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Women Psychiatrists Caucus Chats: A Conversation with Dr. Nada Stotland

  • March 04, 2024

This limited podcast series is brought to you by APA's Women Psychiatrists Caucus and hosted by Anjali Gupta, M.D., President of APA's Women Psychiatrists Caucus. Dr.Gupta is an Assistant Professor in the Department of Psychiatry at the Georgetown University School of Medicine. She has led a number of wellness and equity initiatives at Georgetown and was selected to be a Gender+Justice Initiative Faculty Fellow for her research on The Experiences of Women in Medicine. She is active with APA's Committee on Women's Mental Health and is Chair of the AMWA Literary Committee. In this series, Dr. Gupta will interview women psychiatrists across the country who lead in a variety of ways. These conversations will uncover insights from guests' journeys in psychiatry on a range of topics, including work-life integration, mentorship, gender equity, and more.

In this episode, Dr. Gupta is joined by Dr. Nada Logan Stotland. Dr. Stotland obtained her undergraduate, medical, and residency education at the University of Chicago, her psychoanalytic training at the Chicago Institute for Psychoanalysis, and her MPH at the University of Illinois. She is the author or editor of 7 books and over 60 articles. Dr. Stotland has held leadership positions in academia, public psychiatry, and professional organizations. She has been married to Harold Stotland for 60 years; they have four daughters and four grandchildren.

Transcript of Audio

Dr. Nada Stotland (00:00): Be a little ambitious, go where the people who run things go, and go to their meetings and see what's happening and how they function. And when you're given an opportunity, take advantages when they come, don't think there is a rule book like when you go to school for how to do a thing.

Dr. Anjali Gupta (00:21): Welcome to the Women in Psychiatry podcast by the APA's Women Psychiatrists Caucus. I'm Dr. Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewing women psychiatrists across the country who lead in a variety of ways, so that we can hear their stories and learn from their insights.

(00:40): Thank you for joining us today. I am thrilled to be here today with Dr. Nada Stotland. Hi, Dr. Stotland.

Dr. Nada Stotland (00:40): Hello.

Dr. Anjali Gupta (00:49): Thank you for chatting with us from Chicago, a place, the windy city, that is close to my heart, and thank you again for being here. So I know you are there now, where did your journey start? Where did you grow up?

Dr. Nada Stotland (01:04): My journey started, I was born at the University of Chicago, which is about eight blocks from here.

Dr. Anjali Gupta (01:11): Oh, so have you been in that specific area the whole time?

Dr. Nada Stotland (01:17): I spent one year in Champaign-Urbana at the University of Illinois, and I've lived in three years in the suburbs and a couple of different locations in the Chicago area, but I've been in the Chicago area all my life.

Dr. Anjali Gupta (01:31): Okay. And so as a young woman in Chicago, what inspired you to go to medical school?

Dr. Nada Stotland (01:40): Well, I wanted to be a psychiatrist. Psychoanalysis was a huge interest at the time because we're talking about the fifties, middle to late fifties, et cetera, and my mother was fascinated by it. It was almost the law, the rule. Those are the people who really understood everything. And one of my mother's two best friends was the administrator, the assistant for the head of the Chicago Institute for Psychoanalysis, so it was everywhere. So I thought that was extremely interesting. And then I wanted to do psychotherapy, which is all that they ever talked about, certainly didn't talk about medication. Psychoanalysis was the thing. It was the answer to all questions. It was prestigious, it was glamorous. My mother was absolutely fascinated. My mother had grew up very poor, went to City College for some time. Well, she had one friend who was a dentist, but she never got beyond that stage in terms of becoming a doctor, but she was fascinated by it. So although it wasn't done at the time, I wanted to do it.

Dr. Anjali Gupta (03:15): So it sounds like you, through your mother's friend, actually knew somebody who was a woman's psychiatrist at that time?

Dr. Nada Stotland (03:23): No, she was an administrator. She was a secretary. She was not. My mother's other best friend was a social worker. So the whole thing was very psychoanalytic, psychodynamic, et cetera, to a fault, I would say. And I know that my mother, I think, thought that certainly a woman could do it, but that it was very rare, but she was not about to discourage me. I just thought the whole thing was fascinating.

Dr. Anjali Gupta (04:01): But how nice to have that force who believed in you. So you went to medical school, what was that like being a woman in medical school at that time?

Dr. Nada Stotland (04:11): I went to the University of Chicago Medical School, which was great. There were four women in our class of 72. When I applied, my then boyfriend and I were really quite serious, and we've now been married for 60 years. But when I applied, when I was interviewed, the dean of students asked me whether I had any plans for marriage, and because I thought that would come up, we did not get engaged until I was accepted to medical school, and I just showed up married.

Dr. Anjali Gupta (04:49): So four women. And what was that like? Was there comradery? Did you have any mentors that were women at that point?

Dr. Nada Stotland (04:58): There was a basic science neuroanatomy professor who was lovely, just a lovely person. I wouldn't say a mentor in the sense of giving ideas or anything, but I TAed in her class a couple of years later and she was lovely. There were almost no... You could count on your hands how many, probably in the entire university you could count how many women there were as teachers, so we were fascinated by the very few women that were around, but I didn't know any of them well enough to consider them a mentor. The women in the class were nice to each other. We did some things together. I, number one, was married. Another one of them was married, actually. I was married, and I came from Chicago and I had friends and relatives here, so I really didn't need to make a lot of new friends in medical school, I was still at home, so to speak, living in married student housing, which was interesting.

(06:12): But anyway, we recently had our 55th medical school reunion and a good 12 or 15 or so people showed up from various places, including Africa. And it occurred to me in a way for the first time that we never got a bit of flack from our fellow students who were male, that we were treated like colleagues, like respected colleagues. There was nothing. And in some ways, I think it's worse now. But I had to tell my classmates, I said, "I reflected on this and you guys were terrific." Now, the occasional professor, of course, all the studies were about white college men, but occasionally they might say something, but not much of anything. I decided to have a baby in medical school. I was pregnant, nobody knew it. But I didn't want to go in when patients were getting X-rays. And one of the neurosurgeons said to me, "Are you pregnant?" Because it turns out his wife was pregnant, and that's why he had that on his mind, and our children ended up going to school together.

(07:50): But it was fine, it was hard in other ways. It caused a sensation whenever it came up when you were out of the medical school setting, and how you would ever have children, how you would ever be a wife, et cetera, was a mystery to everybody. My husband, was a lawyer, when we go to a legal function of any kind, I hated when they asked me what I did, because it was, "Oh my God, how can you do that?" And he was making a living, I chose to have a baby in medical school because I could not wait one more minute to have a baby, and though I was very young, but I still couldn't wait another minute to have a baby. And that's, "Oh, then how on earth could you do that?" Well, we had live-in help.

Dr. Anjali Gupta (08:45): That's what I was going to ask you, how did you balance your personal life at that point with your professional?

Dr. Nada Stotland (08:51): We had a full-time, live-in person. At that time, she had one little baby, who was a sweetie, to take care of. And she also, we had a nice apartment, she kept the apartment. And the rule was that if I forgot to make plans for dinner, there was always loads of stuff in the freezer, et cetera, that there was a certain repertoire of things and she would make one of those things. But otherwise, I came home and I made dinner. And I didn't go very many places without the baby, except to medical school. So she went on vacations. We took almost no vacations away from our children.

(09:40): And I had a second baby when I was a resident. And when I had a second baby, I hired a cleaning person to help the live-in person because I said, "If it were me, I would be ready to have a cleaning person by now." They were wonderful people, calmer than I was, taking care of the kids when I wasn't there. So that was a luxury, as my husband was a lawyer making a living, and there was a lot more help. I think my daughters have a much harder time than I did.

Dr. Anjali Gupta (10:17): So it sounds like you had a really good support system to help you. You had the one child in medical school and another child in residency. How was it when you had a child in residency?

Dr. Nada Stotland (10:30): Oh, God. We had no maternity leave, and both of these pregnancies were utterly timed. I was lucky that worked for me. So I had the first baby on my off quarter. Our junior year of medical school, we had three quarters. The University of Chicago is on a four quarter system. Anyway, so one quarter you had off, and I TAed in neuroanatomy that quarter so that I could get it off, and it was the last part of the year so that I had the baby May 31st, and then I started my senior year in July or June pretty soon, with a pretty tiny baby. But that was okay.

(11:19): And then when I was a resident, then you really, the senior year of medical school at that time was all outpatient. There was not much call, et cetera, so that was okay. Now, when I was a resident, that's really a full-time job, and there was no such thing as maternity leave. So we had three weeks of vacation a year, I think, and you could take only two at once. So I had that baby on June 17th. I had the last two weeks of June as the two weeks of that year's vacation, and the first two weeks of July as two weeks of my next year's rotation. And there were actually two women in my class, which was a big deal. We were the only two women in the whole four years of training, and we both had babies, and that was the talk of the town. Though we didn't miss a day.

(12:26): One of our classmates got hepatitis and was out for weeks. Nobody said anything about that. Another of our male classmates got married in Colorado and then the car broke down and blah, blah, blah. They weren't back for days and weeks and whatever longer than they were supposed to be. And nobody said anything about that. But that we had these babies and did not take off one day from training. And in fact, I was on the inpatient unit at the end of that year and the attending, who was a nice man, said, "We're kind of busy, could you stay on longer?" So the baby was due in a few days, I said, "No," I could not stay on longer.

Dr. Anjali Gupta (13:14): There is a pressing matter. Okay.

Dr. Nada Stotland (13:18): That's how that was.

Dr. Anjali Gupta (13:21): So I know you have gone on from residency to have a very long and very accomplished career. What aspects-

Dr. Nada Stotland (13:31): And two more babies.

Dr. Anjali Gupta (13:32): And two more babies, as an attending at that point?

Dr. Nada Stotland (13:36): Well, go on with what you were going to say.

Dr. Anjali Gupta (13:40): No, go ahead.

Dr. Nada Stotland (13:43): When I had the second baby, when my first daughter was age one to two, I was an intern. That was a nightmare. That was every third night, every third weekend day. That was a nightmare. I hated it. And of course it was, I did straight peds. I thought I would do child psychiatry, which I didn't for a variety of reasons. But I was miserable. It was not what I wanted to do, for one thing. For another thing, I had to poke needles into little children, which absolutely tortured me. I used to think, poor things. So that was horrible. So then I had the second baby and I said, "I'm not missing that year again." I had the second baby and when she turned one, I asked for a leave of absence, and I made it open-ended, and I thought it would be for some months or a year and I stayed with my children for seven years.

Dr. Anjali Gupta (14:48): You were home for seven years?

Dr. Nada Stotland (14:50): And had two more babies. Yep.

Dr. Anjali Gupta (14:53): How was that at that time, to make that decision? How hard was that?

Dr. Nada Stotland (14:54): I loved it.

Dr. Anjali Gupta (14:57): You loved it?

Dr. Nada Stotland (14:59): Yeah, I loved it. I had one more year to go, but that year was elective, and so in fact, I got very interested. I was always interested in OB, but I didn't want to do it, but I was very interested. And so when I went back, I went back two years. To do the one year I went two years halftime, and I went back as the psych consultant to OB-GYN. And meanwhile, I had prepared childbirth, I had become the vice president of a lamaze organization, and put a lot of thought into childbirth and so on, and found that the technique worked astonishingly well. So that's how that worked out. And so I had a license, and there were times during those seven years where I had a patient or two. Because that was perfectly legal, I didn't say I was anything I wasn't. And I started going to APA meetings at some point during there, but I stayed home until the youngest one went to nursery school, and then I-

Dr. Anjali Gupta (16:14): Those are those early years where sometimes women desire some flexibility. How was it to reenter after that? How did you come back part-time or full-time?

Dr. Nada Stotland (16:26): I knew it was time, but I was scared to death, and I did come back half-time. First I did my two years of residence, finished my residency, and then I got a half-time job in consultation psychiatry at a related hospital in Chicago. And I had to do some, I think, general medicine or whatever besides, but my real identification was with OB-GYN. And so I did two years half-time just being the psychiatric consultant to OB-GYN at the University of Chicago, and then I got a job doing it at another hospital. And so I've been interested in those things ever since.

Dr. Anjali Gupta (17:15): So you mentioned it was scary. What was scary?

Dr. Nada Stotland (17:18): Actually, I had gotten a call during my seven years, maybe shortly before I went back to work, I had gotten a call from somebody who was, when I talked to, it was a woman moving to Chicago, taking a job at the University of Chicago, a psychiatrist, and she had a child, she was on her own with a child. And they said, "You know everything about kids in Chicago, whatever, would you talk to her?" So I happily spoke to her, and then she became the head of emergency psychiatry. So I thought, that's what I feel I don't know anymore. I hadn't given anybody any emergency medication or admitted anybody for years. And so she gave me a tutorial basically, and it was still scary, but it was okay.

Dr. Anjali Gupta (18:08): It helped the transition. So you had the four children, you took your career break, you reentered part-time, and you went on to, again, an incredible career. As you think about your career, what are some of the joys and some of the things that have brought you meaning during these years?

Dr. Nada Stotland (18:34): Almost everything brought me meaning, joy, and I would say satisfaction. But I remember when I went back to my residency, the then chief resident, of course a man, was jealous because I was so happy. And as far as he was concerned, I had a family and a career, and so I was very happy to be able to do that. Sometimes it's hard, you have a baby and you're on... We took call from home as psychiatry residents at the time, but there's the baby and you get called and you have to go into the ER and take care of whatever the psychiatric problem is. And it's not fun when you have a patient who's suicidal, or also maybe borderline, and things are, that's scary and difficult, but you can help people and it's endlessly interesting. We really got to know the patients, and of course things have changed since then. We had, therapy was 50 minutes. There was no other kind of therapy, except unfortunate people in the public system who got two seconds with a doctor. But most academics were not involved in public psychiatry.

Dr. Anjali Gupta (19:57): Really?

Dr. Nada Stotland (19:58): There were two people in our department, we never even saw them. They worked at a state hospital, they did research on schizophrenia and medication and so on, and we almost never saw them, and they didn't teach us. I think we went out to the state hospital and had a visit one time, and then we also spent a rotation at a community mental health center that opened up in our area, which was disorganized and crazy, and so we had very little contact with that. So it was 50 minutes, it was psychodynamic, and that's how it was. But you got to know people. Almost every patient I've ever had, I've liked as a person, I respected as a person. I think it's a wonderful, interesting career. I think that psychiatry has by far the most interesting colleagues of any discipline in medicine. Psychiatry had very thoughtful, interesting people who cared about people very deeply and so I loved my colleagues, but you don't love every colleague equally, but I never thought I was in the wrong place, never for a minute.

Dr. Anjali Gupta (21:12): That sounds like your patient encounters, the longitudinal relationships with both patients and colleagues have brought you a lot of joy in over the years. You have held many leadership positions, including president of the Women Psychiatrists Caucus. What advice or tips do you have for women in leadership?

Dr. Nada Stotland (21:37): Well, let me say, you asked me earlier about mentors. I think the first mentor I had was I got involved in the Illinois Psychiatric Society, and I started a committee on women, and I started a committee of residents, which I think was the first one there was. And there was a woman president of the Illinois Psychiatric Society, no one could remember when the last woman had been the president. I still don't know who, it was lost in the pyramids or someplace, and she was this lovely, solid, self-assured, but not egotistical, lovely person.

[NEW_PARAGRAPH]And so she said to me, I had these two committees going, and the committee on women gave a presentation at the annual meeting of the organization, and then she said to me, "You are going to be now the chair of the finance committee," and I said, "I'm not interested in finance at all." She said, "Be quiet. You're going to be the chair of the finance committee, then you're going to be the treasurer, then you're going to be the president." Something had never occurred to me in my life, and that's what happened. And I got involved in public psychiatry, and that's another whole venture that I'd be happy to talk about sometime, but that was great.

(22:57): I started in a pan mental health organization in Chicago, in Illinois, in Chicago, including the advocacy groups, the social workers, the psychologists, et cetera, and it's still going. So anyway, that's what I did. And then, and I was very interested in women's issues, and I kept trying to do something, I just wanted to be on the committee, the American Psychiatric Association. And the committee members are chosen by the president and each, I never got it, and then Carol Nadelson became the president. And before that, she and Malka Notman had edited three books about women, and so I knew her that way. And then when she was running for office, the thing at the time, when you were running for office, and also when I run for office, is you ran all over the country giving grand rounds, and campaigning.

Dr. Anjali Gupta (23:56): Getting to know people. Yeah.

Dr. Nada Stotland (23:58): And people would have receptions for you. Anyway, I got Carol invited to my hospital to give grand rounds, which were in the evening, that hospital. And so I invited her to go out to dinner. So we went out to dinner and I got to know her a little bit, and then we came back and she said, "We have some time, I want to call home," and I was blown away. She called home, her son was going for an interview for prep school the next day, and his suit wasn't home from the cleaners, and he was mad, and there was something going on at home, and she was unfazed. She said, "You two work it out," and went on and gave her talk, and all I could think of is if that had happened to me, I would be saying in my head, "How can I possibly give a lecture now, with all this going on at home?"

(24:49): She took care of what she could take care of, she knew they'd be okay, and that was it, and she gave her grand rounds, and then she won. And then she put me on the committee on women, and then I became the chair of the committee on women, and then another female president of the organization made me the head of public affairs, which was a very big deal. That was a different level of committee, it was called the Council. And the other thing I did was, if you want to be a leader, do something, you have to do a lot more, I think, if you're a woman than if you're a man. A woman, whatever position you are interested in that you get, do it. So the committee on women came up with action items and et cetera, and then when I became the head of public affairs, the internet was brand new.

(25:41): There was a network, all the district branches of the APA in the country, and each one had a public affairs psychiatrist person, and I sent out an email almost every day. Whatever, there was a movie that had psychiatric something in it, if there was a problem or a scandal or whatever it was that I thought, your patients may be asking about this, your media maybe asked about this. So I sat at my desk at the job I had then and every day sent out an email to all of them. In fact, after several years when I moved on from that job, the guy who came over, who took the job, assumed that the staff had done that. I said, "No, the staff had nothing to do with this." So I did it, and I gave a report to the assembly at every assembly meeting, I didn't just go. And at that time, the head of public affairs went to board meetings. And although I was seldom called upon because that's how most of the presidents were, I learned what happens at board meetings. So I became known because I did it.

Dr. Anjali Gupta (26:55): It sounds like your pearl of wisdom for women and leadership is the Nike slogan of 'just do it'.

Dr. Nada Stotland (27:03): Do it. First of all, it's more interesting to be on a committee. We had a committee on women and people wouldn't show up for the meetings. And I had a co-chair, this is at the Illinois level, and I used to be so scared if they weren't there, how could we make plans? What if they objected to the plans? And then I saw, they're not here, I don't care what they think about the plans, and so we just did it. And they didn't mind. They, in a sense, got vicarious credit for it, they didn't do it. And then you have to do things and you have to let people know that you're doing them.

Dr. Anjali Gupta (27:44): Sometimes-

Dr. Nada Stotland (27:45): You write an article for Psych News, or whatever your newsletter is, because people deserve to know about it, that the committee on women is having a thing on balancing your professional life and your personal life, and had a panel, or something like that. Don't just do it, let people know you did it. Get up and give a report at the assembly, and have slides. None of that had ever happened before. And then I became the recorder of the assembly, the APA. People said, "All the recorder does is wait to become the speaker." The speaker was the head of the assembly. And I said, "Well, I don't have something to record." So what happened was it turned out that people would write action items all the time, which is like proposing a bill in Congress, and eventually someone would remember that there had been an action paper on that topic.

(28:49): There was one guy who was, I think he's still around, he must be 95, who remembered everything that ever happened in the APA, so he would know. So whatever that action item had passed and should be enforced, and then it would get all messed up because there would be confusion about that. So I said, "Anytime you write an action paper, you have to reference whatever action papers there have been." And the staff had to go where... There was no record of them in any organized way. We made a record. And so when you came to the assembly with an action paper, you knew that you were proposing to change the policy, make a new policy, whatever it may be. And so I recorded. I couldn't stand to be in a position and not do anything for it, that's not even any fun. Anyway, that's what I did.

(29:54): So yes, it's lot easier in some ways to work towards leadership now for women because you don't have to go to so many meetings. I happened to love meetings, and when my kids were little, during which time I was active in the lamaze organization, et cetera, I would take each of them to a meeting with me in rotation, so everybody got a chance. And then of course, you have to leave everything for your help and your husband at home to know what to do. You have to have two sheets of what's going in the lunchbox and what's being served at dinner and who has a date with a friend and who has-

Dr. Anjali Gupta (30:44): Daily logistics.

Dr. Nada Stotland (30:45): Piano. And my children got sugar cereal, they got the little boxes of... Because we didn't eat those things, but they always got that when I went away. They got treats when I went away. And life went on. And so they each had a turn.

Dr. Anjali Gupta (31:05): So I love that you said it's important for women in leadership to not only do important things, but to tell people about them, because we know that sometimes women don't toot their horns.

Dr. Nada Stotland (31:19): No. And it's not-

Dr. Anjali Gupta (31:19): They're uncomfortable doing that.

Dr. Nada Stotland (31:21): I don't mean that when you tell people, you say, "I did this." You say, "The committee on women met and did so-and-so, or a lecture was given by so-and-so." Or all the public affairs reps in the country know that you sent them an email every day. I didn't say, "I," I said, "There's been a murder and the perpetrator had schizophrenia, how do we explain that to..." Whatever the topic was, I tried to say something useful. So it's not about saying, "I, I, I, I did this," but you stand up and you give a public affairs report, it's about public affairs. It's not about you, but you are giving it.

Dr. Anjali Gupta (32:09): So you also have been an amazing mentor, to me personally and to many women. So can you talk a little bit about mentorship for women and what do you see as the important parts of a fruitful mentor-mentee relationship?

Dr. Nada Stotland (32:26): Well, it's best if it's mutual. It's always mutual to some extent because mentor gets a lot of satisfaction out of passing along wisdom. Wisdom makes a lot of difference. But also, I'm writing the, I think it's the third edition of the main gyne textbook, I write the psychiatry chapter. The, I guess it was, I don't know what entity, had a luncheon, a brown bag lunch for women at the APA, and it was for people to come and get mentored. And so I went every year and I said, "If anybody wants to collaborate on writing something, I'm often writing something," and so I think she was a senior resident, has been my co-author, and I made her the first author, because I don't need to be a first author for every edition of that chapter, and other things that we wrote together. And that's how it happened. And boy, is it a blessing to me.

(33:32): So it helps when the mentee needs help at something that the mentor is good at and can offer, and sometimes that's easy and sometimes that's hard. One thing that I encourage people to do is, well, go to a meeting, go to hear a lecture by someone you admire, whose work you've read, sit in the front. The minute that lecture is over, you get up first and run to talk to that person. If you don't do that, there'll be 25 people waiting, and you'll never get your turn because the lecture will have to go and give another lecture someplace. Be in front, have cards, and say, "Dr. So-and-so, I've been so interested in your work. I was so thrilled to be able to come and hear you in person. I'm thinking of doing X, Y, Z," or, "I'm deciding where I want to train," or, "I'm deciding where I want to work," or whatever it may be. "Might I call you? Might I call upon you?" And almost all of them will say yes. And you get their card.

(34:45): And then again, you have to do work. You follow up, you have to read what they're writing and say, "I just read your blah, blah, blah, blah, blah," or, "I see that you once taught at Pittsburgh and now you're at Columbia. I'm thinking of going to Pittsburgh. Can you give me any ideas?" I have a problem now because I'm so long retired that I don't know what's going on. When I knew what was going on, one of the most valuable things I think I did was to help people figure out how to get jobs, how to negotiate for jobs, how to choose jobs, and how to get out of jobs, because women get harassed and et cetera, and you help people decide what questions they want to ask when they go to look for a job.

(35:41): And women especially won't protect themselves well enough, what's in the contract, and they generally need support, even if it's in the contract, actually getting the time to do whatever they wanted to do. They'll be engulfed by people wanting them to do things. Often things, I'm thinking of academia, that won't get you anywhere in terms of advancement, like mentoring other people, which you still want to do. But I remember, one of my daughters is an OB-GYN, and there was one OB-GYN in the department at the University of Chicago who was female, there were almost none, and she couldn't get anything done. By the time my daughter was there, there were a number of women students and everybody wanted her advice, and she had to ration it because otherwise she couldn't have gone on with her career.

Dr. Anjali Gupta (36:40): So you mentioned discussing negotiation with women, and I know the world for women in medicine has changed significantly since you were in medical school, now women are more than half of medical school students, yet there's still work to be done. In discussing gender inequities, are you surprised that we're still talking about salary inequity in 2023?

Dr. Nada Stotland (37:11): Oh, I'm surprised, except that I've been there along the whole trajectory, and so I know it, so I'm not surprised in that way. Things have not gotten much easier. And in terms of not everybody wants to have kids, and that's fine, but if you have dependents, there's not maternity leave. In some ways, it's worse. I think there's more harassment, in some ways, than there was before, because things were so formal. It's not surprising. Women still have to be empathic. Women still can't get angry in the work setting. Women still do most of everything to do with the household and the children or any other dependents that there are, and don't put themselves forward. And also, the system is still rigged.

Dr. Anjali Gupta (38:09): What are your thoughts on how to improve work-life integration? Which is a topic that women are most dissatisfied with.

Dr. Nada Stotland (38:20): There was a time I was going all over the place giving that talk on that subject. I went to Perth, Australia, I spoke to the women dermatologists, anyway, so I know something about that. It is a lot harder getting help and care for your children now than ever. The women who were doctors in 1910, 1920, again, you could get people to take care of your children. You could afford someone to take care of your children. Now, that is really, really hard. Aside from that-

Dr. Anjali Gupta (39:00):

What about in the work environment? What can be done?

Dr. Nada Stotland (39:05): In the work environment is tough. It depends where you are. I don't know what the ethos is now, but it used to be, to be in serious academia, you had to be a triple threat. You had to do clinical work, research work, and teaching. And that is very hard to do, and have a family, and it doesn't make any sense, because those things could be done sequentially. Nobody's doing all of those every minute.

Dr. Anjali Gupta (39:33): So let's talk a little bit about that. When you say those things could be done sequentially, what is something we could do?

Dr. Nada Stotland (39:41): I don't mean we can do them sequentially. I mean there's no reason that's the rule. And I don't know what's happening now, but I saw for generations, young women drop out of academia. They get into an academic position. And I imagine it's somewhat the same in other kinds of paid positions, of which there were very few when I was working, and of which there are many now, and are expected to do usually more than anybody else with very little room to do the things that they really want to do for their family, like go to the ballet recital, or go to the soccer game, or go meet with a teacher, or a million such things. And even though they will get every bit as much work done, et cetera.

Dr. Anjali Gupta (40:37): It sounds like what you're describing are flexible work environments. What do you think is taking so long to get there? What is the barrier to creating flexible work environments for women and men?

Dr. Nada Stotland (40:54): Well, right now, medicine. I don't know that I would've said this 10 years ago or five years ago. Medicine is in a mess. Doctors and nurses are being expected to do too much. Therefore, doctors and nurses are quitting. Therefore, there's all the more for the remaining doctors and nurses to do, and we're chasing people out. And maybe related to that is it's gotten... People always made money being doctors. Some made very humble amounts and some made big amounts, and a lot of people didn't get care because they couldn't pay for it. But it's become so corporatized, so utterly financially driven, and they're telling you how many minutes you can spend with your patient, et cetera, that there's no room for anybody to have room to breathe or to go and do a normal human thing, like be there for their child at a certain time.

(41:58): And when I eventually became full-time, et cetera, and I started writing, and I should thank... Carol Nadelson was asked to write a book, she doesn't do a lot of writing. This is long, I don't know, 25 years ago, she said, "I don't want to do it. Ask Nada Stotland." Never occurred to me to write a book. Other kinds of people wrote books. I wrote books. But when computers came in, and you see that you go back to your document that you were working on, and it tells you when you last worked on it, and it would say 1:00 in the morning. You have to have a lot of energy. And then a lot depends on how much money you have in your family and how horrible your medical school debts are, and that's gotten more expensive and worse.

(42:48): So I don't have that many cheery things to say. I can tell you how not to feel bad about it. I can beg you not to quit academia because the women coming after you and the men coming after you need you, the students need you, the residents need you, the field needs you, the patients need you. But I used to give this example, which people may still not get, but to me is very powerful. And that is, if you send your daughter to a lovely, very good high school, be it private or public, and they would stand up there, the principal would stand up and say at a parent meeting, "The graduates of our school, the boys go to Harvard and Yale and Stanford, et cetera, and the girls, they don't care that much, they go..." There would be an outcry.

(43:51): But time after time after time, I heard chairs of psychiatry say, "Anjali was so good, and she had a baby, and she wanted to spend time with the baby, so she left X university department and she's doing private practice now because she can do it on her own hours." And no one screamed and yelled, "What are you talking about? If the men can go on in academia, why are we having all these women leave?" And they left. Many of them, if not most of them, left at that juncture because they were having babies for the first time, and they were hitting that differential for the first time, that they never had... In fact, young women used to say, "Why is there a meeting of the Women's Caucus at the APA at 7:00 in the morning? I'm going to go to the residents meeting. What's the difference what gender you are? You'll find out. You'll find out."

(44:51): So you have to seek mentorship. You have to be open to doing new things and thinking of yourself as a leader, because maybe you didn't, and it's probably relatively unusual for a woman, what do you want to do? I want to be the chair of a department of gastroenterology, or internal medicine. Don't say that. It's still not really acceptable to say it. When I was the psychoanalysis, something about ambition came up, and I was running around doing all these things. I had a deal. I said to my psychoanalyst, "Look, I will pay you for every session, and I will go to meetings, and I will pay for the sessions I missed, but I don't want to hear about it." But when he said I was ambitious, I said, "I'm not ambitious." He said, "Are you kidding?"

(45:45): I didn't have any particular goals in mind, but I certainly was invested in what I was doing and it having value and so on. So be a little ambitious, go where the people who run things go, and go to their meetings and see what's happening and how they function. And when you're given an opportunity, like ask Nada Stotland to write a book, I found a topic, I wrote about social change in women's reproductive healthcare. You could write a book about that today. It would be very, very apt. And I sat there and there was an editor and I said, "Well, I can write," and I sat there, I wrote that book on the first Mac that came out. When I had to send the disc in, when I finished, it wouldn't all fit on the disc because it took up the whole disc and there was no room for the operating system to put it on the disc. I had to learn to put it on two discs. Now you could have 20 books in your phone for what you couldn't get a whole book on your computer.

(46:57): Anyway, take advantages when they come. Don't think there is a rule book like when you go to school for how to do a thing. You know how to get a good grade in biochemistry. So you think, I was recruited to be the head of the CL service at the University of Chicago after I had been doing it halftime at this other hospital for some years, and I was, what? I don't know how to do it. Nobody knows how to do it. Everybody does it the best way they can. There are certain things. You should have some staff. Also, people have much less staff than they used to. And you think what you would like your service to do and how you want to do it, and there is no rule that you don't know.

Dr. Anjali Gupta (47:52): Well, Dr. Stotland, thank you so much for closing out with all of those pearls of wisdom, and I hope the people that are listening can feel the vibrance that I can feel chatting with you, and that amazing pep talk in the end. So with that, I just wanted to close out and thank you so much for all of your time and all of the thoughts that you have shared today.

Dr. Nada Stotland (48:24): Thank you for having me and having me review all these things and, even when times change, experience and wisdom should not be sneezed at in any venue, so thanks, Anjali.

Speaker 3 (48:44): The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.

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