemed an appropriate trajectory for me. When I was eleven years old in junior school, however, I changed track and decided that I wanted to become a lawyer. I think that this was because of the influence of my mother, a secondary school teacher who was becoming interested in the legal profession at the time. I was also becoming well aware that my verbal skills outperformed my nonverbal skills, and that I may therefore have problems in coping with the practical side of being a medical practitioner. I had, of course, not even heard of psychiatry as a medical specialty. With law in mind, I chose my “O”-level optional subjects to focus on languages and non-biological sciences. At the last minute, however, I added biology to the list. It was very fortunate that I did. I loved the subject, and all the science options, to an extent that I had not previously imagined. Around the time that I was fifteen years old, my parents had a conversation with my chemistry teacher, who told them that he thought that I would make a good doctor. This came as a surprise to me, but I took the advice to heart and focused on sciences and mathematics in my “A”-levels to allow to me to go to the medical school of my choice. The rest, they say, is history.

10.3 What Attracted You to Psychiatry?

During a biology class at secondary school I remember making an apparently controversial statement that the brain was superior to all other organs in the body because it was possible to have a transplant of (pretty much) any of the other 10 Mary Phillips 71 organs, but not that of the brain. I was marked down for saying this because the comprehensive school I was attending at the time was egalitarian—at every level. When I started medical school I wanted to be a gynecologist because my ambition was to help women with health problems. In my third year at medical school, however, I had the opportunity to do a year of zoology as a non-medical year of study. I rapidly became interested in brain–behavior relationships, in particular the study of how specific behaviors emerged from function within specific neural networks. I remember being fascinated when learning about the discovery of the simple neural network in the Aplysia, and how basic understanding of this network facilitated a full understanding of all Aplysia behaviors. Primarily because of this experience, I decided to take a year out of medical school after my preclinical years to do a Master’s Research Degree in Neuroscience, where I focused on the study of optic neuritis using psychophysical approaches. During this time, I was associated with the neurology department at the university hospital. It therefore seemed a natural progression for me to move into a career in neurology. On my return to medical school for the clinical years, I set about with this career in mind. I certainly enjoyed, and excelled in, neurology. It was psychiatry, however, which really captured both my attention and my imagination. Looking back, this was perhaps due to the fact that I had become interested, during my master’s research, in the impact of optic neuritis on sufferers’ emotions. It was also undoubtedly due to the fact that I very much enjoyed deconstructing the thoughts and behaviors of the patients I assessed into recognizable signs and symptoms. I also remember one of the senior registrars (junior attending psychiatrists) in psychiatry at the time saying to me that he thought that I would make a good psychiatrist because I wore “the right eye glasses”—whatever that meant… That said, the lack of emphasis on neuroscience in psychiatry at the time bothered me, and I continued to focus on neurology as a future career pathway. It was only after I graduated from medical school, when I was at a party with a senior colleague who told me about the subspecialty in psychiatry known as “neuropsychiatry.” At last, I had seemingly found an option that appeared to fulfill all the wishes I had for a career in medicine. I later learned, while training in psychiatry at the Maudsley Hospital in London, that it was in fact possible to include a neuroscience perspective in all branches of psychiatry, and that propelled me to pursue a research career in biological psychiatry.

10.4 What Do You Enjoy Most in Your Job Now?

The study of the neural basis of complex human behaviors drives my enthusiasm for psychiatric neuroscience research. I am thrilled to be able to work in the ﬁeld that I do, and to have the opportunity to work with engaging colleagues, and to mentor the next generation of psychiatric neuroscientists. For me, gaining an understanding of brain–behavior relationships in humans is critical, not only to facilitate understanding of complex human behaviors, but also to meet the goal of 72 M.L. Phillips identifying novel neural targets to help with future treatment developments. I have spent many years as a psychiatrist being frustrated at the lack of treatment options for patients with terribly debilitating psychiatric illnesses, and it is, I believe, really only now that there is the technology available to meet this ambitious goal.

10.5 Who Do You Consider Your Mentor(s) During Your Career?

I have had amazing mentors at different stages of my career. There are, however, four standout mentors with whom I have had the pleasure and privilege to work. The first was Professor David Foster, an accomplished visual physiologist, who was my mentor during my master’s year in neuroscience. David taught me the rigor of performing scientific research, the importance of the continual quest for improving research methodologies, and also the art of scientific writing. He was remarkably patient with me, and with his mentorship and support, I was able to publish my first scientific paper. The second was Professor Jeffrey Gray, a brilliant basic neuro- scientist, with whom I was fortunate to work during my research years at the Maudsley Hospital and Institute of Psychiatry in London. It was with Jeffrey that I was really able to move forward with my focus on psychiatric neuroscience as a research career, using the then emerging technique of functional Magnetic Reso- nance Imaging (fMRI). Jeffrey taught me the value of being a team player. His great capacity to listen to, and appreciate the perspectives of, others despite his vast intellect and knowledge base, had a huge influence on my future career. The third was Professor David Kupfer, an eminent psychiatrist, who, quite simply, transformed my life by inviting me to come and work in the USA. David’s experience and aptitude as a research leader and chair of department go without saying. It was his kindness, flexibility, and positive reinforcement at every single stage of my early, and even subsequent, career in the Department of Psychiatry in Pittsburgh that have really helped to shape my trajectory in the USA. He remains a mentor and a dear friend. The fourth was Professor Lori Altshuler. Lori was a consultant on my very first major research grant in the USA. She was much more than that, though. She was able to advise me on grantsmanship skills, discuss research findings in our specialist research field, and be an invaluable friend, particularly in the early and frightening stages of my move to the USA from the UK. Most of all, her positive attitude, even during her last days, was inspirational. I shall never forget her.

10.6 What Was Your Best Career Move?

I can honestly say that I have had wonderful opportunities throughout my career and have been fortunate enough to have been able to take advantage of the majority of them. The decision to study Zoology in medical school, which then motivated 10 Mary Phillips 73 me to take a year to complete a Master’s Degree in Neuroscience, was one of the best moves I ever made. Moving to the Maudsley Hospital and Institute of Psy- chiatry for my psychiatry residency was undoubtedly an opportune move. Making the decision to work with Jeffrey Gray was also a wonderful move for me. It is perhaps the move to the USA that I will remember, in years to come, as my best career move, but that could have happened only because of all the previous good moves that I was fortunate enough to have made.

10.7 What Were the Key Obstacles You Had to Overcome?

Self-doubt is probably the major obstacle. I think that the origin of this probably comes from the implicit sexism that existed during my early years in medical school, and my lack of skills to cope with this at the time. I use the word “implicit” because I do not remember being the recipient of explicit sexism at any stage in my career. With the help of good female and male friends and colleagues, all of whom believed in me, I gradually overcame my self-doubt and learned that achieving good things in the work place generates respect, regardless of sex or gender. Like many other women, I became resilient. While it still remains much more difficult for many women than for men to succeed in our field, and in the medical field in general, things are improving. I think that this is largely because of the greater number of female role models that now exist in academic psychiatry, and in medical research in general, than existed during my early career. The latter is undoubtedly due to female resilience.

10.8 What Kept You Going During Difficult Times?

Quite simply, my husband. He is a remarkable man, who has been with me at every stage in the last seventeen years. He has never doubted me, has always supported me, and has always advocated for me when necessary. He despises sexism, and his behavior proves that.

10.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

There was a clear disadvantage to being a woman during the early years of my career for all the obvious, sexist reasons. Sexist attitudes clearly still exist. That said, I have found that being a woman in neuroscience has sometimes had its advantages. As a woman, one is never anonymous. People will recognize and 74 M.L. Phillips remember you. As a woman, it is sometimes easier to break into conversation at social gatherings or at conferences. This has helped me to gain colleagues and friends. Being female, I believe, helps foster a natural “maternalistic” mentoring ability, which appears to be very much appreciated by mentees.

10.10 How Did You Deal with the Issue of Work–Family Balance?

Having a very supportive husband who works in a similar ﬁeld to mine has been a huge help to me in that regard. We both enjoy our work and talk about it even during our so-called downtime.

10.11 What Would You Do Differently if You Were to Start Your Career Now?

I would probably lose my self-doubt right from the beginning. A wise female colleague recently said that one should treat obstacles as if they were mere “bumps in the road,” over which you drive and move on. Focusing on one’s productivity and not being distracted by the arcane belief systems of sexist colleagues is deﬁ- nitely the way to proceed.

10.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

There is a saying that “behind every successful man, is a woman.” We as women should have another saying: “Behind every successful woman is her brilliance, her hard work, in addition to the support of her family, friends, and colleagues.” There is absolutely no reason why a woman cannot rise to the top level in any career. Women need to promote other women, of course. Women also need to believe in themselves. So, my advice would be to lose unnecessary self-doubt, take opportunities when they arise, and gain the respect of others for being highly productive and invaluable members of the workforce. Natalie Rasgon 11 Natalie L. Rasgon

11.1 Dr. Natalie L. Rasgon

N.L. Rasgon (&) Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, USA e-mail: [email protected]

Dr. Natalie L. Rasgon is a professor of psychiatry and behavioral sciences and of obstetrics and gynecology and associate dean for Academic Affairs at the Stanford School of Medicine in California, USA. Dr. Rasgon heads the Center for Neuro- science in Women’s Health at the Clayman Institute for Gender Research where she founded and directs the Behavioral Neuroendocrinology Program and the Women’s Wellness Program. Dr. Rasgon has established herself as a preeminent researcher on the interface between the endocrine and metabolic systems and brain function in relation to mood disorders and aging. Dr. Rasgon actively promotes junior doctors and researchers through her role as a director of the Stanford Department of Psy- chiatry and Behavioral Sciences Faculty Mentoring Program.

11.2 What Was Your Earliest Ambition?

For the longest time, I thought I would become a pianist. I was classically trained from a young age, on track to go to the conservatory and become a professional pianist. In the former Soviet Union, this was an acceptable career for a woman. Although women were discriminated against, at least in the workplace women received respect for their qualiﬁcations, if given a chance to get in. My musical career aspirations were shut, not because I was a woman, but rather for being Jewish. That experience, as painful as it was, opened a new direction for me, this time in medicine.

11.3 What Attracted You to Psychiatry?

Before coming to the USA, I was an associate professor of obstetrics and gynecology with a subspecialty in reproductive health. My research in neuroendocrinology focused on the neurobiology of chronic pain and premenstrual dysphoric disorder. I was very fortunate to continue my work in the new country, and being in psychiatry helped in developing my research focus from a neuroscience prospective.

11.4 What Do You Enjoy Most in Your Job Now?

Academic medicine in general, and academic psychiatry in particular, affords an incredible luxury of combining all three pillars of medicine—clinical work, research, and teaching. After being a doctor for 35 years, I still enjoy seeing patients. Research collaborations are exciting and stimulating at the same time. But most of all, I cherish the opportunity to discover and mentor a new generation of academic physicians, and in some cases, psychiatrists and neuroscientists. Regardless of what part of medicine my mentees choose, it is my ultimate 11 Natalie Rasgon 77 satisfaction to see them thrive and move through career trajectories in their chosen specialties.

11.5 Who Do You Consider Your Mentor(s) During Your Career?

I am indebted to many people for their guidance over my professional life. Michael McGuire and Lissy Jarvik were my ultimate mentors during my tenure at UCLA. Alan Schatzberg was my chair and a senior colleague who provided me with numerous opportunities for academic growth and remains my go-to person for scientiﬁc advice.

11.6 What Was Your Best Career Move?

Although I was happy at UCLA, moving to Stanford provided opportunities I wouldn’t have had otherwise.

11.7 What Were the Key Obstacles You Had to Overcome?

There are always obstacles in life, but I never dwell on them. I took them all in stride.

11.8 What Kept You Going Through Difficult Times?

Many wonderful colleagues and friends supported me over time, as did my family. There are too many to mention, but I cherish friendships overall and try to recip- rocate whenever I am able to.

11.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

As I mentioned above, in the former Soviet Union, women were not discriminated against in a professional setting. In the USA, I didn’t encounter any hindrance to my career by being a woman. 78 N.L. Rasgon

11.10 How Did You Deal with the Issue of Work–Life Balance?

Women have to do a lot more work to raise a child and build a career, more than we are ever given credit for. We have to have more energy, stamina, and drive than anyone else and must be willing to push ourselves beyond our limits and come out on the other side in one piece. It’s helpful to have resources that mitigate the responsibilities at home, but most importantly is to have the instinct to never stop pushing yourself.

11.11 What Would You Do Differently if You Were to Start Your Career Now?

Nothing at all.

11.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

Get a lot of support for your goals from your family and friends before embarking on your career path. Do a careful estimate of your goals and timelines for achieving them. Work hard and be respectful and collaborative. Do not be afraid to ask for help or step aside, if the pace is too fast. Marcella Rietschel 12 Marcella Rietschel

12.1 Dr. Marcella Rietschel

M. Rietschel (&) Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, J 5, 68159 Mannheim, Baden-Württemberg, Germany e-mail: [email protected]

Dr. Marcella Rietschel is Professor of Psychiatry and Head of the Department of Genetic Epidemiology in Psychiatry at the Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Germany. She is a member of the Heidelberg Academy of Sciences and the German National Academy of Sciences Leopoldina. Dr. Rietschel is vice-president of the Interna- tional Society of Psychiatry Genetics and leads national and international initiatives on the genetics of psychiatric disorders. She is widely recognised for her pivotal contributions to the investigation of the clinical, social, ethical, and legal implications of psychiatric genetics.

12.2 What Was Your Earliest Ambition?

The very ﬁrst ambition I can remember was to jump down as many steps as possible from the staircases. Another ambition also related to locomotor activity and was to jump as high as possible to reach the “ear” in a rubbertwist, jump over high thorny hedges, run quicker than my pursuers or the ones I pursued, and ride a 28-inch bike. More sophisticated ambitions were to master not being ticklish anymore, to catch mice, and to make little cats not run away but stay and accept my caress—and the biggest success: to make them purr. All this taught me early on that achieving goals requires perseverance. Actually as far as I can remember I have never ever in my life had a real ambition for something that I have not been able to achieve. I have always had and still have the feeling that if I do really want something, I can achieve it. Perhaps, I was always very realistic, or lazy, or happy with what I had. On the other hand, I wanted and I got a lot—apart from one thing: more time.

12.3 What Attracted You to Psychiatry?

I have always been interested in the way different people feel and think, why this is so and if this could change. Also people love to tell me their problems, as they feel understood, and I think I really often do understand them, or at least I try. This started very early (when I was not even 10 years old): my father was a judge, and many people came to our house to seek his private advice. Waiting for him, they often talked with me, the child, curious and willing to listen to their problems. I was fascinated by all those problems with husbands, kids, landlords, employers, etc. Moreover, at the same time, I felt sorry for them, empathetic, and also wanted to understand better why people reacted so differently and whether this was inherent or could be changed. This wish persisted and although I was attracted to many things, later in life when I had to decide what I wanted to study, I decided on philosophy and psychology. A few months after I had taken up my studies, I turned to medicine to also learn about the biological underpinnings and to become a psychiatrist. 12 Marcella Rietschel 81

12.4 What Do You Enjoy Most in Your Job Now?

Thinking, learning, brainstorming, discussing, and conceiving new ideas—trying to make them become a reality. The members of my department, whom I look forward to seeing every day, to solve problems and laugh with. Meeting and working with colleagues across the whole world, the endless horizons, and possibilities. And doing this in order to achieve something good for patients and mankind makes my work perfect and worthwhile. I know it sounds megalomaniac, but this is ultimately what I enjoy in my job.

12.5 Who Do You Consider Your Mentor(s) During Your Career?

I have had several mentors. An outstanding one for me was Peter Propping, who was the director of the Institute of Human Genetics in Bonn. I took up my position in the institute after I had been working at the University of Marburg, in surgery for more than 2 years as one out of two women. I had a quite “innovative” plan for that time: continue to have my home base in Marburg and work during the week at Bonn, leaving my two children (5 and 2 years) with my husband who would work halftime as a paediatrician. While others considered this a strange idea, Peter Propping was very open to new approaches and curious as to how I would manage this. In surgery, I had grown quite used to a harsh tone and a hierarchical structure. Peter Propping was outstandingly different, and just the way I had imagined a real researcher and physician to be. A small example may illustrate what I mean: he was always terribly busy, but he always took time to answer questions. The ﬁrst week when I asked him about a syndrome, he enthusiastically jumped up, fetched the ladder, quickly climbed up under the ceiling—which seemed a bit dangerous—to fetch a book out of the shelf, and searched together with me until we got the answer. Nothing special, but so different from what I had experienced before. There is only one saying of his I never liked too much: the enemy of the good is the better… Although I actually only worked 3 years at the Institute of Human Genetics in Bonn, our cooperation turned out to be lifelong (at least it is still ongoing at the moment). This cooperation also includes his colleague and successor Markus Nöthen and his co-worker Sven Cichon. I am convinced that this cooperation and friendship is the key to the success we all had, as this mutual respect and understanding gave us the strength and joy you need to appreciate good times, and to survive the hard ones. 82 M. Rietschel

12.6 What Was Your Best Career Move?

Actually, I have never thought too much in terms of my career but rather in terms of my life. There are individuals who know quite well what they want to achieve in life and in their career. Apart from a few things I never really knew—I just wanted everything: interesting new people, locations, and tasks. And I wanted to do something meaningful and to be happy. And no doubt, I wanted to be independent and free to decide what to do, whom to meet, and where to stay. Also naturally I wanted to have children, a wonderful husband, and an interesting job, so the rest was secondary. When I ﬁrst applied to psychiatry, I was asked: “What do you want— reach out to the stars.” And my immediate answer was: “The most important thing for me is that I live in a way that I continue to stay in harmony with myself, and I will do this whether I get this job or not.” As I do not know what life would have been if I had made different decisions, I cannot really tell what my best move was. But no longer doing clinical work as a consultant and being able to sleep long into the morning without any night duties or the pressing fear that a patient could commit suicide, I think that was quite a good move.

12.7 What Were the Key Obstacles You Had to Overcome?

A key obstacle was that I chose to identify the genetic and environmental factors underlying psychiatric disorders and to do this by phenotyping sufficiently large numbers of patients and controls. This aim was so ambitious that it took so many years to bear real fruit. Working so hard for so many years without knowing whether this was the right way and without any real success was very hard. It has only been in the last few years that the new findings in the field of psychiatric genetics showed that we were right. Short-term goals and successes would have definitely been beneficial. Another problem was/is that phenotyping patients is a demanding task (I started right from the beginning to assess systematically up to 2000 param- eters in each patient) and it is not regarded to be as “scientific” as the molecular genetic work. Although I know it is, it is difficult to convince money givers. However, there is one big obstacle that I have not yet overcome, and I suspect I never will: competition. I studied medicine in order to help those in need and had hoped that I would do this in harmony with like-minded colleagues. Instead, I entered a world of hierarchy and competition. And like stinginess, it is highly contagious. It is like when you play monopoly. While you may not like the game to begin with, you like it even less when you are losing (“do go directly to jail, do not collect the $4000”), but cannot resist enjoying it when you win. Same in academia, even if your primary intention was not winning but helping, you still strive not to lose but rather to win—which means that you have to compete. But as a highly renowned colleague said the other day while discussing sharing resources in science: “It is in the nature of man to compete…” It definitely is, and definitely in the nature of males, but there are many things which are in the nature of man, which we try to overcome. I think the 12 Marcella Rietschel 83 context of how we are conducting research matters. It does not seem honest to me to do research claiming to help the weak and vulnerable, while fighting and competing with other colleagues. We often pay lip service to collaboration when it serves our careers rather than the cause of science. My dream is that this would become reality that all researchers would share resources and help each other in our common fight against mental disorders. There are many problems to tackle, so I am happy if somebody takes on one of these problems. If they come up with a solution, then that is great! It is good to know that this problem has been taken care of, and if I can help, then I gladly will. Why should I try to compete? Imagine, my daughter is preparing breakfast and I say: oh I will do it better, quicker, and more efficient and we both start competing in preparing breakfast. This however also requires modesty and the insight and ability to admit that somebody else is better in doing something. Anyway, I acknowledge that many researchers do like to compete to a certain degree. If they like it and it works for them and for the sake of science, then who am I to say who is right and who is wrong? I definitely do not enjoy competition. It is against my nature, and I do not feel at home with it. Having said this, losing does not feel comfortable either. It is still a man’s world with man’s rules, at least in Germany. Men are willing to accept women who play by these rules and women who stay in academia must adapt. Those who are not willing to adapt and play this game usually leave. And, it seems that many women do leave. How else can we explain the lack of women in senior positions even in disciplines (e.g. psychology) with an overwhelming majority of women at the more junior ranks?

12.8 What Kept You Going During Difficult Times?

As already mentioned, it was the friendship and appreciation amongst Peter Prop- ping, Markus Nöthen, Sven Cichon, and later Thomas Schulze. On the other hand, if I had not had this support and friendship, there would not have been so much to lose by stopping, and perhaps I would have stopped. This may have resulted in a nicer life, with more time for my children and without so much unbelievable stress and feelings of incompetence. But as pointed out before, I do not know whether this would have necessarily resulted in a better life, and I am now quite happy, as our research did bear fruit. My children are adults and we have a wonderful relationship, and I enjoy science and the exchange with the colleagues and travelling. When it was at its worst (leaving home at 7.00 a.m. not getting home before 9 p.m. or much often later, taking on night shifts, absorbing myself in writing applications and papers as well as struggling to keep up with the pace of change in science at night and during weekends, raising my two children on my own, and needing the money), it was just so much that I was not even able to think about alternatives. All I could think about was that I had to survive to the next day and to the next. What helped me was my ability to enjoy even the smallest moments intensely and also the knowledge that it was me who had made the decisions and that it is not my personality to give up, and the realisation of how privileged I was (compared, e.g., with the generation before who was in war, or with women who had to obey their husbands). 84 M. Rietschel

12.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

As I am a woman, it is difficult for me to say what would have been different if I had been aman.Thirty-five years ago, when I started working, Germany was still so conservative that even other women made me feel guilty for not staying at home with my children. There was no expectation that men should stay at home with the kids. But surely, it is not good for kids if both parents are away. And as I wanted the best for my children, I felt unhappy, miserable, and guilty for not being at home as much as I wanted. I did not compete with my male colleagues, which is probably why they did not behave competitively towards me. I think women, by nature, are programmed to share (they are e.g. programmed to be able to get pregnant which implies risking their lives for others, their offspring) and are more prone to need harmony. I definitely do. And here I was trapped: everybody around me, peers and bosses alike, devoted most of their time and their life to work—a bit like a religion. Setting other priorities, like having a work–life balance, weakens the group and makes you an outsider. And how can you relax when you are thinking of all the duties you have not yet fulfilled and when your colleagues without success are not appreciated?

12.10 How Did You Deal with the Issue of Work/Family Life Balance?

I once read a study saying that there is only one group for whom child neglect is tolerated: female doctors, so I considered, I probably was not the only one with this problem. There was not much of a work–family balance. There was only work and more work. But I think the relationship with my children was and is so intense that the short moments we were together made it feel that we were together all of the time. Perhaps it is true that intense moments are deeper and last much longer, and this is perhaps why we still have such an intense relationship now. So while it was very hard then, it is wonderful now. So the overall work–family balance is/was not so bad.

12.11 What Would You Do Differently if You Were to Start Your Career Now?

This is really difﬁcult. I think I still would love to do medicine and psychiatry. I would not go to a place anymore where people expect you to perform in a way you are not willing/able to do, e.g. devote your whole life to work. Naturally, I still would search for work which is meaningful, with devoted, honest, and friendly people—preferentially in a location with a lot of sunshine and wonderful sur- roundings, and if possible tenure, and good payment. It may sound unrealistic; however, one should always strive for the best. 12 Marcella Rietschel 85

12.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

One thing that I can say with absolute certainty is that if one wants to do the best science, one has to work with the best scientists. That is true for both men and women. Right now, it is sort of “en vogue” to tell women that they have to behave like men in order to get to the top. I am hesitant to agree as I think this is a misleading mindset. I do not claim that women are better than men, but we are (still) different. When a woman mentee asks my advice, I first inquire about her wishes and about the premises these wishes are built upon. I then inform her that she has to be aware that her expectations and the expectations of others can be different: women often invest a lot, expecting that others will appreciate it and give back. Oftentimes, they are frustrated when they do not get their share. It is true that as women, we often shy away from explicitly stating what we want. Sometimes, this is because we assume that it is so obvious that other people should simply know. On other occasions, it is because we are not clear ourselves or may have somewhat naïve expectations about fairness and generosity in the world. This is often the case for younger women as it is difficult to have a fully formed plan of the future when so much is up in the air. An important question I always ask is: Do you want children? And if so, when? And how does this fit in your plans? Social freezing? I personally think that if the researchers you want to work with are truly bright, they should be able to work out a way to allow children to be part of our lives. If this is eventually impossible, it is not worthwhile to join them. Although do not only ask what others can do for you, but also what you want to do/sacrifice for your values. It is not the final aim, but the context in which research is conducted, that defines its value. Nina Schooler 13 Nina R. Schooler

13.1 Dr. Nina R. Schooler

N.R. Schooler (&) SUNY Downstate Medical Center, 450 Clarkson Ave., MSC 1203, Brooklyn, NY, USA e-mail: [email protected]

Dr. Nina R. Schooler is a Professor of Psychiatry and Behavioral Sciences in the Department of Psychiatry at the State University of New York Downstate Medical Center in New York City, USA. She is also a founding member of the scientiﬁc council of the Brain and Behavior Research Foundation. She has served as President of the American Psychopathological Association and of the Association for Clinical Psychosocial Research and as elected Councillor of the Collegium Internationale Neuropsychopharmacologicum. Dr. Schooler has distinguished herself as a leading expert in the psychopharmacological treatment of patients with schizophrenia and advanced the frontiers of research into ﬁrst-episode psychosis.

13.2 Introduction

Before answering the speciﬁc questions, I need to write a little about who I am and how I came by good luck to the ﬁeld of psychiatry and psychiatric research. I majored in anthropology as an undergraduate and my PhD is in social psychology—an unlikely beginning and training model for a career largely devoted to psychopharmacology clinical trials in schizophrenia. The Psychopharmacology Service Center (PSC) at the National Institute of Mental Health (NIMH) directed by Jonathan Cole was the on-the-job training ground where I started to learn what my academic experiences had not provided and allowed me to develop from a very naïve (but eager) research assistant to a person asked to be part of this book of essays about women’s career trajectories.

13.3 What Was Your Earliest Ambition?

My earliest ambition was to be a journalist, then an actor. As I was finishing my last year in high school in 1951, my plan was to go to Israel to live and work on a Kibbutz—a collective farm community organized along strict socialist principles in which all work according to ability, have no or few personal possessions and where children live in a group rather than with their parents. In that context, the collective’s leadership would determine the work that I would do and so “ambition” was rather off the mark. However, I qualified for a New York State Scholarship that required that I enter college or forfeit the scholarship. My parents, who were very unenthusiastic about my desire to go to Israel and believed firmly in the value of education, insisted that I start college for the first year and therefore not forego the scholarship money. So I entered college without a very clear academic goal. My interests focused on social sciences, and my ultimate undergraduate major was anthropology. 13 Nina Schooler 89

13.4 What Attracted You to Psychiatry?

My early career was formed by the good luck of being hired by the PSC in 1962. Psychopharmacology was just emerging as a field, and therefore, the credentials for entry were rather flexible and, as a matter of fact, my job was more that of a research coordinator than a scientific collaborator. My bosses, Jonathan Cole and Solomon Goldberg, had so many things to do in the center that I had wonderful opportunities to build my knowledge and skills. Sol was in charge of a major study that compared three phenothiazine antipsychotics to a placebo in schizophrenia at nine hospitals across the USA, and I worked directly for him. I had already encountered schizophrenia on a visit to a Veterans Administration (VA) hospital a few years earlier where my husband was doing an internship and was struck by the lack of social engagement of the men sitting in a dayroom who gazed blankly at a caged TV. By luck, the brief encounter at the VA hospital linked to my new job. I was, as I later learned, hooked by schizophrenia.

13.5 What Do You Enjoy Most in Your Job Now?

Novelty and continuity. I am still active in research, although I no longer lead studies but work with colleagues who are widely scattered across academic and clinical settings. The methods we use are dramatically different from the ones we used in the 1960s and we frame our questions in different ways, but the goal is still to learn about which treatments “work” and perhaps understand why. So, I still love both the actual day-to-day process of conducting clinical research and the challenge of analyzing the resulting data to parse the answers. I especially like that the question is framed in terms of a “job” because that focuses on the nuts and bolts of what one does every day. The second part of the job that I enjoy is working with young people and seeing them develop. The department in which I work at the State University of New York Downstate Medical Center is very heavily committed to resident education and to research training. I also always volunteer for mentoring opportunities at scientiﬁc meetings and have been part of the New Investigator Program at the American Society for Clinical Psychopharmacology since its inception. Meeting and working with new young colleagues has been invigorating. I get as much as I give. I always learn something.

13.6 Who Do You Consider Your Mentor(s) During Your Career?

The people who gave me the opportunity to enter the field were Jonathan Cole and Sol Goldberg at the NIMH. The Psychopharmacology Service Center under Cole’s leadership was a remarkable place to work. There was a sense of energy and 90 N.R. Schooler promise and the chance to do as much as you could with little attention to formal credentials. Speaking of credentials, when I started work at the PSC, my highest degree was an ABD (all but dissertation). It was Sol who gently pressed me to correct that deficiency by doing a doctoral dissertation. And the final mentor I should mention was my dissertation sponsor at Columbia University, Richard Christie. Dick was a social psychologist with no special knowledge or interest in schizophrenia or psycholinguistics, the topic of my doctoral research, but he provided the support I needed to move through the process. With their guidance and encouragement, I received my PhD in 1969, fourteen years after I had completed my undergraduate degree.

13.7 What Was Your Best Career Move?

To leave the nest. I started my work life at the PSC, stayed there through several NIMH reorganizations, advanced through the administrative ranks, and had the chance to develop my interests and skills. The question that lurked for me was whether I could succeed in the wider academic community. So in 1988, I accepted an offer from David Kupfer at the University of Pittsburgh to join the Department of Psychiatry and head a program called Psychosis Research. This was a hollow title that I would need to fill with research (and grants). It was the first time that my job put me into day-to-day contact with clinical research colleagues and with patients. I loved it. I worked with Rob Conley, Robert Baker, Joe McEvoy, Rohan Ganguli, Matcheri Keshavan, Cameron Carter, and Jonathan Cohen. We developed a first-episode psychosis program at the Western Psychiatric Institute and Clinic and a program for psychopharmacology clinical trials at the Mayview State Hospital. I sat down with patients and asked them to commit their time (and their treatment) to research. I learned the importance of only asking people to make the commitment to important questions.

13.8 What Were the Key Obstacles You Had to Overcome?

My view was that men were smarter than women and I felt shy about speaking up. I can remember being at a meeting of the American College of Neuropsy- chopharmacology (ACNP) relatively early in my career, hearing an interesting talk, and having a question. I framed the question and then waited for someone else to ask it. When no one did, I assumed that it had not been important. 13 Nina Schooler 91

13.9 What Kept You Going During Difficult Times?

I found this a hard question to answer. Skipped it. Came back to it and ﬁnally con- cluded that I did not have many times that I recognized or acknowledged as difﬁ- cult because I saw them as expected ups and downs. The closest has been this past year when my husband was quite ill (now recovered). Work both suffered and provided a retreat that allowed me to focus on things that were not as scary as his illness.

13.10 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

Both the positives and negatives have been, I think, rather subtle. I cannot point to a speciﬁc promotion denied or frank discrimination. The positive role of being a woman was that there was little question raised about the peculiarities of my career start. A fourteen-year gap between my bachelors and doctoral degrees—what did that mean? I think that would have been a greater hurdle to overcome for a man. The negatives are equally subtle. I was given opportunities when I had demonstrated that I could meet the requirements rather than based on potential. At the time that seemed only fair, but in retrospect there were men in similar positions of experience whose potential was recognized. I had an experience that younger women report that I did not recognize at the time, having your ideas ignored only to be acknowledged when stated by a man. Lastly, at professional meetings I would see male colleagues being asked about their work and I was not. All in all, I do not think that being a woman has been an impediment and the advantage I was afforded by being allowed to start slow was very substantial.

13.11 How Did You Deal with the Issue of Work–Family Balance?

There are two components to manage home and work. First, I had the good fortune that my husband, Carmi Schooler, who is also a psychologist with a successful research career, believed in truly sharing home responsibilities. It was never framed as my responsibility and he would “help.” Responsibility was joint. Our children were also part of the system, and they had the opportunity to see both of us at work. Second, our children were grown at the time I made the most challenging move in terms of home/family balance—which was beginning a weekly commuter life between Washington DC and Pittsburgh. For the ten years that I was at Pitt, I ﬂew there almost every Monday morning and returned to DC on Thursday evening. This was made all the easier because my older son was a faculty member in the Psy- chology Department at Pitt and my younger son was a graduate student at Carnegie Mellon when I started. 92 N.R. Schooler

13.12 What Would You Do Differently if You Were to Start Your Career Now?

I would get a medical degree. On-the-job learning is great, and we all require it since the basic education is truly the starting point. However, being a psychologist in psychiatry is a continuing challenge. Although I study medications, I have never prescribed one and have never been able to take responsibility for a patient’s treatment. I can only advise clinical colleagues based on my research, my reading of others’ research, or the experiences of those I trust. A medical degree would have been a sounder platform on which to build the career trajectory that I have followed.

13.13 What Advice Would You Give to a Young Woman Starting Her Career Now?

Read this book! I have three adolescent granddaughters and I plan to give them all copies. I suspect that the chapters will have valuable perspectives even though they are not apparently interested in a career in psychiatry. A woman today has some significant advantages in that there are more role models to follow. Young women I meet are less timid and more self-confident than I was. There is a concern within the field to insure that women have appropriate opportunities. For example, in earlier times, there were nepotism rules at universities that limited opportunities of women married to men in the same field. However, women still face the challenge of balancing work and family responsibilities, and “time-outs” for childbearing and rearing may be allowed but taking them has risks of losing currency in an ever-faster-moving world. My best advice to a young woman today would be to follow your heart and your head in choosing a path that will be rewarding. Rec- ognize that there are chance elements and events that may be as or more significant as your plans and choices in determining how life and work play out. My closing words would be good luck. Patricia Suppes 14 Trisha Suppes

14.1 Dr. Trisha Suppes

T. Suppes (&) Department of Psychiatry and Behavioral Sciences, Stanford University, 3801 Miranda Ave. (ISI) T, Palo Alto, CA 94304, USA e-mail: [email protected]

Dr. Trisha Suppes is Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine and the Director of the Bipolar Disorders Research Program at the VA Palo Alto Health Care System in California, USA. She had an instrumental role in the development of guidelines for the treatment of bipolar disorder through her contribution to the Work Group for the Practice Guidelines for Bipolar Disorder of the American Psychiatric Association and the Texas Medica- tion Algorithm Project. She also contributed to the formulation of current diagnostic criteria for this disorder included in the 5th revision of the Diagnostic and Statistical Manual for Mental Disorders.

14.2 What Was Your Earliest Ambition?

For me, it was always about “my vision.” I never actually thought about it in terms of ambition. My first vision of my work was also my first ambition. Surprisingly, it happened while I was an undergraduate student at Stanford. So while I seemed to have a lot of drive because I stayed in school for extensive training after college, for me it was always about my vision. What is perhaps even more surprising is that my earliest idea of what I wanted to do is pretty much exactly what I’m doing now! This early idea was in fact to study how the brain worked and apply it to human conditions of illness, especially focused on brain or mental illnesses. While I did briefly consider neurology at one point, my more fundamental interest has always been on con- sciousness and alterations of perceptions of reality. These are central questions in the area I’ve ended up working in, which is research into bipolar and depressive disorders. I think I might quite justifiably be accused of having a single-minded focus.

14.3 What Attracted Me to Psychiatry?

Given my interest in understanding the brain as it relates to our experience as human beings, I do not think there was anywhere else to go. Before attending medical school, I did go to graduate school to obtain a Ph.D., doing research in electrophysiology on single cells in tissue culture. I think my drive to do electrophysiology was based on wanting to understand how the brain works at a fundamental level. When I was about two years from ﬁnishing my degree, I came to the conclusion that the pure neurosciences of the 1970s and early 1980s were not going to get me into the human experience, which was the arena of research I was most interested in. 14 Patricia Suppes 95

14.4 What Do You Enjoy Most in Your Job Now?

I feel very lucky to have the breadth of choice and opportunity to work in my chosen area of research, which is the understanding of the neuroscience mood disorders and identifying the best treatment approaches for patients suffering from mood problems. What I particularly enjoy is collaborating on new ideas and the give-and-take of working with others to pursue new research questions. I ﬁnd that progress in neuroscience is opening up a new era of understanding of the brain relative to different states, such as mania or depression. The possibility of looking at the neuroscientiﬁc basis of our patients’ experience is very exciting to me. Through this process, I hope we may not only understand these conditions better, but also more accurately diagnose and provide targeted treatment. Another major area of interest that also gives me great enjoyment is supporting young people and infor- mally mentoring women in academic research settings.

14.5 Who Do You Consider Your Mentors to Be in Your Career?

I feel very lucky with the mentorship I’ve received throughout my career. It is very important, I believe, to have good mentorship and support especially during the early phases of one’s career. To begin with, however, it was each of my parents who set the stage for my pursuit of an academic career. My father, a professor at Stanford, infused me with the idea that “the sky was the limit” for what I could do. My mother inspired and encouraged me with her strong support for women pursuing careers and competing at the same level as men. During my undergraduate work at Stanford, Donald Kennedy, who was a biology professor at the time, gave me the opportunity to work in his laboratory. While I was not able to do the electrophysiology I was interested in, I received a lot of support and had the opportunity to carry out a detailed project in anatomy showing, for the first time, the addition of cells to the CNS of crayfish after birth. The excitement of scientific discovery felt like finding a new continent. I continued on to graduate school where Arnold Schiebel was an important inspiration for me. He was my neuroanatomy professor at UCLA where he also worked as a psychiatrist. He had made fundamental discoveries about the brain including finding new basic cell types. Dr. Schiebel introduced me to the possibility of studying how our brains work and influence behavior and perception, something I was directly interested in. In my psychiatry residency at McLean Hospital, I was fortunate to have had a number of mentors that really shaped my career. First was Ross Baldessarini, who encouraged me to think of new questions and brought his analytical capabilities to bear when considering potential answers. In a surprising turn, one of the first 96 T. Suppes questions I asked in clinical research led to a broad change globally in our approach to treatment and research on patients with bipolar disorder. This study, on lithium discontinuation, was important both to the field and in shaping my future opportunities in academics. Also at McLean, Susan McElroy had a big influence in my approach to research and in the treatment of patients, and she was actually the first woman I had as a mentor (though I’m not sure she thought of herself this way). That Sue was the first woman mentor, speaks to how important I believe it is that “senior” women provide new opportunities and mentoring to the next generation. Sue was vocal about women getting equal treatment in academia, and she shared my excitement about clinical research as a way of improving our understanding of how to help patients. My first academic job was at University of Texas Southwestern Medical School (UTSW) in Dallas. There I met John Rush who played a crucial role as my direct mentor and helped me springboard my career for the first 10 or so years. He helped me to hone my focus and most importantly he showed me how to tame anxieties about moving forward in the world. While we collaborated across the aisle, as my work focused then primarily on bipolar disorder and his on unipolar depression, we published and carried out a number of studies together as part of a larger team.

14.6 What Was Your Best Career Move?

When I finished my residency and fellowship, I was offered a job at Harvard as junior faculty. However, the offer I accepted from UTSW, included support and enough money to conduct an extensive clinical trial on the first use of a second generation antipsychotic on patients with nonpsychotic bipolar disorder. This trial was important to me because I had seen some very ill patients improve significantly on this new medication, and I was committed to doing this study. One aspect of this decision that made it a strong choice in retrospect is that I was also the only person at UTSW focused on bipolar disorder versus being one of many at Harvard and other institutions that I had considered.

14.7 What Were the Key Obstacles You Had to Overcome?

The primary one was to maintain conﬁdence in my capabilities and to pursue my vision regardless of outward appearances of success or failure even during dark days. I believe it was also important that I never allowed myself to think that my vision was too big. In academics, it is important to have a thick skin and to realize that when people are trying to keep you down, it is their problem and not yours. Although we have to be ﬂexible and responsive to external circumstances, it is also vital to maintain our belief in the importance of our own ideas. 14 Patricia Suppes 97

14.8 What Kept You Going During Difficult Times?

This is a tough question. A large part of what kept me going is that there was never another path that I was really excited to pursue. While I enjoy seeing patients and teaching, it is the excitement of research and new discovery that truly inspires me. Certainly, I needed to believe in myself but that is not what kept me going. Friends, family, mentors, and having fun along the way have all been important.

14.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

I come from a family of educated women who were not able, because of the times they lived in, to use their intelligence and realize their potential to the fullest extent. Both my maternal grandmother and mother believed women should have equal opportunities with men and supported me in my efforts to pursue the research career I was interested in. When I ﬁrst entered graduate school and later throughout my career, there were almost no women doing what I was doing and very few senior women were available. I found this lonely, and I did feel a bit in the wilderness. It is only very recently that the academic culture has moved toward greater support of women, though much progress is still needed. There are more women in academics, and they seem able to succeed on their own terms. Having said this, there are still many situations, such as scientiﬁc meetings, in which 90 % of those attending are men. There still is not a fair balance.

14.10 How Did You Deal with the Issue of Work–Family Balance?

It is critical to have good help on the home front. It is essential, I think, not to try and be the housekeeper, accountant, cook, caregiver, and so on. It was important to me to have time for my children and they took priority over work commitments. I once saw a well-known cardiology researcher at UTSW receive a major national award, and the ﬁrst person she thanked was her housekeeper. My situation is not far off. If I had to deal with my housekeeping and laundry every week, it would have adversely impacted my ability to succeed at work and make time for my family at home. I made a clear choice not to miss school events or other activities and shaped my attendance at meetings and so on around the children’s schedules. Having said that, I can also remember a number of mornings working from 5 to 7 am before anyone was up for the day. 98 T. Suppes

14.11 What Would You Do Differently if You Were to Start Your Career Now?

I think the main difference would be to take more chances in my research choices. In my early years, part of coping in the overwhelming male world of academics was a sense that I needed to be absolutely certain about my research ideas before moving forward. I believe this slowed me down and diminished my creative approach at the time. Now with the beneﬁt of hindsight and recognized academic success, I’m more comfortable taking bigger leaps with less certainty of where they might land me.

14.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

Firstly, do not believe everything you hear. One of the key things for me was working from home about 50 % of the time, a practice that is apparently still rare in academics. This was work time when the house was quiet and no kids were around, but having this type of uninterrupted work time was critical to my career. If you do not ask about working from home or give it a try you will not know if it may work for you. Very few academics I have seen adopt this approach, but I got the idea from my father, who was a professor at Stanford, and worked at home every morning. There was also something about working from home that helped me feel more connected to the everyday life of my family, even though they were absent during those morning work times. Research work provides infinitely more flexibility in comparison to clinical jobs. I would also say, “go for it.” Women, myself included, often will not take on potentially bigger roles. Perhaps we are afraid of feeling overwhelmed or not doing a “good enough” job. So I say, go ahead and try these roles out—nominate yourself or speak to colleagues about nominating you. Put yourself out there, and importantly let people in your field know about your interests. It is critical to have good mentorship and support from people around you and if possible at a peer level too. My friends in my field, both women and men, have made the experience richer and more fun. Carol A Tamminga 15 Carol A. Tamminga

15.1 Dr. Carol A. Tamminga

Dr. Tamminga holds the Lou and Ellen McGinley Distinguished Chair and the McKenzie Chair in Psychiatry and is the Chairman of the Department of Psychiatry and the Chief of the Translational Neuroscience Division in Schizophrenia at the University of Texas Southwestern Medical School. The goal of her research is to determine the mechanisms underlying schizophrenia, especially its most prominent symptoms, psychosis and memory dysfunction, in order to improve treatment. Dr. Tamminga is a member of NIMH’s National Advisory Board and the Advisory

C.A. Tamminga (&) Translational Neuroscience Division in Schizophrenia, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA e-mail: [email protected]

Board of the Brain and Behavioral Research Foundation. She has previously served on the Board of Scientiﬁc Counselors of the National Institute of Mental Health and the National Institute of Drug Abuse, as Council member and President of the American College of Neuropsychopharmacology, as a Member and Chair of the Psychopharmacological Drugs Advisory Committee of the FDA, as well as consultant for the Orphan Products Development Review Group, FDA. She serves as Deputy Editor of the American Journal of Psychiatry and on the editorial board of several other journals. Dr. Tamminga was elected to the Institute of Medicine of the National Academies of Sciences in 1998 and has served on several IOM committees in that capacity.

15.2 What Was Your Earliest Ambition?

From the beginning, it was an easy career formula for a girl from a small Mid- western town: graduate high school = become a secretary; graduate college = become a teacher or nurse; inevitably, become a housewife. So, it was nursing for me since science was, even then, a wonder. This goal was both strong and orienting, and lasted until one day, when LIFE magazine (in its old oversized format) published an article titled “A day in the life of a medical student.” The student was studying medicine at the University of Chicago, led a fascinating life full of science and discovery, was female, and had long brown hair (styled just like mine). The story opened up a new and vibrant career option, which I immediately adopted and never let go, despite the inevitable discouragements and slights along the way. It is hard to forget the negative comments and perverse “advice” from all fronts (except from my family) about the pitfalls and dangers of becoming a physician. It was an era when women were actively advised to follow the status quo and never challenge career boundaries. My family, on the contrary, was matter-of-fact and supported educational achievement of any kind. As long as my family (husband and children) was cared for and my house was kept clean, I could pursue any career I so chose.

15.3 What Attracted You to Psychiatry?

It was clear from the beginning of medical school that I was interested in the brain and exploring its mechanisms for generating thought and behavior. The more traveled career path to study these complexities would have been neurology; however, I was drawn to the challenge of understanding psychiatric disorders, especially developing an explanation for psychosis. And so I chose to pursue psychiatry. Mine was an academic track from the beginning. It occurred to me that if I ever had to “work” for a living (i.e., practice), it would be much more interesting to be a psychiatrist than a neurologist. The explosive growth in basic neuroscience, with its fundamental contributions to our knowledge of brain mechanisms, threw 15 Carol A Tamminga 101 open the doors to understanding neural pathology in human brain disease. This journey in academic psychiatry has never disappointed. I ﬁnd it the most capti- vating ﬁeld in medicine and it still promises to bring treatments to brain diseases that we are not even sure we can correctly name.

15.4 What Do You Enjoy Most in Your Job Now?

I still love the challenge of identifying brain mechanisms to explain psychiatric phenomena; however, seldom it actually occurs. New discoveries from basic neuroscience, which are reported daily, document how complex brain mechanisms really are and provide us all with increasingly realistic neural mechanisms poised to model mental phenomena. It is the work in the trenches that remains most encouraging for me: new ﬁndings which pull together a novel explanation; an actual replication of an experiment; seeing a student becoming invested in discovery; ﬁnding a new perspective for a set of observations. The task of translating these discoveries into clinical applications still remains a lofty challenge.

15.5 Who Do You Consider Your Mentor(s) During Your Career?

It was Danny Freedman who ﬁrst took me from a naïve resident to an early scientist and challenged me to think clearly and work hard. He was unforgettable, a lifelong mentor, and an inspiration to many of us. It is hard to strictly separate friends and colleagues in the ﬁeld from mentors, as many of them have made such great contributions to my personal and intellectual growth. I have been truly blessed in my career by the kindness and attention from many friends, collaborators, and colleagues.

15.6 What Was Your Best Career Move?

I am a settled sort and prefer familiarity. But it was my move from the Midwest to Washington DC and to the rich research programs and personalities of the NIH that most changed my research. It was the chance to work within the crowded hallways of NIH scientists that cued me into solid science tracks in brain research and psychiatry. 102 C.A. Tamminga

15.7 What Were the Key Obstacles You Had to Overcome?

In the beginning, my friends and family heard me talk about the oddities of being in medical school with classmates who were almost exclusively male. I was in the ﬁnal years of the era when women were not provided for in a medical school: where the doors in the surgical suite were labeled “WOMEN” and “SURGEONS” and women’s overnight call rooms did not exist. In those days, the head nurses saved me a private (hospital) room each night I was on call, doting on the only woman medical trainee in the hospital. First-year anatomy class still started with the large-breasted nude woman with the quip: “Anatomy can be fun.” The realization of the inappropriateness of all of this came gradually and has changed entirely with time. Now it seems like all that must have been centuries ago. I had the support of many of my classmates and teachers, especially those who considered merit, contribution, and aspirations rather than gender in our relationships.

15.8 What Kept You Going During Difficult Times?

No question: my mother.

15.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

I have always taken great pleasure in being a woman and think that women have profound advantages in life; as such, I am protected from basic envy. In the beginning, and sometimes even now, there are disadvantages in interpersonal and in work situations; I would put practical career details on this list, including important things such as salary. But after my first few years in academic psychiatry, once I had achieved enough seniority to have become a secure fixture, gender-related opportunities began to emerge. At this time, gender balance on important committees became a federally dictated necessity and recruitment opportunities for plumb committee assignments began coming to women. I undertook membership and even leadership of terrific efforts much before my male peers and learned a tremendous amount in the process. It has always taken extra effort to get papers published in the best journals and to get on the fast track for grant funding, given the unconscious bias in judging merit; but every life path has its challenges and I find this life path deserving. 15 Carol A Tamminga 103

15.10 How Did You Deal with the Issue of Work–Life Balance?

I was not good at this. And I had no friends with whom to discuss the topic, because all my friends were male and had wives—what a gift!! It was either all or nothing in the early days. It is good to see women and men today considering different paths forward and ﬁnding their own niche. But all decisions made during early years can have outsized career implications, so careful consideration is wise. I am big on advising early career professionals today against taking seemingly small advantages for the “life” part of the balance that will have outsized effects on the “work” side.

15.11 What Would You Do Differently if You Were to Start Your Career Now?

I would be bolder. Take more risks. I would embrace mistakes and face lost challenges because they provide personal and intellectual growth. Lots of understanding and wisdom come from making and recognizing mistakes. It was Julie Axelrod who said about himself that there was no one he knew who did as many failed experiments as he; it always got a laugh. I would also be more strategic in order to gain ground in the areas of achievement that were of primary importance to me. And ﬁnally, I would have made more women friends in the ﬁeld and talked with them more.

15.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

Go girl!! Life deals out many hard situations that have beautiful and enhancing outcomes. Never give up. Keep your sight on what you really want to do with your life and go for it unfailingly. Know what you need to make yourself successful. Margaret Meade carried 5 objects (all very small) with her on all her travels that, once set up, transformed her environment—however primitive—into her home. I was never this thrifty, but still like the concept. Be realistic. There are many, many different roads and career paths, all of which are contributory and honorable. And, above all, have fun in what you do. Danuta Wasserman 16 Danuta Wasserman

16.1 Dr. Danuta Wasserman

D. Wasserman (&) Head of the National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Granits Väg 4, Stockholm 117 65, Sweden e-mail: [email protected]

Dr. Danuta Wasserman is a professor of psychiatry and suicidology at the Karolinska Institutet in Stockholm, Sweden. She currently serves as the head of NASP, National Centre for Suicide Research and Prevention of Mental lll-Health, at Karolinska Institutet and as the director of the WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention for nearly 20 years. Dr. Wasserman has an impressive career as both a researcher and a psychiatrist and was the ﬁrst female president of the European Psychiatric Association (EPA) and of the Interna- tional Association of Suicide Research (IASR). She has made an unparalleled sci- entiﬁc and public health contribution to the understanding and prevention of suicide.

16.2 What Was Your Earliest Ambition?

I am a psychiatrist and researcher with special interest in suicidal behaviours. In my research through the combination of methods, ranging from the molecular biological, to the studies of emotions, experiences and behaviours, I strive for an inclusive understanding of this unnecessary death and knowledge of how to prevent it. Over the last decade, my research has been focused on public mental health and the development of universal school-based mental health-promoting and suicide-preventing activities. My earlier psychodynamic studies are of great help in this context. However, it all begun shortly after World War II, when I was born in Warsaw, Poland. This was a city, which was in ruins, after a relentless war and two heroic uprisings, namely in Warszawa’s Jewish Ghetto during 19 April to 16 May 1943 and the Warsaw Uprising between 1 August and 3 October 1944. After the war ended on 9 May 1945, the feeling of euphoria, hope and future outlook for democratic development subsided rather quickly, due to forced Soviet like socialism, reprisals and subsequently “the Iron Curtain”, which separated us from the West for several decades. Those of us who grew up in Poland during this time were deprived of exchanges with the outside world and today’s opportunities of choice, something we yearned for very much. Shortly after I was born, for political reasons, my parents moved from Warszawa to a village called Bukowina Tatrzańska and then to a small city, Zakopane. Both were located in the beautiful countryside of the Tatra Mountains, bordering Slo- vakia, and I loved to ski, which I did almost every day. Despite or perhaps due to the severe economic hardships and political perse- cutions during this time, there was a surge of strong humanistic interests in music, literature, philosophy, politics and history. History, and my family’s history in particular, taught me that worldly possessions can be taken from you. Knowledge was the only feature, which no one could take away. Education was always encouraged by my parents. Parallel to normal primary and secondary schools, I attended music school during the late afternoons and evenings, wherein I learned to play the piano, harmony and composition. To this day, clas- sical music is an important part of my daily life. 16 Danuta Wasserman 107

My parents were survivors of both the war and communist regime. My mind is ﬁlled with conﬂicting memories from my childhood and adolescent years, with the love and support I received from my family mixed with the harsh reality of a world grown hard, gloomy, dangerous and unjust. I still have childhood memories of the looming threat of Stalin’s terror on my family and the feeling of relief following his death.

16.3 What Attracted You to Psychiatry?

I continued my studies at the secondary normal and music school in the medieval city of Krakow, a vibrant academic and cultural city with opportunities for many contacts, friendships and attractive happenings. Thereafter, I began my university studies at the Medical Academy at the Jagiellonian University, which is one of the oldest universities in Europe, founded in 1364. At this time, I had not yet decided to become a psychiatrist; however, I knew early on that I wanted to be a doctor. The aspiration to cure, to care, to repair and to bridge conflicts became a driving force in my life. After persuading the university management, I obtained permission to study psychology in parallel with medical studies. The combination of natural and social sciences broadened my perspective and proved helpful in my future work as a psychiatrist and researcher. My interest in psychosomatics attracted the attention of a professor in medicine, Julian Alexandrowicz, who gave me the assignment to write a small, but interactive compendium in psychosomatics for my colleagues. He also encouraged me to develop my first research project on how the progress of leukaemia was influenced by psychological traumas and psychotherapy. These years ended abruptly when in the summer of 1968, I alongside other students was expelled from the university due to political reasons. This message arrived when I was on holiday in Sweden. I started my new life in Lund, only a few hundred kilometres from Poland, but it felt as though it was a continent apart. One year later, I resumed my medical and psychological studies at Uppsala University, the oldest university in the Nordic countries founded in 1477. In the student environment, it was easy to make new friends, greatly facilitating my integration in my new home country. It took time to learn a new language, culture, a different political system, the Swedish people and practicalities, such as where to find the shelf with a particular food in the super- market, to cope with the loss of old flavours and fragrances, while learning to develop new senses and to find places where “wild strawberries” grow. I certainly became richer in experiences and perceptions; however, there were times when I believed that I would be happier without them. A few years later, during my specialist training in general psychiatry, my interest in psychological and psychiatric research was awakened when confronted with suicide attempts and suicide of young patients. Those events actualized memories of one of my friends from my school years who committed suicide many years ago. 108 D. Wasserman

Years past between my first tentative steps in research and my official start as a researcher. By obtaining grants from the Medical Research Council for my doctoral studies, followed by a research position, I subsequently received long-term funding, enabling me to build a research team using an interdisciplinary approach to study suicidal behaviours. Sweden has a long tradition of conducting suicide research, with a strong focus on biological and epidemiological perspectives. During the time I was writing my thesis, there was a substantial development in social psychiatric and psychodynamic research, and I decided to study both psychoanalysis and psychotherapy. In 1986, I defended my PhD thesis “Attempted suicide—patient’s family, social networks and therapy” at Karolinska Institutet. I studied the development of the suicidal process in psychiatric patients with different diagnoses, with a particular focus on patients’ suicidal communication with family, significant others and caregivers and how they responded. If a suicidal patient encounters silence, ambivalence or aggression during this exchange, it is often perceived as a rejection and lack of support, influencing the suicidal process.

16.4 What Do You Enjoy Most in Your Job Now?

The most attractive part of my work has always been the ability to determine the direction of my research and to influence decisions that are of importance for the treatment, prognosis and prevention of suicidal behaviours among those who suffer. After Stockholm County Council’s initiative to support suicide prevention in 1993, I became the founding director of the National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) in 1994, which I still lead today. In this role, I contributed to the Swedish National strategies for suicide prevention, which were later approved by the Swedish Parliament. It took more than 20 years to develop NASP with the help of an ever-growing group of very talented coworkers, who have the aptitude and interest to study suicidality using multidisciplinary approaches. Involvement in international projects as the director of WHO (World Health Organization) collaborating centre, and principal investigator of projects managed by large consortia and funded by the European Union, provides remarkable learning experiences, as one develops new knowledge to tackle new and old research questions together with motivated and experienced researchers. Recently, as a partner in an EU project studying new information and communication technolo- gies, I have the opportunity to understand the next wave of innovative efforts for self-managed care. As a young girl in Poland, I often dreamt of achieving this level in my career. This is now a daily reality for me. The road of isolation from external and international influences to extensive international collaborations is rewarding and fulfils my previous child and adolescent curiosity about how people from other countries live, work and think. 16 Danuta Wasserman 109

16.5 Who Do You Consider Your Mentor(s) During Your Career?

Knowledge is wealth and no one can take that away from you, said my parents. Like a whisper in my ear, I can still hear, even to this day, the words of my mathematics teacher Olga in elementary school, as she pushed me when I was hesitant: “Danusia, if not you, then who?” Alongside my parents, she too believed in me. It was a real mentorship. I did not know then that she was in effect paraphrasing Hillel the Elder, the Jewish sage who lived around the beginning of our era. Over the years, what I have read by him has greatly inspired me, in many ways influencing my worldview. In his teachings, Hillel emphasized the importance of this moment over others: “If not now, then when?” and that one needs to take care of oneself, “if I am not for myself, then who will be for me?” while never neglecting others, “if I am only for myself, what am I?” As a child, I read a book, whose title I do not remember any longer, about a girl with rebellious thinking, who disguised herself as a boy in order to gain access to education at the Sorbonne, during the Middle Ages. She taught me that to achieve something in this life, one has to fight and be inventive. In the adjacent village to where we lived during my childhood stood an aban- doned house of relatives to Marie Curie—Sklodowska. I admired how she succeeded in her endeavours, despite living in a foreign country. When I visit Paris, staying in the Latin Quarter, I often pass her and her husband’s physics and chemistry laboratory and remember my childhood thoughts. Medical studies were highly competitive in Poland. As my family was black- listed as oppositionists, I knew I would be rigorously audited in the attempt to stop my professional ambitions. The condition after the entrance examination given to me was to gain a one-year internship at the hospital, before I was accepted into my coveted education. It was gratifying to work at the hospital pharmacy, orthopaedic ambulatory and bacteriological laboratory, with many inspiring female and male role models from an array of different medical professions. At the University of Krakow, there were few female professors. One, at that time associate professor in anatomy, Janina Sokolowska, made a strong impression on me. During an autopsy demonstration, she reflected on the tattooed number from the concentration camp on the underarm of the examined male body. She then showed us her number and said, “I was lucky to survive”. She was a demanding teacher and an excellent researcher and stimulated students to engage in research circles, who were led by the prominent professors. My mentor in Sweden was my doctoral supervisor, Professor Johan Cullberg, who is a pioneer in social psychiatric research and, during my postdoctoral period, Professor Bengt Jansson, head of the Psychiatric Clinic at the Karolinska Huddinge University Hospital, an engaged spokesman for ethical questions in psychiatric research. I was also mentored by a professor in stress medicine at Karolinska Institutet, Lennart Levi, an internationally renowned researcher, who also served as 110 D. Wasserman the director for the National Institute for Psychosocial Medicine, and advisor to the WHO, International Labour Organization and EU. The opponent for my dissertation, Professor Nils Retterstøl, nestor of psychiatry in the Nordic Countries and head of the Psychiatric Clinic at University of Oslo, Norway, mentored me many years after my PhD studies. Although limited in the beginning as an outsider, I was able to build up a supportive network of colleagues in the Nordic and Baltic countries. Many of them today are my close friends. This network gave me a starting point for my further involvement in European collaborations that eventually led to the expansion of my network through the WHO to all continents.

16.6 What Was Your Best Career Move?

In 1968, my move to Sweden proved to be the best move for my career. As a young medical student, I started from zero—but maybe not. For, “the only thing one carries are skills one has in one’s head and fingers” is what my parents often told me when I was young. Sweden is my home now, and I am very grateful for the security and support this country has offered me. In 1995, I was appointed as a professor in psychiatry and suicidology, at the National Institute for Psychosocial Medicine, followed later by a full professorship at Karolinska Institutet, where I held academic leadership positions. At the international level, as the director of the WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention since 1997, I had the opportunity to assist in the development of suicide preventive research on the five continents. It required extensive travelling, while neglecting sometimes important family duties. As the president of the International Acad- emy of Suicide Research, I pushed the field of suicidology towards a global perspective. During my time as the head of the Department of Public Health Sciences at Karolinska Institutet, I had the opportunity to raise awareness of the role of lifestyles, such as dietary customs, physical exercise, sleep, and environmental and work-related factors for mental health. Public mental health was the topic when in 2009, I organized together with my colleague from the Karolinska Institutet, Lars Terenius, the “Nobel conference on the role of genetics in promoting suicide prevention and mental health in the population”, which was sponsored by the Nobel Assembly at the Karolinska Institutet. A summary of the whole conference was published in a special issue in European Psychiatry, 2010; 25(5): 249–310. I tried to underscore as well, the role of lifestyles in mental health, during my years as the first female president of the European Psychiatric Association. 16 Danuta Wasserman 111

16.7 What Were the Key Obstacles You Had to Overcome?

I decided early on to study medicine and pursue my quest for academic achievement; however, my career happened to ﬂourish in Sweden and not Poland. This was not done by choice. The increased political freedom took place in Eastern and Central Europe during the 1960s, with an increasingly open opposition culminated in a brutal end in 1968, subsequently disrupting my studies in medicine and psychology in Krakow. These early obstacles that could have hindered my continued education stay with me and motivate me until this day. Today, as for most researchers, the main obstacles relate to funding. There is, for example, a very low success rate of receiving EU grants. Not to lose one’s drive and keep one’s self-esteem intact is a constant challenge, especially when devoting such a signiﬁcant amount of time in writing extensive applications and when grants must constantly be sought anew.

16.8 What Kept You Going During Difficult Times?

Perspective and context helps me in overcoming difﬁcult moments in my life. I see research as a creative profession, comparable to the work of other creatives, such as artists and writers, with no age limits, as long as one takes full advantage of opportunities. This work gives me inner satisfaction and helps to minimize and overcome adversities.

16.9 What Role (Positive and/or Negative) Did Being a Woman Play in Your Career?

In retrospect, I believe I have not reﬂected enough on this aspect of my being and my place in the world because of my gender. Perhaps I like to pretend that it does not matter, but of course, it does. As I am quite optimistic by nature, I try not to be bitter and instead always try to make the best of any situation in the various roles of my life. Sometimes, however, I am painfully aware that there are many closed opportunities and “rooms” due to my gender. This harsh reality used to hurt me deeply, but it does not hurt any longer. However, I also feel that things have changed in academia, as well as in national and international associations. There appears to be more trust between female and male colleagues today. If my project or application is rejected, or I do not reach the position I strive for, I believe it is not due to my gender, as many of my male colleagues have similar experiences. I truly feel the support and inclusiveness from my male colleagues, but psychiatry is probably an exceptional discipline. 112 D. Wasserman

16.10 How Did You Deal with the Issue of Work–Family Balance?

Life as a researcher includes a large amount of competition, but it suits me quite well. Challenges and resistance stimulate me. At the same time, it is important to feel the support from your family and your partner and to give support to your children. Together my husband and I have 5 children: two on each side are from our previous marriages and one together. Three children live in Stockholm, with ﬁve grandchildren, and two in NYC, with two grandchildren there. My husband of nearly 40 years, Jerzy, is also a medical doctor and professor of immunology and bacteriology. Since the 2000s, we have worked closely together studying the genetics of suicidal behaviours. To have a life partner who shares professional ambitions, interest in the arts, literature and history, while providing emotional, intellectual and practical support, is invaluable. We have a rich and interesting life together.

16.11 What Would You Do Differently if You Were to Start Your Career Now?

In addition to conducting research, a professor’s tasks comprise the responsibility for higher education, expertise in diverse contexts, review of scientific articles, to seek financial support, to work with national and international committees, to serve in administrative posts at the university and in international associations, to write articles, books and book chapters, to attend meetings and conferences, to lead your research team and to address the many other tasks that may arise throughout one’s career. Given the constant flow of incoming requests, you have to think and choose before agreeing to commit to a task at hand, in order to not set aside your own research. This demands a high capability to prioritize, which is not my strong side. Today, I am slightly better in prioritizing, but despite all my experience, not good enough. During my time as the head of the Department of Public Health Sciences, I came into contact with students, researchers and academics full of curiosity and energy from Asia, Africa and Latin America, who were very grateful to receive advice and help with grants. I wish I had the time to develop more preventive intervention projects and graduate and postgraduate programs in suicide prevention with these students. Today, I work indirectly through the WHO in low- and middle-income countries; however, it is not the same experience as to be directly involved. 16 Danuta Wasserman 113

16.12 What Advice Would You Give to a Young Woman Starting Her Career Now?

To listen to and integrate ideas of your supervisors and older researchers with your own thoughts and, at the same time, believe in yourself and seize every opportunity to develop your unique research line. Research renews and innovates by new ideas built upon the reﬂection on the old ones. The choice of a life partner was A–Z for me, as we could then share both professional and private interests. A partner, who understands, respects, encourages, supports and, at the same time, can give the critical feedback, is a treasure that one must revere. Life becomes so much richer when you can share experiences and emotions, even in your career, with somebody you love. Freud said that “love and work are the cornerstones of our humanness”, but work must be pleasurable, thus try to combine work–love–play. Part II Plan Your Way

Dr. Sophia Frangou, MD, PhD, is Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. Her research uses clinical, cognitive, genetic and neuroimaging techniques to determine the pathophysiology of psychotic disorders and identify factors associated with increased vulnerability as well as resilience. She is a Fellow of the Royal College of Psychiatrists and vice-chair of its Pan-American division. She is also Fellow of the European (EPA) and of the American Psychiatric Association (APA). She is editor of “European Psychiatry” and associate editor of “Human Brain Mapping”. She serves on the academic faculty of the Royal College of Psychiatrists and as vice-president of the International Society for Bipolar Disorders. She is founding chair of EPA Section of NeuroImaging and of the Brain Imaging Network of the European College of Neuropsychopharmacology. The Pursuit of Happiness 17 Sophia Frangou

17.1 The Pursuit of Happiness

The American Declaration of Independence lists life, liberty and the pursuit of happiness as the unalienable rights of humanity. I have always been struck by the inclusion of happiness as a fundamental human right in a document that is now two hundred and forty years old. It is such a modern concept to have originated with a group of rather paternalist men. Nevertheless, the pursuit of happiness is indeed the most fundamental organizing principle for our lives. And it applies equally to men and women. All the women profiled in the preceding chapters talked about the joy they derive from their work and the sense of meaning it brings to their lives. So their success is not simply based on professional recognition but on their willingness to pursue those activities, academic and otherwise, that made them feel happy and fulfilled. The emphasis of this book is on female leadership and success in academia. However, it would be wrong to assume that this represents a general statement regarding what success should look like for all women psychiatrists. Success is a multidimensional and ultimately a deeply personal concept, predicated on a sense of fulfilment consistent with each individual’s beliefs and values. It is this freedom to pursue one’s individual path that represents a core value of this book. This is contrasted with the issue of gender stereotypes, a recurrent topic in many chapters. The main criticism levelled against stereotypes is that they represent restrictive generalizations. This applies equally to “Stepford Wives” and “Wonder Woman”. Success is not about meeting predefined ideals but about personal choices.

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

In this respect, our narrative deviates from that of progressive feminism where gender equality is often framed in terms of equal numbers of men and women across all tiers of seniority. Closing the numbers gap is of course important, and having more women in leadership positions is a key component for effecting change. Although men and women have to compete in the workplace for the top jobs, our emphasis is not about pitting men against women. The focus is on freedom of choice as a conduit to personal happiness and success. In this respect, this book is very much aligned with freedom feminism, as proposed by Christina Hoff Somers, resident scholar at the American Enterprise Institute. According to Hoff Somers, “freedom feminism stands for the moral, social, and legal equality of the sexes, and the freedom of women to employ their equal status to pursue happiness in their own distinctive ways” [1]. What is refreshing about this view is that it does free women from positive and negative stereotypes and affirms the value of personal choice. We want more women in leadership positions because such women represent visible models of these principles. The women who have chosen or are considering a career in academic psychiatry often aspire to reach the top jobs. This would mean leadership positions of research programs, institutes, centres and departments. The low number of women in such positions suggests that there are gender-related obstacles that stand in their way. However, this may not be true for all women. Priorities in life do change over time. I have seen this happen more than once, particularly for women who decide to have a family. The emphasis may shift from career progression to home life and back again, usually when the children become more independent. In much of the current societal debate about the gender gap, this flexible reordering of life priorities adopted by many women is seen as “evidence of entrenched sexism and internalized oppression” [1]. An alternative view is that women are experiencing and exercising more freedom than men in their life choices and they are indeed making choices consistent with their internal compass in the pursuit of happiness. Having said this, the key concept we keep returning to is that of choice, based on personal preferences rather than necessity. This book aspires to provide a resource for women so that they do not feel that they have to opt-out from academic psychiatry. We acknowledge women often opt-out because the environment they work in is not conducive to happiness or success. Institutional practices and policies, unfavourable stereotypes and gender-related differences in working style and willingness to compete are major factors. The women profiled in the preceding chapters offer a wide variety of examples where personal ambition and work environment collided. They also illustrate the many individual approaches they used to problem-solve. The most important recurrent theme is that success for them was measured in terms of having accomplished something important in their field of study. They were less driven by the need for external recognition and more by their passion for pursuing projects that held meaning for them. And this is something worth emphasizing again. Although the focus of the book is on female leadership, it is not about the pursuit of power and influence for the sole purpose of self-aggrandizement. It is about empowering women to pursue what is important to them while ensuring they get the credit and recognition they deserve. 17 The Pursuit of Happiness 119

Reference

1. Sommers, SH. Freedom feminism: its surprising history and why it matters today. AEI Press; ISBN-13: 978-0844772622. External Barriers: Societal Attitudes 18 Sophia Frangou

Men significantly outnumber women in positions of leadership, regardless of setting and definitions of leadership. This bias toward male dominance in power and influence is present no matter how far back we can trace its history. It is therefore expected that men “take charge” [1]. Conversely, women have had lower status positions and their role has been restricted to functions relating to motherhood and homemaking. Women are therefore expected to “take care.” These stereotypes define societal beliefs about the personal attributes and expected roles of men and women when it comes to promotion and ultimately leadership evaluations. Sadly, they do not favor women. Women are often perceived to be deficient in many qualities important for leadership. One of them is competence. I first became aware of this about 20 years ago now while listening to one of my old professors describing faculty members in our department. Men were always “very clever fellows.” The best attribute women could aspire to was “sensible.” Difficult to know what sensible actually meant, but my niggling suspicion is that it referred to “knowing one’s place,”“not making trouble,” and “not being emotional.” Academic competence in women is neither assumed nor valued. Even worse, it may be unwanted. Most academic institutions are explicit about being inclusive and meritocratic. In such environments, competence has to be seen to be rewarded. Any incongruence between value statements and actual practice is very uncomfortable. And the gender disparity at the top of all academic institutions bears testament to this uncomfortable truth. Another area of perceived deficiency in women is authority. Many women sitting at the “top table” of academic institutions are often confronted with situations where their voice is ignored. This modern version of “women should be seen

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

but not heard” is so widespread that has generated a new vocabulary to better capture the most frequent and frustrating experiences:

(a) Manterrupting [2, 3]: Unnecessary interruption of a woman by a man. Women get interrupted more often than men when they speak. The main perpetrators are men, but when women decide to interrupt, they are also more likely to interrupt other women. Interruptions are a subtle yet extremely powerful message to the entire group that the person speaking is of lower status and/or that their opinion is of less value. (b) Mansplainer [4]: A man compelled to explain, especially to a woman, something that she already knows better than him. This word became so popular that it made the New York Times word of the year list in 2010. There is not a single woman in the world that has not had to deal with mansplaining in every aspects of life. Within academia however the phenomenon is particularly rife as academic kudos is based on our ability to explain things. Those doing the explaining immediately set themselves up as experts, while those having things explained to them would be, by inference, less knowledgeable and less accomplished. (c) Bropriating [2, 3]: Taking a woman’s idea and taking credit for it. This is perhaps the most unnerving scenario and one that is all too familiar to most women. Ideas put forward by women at meetings are either not acknowledged or met with ambivalent silence. But when the same ideas are repeated by a man later in the meeting, they are presented as novel and are treated as such by the rest of the group. Except of course the woman who proposed the idea in the ﬁrst place who is left puzzled and defeated.

Are these behaviors intentionally aimed at diminishing women? Undoubtedly, sometimes they are. Fundamentally however, they are tools for displaying or gaining dominance in any given situation. The pursuit of leadership is a competitive game. As positions are fewer at the top, the competition becomes more intense. Within academic psychiatry, verbal communication is the battleﬁeld for dominance and inﬂuence. This is particularly true for public discussions and important committee and other group meetings. Men seem to engage much more enthusiastically and consistently in these competitive games than women. Women seem to hold back, and this is perhaps where we might be losing our competitive edge. Women may hold back out of a sense of politeness. We have also been socialized to respect and listen to speakers, and we adhere to this convention much more than men. Women may hold back as we tend to use empathy much more naturally than men. Instead of trying to dominate a discussion, we are often more likely to try to understand where others in the group are coming from. Women may hold back because we may approach situations with a less clearly formulated competitive strategy. For most women, collaboration rather than competition is the preferred default strategy. The end result is that we hold back. That is not a strategy conducive to leadership. So whenever we are interrupted, talked down to, or denied credit for our ideas, we need to reclaim the narrative. We need to speak up for 18 External Barriers: Societal Attitudes 123 ourselves and to stand beside our women colleagues by openly supporting their contributions. Awareness and action, rather than acceptance and resentment, is the way forward.

References

1. Catalyst Report. Women “Take Care”, “Men Take Charge”. Stereotyping of U.S. Business Leaders. 2005. http://www.catalyst.org/system/ﬁles/Women_Take_Care_Men_Take_Charge_ Stereotyping_of_U.S._Business_Leaders_Exposed.pdf 2. Zimmerman DH, Candace M. Sex roles, interruptions and silences in conversation. 3. Solnit R. Men explain things to me. Haymarket Books; 2015; ISBN: 9781608464661. 4. http://web.stanford.edu/*eckert/PDF/zimmermanwest1975.pdf Internal Barriers 19 Sophia Frangou

There is no doubt that women face stereotype-based discrimination throughout their careers. These stereotypes are so engrained into society that even women themselves are not immune to “internalization”, or the process by which we uncon- sciously adopt the stereotypes we have been exposed to. These internalized beliefs affect how we interact with other women (implicit negative biases), how we view ourselves (self-doubt) and how we react to our perceived failure to meet societal expectations of our roles (guilt). A large body of evidence has demonstrated that the evaluation of women is subject to negative, implicit biases. Women are consistently underrated, while men are consistently overrated, a fact which is sadly true even when women are doing the evaluations. In the 1960s, Philip Goldberg brought this reality to light when he developed his now classic paradigm for uncovering implicit gender biases. In Goldberg’s original study, women participants were divided into two groups and asked to evaluate a selection of abridged articles from different ﬁelds of study [1]. The names of the authors were changed so that one group of evaluators thought the articles were written by women, while the other group thought that the same articles were written by men. He found that women tended to downgrade the work of other women, even when the articles came from ﬁelds of study traditionally reserved for women, such as education. This report was followed by multiple other investiga- tions, notably including the studies by Steinpreis and colleagues in 1999 and by Moss-Racusin and colleagues in 2012 [2, 3] who used very similar experimental designs to detect gender biases within academia. In these studies, faculty members were asked to rate the resumes of potential job applicants. Identical applications were randomly assigned either a female or a male name. Women were generally

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 125 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_19 126 S. Frangou judged more negatively than similarly qualified male applicants. However, women faculty were just as likely as men to rate male applicants as more competent and more hireable and to offer them higher starting salaries with more mentoring opportunities. The persistence of these negative attitudes towards women over the span of decades bears testament to how entrenched they are, even in women themselves. They also suggest that unfavourable judgement and lack of career development opportunities right from the start are key reasons for the “leaking” female leadership pipeline. That women continue to contribute to judgements of diminished competence in other women may explain why we have traditionally not provided the much needed support to each other. This extends beyond the realm of academia and represents an unsettling reality that we all have to face up to. As Susan Albright, former US Secretary of State, famously warned “there is a special place in hell for women who don’t help other women” [4]. Self-doubt is another expression of internalized barriers that hold women back in life. Women are often plagued by the “demons of inner doubt” that significantly constrain their ability to move forward and upward within the world of academia. Self-doubt is by no means unique to women. It is a universal human experience, wonderfully expressed by Shakespeare when he says that “Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt” [5]. Dunning and Ehrlinger [6] offer an equally renowned scientific perspective on how self-doubt affects women and men differently. They invited college students to participate in a science quiz and asked them to provide their own self-assessment of their scientific skills in general and of their performance on the specific quiz. The students were then offered the opportunity to participate in a science competition to win prizes, without being given any feedback as to how they had performed on the quiz. Women not only underrated their skills and their performance, but were also more likely to opt out of participating in the competition. Women seem disproportionally affected by a sense of self-doubt and fear which prevents them from acting on their dreams and ambitions and in turn leads them to choose the path of least resistance. But it is a choice! We can choose to give in or we can choose to move on and move past self-doubt. We may or may not be able to cast away our demons, but we can learn to ignore them and to get on with what matters. This brings us to another internal barrier, that of the perpetual female guilt, which often feeds our feelings of self-doubt. Women feel guilty for a multitude of reasons, but none rivals the guilt women feel when prioritizing academic activities over spending time with their children. Many women profiled in this book emphasized the need for practical help with children as well as house chores, but the sense of guilt goes beyond concerns about practicalities. I think it stems from a self-imposed expectation of “perfection” that is uniquely modern, unrealistic, and fundamentally degrading for women. We seem to have swapped the stereotype of the “perfect housewife” for that of the “amazing superwoman”. Although the latter is more flattering, it is equally damaging when it is used by society to define impossible standards that are then uniquely applied to women. Let us simply do our best while doing the things we love and stop worrying about the rest. 19 Internal Barriers 127

References

1. Goldberg P. Are women prejudiced against women? Transaction. 1968;5:28–30. 2. Steinpreis RE, Anders KA, Ritzke D. The impact of gender on the review of the curricula vitae of job applicants and tenure candidates: A national empirical study. Sex Roles. 1999;41:509–28. 3. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ. Handelsman. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci USA. 2012;109:16474–9. 4. Keynote Speech, Celebrating Inspiration luncheon, Women’s National Basketball Association All-Decade Team, 2006. 5. Measure for Measure, Act I, Scene IV. 6. Ehrlinger J, Dunning D. How chronic self-views inﬂuence (and potentially mislead) estimates of performance. J Pers Soc Psychol. 2003;84:5–17. Putting Yourself First 20 Sophia Frangou

In December 2011, Barbara Walters interviewed the US president, Barack Obama, together with the first lady, Michelle Obama, for a special 20/20 ABC program [1]. Mrs. Walters asked the first lady: “Mrs. Obama, you’ve recently said something that I thought was very interesting for other women to hear. You said ‘you put your own self highest on your priority list. That sounds selfish?” To this, Mrs. Obama responded: “No, no, it’s practical. It’s something that I found I needed to do for quite some time, even before the presidency. And I found it in other women, similarly situated balancing career family, trying to do it all and a lot of times we just slip pretty low on our own priority list because we’re so busy caring for everyone else. And one of the things that I want to model for my girls is investing in themselves as much as they invest in others.” Tellingly, Mrs. Walters did not go on to ask the president whether he too struggled to put himself highest on his priority list, or whether his doing so might be considered “selfish” and thus require justi- fication. An important point, Mrs. Obama stressed during this discussion was that putting herself first did not come naturally, but was an effortful choice that she hoped would inspire her daughters. This exchange, much commented on in the press, exposes the powerful societal expectation that women should put the needs of others, especially those of their family, ahead of their own [2]. Responding to the needs of others, in our personal and professional lives, provides the building blocks of enduring human relationships. However, when caring for others devolves into self-sacrifice it is neither healthy nor necessary [3]. It implies a hierarchy of needs, in which the needs of women are not as worthy or as important as those around them. In fact, Mrs. Walter’s question even goes so far to suggest that a woman who puts herself first

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 129 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_20 130 S. Frangou may be committing the moral transgression of acting selfishly. The problem is that this stereotype resonates strongly with women themselves. We slip too easily into situations where we assume responsibility for the needs of others, both in our personal life with our families and our partners and in our professional lives with our work colleagues. As a result, we give too much to others and not enough to ourselves. Now is the time for us to change this. Putting ourselves first means taking responsibility for our personal growth and well-being and taking action to moderate and balance our “giving” before it overwhelms us. This is not selfish but pragmatic and “practical.” Within academia it is also vital for career advancement. Academic life is packed with multiple and conflicting demands on our time. How we prioritize these demands directly impacts our chances of success, as none of us (woman or man) are unlimited resources. When we put ourselves first, we get more done because we are not distracted by other people’s issues that may be peripheral to our immediate goals. This is especially crucial in a world dominated by hard deadlines and productivity-based evaluations. There is some suggestion that women academics publish less than men because they spend more time mentoring, teaching, and attending to the needs of their coworkers. Whether or not this is true, it is worth keeping an eye on our schedules and being strategic about how we invest our greatest assets: ourselves and our time. We therefore have to ensure that the commitments we take on are both reasonable and in line with our primary career objectives. So we have to learn how to say “no.” This does not mean that we will turn down anything we do not like. Occasionally, we may even have to shoulder responsibilities that are just dumped on us and take these in stride realizing that this is all part of the game of give-and-take within large organizations. However, the general rule of thumb is to spend a few moments in self-reflection before responding to any requests in order to make clear to yourself the reasons for accepting or rejecting them. The key question to ask is simple: “What am I gaining from this?” Accepting requests should not be motivated by the need to “please” or by insecurity about our place within our organizations. This approach is likely to backfire because giving into unwanted requests is a form of self-silencing [3]; personal choice is subjugated by conformity to cultural stereotypes either because of fear of rejection and con- frontation or because of guilt triggered by veering away from the internalized behavioral norms. By giving in, we simply reaffirm these stereotypes and become entrapped by them. Giving in or over-giving to others has further negative sequelae for women. We expect our giving behavior to generate gratitude and reciprocity at the personal level and reward at the organizational level. In fact, research from applied organizational psychology suggests that the opposite is true. Women and men are judged very differently when engaging in “organizational citizenship behaviors,” that is, behaviors that involve being helpful to colleagues without expectation of personal benefit[4, 5]. Helpful behavior in men attracts high favorable ratings by evaluators, while similar helpful behavior in women is considered inconsequential, probably because it is culturally expected. Moreover, women who refuse to engage in helpful 20 Putting Yourself First 131 behaviors are penalized in performance reviews, while men are not. This disparity in outcomes can generate resentment and anger but also suggests that for women, saying “no” is an art that should be mastered. Key elements of an artful refusal can be summed as validate, refer, defer, and modify. Outright refusals should always provide validation for the person being turned down, as maintaining good professional relationships is a major strategic aim. Alternatively, you may consider being helpful in a different way—not by accepting the task, but by referring the person making the request to others who might be able to assist them. On other occasions, requests may be appropriate and interesting but ill-timed, as they may coincide with other tasks or career priorities. Deferring fulfilling requests to a time of your choosing ensures that you are still seen as cooperative while allowing you to maintain control of your workflow. Finally, some requests that may not be interesting or manageable when they land on your desk, but they may have potential. It is perfectly acceptable to negotiate modifications that would make such requests worth your time and effort. Putting ourselves first is essential for being considered for leadership positions within academia. As we have discussed in this chapter, successful career advancement requires us to take on additional tasks and responsibilities. At the same time, personal success demands that we attend to our friends and our families. Our “to-do” lists are extensive, and our resources as human beings are defined. The women profiled in this book provide us with different models of how we can achieve much needed balance in our lives. A common underlying theme that each woman clearly articulates is that what motivated and sustained them was their passion for psychiatric research and their success in never losing sight of their personal priorities.

References

1. http://abcnews.go.com/2020/video/obama-president-michelle-walters-moms-parenting-15215714 2. Catalyst Report. Women “Take Care”, “Men Take Charge”. Stereotyping of U.S. Business Leaders. 2005. http://www.catalyst.org/system/ﬁles/Women_Take_Care_Men_Take_Charge_ Stereotyping_of_U.S._Business_Leaders_Exposed.pdf 3. Jack DC, Ali A. Silencing the self across cultures: depression and gender in the social world (Reprint Edition): Oxford University Press; 2012; ISBN-10: 0199932026; ISBN-13: 978-0199932023. 4. Heilman ME, Chen JJ. Same behavior, different consequences: reactions to men’s and women’s altruistic citizenship behavior. J Appl Psychol. 2005;90:431–41. 5. Allen TD. Rewarding good citizens: the relationship between citizenship behavior, gender, and organizational rewards. J Appl Psychol. 2006;36:120–43. Putting Yourself Forward 21 Sophia Frangou

I cannot emphasize enough the importance of putting yourself forward for career success. What does this mean? It means taking initiative and taking action. It is crucial to be clear about your interests, your priorities, and your ambitions and to actively pursue opportunities that can help you advance toward these goals. Putting yourself forward is as vital to success in the core activities of academia, be they research projects, manuscripts, or grants, as it is to your position within organizations, be they in institutions, learned societies, or research networks. My personal “aha” moment came about 15 years ago. A male colleague was sharing the good news about taking up a leadership role in a major international research project on a topic that we had similar experience and expertise. I admit to a twinge of jealousy, as I thought that I had the appropriate qualifications to have led this project or at least to have been asked. I immediately made two assumptions. One that he was probably better than me and that I would therefore have to try harder if I too wanted to move forward. The other was that his “superior” skills had been recognized by the senior principle investigators who had then asked him to join them. Instead of going into silent introspection, I decided to probe for details. So I asked him to tell me how this had all come about. It transpired that he was the one who had approached the senior investigators first and that he had “lobbied” hard for that position presenting again and again the benefits of him joining the project. So he was better, not as a scientist, but at “putting himself forward” while I had been passively “waiting to be asked.”

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

This “waiting to be asked” attitude is all too common both in senior and junior women colleagues. Part of the reason for this comes down to confidence, but other factors are also at play. Women continue to be socialized on the “wait to be asked” principle in all areas of behavior, from dating to job promotion. These socially defined gender expectations seem to continue to influence women and hold us back when we should be actively and openly advocating for our own agenda. As one advances, the pyramid becomes increasingly more narrow and the competition increasingly more intense. And this puts women at a disadvantage because we do not enjoy competition whereas many men do. This behavior is obvious from a very early age as boys are far more likely than girls to engage in competitive sports and games [1] and report greater enjoyment and motivation from competing [2]. Putting yourself forward for a promotion or leadership position does mean that you are putting yourself before others and that can lead to some pushback. In these situations, it is not uncommon to attract negative criticism and to be accused of being “aggressive.” Social norms encourage assertive and even aggressive behavior in men within the workplace, but are less approving of such behavior in women. Assertive behavior in women is just not “ladylike.” Like most women who have pursued their ambitions, Claire McCaskill, the two-term US Senator from Missouri, is all too familiar with this phenomenon. She argues that we need to reclaim that adjective and redefine female leadership, and all that goes with it, as “plenty ladylike” [3]. “Putting yourself forward” is more crucial today than ever. The context in which we work within academia has changed. We find ourselves working within large organizational structures and within large and diverse research groupings, which often cross national borders. Although there is a huge scope for growth, getting noticed among so many other highly qualified, competent and ambitious people is not something that will just happen by itself. It needs wide-angle strategic thinking, the willingness to take on additional responsibilities, and the courage to ask people to join you in new initiatives. In short, it requires both initiative and action. It does not matter how big or small this action is. All that matters is that you start and you continue. Of course you should be prepared to accept that occasionally things may not go your way and be able to recognize that such instances are also part of the journey. Setbacks can be frustrating and disappointing, but can also be helpful in that they can point to new directions that may ultimately prove more fruitful than our initial choices. When considering strategies for putting ourselves forward, it is important to be clear that the ultimate goal is to take positive action. It is definitely not about being mean, underhanded, or uncooperative. Such behavior is unacceptable in women and men. As women, we need to try harder to succeed but we also need to be positive role models and leaders. The diversity we bring and the equality we seek is not that of numbers but of principles [4, 5]. What we should bring to the “top” is our authenticity, our courage, our passion, our gift for communication, our empathy, and our ethic of care. 21 Putting Yourself Forward 135

References

1. Hartmann T, Klimmt C. Gender and computer games: exploring females’ dislikes. J Comput-Mediat Comm. 2006;11:910–31. 2. Niederle M, Vesterlund L. Do women shy away from competition? Do men compete too much? Q J Econ. 2007;122:1067–101. 3. McCaskill C. Plenty ladylike. Simon & Schuster, 2015. ISBN-10: 1476756759; ISBN-13: 978-1476756752. 4. Plehwe K. Die Macht der Frauen. Hanseatic Lighthouse Verl, 2014. ISBN 10: 3981262948; ISBN 13: 9783981262940. 5. O’ Connor K. Gender and women’s leadership: a reference handbook. SAGE Publications, Inc, 2010. ISBN-10: 1412960835; ISBN-13: 978-1412960830. Project Confidence 22 Sophia Frangou

Much ink has been spilled on the role confidence plays in women’s ability to succeed in all fields of human enterprise. Whether one looks to the popular press or the academic literature, there is general consensus that women lack confidence while men have it in abundance. As we discussed in “Internal barriers,” female students tend to underrate their general knowledge and skills [1]. Regrettably, senior women do this too. A meta-analysis of 95 studies found no gender difference in leadership effectiveness; yet men rated themselves as significantly more effective and women rated themselves as significantly less effective in self-evaluations [2]. Remarkably, many extremely accomplished women still harbor doubts about their abilities and struggle to experience an internal sense of success; instead, they consider themselves to be “impostors.” The impostor phenomenon was first described in 1978 by psychologists Pauline Rose Clance and Suzanne Imes based on their psychotherapeutic work with 150 high achieving women from different academic disciplines [3]. Clance and Imes traced the origins of the impostor phenomenon to the early family histories of these women. Two patterns emerged. About half of the women had grown up being told they were socially adept but not as “bright” as other siblings or close relatives. Although these women had worked very hard to disprove their families’ perception, part of them still believed that their family’s assessment was right. The other half had grown up being told that they were “perfect” and that they could achieve “anything and everything” they wanted. These women felt obliged to live up to this idealized portrayal of their potential that was however incompatible with any experiences of difficulty or failure. When they fell short of these unrealistic standards, they tended to respond with exaggerated negative self-judgment and self-doubt.

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

Some of us might recognize elements of our own upbringing in Clance’s and Imes’ findings, but all of us would agree that women have an uneasy relationship with success. However, as Nelson Mandela famously said, “There is no passion to be found in playing small—in settling for a life that is less than the one you are capable of living” [4]. If we downplay our accomplishments and doubt our abilities, then how can we possibly expect to play big? Playing big is about taking action and taking initiative to accomplish what we believe in; it is about “putting ourselves forward” rather than avoiding challenges and playing it safe by aiming only for goals that are easily within reach. How can we push through self-doubt and fear and project the confidence necessary for success? I think it boils down to 3 simple and yet powerful tools: Ask, Assert, and Accept. Ask: I was in my late twenties when I made the amazing discovery that people are more likely to say “yes” than “no” when you ask them. Very early in my career, I wanted to invite an academic superstar in brain imaging to participate in a scientific symposium proposal I was planning. Given that I was an absolute beginner at the time, we were academic light years apart. So I spent days ruminating on whether or not to approach this person. I considered the possible outcomes; they will accept (brilliant!), they will refuse (sad, but at least they would have acknowledged the invitation), and they will ignore my message (more sad, but not tragic). Having assessed that the potentially unwanted outcomes would never ever be featured in anyone’s life-events scale, I went ahead and sent an e-mail invite. A day later, my celebrity scientist confirmed they were happy to accept the invitation. So there! Since then, I always simply ask. It works wonders far more frequently than you could ever guess. Assert: The focus here is on strategic asserting, not blurting out unfiltered thoughts in the name of self-expression. Assertiveness is an interpersonal skill of expressing your views and your rights while respecting those of others. Treating others with consideration and respect at all times is not just the decent thing to do, but it also enhances your position and allows relationships to evolve despite occasional conflict or disagreement. Assertiveness is not about getting your way all the time or about having the last word. It is about negotiating the best possible outcome in any situation. Accept: First and foremost, we need to learn to accept and not deflect praise. Our habitual response to congratulatory statements or public praise is to either downplay our accomplishment or refuse to accept credit for them. However, praise, especially public praise, is a two-way gift [5]. It honors and validates the person receiving the compliment, while it makes the giver feel generous. In this social exchange, the giver expects appreciation for their thoughtfulness, not public contradiction. Such behavior is discourteous as it questions the judgment or sincerity of the person complimenting you. Praise should be accepted graciously with two words: thank you. We also need to accept responsibility for our own actions and their consequences. It is undeniable that as women we face discrimination and negative stereotyping within academia. We should not—not even for a minute—conceive ourselves as passive victims of societal restrictions. There is no easy fixor 22 Project Confidence 139

“prescription” for handling the challenges of being a woman in academia, other than taking action and initiative and responsibility for our choices, because “the willingness to accept responsibility for one’s own life is the source from which self-respect springs [6].”

References

1. Ehrlinger J, Dunning D. How chronic self-views inﬂuence (and potentially mislead) estimates of performance. J Pers Soc Psychol. 2003;84:5–17. 2. Paustian-Underdahl SC, Walker LS, Woehr DJ. Gender and perceptions of leadership effectiveness: a meta-analysis of contextual moderators. J Appl Psychol. 2014;99:1129–45. 3. Clance PR, Imes S. The impostor phenomenon in high achieving women: dynamics and therapeutic intervention. Psychother Theor Res Pract. 1978;15:1–8. 4. Mandella N. Long walk to freedom: the autobiography of Nelson Mandela. Back Bay Books; 1995; ISBN-10: 0316548189; ISBN-13: 978-0316548182. 5. Mohr T. Playing big: practical wisdom for women who want to speak up, create, and lead. Avery; 2015; ISBN-10: 1592409601; ISBN-13: 978-1592409600. 6. Didion J. Slouching towards bethlehem: essays. Farrar, Straus and Giroux (Classics); 2008; ISBN-10: 0374531382; ISBN-13: 978-0374531386. Be Visible 23 Sophia Frangou

When I started my training at the Maudsley Hospital, it was customary for trainees to rotate through different clinical specialties to maximize exposure to diverse patient populations. Trainees were usually assigned to these rotations in pairs, to ensure that a junior doctor would be on hand at all times and to make certain that any absence or leave would be covered with minimal service disruption. In one of these rotations, I found myself working on an extremely busy inpatient unit with a ferociously ambitious male colleague. Although I was also ambitious, I thought that the best way forward was to apply myself diligently to the tasks at hand. So I was dutifully slaving away on the ward showing what I believed to be efficiency, competence, and teamwork, when I became aware that I was in fact shouldering most, if not all, of the work. My male colleague spent the absolute minimum amount of time on his ward duties and was often not around. What was he doing? He had effectively delegated to me a subordinate “helper” role while making sure that he spent most of his time doing things that increased his visibility within our institution. He was furiously networking and focusing on his research. So he was the “brilliant” one and I was the “hardworking” one. Although I do not applaud or condone his behavior, this experience taught me an important lesson. It helped me understand the value of being effective as opposed to efficient. I was being an efficient junior doctor but ineffective in promoting my career goals. The key message here is that task-based competence does not necessarily translate into career success. In academia, competence is an entry-level requirement. Visibility, however, is the crucial link between merit and success [1, 2]. My

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 141 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_23 142 S. Frangou personal anecdote characterizes an important gender difference within the workplace, which holds equally true in academic psychiatry as it does in other competitive environments [1, 2]. Women believe that merit alone should be sufficient for promotion, while men focus on being visible and well-connected [2]. But this is not the only difference. Oftentimes, women feel uncomfortable pursuing and cul- tivating relationships when the aim is self-promotion. As we have discussed, assertive self-promotion does not conform to traditional views of femininity, and as a result, many women are concerned that acting with such ambition will label them “pushy.” More often, though, women believe that using personal connections for career advancement is undignified and unfair [2]. Ultimately, academia like all aspects of life is about transactions between people: the more people know you and your work, the more career opportunities will open up for you. My personal view on the issue of visibility extends beyond self-promotion or career advancement. A prerequisite of performing meaningful work in academic psychiatry is engaging in continuous dialogue with clinicians, neuroscientists, basic scientists, policy makers, our patients and their families, and society at large. Our work requires us to make our findings and opinions visible to others and relevant to the bigger questions facing our field. In order to be visible, you need to take initiative and action, a theme that recurs frequently throughout this book. Networking is an important part of improving visibility. Networking is not done exclusively at specific “networking” events, even though participating in such events is important. Networking is a way of interacting with others in a career oriented and strategic fashion. In practice, it means actively seeking out opportunities to make your work known to people who are influential in the field and even more importantly creating ways of enlisting their support. Therefore, networking should really be understood as a process aimed on becoming a member of a network. Women and men approach networking differently. Men’s approach is “transactional” and focuses on fostering interactions linked to specific career objectives, while women’s networking style is “relational” and focuses on building personal connections even when those connections do not serve their immediate career goals [3]. The relational approach can often be disadvantageous to women in professional networks. Professional relationships do indeed involve sympathy and esteem, but at their heart, they are mutually beneficial alliances. So we need to use a “business” perspective in assessing what we have to offer prospective professional contacts and what we stand to gain from them. Networking is not the only way to achieve visibility. Being visible also means ensuring that people within your institution are aware of you and your leadership potential. This involves creating opportunities for self-promotion, taking credit for achievements and being aware of the “big picture.” Becoming part of the “big picture” requires you to understand your institution’s strategic objectives and to articulate your contribution to achieving these objectives. There are multiple ways to accomplish this. Some are as basic as letting key people know of your publications, presenting routinely at in-house meetings and having a regular newsletter. The Internet and social media have transformed how academics can interact with each other to disseminate findings and engage with a wider community of 23 Be Visible 143 stakeholders to garner interest and funding. Tweeting, blogging, podcasting, pin- ning news on Internet forums, self-archiving your publications, and maintaining an appealing, informative, and regularly updated Web site are all crucial elements of visibility in the digital era.

References

1. Hewlett SA. Executive presence. Harper Business; 2014; ISBN-10: 0062246895; ISBN-13: 978-0062246899. 2. Hewlett SA, Peraino K, Sherbin L, Sumberg K. The sponsor effect: breaking through the last glass ceiling. Harvard Business Reviews; 2011. 3. Women of Influence. White Paper: Solutions to Women’s Advancement. 2014. http://www. womenofinfluence.ca/wp-content/uploads/2014/04/Women-of-Influence-WhitePaper-2014.pdf Be Memorable 24 Sophia Frangou

People make important judgments about others in a matter of seconds. Research suggests that it takes between 2 to 30 seconds to form an impression of someone during a personal interaction. Similarly, recruiters take all of 6 seconds to look at a resume before deciding whether an applicant is a good or bad fit for a position [1]. Regardless of whether or not these figures are completely accurate, they do make the point that the time frame for making positive impressions on others is very short. The initial impression formed during that short time, be it positive or negative, serves as a filter through which all subsequent interactions are processed. Because of this lasting impact, making a good first impression should be among your top priorities. When interacting with others, the first thing we notice is their appearance; how they dress; and how they carry themselves. Deborah Tannen, Professor of Lin- guistics at Georgetown University, has focused her research on how language depicts and affects relationships and highlights gender differences in communication. Her now-famous essay, “There is No Unmarked Woman,” expands upon these concepts to explore how gender influences choosing and judging appearances [2]. In linguistics, markedness refers to the way words are changed in order to impart a special meaning. An “unmarked word” refers to a word in its most basic form. Take for example the word “academic.” The singular, “academic,” is the unmarked word. To denote the plural form, we mark the word by adding an “s,” as in “academics” thereby transforming it into a “marked word.” This same idea applies to words that imply gender. Words associated with men are unmarked (e.g., male) and unmarked words are assumed to be male. In contrast, those referring to women are typically marked (e.g., female). Tannen remarks that men’s appearance is also unmarked because their choices (e.g., suit) are limited and carry only very

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 145 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_24 146 S. Frangou basic significance. In contrast, because there are numerous work-wear options for women (e.g., dress, skirt, pantsuit), our choices are inevitably “marked” by added meaning. Tannen concludes her essay by commenting that it is “impossible for a woman to get dressed in the morning without inviting interpretations of her character.” Yet this is certainly not an appeal for conservatism in dress code for women in academia. Instead, it is a call for awareness that our appearance will be memorable, whether we intend for it to be or not, and that the way we look outwardly will be used, by both women and men alike, to construct perceptions of our identity. It is therefore important that the choices we make about our appearance, whatever they may be, are consistent with the narrative we want to project for ourselves and are in line with promoting our career goals. Before being introduced to senior colleagues who may play important roles in your future career, make sure you have done your homework and are able to engage them in a way that showcases both your knowledge and appreciation of their work. In general, neither women nor men remember a face in the crowd, but they do remember the people who pay them compliments or make interesting remarks about their work. As there are few women in academia, and even fewer in leadership positions, we are often memorable simply because our gender makes us stick out in male-dominated rooms. Although most of us would gladly give up this advantage, until women and men are equally represented in academia, we need to use it as an opportunity to be noticed. Yet this can be difficult. On the first advisory board I was invited to join, I had the triple distinction of being the youngest person, the only woman, and the only foreigner. I was treated as an outsider throughout my time on this particular board and felt neither welcomed nor valued. My comments were met with indifferent silence or patronizing put-downs, both of which are common tactics that intimidate many women faculty into keeping quiet. If we are really aspiring to success in academia, then silence and token participation is not the way forward. We need to use our “uniqueness” in these forums to promote ourselves and to demonstrate that women can contribute to discussions at the “top table.” Regardless of seniority, success in academic psychiatry does not simply depend on the value of our work. Our ability to communicate our achievements plays an equally significant role. We need to throw modesty out of the window. This is not to advocate bragging, which is generally off-putting, but to stop ourselves from using language that downplays the significance of our work and minimizes our personal contribution. We should stop diminishing our accomplishments by attributing them to “luck” and “teamwork.” Under-reporting our accomplishments not only hurts our careers, but also increases the competitive advantage of men. Men tend to report higher levels of past achievement and to overestimate their future potential. Potential evaluators seem to take these gender differences in presentation at face value, thus assuming that females are less accomplished especially in academic environments where gender biases are pervasive [3]. The net result is that men’s ability to self-promote increases their chances of being offered more career opportunities [4]. To overcome this unfortunate status quo, you must make use of any opportunity to showcase your work. Use your resume as a marketing 24 Be Memorable 147 tool, focusing on accomplishments rather than a timeline of life events. Similarly, take advantage of any occasion to present your research, both at in-house or at external meetings, and use them as valuable occasions to highlight the importance of your work. Although research presentations should be based on solid scientific findings, their purpose is not to detail procedures and facts. Instead, their objective is to provide a memorable account of your research findings so that other people can appreciate them and their significance. Every presentation should tell a story, and like a good story, a good presentation has a strong central theme and a “flow” that is easy to follow. The primary focus of your interactions at work must be based on your strengths and priorities and should assist you in building a strategic toolkit to promote your achievements and convey your leadership potential.

References

1. http://cdn.theladders.net/static/images/basicSite/pdfs/TheLadders-EyeTracking-StudyC2.pdf 2. Tannen D. There is no unmarked woman. In: Cohen S, editor. 50 essays: a portable anthology. Bedford/St. Martin’s; 2003; ISBN: 0-312-41205-3. 3. Pololi LH, Jones SJ. Women faculty: an analysis of their experiences in academic medicine and their coping strategies. Gend Med. 2010;7:438–50. 4. Reuben E, Sapienza P, Zingales L. How stereotypes impair women’s careers in science. Proc Natl Acad Sci USA. 2014;111:4403–8. Be Connected 25 Sophia Frangou

In academia, as is the case in all other aspects of life, “those who know how to build strong positive social networks reap many benefits” [1]. To survive and thrive, we need a “tribe.” Building a tribe goes beyond networking. As we discussed in “Be Visible,” networking is largely based on transactional alliances focused on a specific shared interest or goal. In contrast, tribes are formed when people connect with others to build long-term, trusting, and mutually supportive relationships that transcend immediate needs. Tribes satisfy a fundamental human need, the “need to belong” [2]. This need motivates modern-day humans as much as it did for pre- historic cave dwellers. Tribal membership is associated with many benefits including greater life satisfaction, greater happiness, and better subjective health [3]. Although your tribe should include family and friends as well as colleagues, we focus here on professional or “academic tribes.” It was Roy Anthony Becher, the founding father of higher education research in Britain [4], who first made us aware of the tribal nature of academia through his influential book, “Academic Tribes and their Territories” [5], first published in 1989, which drew from his observations and experiences at academic institutions in the USA and UK. Since then, numerous studies have shown that the strongest predictor of research output and career advancement is being part of a productive academic tribe. The tribe effect gives you access to a wider range of resources and contacts which, in turn, increases your value as an academic. Co-authorship and citation networks are perhaps the most objectively measurable functions of academic tribes. Analysis of these networks can be performed using mathematical models derived from network and

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 149 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_25 150 S. Frangou communication theories and has been greatly enabled by the availability of electronic databases [6]. In addition to serving as an assessment of tribal influence, citations also measure of one’s own scientific impact and standing, as they indicate endorsement and confer authority. A study of research collaborations among scientists found that most (60–80 %) were short-lived and lasted less than a year, with significant further attrition over five years [7]. The same study also showed, that about 1 out of 25 researchers had “super-ties” with other collaborators with whom they continued to work over decades [7]. Articles from researchers with super-ties were cited on average 17 % more often those of their counterparts [7]. This analysis is just one of multiple examples demonstrating the differential value of networking (short-term collaborations) compared to academic tribal membership. The later comprised long-term relationships between scientists and was characterized by “trust, conviction, and commitment [7].” In academia, tribal membership is not inclusive but selective. Selection is based on performance in various academic rites of passage that mark key transition points in career trajectories, as well “goodness-of-fit” assessments between prospective tribal members and the existing tribal culture. At the beginning of our careers, it is important to look out for sponsors and mentors who are successful tribal leaders. These individuals will have established and widespread collaborative relationships and should represent key figures of authority in our field of interest. Shelda Debowski [8], whose expertise in higher education is marked by her experience as Deputy Vice Chancellor and Professor of Higher Education Development in Australia, defines the first phase of tribal membership as the “good citizen” phase. The emphasis during this stage is on engaging in collegial activities that establish one’s value to the tribal leader and to the other members of the tribe. According to Mary Evans, Centennial Professor at the Gender Institute, London School of Economics, these activities are particularly meaningful for women as “building friendships through work as a ‘citizen’ is a huge help in limiting that sense of isolation that is part and parcel of being an academic” [9]. On the flip side, being a “good citizen” carries the danger of getting stuck in a position where one is indispensable but also invisible. Both gender stereotypes and our own behavior place us at greater risk of becoming trapped in this scenario. As women, we are more vulnerable to falling victims to the “loyalty trap” [10], because we value personal relationships and, as we saw in “Putting yourself first,” we often prioritize others’ needs above our own. We therefore have to ensure that we move quickly from the “good citizen” phase to what Debowski calls the “strategic phase” [8], where we begin to carve out our own niche within the tribe and promote our own agenda and identity. The third stage of tribal membership is that of the “engaged scholar” [8], where the emphasis shifts again from that of following and belonging, to leading or building a tribe of one’s own. The stories of the women who participated in this book demonstrate our potential for leading our own tribes and describe some of the many ways this can be achieved. Each and every one of these women has made significant contributions to the discipline of psychiatry and to the lives of patients and their families. Although 25 Be Connected 151 they all experienced challenges in their academic journeys, they stand out because they understood their worth, refused to give up on their vision, and in doing so achieved great professional success.

References

1. Southwick SM, Charney DS. Resilience: the science of mastering life’s greatest challenges. Cambridge University Press; 2012; ISBN-10: 0521195632; ISBN-13: 978-0521195638. 2. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995;117:497–529. 3. Greenaway KH, Haslam SA, Cruwys T, Branscombe NR, Ysseldyk R, Heldreth C. From, “we” to “me”: group identification enhances perceived personal control with consequences for health and well-being. J Pers Soc Psychol. 2015;109(3):53–74. 4. https://www.timeshighereducation.com/news/people/obituaries/roy-anthony-becher-1930- 2009/406027.article 5. Becher R. Academic tribes and territories: intellectual enquiry and the cultures of discipline. Open University Press; 1989; ISBN-10: 0335092217; ISBN-13: 978-0335092215. 6. Newman MEJ. Coauthorship networks and patterns of scientific collaboration. Proc Natl Acad Sci USA. 2004;101(Suppl 1):5200–5. 7. Petersen AM. Quantifying the impact of weak, strong, and super ties in scientific careers. Proc Natl Acad Sci USA. 2015;112:E4671–80. 8. Debowski S. The new academic: a strategic handbook. 1st ed. Open University Press; 2012; ISBN-10: 0335245358; ISBN-13: 978-0335245352. 9. https://www.timeshighereducation.com/features/is-academic-citizenship-under-strain/ 2018134.article 10. Women of Influence. White Paper: Solutions to Women’s Advancement. 2014. http://www. womenofinfluence.ca/wp-content/uploads/2014/04/Women-of-Influence-WhitePaper-2014. pdf Be Persistent 26 Sophia Frangou

Success in academia is a triumph of determination and passion over rejection and criticism. Academic life is full of evaluative rituals, from institutional performance appraisals to various forms of “peer review” of our academic output. Added to this, we have to deal with overt rejection from academic journals, from conference organizers, and from grant-giving bodies. We can ﬁnd solace in knowing that academics are not alone in dealing with rejection and in realizing that rejection itself does not necessarily reﬂect the true value of our work. Earlier this year, J.K. Rowling, the best-selling author of the Harry Potter series, published letters of rejection she received from different publishing houses at the beginning of her writing career [1]. These letters are full of “helpful” but essentially patronizing advice not unlike the “feedback” we often get from the journal editors. Rejection and criticism are distressing experiences for both women and men. However, criticism, rejection, or even outright failure can only really stop you in your tracks if you let them. As much as this may sound like a platitude or an unrealistic ideal, it is certainly not. In fact, it is exactly what DeCastro and colleagues [2] found when they interviewed 100 former recipients of National Insti- tutes of Health Mentored Career Development Awards and 28 of their mentors. All interviewees reported that rejection was the prevailing experience of academic life. Both women and men rated the ability to persevere and persist in the face of adversity, as more predictive of success than intellect or competence. They commented on the “grit,”“toughness,” and “thick skin” required to overcome negative outcomes and feelings of frustration and stress. Although men and women expressed similar opinions about the importance of perseverance in academia, there were some distinct differences in how each gender group processed and responded

S. Frangou (&) Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA e-mail: [email protected]

© Springer International Publishing Switzerland 2016 153 S. Frangou (ed.), Women in Academic Psychiatry, DOI 10.1007/978-3-319-32177-6_26 154 S. Frangou to academic criticism and rejection. The study found that women were more prone to interpreting rejection as the evidence of lack of ability. They were also more likely to transform a single rejection into a negative perception of their whole professional life and their entire self-worth. Increased sensitivity to negative judgments is a typical response of individuals who believe themselves to be undervalued by those determining whether or not to confer approval [3, 4]. This phenomenon, termed rejection sensitivity, is not unique to women or even academia. Rejection sensitivity has been well documented in all competitive environments in which negatively stereotyped individuals are restricted from obtaining the necessary means for success [4]. As we have already seen, women within academic institutions are often undervalued and offered fewer career-enhancing opportunities simply because of their gender. Based on this widespread occurrence within academic institutions, London and colleagues [5] expanded the concept of rejection sensitivity to encompass gender. They proposed that within academia, women’s awareness of negative gender stereotypes may lead to “self-silencing” [5, 6]. Self-silencing involves suppressing those thoughts, feelings, and actions that may be considered incongruent with expected societal norms in order to avoid criticism or rejection. Societal norms prescribe affiliative, supportive, and subordinate roles for women and discourage overtly competitive, ambitious, and assertive behavior. Outwardly, self-silencing in women leads to the inhibition of self-expression and action, while inwardly it may trigger feelings of anger, depression, self-doubt, and alienation. In a series of studies, London and colleagues examined the effect of gender rejection sensitivity on the behavior and academic engagement of men and women in highly competitive and evaluative academic institutions [5]. Although their work did not focus on psychiatry, their findings resonate with similar research on academic medicine [2]. They saw significant individual variability in rejection sensitivity within both gender groups but found that in general, women were more likely than men to expect gender-based rejection. Women with higher rejection sensitivity were more likely to engage in self-silencing as a coping mechanism, which in turn led to increased feelings of alienation and eventual disengagement from academic life. In other words, rejection sensitivity increased the odds of women opting out of academia because they did not feel they belonged. Women with young children may be particularly vulnerable to this, as their sense of underachievement at work is compounded by feelings of guilt for their perceived failure to conform to the traditional female homemaker model [2]. London and colleagues [5] also suggest that gender-based rejection may invoke an additional type of detrimental reaction involving denial. Some women minimize gender rejection sensitivity by ignoring or reframing signs of gender discrimination or bias. Although this behavior may protect the individual, it creates an environment where gender biases are allowed to persist because their existence is denied by those they affect the most. Denial of gender-based rejection also feeds into the negative stereotype of women as not being a “good fit” for competitive academic environments. Many lines of evidence underscore the importance of mentorship and support networks within academia. For me, the best practical advice comes from Carla 26 Be Persistent 155

Harris, Vice Chair of Wealth Management, and Managing Director and Senior Client Advisor at Morgan Stanley, because she clearly defines the types of support that you need. Harris [7] explains that it is important to have an “advisor,” a “mentor,” and a “sponsor.” Many different people, both within your institution or without, can play the role of advisor. Advisors are the individuals you can trust to help you increase your “situational understanding” and make you aware of the issues at play as you negotiate professional transitions and plan important career moves. A mentor is a senior colleague with whom you have a personal relationship and who truly cares about your professional and personal development. Mentors serve as insightful resources and can provide strategic advice about your career. A sponsor should be someone with resources and power. Their role is to provide and facilitate access to resources. Within academia, that would mean access to laboratory space, research funds, or patient cohorts. The sponsor is also the person who should act as your advocate, willing to “fight your corner” at all the crucial decisions regarding your career. Will these people come knocking at your door? Experience says this is unlikely. Establishing these valuable relationships requires initiative and action as well as a clear understanding that reciprocity underlies each one. Advisors, mentors, and sponsors must be people whose interests are aligned with your own. They are the people to whom you are unforgettably visible because of your unfaltering persistence and your unabashed confidence to consistently put yourself forward.

References

1. https://twitter.com/jk_rowling/status/713298761288708096 2. DeCastro R, Sambuco D, Ubel PA, Stewart A, Jagsi R. Batting 300 is good: perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers. Acad Med. 2013;88:497–504. 3. Horney K. The neurotic personality of our time. New York, NY: Norton; 1937. 4. Merton RK. Social theory and social structure (Enlarged Edition). Free Press; 1968; ISBN-10: 0029211301; ISBN-13: 978-0029211304. 5. London B, Downey G, Romero-Canyas R, Rattan A, Tyson D. Gender-based rejection sensitivity and academic self-silencing in women. J Pers Soc Psychol. 2012;102(5):961–79. 6. Jack DC, Ali A. Silencing the self across cultures: depression and gender in the social world (Reprint Edition). Oxford University Press; 2012; ISBN-10: 0199932026; ISBN-13: 978-0199932023. 7. Harris CA. Expect to win. Plume; 2010; ISBN-10: 0452295904; ISBN-13: 978-0452295902. Index

A Brain plasticity, 32 Academic success Brown, Alec, 40 academia, 138 Buchsbaum, Monte, 7 assert, 138 Butters, Nelson, 33 conﬁdence, 137 impostor phenomenon, 137 C leadership, 137 Center for Neuroscience in Women’s Health, perfectionism, 137 76 praise, 138 Cichon, Sven, 81 psychiatry, 44, 142 Clayton, Paula, 7 Altshuler, Lori, 72 Cole, Jonathan, 89 American Psychiatric Association, 94 College of Occupational Therapists, 24 American Psychopathological Association, 88 Cullberg, Johan, 109 American Society for Clinical Curie, Marie, 4, 7 Psychopharmacology, 89 Andreasen, Nancy, 7, 33 D Anti-depressant drugs, 39 DeLisi, Lynn E. Antipsychotic drugs, 39 ambition, 4 Assertiveness, 138 aspirations, 5–6 Association for Clinical Psychosocial best career move, 7 Research, 88 career advice, 10 difﬁcult times, handling, 8 B doing differently, 9–10 Baldessarini, Ross, 95 leadership and negotiation skills, 9 Behavioral Neuroendocrinology Program, 76 mentor(s), 6–7 Beyond Words, 24, 25 neuroimaging and genetics, 4 Biological psychiatry, 5, 33 to psychiatry, 4–5 Biosignatures of pediatric mood disorders, 64 obstacles, 7–8 Bipolar disorder, 20, 65, 96 role (positive/negative), 8–9 Bipolar Disorders Research Program, 94 schizophrenia research, 4 Board of Biological Psychiatry, 7 work–family balance, 9 Board of Science at British Medical Diagnostic and Statistical Manual for Mental Association, 24 Disorders (DSM), 94 Boomsma, Dorret, 33 Booth, Chris, 41 E Borderline personality disorder, 56, 60 Edinburgh High Risk Study, 38 Brain and Environmental Training Towards Emotional processes, 70 Emotional Resilience (BETTER), 65 European Psychiatric Association (EPA), 106, Brain Center Rudolf Magnus, 32 110 Brain imaging, 12, 32, 56, 138

F H Female healthcare provider, 51 Henn, Fritz, 7 Female mentorship, 57, 68 Herrington, Reg, 40 First-episode psychosis, 88 Hersenstichting Nederland, 32 fMRI. See Functional magnetic resonance Hillyard, Steve, 13 imaging (fMRI) Hollins, Sheila Ford, Judith M. ambition, 24 ambition, 12 being different, 28–29 best career move, 13 best career move, 25–26 career advice, 15 career advice, 29 day care, 15 ‘cross-bench’ peer, 24–25 difficult times, handling, 14 intellectual disabilities, 24 EEG, 12 married life, 27 imaging modalities, 12 mental health and developmental disability, interacting with patients, 13 24 mentor(s), 13 mentor(s), 25 neural mechanisms, 13 obstacles, 26–27 obstacles, 14 to psychiatry, 24 role (positive/negative), 14 role (positive/negative), 27–28 psychopathology, 13 work–family balance, 28 schizophrenia brain imaging project, 12 translational psychiatry, 12 I work–family balance, 15 Immortality, 4, 6 Foster, David, 72 Ingram, Malcolm, 40 Frank, Ellen Institute of Human Genetics, 81 ambition, 18 Intellectual disability, 40 best career move, 20 International Association of Suicide Research career advice, 21–22 (IASR), 106 difficult times, handling, 20 International Society of Psychiatry Genetics, emerita status, 19 80 mentor(s), 19 Internationale Neuropsychopharmacologicum, as mother, 21 88 obstacles, 20 Internet, 33, 35, 142 to psychiatry, 18–19 Interpersonal and Social Rhythm Therapy for role (positive/negative), 21 Bipolar Disorder, 18 unipolar and bipolar disorders, 20 Ivy League education, 59 work–family balance, 21 Freedman, Danny, 101 J Freedom feminism, 118 Jansson, Bengt, 109 Functional magnetic resonance imaging Jarvik, Lissy, 77 (fMRI), 65, 66, 68, 72 Joëls, Marian, 33 Johnstone, Eve C. G ambition, 38–39 Gabor Ungvari, 65 career advice, 44–45 Gender equality, 118 Clinical Research Centre, 41 Gender, 18, 21, 25, 35, 41, 43, 59, 65, 73, 101, clinical skills, 44 121, 134, 145, 146, 150, 154 difficult times, handling, 42 Genetics Medical Research Council, 41 and ethics, 80 mentor(s), 40–41 psychiatric disorders, 80 obstacles, 42 Gershon, Elliot., 7 to psychiatry, 39–40 Grantsmanship skills, 72 role (positive and/negative), 43 Gray, Jeffrey, 72 work–family balance, 43–44 Index 159

K difficult times, handling, 58–59 Kahn, René, 33 mentor(s), 57 Karolinska Institutet, 110 NIH- and VA-funded research, 58 Kibbutz, 88 obstacles, 58 Kraemer, Helen, 19 to psychiatry, 56–57 Kupfer, David, 72, 90 role (positive/negative), 59 Kydd, Robb, 64 work–family balance, 59–60 NIMH. See National Institute of Mental Health L (NIMH) Learning disabilities, 24 Nöthen, Markus, 81 Levi, Lennart, 109 Lithium discontinuation, 96 P Patrick Wild Centre, 39 M Pavuluri, Mani Maternalistic mentoring ability, 74 ambition, 64 McElroy, Susan, 96 career advice, 68 McGuire, Michael, 77 difficult times, handling, 66–67 Medical Research Council, 41, 108 fMRI research path, 68 Metabolic disorders, 76 mentor(s), 65–66 Misri, Shaila obstacles, 66 ambition, 48 phenomenology, 65 career advice, 53 to psychiatry, 64–65 difficult times, handling, 50–51 role (positive/negative), 67 mentor(s), 49 work-family balance, 67–68 obstacles, 50 Pediatric Mood Disorders Clinic Program, 64, perinatal mental health, 49 66 psychiatric illness, pregnant and Personalized interventions, 64 post-partum mothers, 49 Pfefferbaum, Dolf, 13 to psychiatry, 48 Pharmacological treatments, 56, 88 research obligations, 52 Phillips, Mary L. role (positive/negative), 51–52 ambition, 70 work–family balance, 52 brain–behavior relationships, 71 Mood disorders, 70, 76 career advice, 74 Mullen, Paul, 67 mentor(s), 72 Multi-photon microscopes, 40 obstacles, 73 psychiatric neuroscience research, 71 N to psychiatry, 70–71 National Academy Medicine, 18 role (positive/negative), 73–74 National Centre for Suicide Research and self-doubt, 74 Prevention of Mental Ill-Health, 108 work–family balance. 74 National Institute for Psychosocial Medicine, Pol, Hilleke Hulshoff 110 ambition, 32 National Institute of Mental Health (NIMH), 5, career advice, 36 6, 8, 58, 88 difficult times, handling, 34 Netherlands Twin Register, 32 genetic and environmental influences, 32 Neurobiology of schizophrenia, 38 mentor(s), 33 Neuroimaging, 4, 34, 38, 70 neuropsychology, 34 Neuropsychiatry, 71 new ideas, implementation of, 33 Neuroscience, 12, 13, 32, 34, 40, 57, 58, 65, obstacles, 34 71, 72, 95, 100 to psychiatry, 32 New, Antonia role (positive/negative), 34–35 ambition, 56 structural and functional brain brain imaging and genetics, 52 plasticity, 32 career advice, 60–61 work–family balance, 35 160 Index

Precision neuropsychopharmacology in obstacles, 82–83 developing brain, 65 to psychiatry, 80 Pregnancy Blues, 48 role (positive/negative), 84 Professional achievement work–family balance, 84 female ambition, 134 Roth, Tom, 13 initiatives, 134 leadership, 134 S self-promotion, 134 Saxby, John, 65 strategy, 134 Schatzberg, Alan, 77 success, 129 Schiebel, Arnold, 95 Propping, Peter, 81 Schizophrenia International Research Society, PSC. See Psychopharmacology Service Center 4 (PSC) Schizophrenia Research, 4, 5, 7 Psychiatric genetics, 80, 82 Schizophrenia, 4, 5, 12, 33, 38–40, 42, 80, 89, Psychiatric imaging, 44 90 Psychiatric research, 19, 107, 131 Schooler, Nina Psychiatric services, 50 advice, 92 Psychiatry of disability, 24 ambition, 88 Psycho-biosocial models, 65 difficult times, handling, 91 Psychodynamics, 65, 106 education, 88 Psychopharmacologic Drugs Advisory Panel, mentor(s), 89–90 18 mentoring opportunities, 89 Psychopharmacological treatment of patients obstacles, 90 with schizophrenia, 88 to psychiatry, 89 Psychopharmacology, 6, 89 role (positive/negative), 91 Psychopharmacology Service Center (PSC), 88 work–family balance, 91 Psychosis, 12, 38, 40, 100 Scientific Advisory Board of the Dutch Brain Psychosis research, 38, 90 Foundation, 32 Psychosomatics, 107 Self-fulfilment, 117 Psychotic disorders, 70 Sexism, 73 Sexual discrimination, 8 R Siever, Larry, 57 Rapoport, Judith, 33 Single-mindedness, 57 Rasgon, Natalie Societal attitudes, 121–123 ambition, 76 Sole, Goldberg, 89 career advice, 78 “Sugar lump” polio vaccine, 38 difficult times, handling, 77 Suicidal behaviours, 106 mentor(s), 77 Suicide prevention, 106, 108, 110 obstacles, 77 Suicidology, 106 psychiatry, 76 Suppes, Trisha research collaborations, 76 advice, 98 role (positive/negative), 77 ambition, 94 work–life balance, 78 bipolar disorder, 96 Ree, Jan van, 33 career advice, 98 Reproductive medicine, 48 difficult times, handling, 97 Reproductive Mental Health Program, 48, 50 mentor(s), 95–96 Retterstol, Nils, 110 neuroscience of mood disorders, 95 Rietschel, Marcella obstacles, 96 ambition, 80 psychiatry, 94 career advice, 85 role (positive/negative), 97 difficult times, 83 work–family balance, 97 mentor(s), 81 Sweeny, John, 65 Index 161

T WHO Collaborating Center for Research, 106 Tamminga, Carol A. Women ambition, 99–100 academia, 146 brain mechanisms, 100 academic tribes, 149 career advice, 103 appearance, 145 difﬁcult times, 101 attitudes, 126 failed experiments, 102 belonging, 150 mentor(s), 101 communication skills, 146 obstacles, 101 competency, 121 psychiatry, 100 external barriers, 121–123 role (positive/negative), 102 female guilt, 125, 126 work–life balance, 102 helpful behavior, 130–131 Telephone conference, 35 implicit bias, 125 Tenured faculty, 13 internal barriers, 125–126 Texas Medication Algorithm Project, 94 Internet and social media, 142 leadership, 126, 131, 142, 146 U mentorship, 154 University of Edinburgh, 38 merit, 141 University of Texas Southwestern Medical networking, 142 School (UTSW), 96 over-giving, 130 perseverance, 153 V persistence, 153–155 Veterans Administration Medical Center, 33 psychiatry, 142, 150 rejection, 154 W self-doubt, 125, 126 Wasserman, Danuta self-promotion, 142, 146 advice, 113 self-silencing, 130, 154 ambition, 106–107 setting priorities, 131 career advice, 112 societal expectations of, 129 difﬁcult times, 111 success, 117 mentor(s), 109–110 tribal culture, 150 obstacles, 111 verbal communication, 122 psychiatry, 107–108 workplace interaction, 147 role (positive/negative), 111 Women's Leadership Group, 70 suicidality, 108 Women's Wellness Program, 76 work–family balance, 112 World Health Organization (WHO), 108, 110 Weissman, Myrna, 7, 19 Wright, Jim, 64 WHO. See World Health Organization (WHO) Wyatt, Richard J., 6