How might narrative improve understanding of our clients and ourselves, enhance skills in assessment and testimony, inform the creation and critique of expert reports, and further our adherence to the ethics-based goals and aspirations of our profession?
—Philip Candilis and Richard Martinez [Ref. 1, p 12]
The Reflections and Narratives section of The Journal invites forensic mental health professionals (and others) to share their perspectives on professionalism and personal values and experiences. Gender is one topic that merits personal and professional exploration in psychiatry. Women represent 34 percent of U.S. psychiatrists and 55 percent of current psychiatry residents (p xiii). These professionals and those who train and collaborate with them may seek resources about female psychiatrists who are leaders in North America. Women in Psychiatry: Personal Perspectives, which was conceptualized from a 2007 American Psychiatric Association (APA) Special Presidential Symposium, “Women Leaders in the APA and Beyond,” merits serious consideration.
The book is edited by three female psychiatrists. Child and adolescent forensic psychiatrist Donna M. Norris, MD, was the first female Speaker of the APA Assembly. She is Chairperson of the Board of Trustees of Regis College and is on the clinical faculty at Harvard Medical School. Geetha Jayaram, MD, MBA, has appointments in the Departments of Psychiatry and Health Policy and Management at Johns Hopkins University School of Medicine. She has chaired the APA's Scientific Program Committee for several APA Annual Meetings. Annelle B. Primm, MD, MPH, is Deputy Medical Director and Director of the Office of Minority/National Affairs of the APA. The editors say that the springboard for this book was the changes that resulted from the women's and civil rights movements, as well as the need for women in psychiatry to document their narratives, so that others, particularly students, residents, and women in psychiatry, may benefit from their experiences.
The book is controversial by design. Psychiatrists are trained to limit self-disclosure and to contain the influence of personal matters on the treatment milieu and transference. In the 21st century, these standards have begun to change slowly, perhaps unintentionally, because of the Internet, electronic media, and social networking. Yet, self-disclosure can leave people vulnerable to unintended outcomes. The editors say that several psychiatrists who were asked to participate in this project respectfully declined because they were concerned “that meeting this request for candor would be too risky, with such personal exposure possibly placing their professional careers in jeopardy” (p xiv). The book contains 21 narratives.
Many of the trailblazers in this book had to think outside the box to advance their careers; yet, they found a way. They include several APA leaders, including the first female President who also is a former college president; the first woman with both medical and legal degrees to serve as President of the American Academy of Psychiatry and the Law and is a hospital president and CEO; several past presidents and leaders of other medical professional organizations; the first female psychiatry consultant to the U.S. Surgeon General, a co-founder of a women's mental health network, leaders in psychiatric research; and leaders in public and private sector mental health. The women are of various faiths, races, cultures, and ethnicities.
The editors attempted to add balance to the book by including narratives of a medical student, residents, and early career psychiatrists. Most authors are midcareer and senior-level professionals. Although several authors have forensic psychiatry training, law degrees, or both, others have served as expert witnesses, court consultants, policy consultants, and judicial educators in cases and projects that have had a transformative effect on mental health care law and policy.
The authors describe their experiences from childhood to present, including milestones, triumphs, and setbacks. There are informative discussions about selecting a career path (direct clinical care, research, administration, teaching, and medical politics), tenure, and program and policy development. Each author comments on how she has been able to balance her career and personal life. The authors describe challenges that they have encountered as parents, partners, and colleagues. Some have excelled as martial artists, pilots, and blackjack players. They use setbacks to inform future planning and successes. Almost every chapter ends with a listing of “Practical Tips for Women Psychiatrists” which contains pearls that may benefit all types of professionals, regardless of gender. The authors emphasize the importance of finding mentors, networking, supporting future generations of psychiatrists, and having a balanced life, including time for family and self.
A chapter authored by an expert in military behavioral health and suicide was timely, interesting, and controversial. The author describes a remarkable career during which she balanced deployment with raising a family. She has published extensively and discusses her role in developing various mental health programs and protocols for the troops. She says, “The outside world focuses on ‘military’ sexual assault. In my experience, although sexual harassment and assault do occur, they are probably no more common than in the civilian world. The Army has really tried to discourage these behaviors” (p 212). Clarification is needed regarding whether her opinion is based on empirical or anecdotal evidence.
Women in Psychiatry: Personal Perspectives merits a wide audience. The book is an excellent resource for readers seeking to understand the history of women in psychiatry from professional and personal vantage points. I have recommended the book to female and male psychiatry and forensic psychiatry residents who are concerned about their career pathways, negotiating challenges, and balancing their professional and personal lives. The book, too, may serve as a resource for forensic psychiatrists who are contemplating contributing a Reflections and Narratives article to The Journal. The book's clarity, organization, and wealth of unique information about how careers in psychiatry can foster forensic involvement in expert testimony and policy consultation make it a worthwhile addition to a forensic library.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2013 American Academy of Psychiatry and the Law
References
- 1.↵