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Women in Psychiatry: Personal Perspectives

edited by Donna M. Norris, , M.D., Geetha Jayaram, , M.D., M.B.A., and Annelle B. Primm , M.D., M.P.H. Washington, DC, American Psychiatric Publishing, 2012, 345 pp., $65.00.

Reviewed by Mary Anne Badaracco, M.D.
Am J Psychiatry 2012;169:996-997. doi:10.1176/appi.ajp.2012.12050721
View Author and Article Information

She reports no financial relationships with commercial interests.

New York, N.Y.

Dr. Badaracco is Director and Chief of Psychiatry, Bellevue Hospital, and Professor and Vice Chair of Psychiatry at New York University, New York.

Accepted June , 2012.

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This book is comprised of personal accounts of the professional development and careers of 21 female psychiatrists, ranging from those in the earliest phases of their careers to those who have more than four decades of experience. In addition to Caucasian Americans and Canadians, the ethnic and racial diversity includes African Americans, Latinas from the United States and abroad, Native Americans, and women who themselves or whose families emigrated from India. These women represent different religions, socioeconomic backgrounds, and sexual orientation and are from both rural and urban environments. Most are married or have consistent partners, and most also have children.

In addition to their medical accomplishments, the authors’ professional achievements include M.P.H., M.S., Ph.D., J.D., and M.B.A. degrees. Although each describes her love of patient care, the range of professional titles and responsibilities include hospital CEO, Army officer, litigator, inspector general, college president, health care policy expert, insurance company executive, parity advocate, and researcher. Many have served in leadership roles in psychiatric or other professional societies. Mary Jane England served as APA President. The framework of each chapter begins with a description of each author’s developmental journey, focusing on professional and personal accomplishments and barriers, and ends with specific tips for other women in the field. The varied journeys are described with wisdom and frequent humor. Amy Ursano, from the University of North Carolina at Chapel Hill, encourages other women to appreciate the humor and even the absurdity of their continuous, seemingly impossible juggling acts. Deborah Deas, from the Medical University of South Carolina, titled her chapter “Farmer’s Daughter Excels in Psychiatry.” Jo-Ellyn M. Ryall, from Washington University, describes herself as “addicted to medical politics.” She describes the way to the inner circle of “academic power” as follows: “show up, have a car, know directions.”

The authors’ accounts share multiple themes. Many refer to medicine and/or psychiatry as a “calling” or as “mission driven.” Among these are Crystal R. Bullard, a Native American psychiatry trainee at the University of South Carolina, and Anita Everett, a recent chair of the APA’s Council on Healthcare Systems and Finance. Many of the authors, including Patricia R. Recupero, an attorney and Professor of Psychiatry at Brown University and CEO at Butler Hospital, refer to some commonly accepted barriers to women’s professional success, such as the need to please others and the conviction of being an imposter.

Each author focuses on the balance between the professional and the personal, with the latter focus most often being on children and spouses. All emphasize the essential importance of a mentor, and most emphasize the need to take care of one’s self. A frequent theme is the importance of spiritual factors or formal religious institutions as a source of strength, most notably by the African American contributors, as exemplified by Cassandra Newkirk, who movingly portrays the central role her church has played in her life.

Although many of the authors comment on the distinct advantages women bring to leadership, Ann Sullivan’s overview is the most comprehensive. In her view, women experience less need to be immediately decisive and thus can take time to think, to allow others to contribute, and to facilitate team building. In her description of women’s teambuilding skills, she references Lao Tzu’s characterization of a good leader as one whose people will attribute success to their own efforts, not to those of the leader.

Not surprisingly, common tips include suggestions for development of a specific area of expertise, perhaps even an area “against type,” such as Gail Robinson’s assuming financial management of a physicians’ group at the University of Toronto. The title of one chapter, “Specializing in the Wholly Impossible,” captures the unpredictability and fun of following one’s heart. Several authors encourage others to have a plan but to be open to surprise, and almost all underline the importance of support networks, especially organizational ones such as APA.

Although gender issues are the identified distinguishing characteristic of these accomplished psychiatrists, some of the most interesting aspects of the book revolve around nongender issues, including race, general civil rights, religion, economic and social privilege, and sexual orientation. Especially intriguing is the interweaving of the American civil rights and feminist movements. Several contributors describe the lack of black peers and role models and the particular isolation and loneliness of being both African American and female in the field. Most poignant among this is Altha Stewart’s account of one of her first patients, a black woman who rejected her only to request a “real” doctor (i.e., a white male doctor).

The individual narratives are graceful and natural and, as written, almost free of tension and drama. Reading the accounts of these multitalented women, one can sense that their success was almost foreordained. Paradoxically, the sweeping cultural changes ushered in by the feminist movement in the 1970s make these extraordinary stories seem almost ordinary. In order to fully appreciate the nature of the authors’ successes, one would need to compare the situation existing for women before 1970 with our current environment. A playwright or novelist could portray the subtle and not so subtle expectations and discrimination of the cultures in which many of these remarkable women began their journeys. Such a picture would powerfully demonstrate the contrast between our current culture and a time when women were not as able to choose a rewarding career in medicine. Such a contrast would do justice to the remarkable, marvelous nature of these women’s lives.

Although the stories are heartwarming and real, I often found myself wishing for more description of struggle and of dealing with life’s disappointments and even regret. It is clear that most of the women are satisfied with their professional lives. Some do acknowledge that their academic or leadership careers may have suffered because of gender or family issues, but this in general is approached lightly. I also would have appreciated an acknowledgment that many women’s challenges are shared by men, including conflicts between the personal and the professional and issues concerning clinical, academic, and financial achievements.

The book would have been strengthened by more scholarly approaches to commonly held assumptions about women’s characteristics, such as strengths in listening, collaborating, and consensus building. A more in-depth exploration of some innovative approaches to common professional challenges faced by women (such as broadening academic and leadership opportunities, ensuring salary equity, and dealing with the power differential inherent in existing organizational structures) also would have been welcome.

Overall, this is an engaging, lively, and hopeful book that I would recommend to women contemplating a career in psychiatry, as well as to men interested in understanding challenges faced by their female colleagues. Most importantly, these accounts celebrate the excitement and wonder of a psychiatric career, surely one of the most fascinating paths in all of medicine and a path now open to women as well as men.

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