April 16, 2025 • 45 mins
This limited podcast series is brought to you by APA's Women Psychiatrists Caucus and hosted by Anjali Gupta, MD, 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. Laura Roberts, who serves as Chairman and the Katharine Dexter McCormick and Stanley McCormick Memorial Professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. She has written hundreds of peer-reviewed articles and has written or edited many books in the areas of professionalism and ethics in medicine, professional development for physicians, and major texts in clinical psychiatry. Dr. Roberts is the Editor-in-Chief of the journal Academic Medicine and has served as Editor-in-Chief of Books for the American Psychiatric Association since 2016.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
academic medicine is phenomenal.
It just is wide open.
So there's a lot of creativity.
I guess I would hope that people who are listening would exercise that, know, see that assomething that they can do, not be cookie cutter in terms of, don't know, I do inpatient
psychiatry, let's say, or I do this or I do that, like, forget all that, but put it alltogether and feel feel that you can.
(00:27):
Welcome to season two of the Women Leaders in Psychiatry podcast by the AmericanPsychiatric Association's Women Psychiatrists Caucus.
I am Dr.
Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewingwomen psychiatrists across the country who lead in a variety of ways so that we can hear
their stories and learn from their insights.
(00:50):
I have the pleasure of being here today with Dr.
Laura Roberts.
Dr.
Roberts serves as chairman
and the Catherine Dexter McCormick and Stanley McCormick Memorial Professor in theDepartment of Psychiatry and Behavioral Sciences at Stanford University School of
Medicine.
She's an internationally recognized scholar in bioethics, psychiatry, medicine, andmedical education.
(01:15):
She has held numerous leadership roles, including currently being editor-in-chief for thejournal Academic Medicine, as well as editor-in-chief for books of the American
Psychiatric Association.
Thank you, Dr.
Roberts, for joining us today.
I'm really looking forward to our conversation.
Thank you so much for inviting me.
Delighted to be here.
(01:36):
So I thought we would start out going back in time and have you tell us a little bit aboutyour journey.
I know you were a history major at the University of Chicago.
How did you decide on medical school and then the field of psychiatry?
Yeah, thank you.
(01:57):
Right.
Well, I am the daughter of a physician and a nurse.
So there was no way I was going to go into medicine.
And what really happened was, I had a wonderful interdisciplinary kind of educationaljourney at University of Chicago.
did a bachelor's in history, history and philosophy of medicine.
(02:19):
And that was fantastic.
And I had a job during that time.
where I worked at the school that was established by Bruno Betelheim.
It was called the Orthogenic School.
And it was a school for emotionally disturbed children that had been in place for manyyears at University of Chicago.
And when I went there, I saw a lot of young people with dysmorphic features, withrepetitive behaviors, with...
(02:53):
things to kind of a medical, from a medical lens, you could really see that there werebiological and medical determinants of what they were experiencing.
And the school did not want to view it in a medical model.
They wanted to view it more on a psychological model, was almost the era ofschizophrenogenic kind of logic that kind of the parents were to blame, or there were
(03:18):
dynamic factors that led to things.
And
I really felt uncomfortable with that.
And for some kids there, maybe kids who'd been traumatized or neglected, there really werepsychological or psychosocial factors that were totally driving their experience.
(03:38):
But for others of the children there, had some genetic loading or some medical conditionthat was really influencing their experience.
So I kind of reluctantly
became a future psychiatrist from that experience because I really felt that the childrenwere not receiving an appropriate standard of care and that we really needed many more
(04:02):
people to go into medicine who cared about child psychiatry or neurodevelopmentaldisorders.
And I felt very inspired to go into medicine.
So I had this history background and I did a master's degree.
in the Conceptual Foundations of Science there at University of Chicago.
And I did my pre-med requirements, applied to medical school, and then loved everything.
(04:28):
Maybe you did too when you were in medical school.
I loved everything.
But I really stayed true to this idea of going into psychiatry, but informed with amedical perspective, not a reductionistic or exclusionary view of it, but
At the very least, you had to include a medical or biological kind of component in termsof understanding children with mental health issues.
(04:54):
So you knew early on you kind of had that sense that something more was happening evenbefore you had kind of studied it.
Yeah, yeah.
And I don't know quite how to explain it.
It's just if you've, I don't know, seen a kid set a cup down 15 times or count, count,count, count, count, count, as I say, some of the children, you know, clearly had some
(05:23):
kind of a neurodevelopmental or genetic can be a component of their condition.
And so it, if you were observant, you know, you could see it.
And, and I,
I felt like the people there were fantastic people.
They were so dedicated.
They just hadn't been educated with the medical piece.
(05:44):
They see what mean.
And so that's why I didn't want to make the mistake of not seeing what was in front of mebecause I had failed to have a complete education.
least that's how I viewed it.
that anyways, that's how I ended up going to medical school.
And, and as I say, I loved everything, but I really wanted to stick with psychiatry.
Yeah.
(06:05):
And then what drew you to the ethics piece of it?
I know that you've done a lot of the ethics in your journey.
Oh, I think it was multiple hits there.
So one was that I had some preparation in terms of philosophy, moral philosophy, socialstudies.
(06:25):
I studied altruism and sociobiology.
I on a great adventure.
went to Australia when I was 19 and studied bird behavior.
And so I had a big interest in sociobiology and the origins of altruistic behavior.
And then this experience at the orthogenic school, I often say that turned me into afuture physician and a future ethicist at the same time, because I could see where very,
(06:55):
very good people inadvertently were doing, I think, some harm because they just were veryattached to certain ideology and didn't...
pay attention to say these medical features.
I want to say this very carefully because they really were very good people doingincredibly dedicated work.
(07:17):
But the ultimate result, at least for some of the children, was that they were deprived ofan appropriate standard of care for a period of time, which is an ethical justice kind of
issue.
And then probably the third hit was then later when I was an intern and I was taking careof a lot of people living with schizophrenia and
(07:37):
different psychotic disorders.
And there was a raging controversy about whether people with lived experience of psychosiswere able to give consent to say, be in research.
And working all day long with all different kinds of people living with psychosis, theanswer was sometimes they can and sometimes they can't.
(08:00):
But if we don't do research,
we're never gonna have the answers.
We're never gonna have improved therapies.
And so I started really looking at ethics of human research and ethics of researchinvolving seriously ill people, whether it was, I've done a lot of consult liaison
(08:21):
psychiatry.
So whether it was HIV or cancer or psychosis, schizophrenia, what was different?
I started being very interested in the question of
whether psychiatric exceptionalism was appropriate, you know, is there somethingintrinsically different?
Or what I found in our research is that this fundamental experience of suffering makes usall very similar, not quite so exceptional, right?
(08:47):
That's a bit different fundamentally.
So anyways, I started doing ethics work in part because I saw the need for research andwas convinced based on my clinical experience that there would be ways to do it ethically.
And there also were ways to do it in a very exploitative way.
And I wanted to kind of derive, empirically derive guidance for the field so that in thiscase, schizophrenia research could be conducted ethically and come up with answers,
(09:16):
improved care for people with such really devastating conditions.
your work has helped to establish that framework for vulnerable populations such as
Yeah, yeah, it's been fun.
It's been, you know, a great privilege.
In psychiatry, I feel like so many people with these kinds of sensitivities and interestsend up often going into forensic psychiatry.
(09:39):
Psychiatric ethics itself hasn't really been as well developed as a field.
So I feel honored to be among the people who've been kind of laboring to try and bringthis field forward.
And would like us all to be a little bit more reflective about, you know, what is
forensic, what's the forensic dimensions of psychiatry and what are some of these ethicaldimensions?
(10:02):
So as you think about important ethical issues in psychiatry currently, what are some ofthe more pressing ones do you think today?
my gosh.
I think, well, let's start with the doctor-patient relationship and then move outward,right?
(10:27):
So, I mean, I do think that there are...
you know, real threats to the creation of that therapeutic alliance when people don't haveenough time or they're not in a position to really connect with patients.
And so I think for all of us who serve and take care of patients, remain very, veryfocused and mindful on the ethical dimensions of that relationship and protecting that
(10:54):
relationship.
You know, our field is the field where we can model
how the therapeutic relationship makes a difference in people's lives.
And so there are lots of threats to that, not having enough time, not having a workforcethat's sufficient to make sure that there's adequate expertise there.
(11:17):
At one point you asked me about AI and there are like AI generated therapists now.
And I'm kind of in an equipoise position about it, it might be okay.
might not be okay.
So I think, right, the primacy of the doctor patient relationship is one thing that Ithink a lot about.
(11:42):
Confidentiality is very, very difficult.
Being able to protect privacy is very difficult.
Thinking about the repercussions of not having sufficient privacy, the stigma and theimplications for people's lives.
On a much bigger scale, I'm worried about equity and the fact that it's
(12:10):
Many people who develop mental disorders aren't able to work, aren't able to advocate forthemselves, aren't able sometimes to care for themselves, make decisions.
There aren't sufficient resources, facilities, workforce to take care of them.
So it's really a profound social justice issue, the lack of adequate resources and supportfor people with mental illness.
(12:33):
And then if you put on the perspective of the world,
and you see the disease burden, disability associated with mental disorders andneurocognitive disorders with the aging of our population.
You can just see the weight of these things.
Then intersect on that, people without resources, people who feel marginalized, it's clearthat there are many people.
(13:02):
even in this difficult situation, have a little bit more privilege.
And there are a lot of people who have a lot less access to resources.
So I think there's a lot there.
And I've already alluded to how the scientific neglect of mental disorders to me is aprofound issue.
We have so much investment, billions and billions of dollars of investment in certainmedical conditions, cancer, and...
(13:28):
And more power to them, have no, I'm not trying to take away in any way.
I'm just trying to advocate that mental disorders are profoundly disabling, are lifethreatening, are devastating across generations.
They deserve societal investment too.
So give me a day, I'll tell you more.
There's so many ethical issues, but those are the kinds of things that I spend my timethinking about and trying to address.
(13:52):
Yeah, and I want to follow up on a couple of those.
I know that you mentioned just the workforce.
About half of physicians experience symptoms of burnout.
And we know there are upcoming anticipated physician shortages.
(14:13):
Physician well-being feels like a moral issue, a financial issue, a public health issue.
Ethical responsibilities do institutions and healthcare leaders have to support thewell-being of healthcare workers.
Yeah, it's a great question.
you know, for people who are really interested in this, there's a lot that's been done.
(14:33):
There's a lot out there in the literature.
The AAMC in particular, the Association of American Medical Colleges has done quite a lotlooking at the determinants of burnout.
And, you know, two thirds of those are institutionally driven.
You know, the context in which people provide care.
(14:55):
I think, you know, years ago, I
first started studying medical student healthcare and medical student wellbeing.
It was one of the early people working in this field of professional wellbeing.
And at that time there really was less recognition of the institutional factors.
was more like a moral failing if you got burned out.
(15:18):
Don't you know that you should be inspired and that you should be tough, superhuman to bein this privileged role?
We've come a long way since then in terms of recognizing our own humanity and being selfcompassionate.
And I do worry sometimes, know, being a physician is always gonna be hard.
(15:42):
It's always gonna be meaningful, but it's always gonna be hard.
And I think we kind of sanitize or wish that everything was perfect and it could be all, Idon't know, lovely.
But if we're going to be with people who have these profoundly disabling conditions or theextremes of life or dealing with grief and trauma and loss, it's going to be hard.
(16:08):
So I think I emphasize that because there's a certain amount of insight that we all needto bring to the task of being a physician and the human condition and being right next to
that and the wisdom of pacing oneself and
safeguarding oneself to be ready for that work.
(16:29):
But there is a lot that institutions can do to create a platform of support and compassionacross teams, communication, sufficient staffing, a milieu in which perfection
(16:50):
isn't expected.
Mistakes are understood to be sometimes things that occur and that we respond to supporteveryone when there's a mistake.
So anyways, there are a lot of things that institutions can do.
And the only other thing I want to comment about this is I'm so tired of the term burnout.
I don't like deficit framing.
(17:10):
I like finding sources of resilience, finding sources of professional fulfillment, finding
empirically derived solutions to help us learn how to sustain ourselves.
And I do think, I do want us to look at the unvarnished truth that burnout exists, but Iwould also like us to elevate the positive aspects of being a caregiver.
(17:39):
We're the luckiest people in the world.
We're educated, we're supported, we're given a privileged role in society.
And so we do have some responsibility to keep focused on the positive and the ways inwhich we can serve and support others.
And I do worry that we get a little caught up in this negative negativity.
(18:00):
And my gosh, after the pandemic in particular, you know, no harm, no foul.
It's understandable.
But as I look to the future, I really would like us to figure out how to build in apositive way toward the future.
so that we can support others without exhausting ourselves.
(18:21):
And I also think it's a richer conversation about wellbeing to discuss fulfillment anddiscuss all of that and not just eradicating burnout, right?
It's a richer conversation.
So as we think about system level changes, for instance, in terms of enhancing wellbeing,
(18:51):
efficiencies in the work environment that could also improve work life integration andimprove kind of that spillover if there's more efficiencies.
What are your thoughts on work life integration?
It's a topic that is very important and women is a topic in terms of dissatisfaction.
(19:18):
So, reason women physicians exit.
What can we do to enhance work-life integration for men and women?
Yeah, you know, so it's interesting.
My father was a physician.
My stepfather, really, I consider my father was a physician a long time ago.
And, you know, he lived in the hospital for like years when he was doing his training.
(19:42):
He had zero roll strain, zero.
He was a physician, period.
And it's interesting to think about
how as we've tried so hard to live a complete life and be a, you know, fulfillment in ourhome life and fulfillment in our professional life and seeing them as different has
(20:10):
actually paradoxically brought some new challenges.
I'm not recommending the old model, but I think it is worth reflecting on how
I almost see it as another kind of perfectionism.
We're supposed to be perfect in our roles as physicians and we're supposed to be perfectin our roles as mothers, spouses, daughters, sisters, best friends, et cetera.
(20:33):
And if you create, we just let go just a little bit and not be quite so demanding ofourselves.
so I'm not sure I have any insight that anybody else would have on this.
I would just comment that in my life,
I've had worse role strain and exhaustion at certain points and less at other points.
(20:59):
I've had adapted work styles where I worked like a fanatic at work and then I went homeand I stepped completely back.
Didn't do any work.
And then I've had other periods where every spare minute I would go in the other room,have to work on the computer, take a phone call, et cetera.
And it was
integrated kind of in terms of it being from a time perspective.
(21:23):
And so, and probably the, the time when I have the least roll string in my life wasactually after I lost my husband, I lost my husband.
It's a fairly, fairly young mother with a bunch of kids.
And before that, it was really interesting.
I had to be a perfect woman, know, perfect mom, perfect this perfect that.
(21:48):
And then I was in a more male oriented field, right?
And at that point, actually, I was a chairman of psychiatry at a medical school where myfirst leadership retreat, there were 43 men in me.
I was the only female in the room.
I've been kind of a first female in some ways.
(22:08):
But after I lost my husband, it was very interesting.
I didn't feel as guilty about holding a role that some might view as more typically
a role held by men, especially at that time.
It's a little bit less a problem now.
Kind of all my roles just came down to one, to take care of my family, to be a goodmother.
(22:30):
I had to go to work and I had to take care of everybody in my world.
And part of that was the job I had allowed me to do that.
And it was interesting to not have roles during anymore.
I was almost like I didn't realize the burden I had had, the guilt I felt being a littlebit late, being a little bit, not being fully present, fully accessible, fully every
(22:55):
single minute, every single day.
It was like I could give myself some space to just be who I needed to be just to getthrough the day and to take care of the people and all that.
So I don't know if other people are going to have a moment where
there's some pivot or some difference.
(23:16):
For you and for the listeners, I remarry, I have an incredibly lovely husband, I have morekids, my life is lovely.
But it was interesting to have this sudden shift and to recognize more of what I'd beencarrying before that moment.
And I don't know if people could do a thought experiment or some way of suddenly shifting.
(23:42):
their mindset or their self reflection, and maybe let go of some of it that we put onourselves.
We put I don't mean in a blaming way.
It's natural in response to the kind of social pressures we feel.
But if there's just a way somehow to step out of it and then choose or be in it or not, orat least be self reflective with some of those pressures that we feel.
(24:07):
Yeah.
so insightful you know I am just thinking as you're saying that you know is that is thatis there a role for coaching to kind of come out of the way that you normally see things
and kind of maybe see them from a more compassionate way or self-compensation
(24:33):
I'm a big fan of coaching.
I like coaching.
I have this wonderful coach.
had, I don't know, when we're in psychiatry, we learn a lot of skills that translatebeautifully to administration.
So a lot of things about administration are pretty natural for me or pretty easy or I canuse my skillset and work through it.
(24:54):
But I did have a challenge that I was really struggling with.
And anyways, I got this coach.
He was wonderful.
and he had this Buddhist training and we would talk about things.
But one time he had me do a kind of visualization exercise, you know, where I could haveimagined and I was relaxing and I was like, know, well, I become a bird.
(25:16):
I'm a bird.
I'm a bird flying around and there's a storm coming.
And what do do?
I fly higher.
And what we ended up doing was talking about that because that's totally what I do.
If there's a conflict, I pull up and understand the full context.
(25:39):
I don't see conflict.
I pull out of it.
And it was just a really great way to get insight about my own adaptive style aroundcertain kinds of conflicts.
It was incredibly useful for
the work I did with this coach around the one particular issue I was struggling with atthat time.
(26:00):
And I think if you have a really good coach, just like if you have a really good, I don'tknow, therapist or psychiatrist or whatever, they can bring you out of your usual
defenses.
In residency, we had this wonderful therapist who taught us imagery techniques.
And in that case, it was interesting.
We were walking, we're walking in a river, beautiful green.
(26:22):
sky is shining, blah, blah, blah.
You look down, you find a box, you open up the box.
Well, what did I found?
I found a compass.
And I think about that all the time.
I had a thing in my life I was struggling with.
I was thinking which way to go.
I found a compass.
So if you work with somebody really good, a coach or a therapist, you can shift out ofyour usual defended place and think differently.
(26:49):
So I like your suggestion that way.
think the other guided imagery coaching exercise is the future self, you know, when peopleare struggling with clarity in choices and things.
Have you ever done that?
So I coach faculty here at Georgetown and I've done that with a few people and there theseaha moments of it's pretty neat.
(27:17):
Isn't it neat when people are like way smart and they're thinking all the time and they'reself observing and yada, yada, yada, but you can disrupt it and do something.
So thank you for doing that.
I think that's great.
I bet your, people really, really appreciate that experience with you.
think it's what you just said with administration.
think the coaching piece, trained as a psychiatrist comes a little more naturally.
(27:45):
Yeah.
And also you value insight.
value how that shift can make a difference in people's lives, which I don't know, from adistance might seem a little, I don't know, corny or not as impactful.
But if you're with it, you know, really with a person who's in that experience, it reallydoes make a difference.
(28:07):
Well, and the premise of coaching, really like to the premise is that the person in frontof you is whole and capable and has the answers within them.
And you're simply giving them props and exercises for them to come to the answers theyhave within themselves, which is also.
(28:32):
The next way to think through it.
Yeah, getting at that deficit thing we were just talking about, right?
Viewing people in a more complete, you know, prepared sort of way.
So I would love to hear you lead in so many different ways.
(28:53):
I'd love to hear some of kind of your insights in terms of women in leadership.
know, it's so nice for the younger generations to be able to look up and see people likeyourself.
and you know and know that there are amazing women leading in these ways.
(29:17):
Having said that there's also more work to be done in this area.
What do you think about as you think about departments and institutions looking to promotemore women into leadership?
What advice would you give or what are your
thoughts?
a lot of different thoughts.
(29:38):
I mean, I've ended up in leadership roles because I'm a responsibility seeker.
You know, I'm, in fact, I'm comfortable with competition and kind of, I don't know,whatever sports analogy there might be, but I, I naturally shoulder responsibility.
(30:00):
And, and I'm more comfortable
when I'm shouldering the responsibility than sometimes when I see other people doing it.
You know what I'm saying?
maybe it's a little, I don't know, self-aggrandizing, I'm not sure, or maybe controlling,but it's just when I'm in a situation, I step up, I like responsibility, I feel solid
(30:29):
holding responsibility.
And I actually prefer being behind the scenes.
I have visible roles and maybe that'd surprise people, but it's not my preferred place.
I'm much happier holding responsibility and I don't care where I am kind of on theplatform for that.
(30:49):
So I guess the first thing would be to understand kind of what your motivation is and whatmakes you comfortable, what makes you uncomfortable.
I think a second thing is
You know, I did not see people who looked like me in positions above me.
And I don't know if I'm just clueless, but that didn't bother me.
(31:13):
It was more that if I could see a way that I could hold responsibility and bring aboutbetter things or protect certain things that matter to me, that felt okay, you know.
So I think I was not as sensitive to certain
I don't like a lot of visibility, but I don't think I was as sensitive to some of thethings that other people worry about.
(31:42):
Do I look like the other people in the room or do I fit in or am I supposed to be here?
I kind of just didn't have that.
I had a little bit of imposter syndrome, but I wasn't really preoccupied with that.
was more, my gosh, this matters.
And if I don't do it, who will?
(32:04):
My psychology is a little bit more like that.
And the other thing I would say about myself, and I think it worked out well in the end,but it could have not gone well, was my interests were pretty diverse.
So I developed skills in medical education, in consult liaison psychiatry, I got trainingin child.
(32:32):
general adult and child psychiatry.
I started doing research on informed consent.
I also in it, well, I first did medical student healthcare and resident healthcare andphysician wellbeing.
And then I was doing informed consent and vulnerable populations.
And then I was in New Mexico.
(32:54):
So I was doing rural health disparities and.
And there were all these things with genetics.
And so I was doing genetics innovation.
I, you know, I am very comfortable with multiplicity.
So, but I was doing a lot, a lot of different things.
My first job was part time and I was carrying all these different kinds of things.
(33:14):
And I think objectively,
my advances in each individual area did not go as quickly as someone who just had a narrowgoal, was really goal-focused and just ran in one area.
But that was okay with me.
(33:35):
I was loving it and doing good work and holding all these things.
And then I started seeing all these connections that were really exciting about
you know, what context creates vulnerability?
What context creates strengths?
How is a medical student with an, as an overlapping role as a student in a patient kind ofsimilar to some of the things that people who were employed and then their boss asked them
(34:01):
to do genetic testing for their job.
How is that similar to a recognized vulnerable population like an imprisoned justiceinvolved person with mental illness?
I mean, I just could see all these connections.
So it was fun for me, but I think it's contrary to the advice, know, go narrow, go fast,just focus on one thing.
(34:24):
And I just didn't do that.
I'm very comfortable with multiplicity.
But what it meant was then I built a big skillset.
I built a lot of areas of knowledge, huge networks of friendships.
So I had, you know, I have a whole ton of friends that are researchers and I have a wholeton of friends who are educators.
I, you know, I...
(34:44):
it ended up having all these wonderful, it bore so much fruit, but it was contrary to themaybe the advice, career advice that you would get.
And I already mentioned my first job out was part-time and people would say, can you beserious about academics if you're part-time?
And I'm like, watch me, it was kind of my response to that.
(35:07):
I didn't feel the need to explain it really.
And then,
Over the arc of my career, all the pieces came together.
So, you know, the administrative skills, skillset, content expertise and clinicalresearch, education, all these different pieces.
And then now in this last, I've been a chair for a long time now, but these last manyyears, I've kind of drawn upon all those experiences in these leadership roles.
(35:38):
Well, and as you what we're going through it, it sounds like you must have really knownyour North star.
Like you really were grounded in this is these are the things I want to do and it's okay.
And you know, I think sometimes the linear the linearity and the kind of what you shoulddo confusing for folks, but it sounds like you
(36:06):
able to just be true to what you wanted to study and what you wanted what you wereinterested in and some of the rest of it.
I mean, think so.
I mean, if you if you I've had a very unexpected career, right?
I mean, if you told me that I would be the chair at Stanford, you know, leading thisphenomenal department, I would not have believed you.
(36:32):
mean, I would tell you I would be like running something.
I'm sure of that, because that's just how I'm built or carrying a lot of responsibilityfor sure.
But
That's part of what I love about academic medicine and academic psychiatry is there are somany ways to serve and contribute.
(36:53):
There's so many paths, for example, to leadership, but there are so many ways, I mean,look at you, so many ways to serve in your clinical capacity, then use that strength to
support others in some way, and then to further lead at a national level with all of thattogether.
think academic medicine is phenomenal.
(37:13):
It just is wide open.
So there's a lot of creativity.
And I guess I would hope that people who are listening would exercise that, know, see thatas something that they can do, not be cookie cutter in terms of, don't know, I do
inpatient psychiatry, let's say, or I do this or I do that.
Like forget all that, but put it all together and feel that you can.
(37:38):
And the other thing is, you know, I...
you talked about my undergraduate, you know, I've always loved writing and you know, look,all day long now I'm working with words that, know, with my editing roles and in academic
medicine and with APA publishing.
And so it comes around.
(37:59):
I guess that would be the other piece of advice is you don't have to do everything, everysingle thing, every single moment, every single time, or you'll lose it forever.
That's not how it is.
can weave it, you can do part-time, you can do full-time, you can do this kind ofactivity, and just you can hold it and bring it together.
And all these passions and loves, that's another thing about psychiatry that I love, allthe things that make us who we are are things we can connect with others around, and you
(38:26):
can bring that to the work itself.
it's, to me, it's just a wonderful, a wonderful profession.
And I think that for women of younger generations who might be starting out or trying tofigure this out, it is really helpful to have someone like you, you know, just reiterate
(38:48):
that it to follow kind of your heart and, you know, meander if you need to a little bitand do things that you enjoy.
Yeah.
But now I'll say the tough part of it.
mean, but you also have to be a little bit tough.
You know, let's let's be pragmatic here.
You have to build certain skill sets if you want certain kinds of roles.
(39:11):
So passion and authenticity are the to me are preconditions.
But it's good to be smart and strategic.
So, you know, because I've had I've had the hard side to
I've had, you your, you know, part time mommy, you don't get an office and a computer.
(39:36):
You're, I don't know, you're not serious, you're part another one, you're part time,you're not serious about an academic career, you know.
Another big one that a lot of people in psychiatry, you're in psychiatry, you're not aserious physician, you know, there's all kinds of ways that and
(39:59):
How did you navigate some of those films?
Yeah, I don't...
Sometimes I get mad, you know, like make me mad, you know.
I was like, you raise a bunch of kids and write an R01 and then tell me who's seriousabout doing research, you know.
(40:19):
But I can't stay in that place very long, you know, maybe get me over a littlemotivational hump or something to put a little extra work into something.
But I think the rate limiting steps that I see for a lot of people are speaking skills,financial skills.
(40:44):
I'll say writing skills, but writing skills as applied in lots of different ways.
So grant writing or publications or whatever.
Figuring out how to leverage power is...
So I was in New Mexico.
And a lot of people didn't think highly of New Mexico.
(41:07):
I went there because it was a place where I felt like I could make a difference.
I mean, I feel like I've had the best training of anyone I know because the patients wereso extraordinarily ill.
I really, really learned a lot.
But so, you know, it kind of got my backup that people didn't understand what anextraordinary place, the extraordinary training.
(41:32):
And so, you know, I would do things that would bring visibility to the excellence of theprogram I had in New Mexico.
So I don't know, I think I was strategic.
You know, I learned, I'm good with money and I learned about budgeting and you know, I'mnot scared of money.
don't view it as the, I view it as a path toward good, not a source of evil or whatever.
(41:56):
So I really encourage people to understand.
you know, how money works, how resources work, how to leverage resources to accomplishsocial good.
And you don't learn that in medical school, something, it's a skillset you have todevelop.
really encourage people to learn how to speak comfortably and clearly about complexthings, how to write.
(42:20):
If you want to be a researcher, how to write grants, how to write papers, you know, there,there are these kinds of threshold skills.
And I wouldn't have the career I have unless I was able to acquire them.
I did do some professional leadership.
I'm interested if you did too.
I did do some professional leadership training things.
I had kind of a mixed reaction to some of them.
(42:44):
But what I did do is I met kind of other people who maybe were recognized for theirpotential, leadership potential.
And so talking with them, networking with them, that was always valuable.
Even if I thought the program, like, oh my God, I went to one program and there was thisperson wearing a very loud outfit and she said, oh, the key to leadership is you have to
(43:09):
have a very big watch and a hairdo that people remember.
And I was like, give me a break.
And I was like, wow.
And I always have a hairdo that people will remember.
to me, it was so contrived.
You I didn't like that.
So, you you're gonna get, you're gonna...
You're going to have your own opinion about what material is presented, but meeting otherpeople is always, always valuable.
(43:33):
And I think that even for professional meetings and other places, there was the content,is great, but also meeting people and connecting with people.
Yeah, I think getting involved.
sorry, I was just gonna say, I do think getting involved with professional societies isreally critical for all the things we talked about, know, self care, kind of calibration
(44:00):
in the world, you know, being somebody, my God, what job did they offer you on the EastCoast compared with the Midwest compared with the West Coast, you know, supporting one
another, writing letters from one another, nominating each other for awards.
you know, comparing notes and supporting one another when you go through difficult lifeexperiences, those are incredible relationships and friendships.
(44:24):
So I think that's another protective and supportive factor for sure in my career.
And I hope others would pursue those.
Dr.
Roberts, feel like I could talk to you for another hour, but your time is up.
It has been just fabulous to listen to your pearls of wisdom.
And so I really appreciate you taking the time with us today.
(44:47):
Thank you so much.
I'm very grateful for the conversation.
you.
academic medicine is phenomenal.
It just is wide open.
So there's a lot of creativity.
I guess I would hope that people who are listening would exercise that, know, see that assomething that they can do, not be cookie cutter in terms of, don't know, I do inpatient
psychiatry, let's say, or I do this or I do that, like, forget all that, but put it alltogether and feel feel that you can.
(00:27):
Welcome to season two of the Women Leaders in Psychiatry podcast by the AmericanPsychiatric Association's Women Psychiatrists Caucus.
I am Dr.
Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewingwomen psychiatrists across the country who lead in a variety of ways so that we can hear
their stories and learn from their insights.
(00:50):
I have the pleasure of being here today with Dr.
Laura Roberts.
Dr.
Roberts serves as chairman
and the Catherine Dexter McCormick and Stanley McCormick Memorial Professor in theDepartment of Psychiatry and Behavioral Sciences at Stanford University School of
Medicine.
She's an internationally recognized scholar in bioethics, psychiatry, medicine, andmedical education.
(01:15):
She has held numerous leadership roles, including currently being editor-in-chief for thejournal Academic Medicine, as well as editor-in-chief for books of the American
Psychiatric Association.
Thank you, Dr.
Roberts, for joining us today.
I'm really looking forward to our conversation.
Thank you so much for inviting me.
Delighted to be here.
(01:36):
So I thought we would start out going back in time and have you tell us a little bit aboutyour journey.
I know you were a history major at the University of Chicago.
How did you decide on medical school and then the field of psychiatry?
Yeah, thank you.
(01:57):
Right.
Well, I am the daughter of a physician and a nurse.
So there was no way I was going to go into medicine.
And what really happened was, I had a wonderful interdisciplinary kind of educationaljourney at University of Chicago.
did a bachelor's in history, history and philosophy of medicine.
(02:19):
And that was fantastic.
And I had a job during that time.
where I worked at the school that was established by Bruno Betelheim.
It was called the Orthogenic School.
And it was a school for emotionally disturbed children that had been in place for manyyears at University of Chicago.
And when I went there, I saw a lot of young people with dysmorphic features, withrepetitive behaviors, with...
(02:53):
things to kind of a medical, from a medical lens, you could really see that there werebiological and medical determinants of what they were experiencing.
And the school did not want to view it in a medical model.
They wanted to view it more on a psychological model, was almost the era ofschizophrenogenic kind of logic that kind of the parents were to blame, or there were
(03:18):
dynamic factors that led to things.
And
I really felt uncomfortable with that.
And for some kids there, maybe kids who'd been traumatized or neglected, there really werepsychological or psychosocial factors that were totally driving their experience.
(03:38):
But for others of the children there, had some genetic loading or some medical conditionthat was really influencing their experience.
So I kind of reluctantly
became a future psychiatrist from that experience because I really felt that the childrenwere not receiving an appropriate standard of care and that we really needed many more
(04:02):
people to go into medicine who cared about child psychiatry or neurodevelopmentaldisorders.
And I felt very inspired to go into medicine.
So I had this history background and I did a master's degree.
in the Conceptual Foundations of Science there at University of Chicago.
And I did my pre-med requirements, applied to medical school, and then loved everything.
(04:28):
Maybe you did too when you were in medical school.
I loved everything.
But I really stayed true to this idea of going into psychiatry, but informed with amedical perspective, not a reductionistic or exclusionary view of it, but
At the very least, you had to include a medical or biological kind of component in termsof understanding children with mental health issues.
(04:54):
So you knew early on you kind of had that sense that something more was happening evenbefore you had kind of studied it.
Yeah, yeah.
And I don't know quite how to explain it.
It's just if you've, I don't know, seen a kid set a cup down 15 times or count, count,count, count, count, count, as I say, some of the children, you know, clearly had some
(05:23):
kind of a neurodevelopmental or genetic can be a component of their condition.
And so it, if you were observant, you know, you could see it.
And, and I,
I felt like the people there were fantastic people.
They were so dedicated.
They just hadn't been educated with the medical piece.
(05:44):
They see what mean.
And so that's why I didn't want to make the mistake of not seeing what was in front of mebecause I had failed to have a complete education.
least that's how I viewed it.
that anyways, that's how I ended up going to medical school.
And, and as I say, I loved everything, but I really wanted to stick with psychiatry.
Yeah.
(06:05):
And then what drew you to the ethics piece of it?
I know that you've done a lot of the ethics in your journey.
Oh, I think it was multiple hits there.
So one was that I had some preparation in terms of philosophy, moral philosophy, socialstudies.
(06:25):
I studied altruism and sociobiology.
I on a great adventure.
went to Australia when I was 19 and studied bird behavior.
And so I had a big interest in sociobiology and the origins of altruistic behavior.
And then this experience at the orthogenic school, I often say that turned me into afuture physician and a future ethicist at the same time, because I could see where very,
(06:55):
very good people inadvertently were doing, I think, some harm because they just were veryattached to certain ideology and didn't...
pay attention to say these medical features.
I want to say this very carefully because they really were very good people doingincredibly dedicated work.
(07:17):
But the ultimate result, at least for some of the children, was that they were deprived ofan appropriate standard of care for a period of time, which is an ethical justice kind of
issue.
And then probably the third hit was then later when I was an intern and I was taking careof a lot of people living with schizophrenia and
(07:37):
different psychotic disorders.
And there was a raging controversy about whether people with lived experience of psychosiswere able to give consent to say, be in research.
And working all day long with all different kinds of people living with psychosis, theanswer was sometimes they can and sometimes they can't.
(08:00):
But if we don't do research,
we're never gonna have the answers.
We're never gonna have improved therapies.
And so I started really looking at ethics of human research and ethics of researchinvolving seriously ill people, whether it was, I've done a lot of consult liaison
(08:21):
psychiatry.
So whether it was HIV or cancer or psychosis, schizophrenia, what was different?
I started being very interested in the question of
whether psychiatric exceptionalism was appropriate, you know, is there somethingintrinsically different?
Or what I found in our research is that this fundamental experience of suffering makes usall very similar, not quite so exceptional, right?
(08:47):
That's a bit different fundamentally.
So anyways, I started doing ethics work in part because I saw the need for research andwas convinced based on my clinical experience that there would be ways to do it ethically.
And there also were ways to do it in a very exploitative way.
And I wanted to kind of derive, empirically derive guidance for the field so that in thiscase, schizophrenia research could be conducted ethically and come up with answers,
(09:16):
improved care for people with such really devastating conditions.
your work has helped to establish that framework for vulnerable populations such as
Yeah, yeah, it's been fun.
It's been, you know, a great privilege.
In psychiatry, I feel like so many people with these kinds of sensitivities and interestsend up often going into forensic psychiatry.
(09:39):
Psychiatric ethics itself hasn't really been as well developed as a field.
So I feel honored to be among the people who've been kind of laboring to try and bringthis field forward.
And would like us all to be a little bit more reflective about, you know, what is
forensic, what's the forensic dimensions of psychiatry and what are some of these ethicaldimensions?
(10:02):
So as you think about important ethical issues in psychiatry currently, what are some ofthe more pressing ones do you think today?
my gosh.
I think, well, let's start with the doctor-patient relationship and then move outward,right?
(10:27):
So, I mean, I do think that there are...
you know, real threats to the creation of that therapeutic alliance when people don't haveenough time or they're not in a position to really connect with patients.
And so I think for all of us who serve and take care of patients, remain very, veryfocused and mindful on the ethical dimensions of that relationship and protecting that
(10:54):
relationship.
You know, our field is the field where we can model
how the therapeutic relationship makes a difference in people's lives.
And so there are lots of threats to that, not having enough time, not having a workforcethat's sufficient to make sure that there's adequate expertise there.
(11:17):
At one point you asked me about AI and there are like AI generated therapists now.
And I'm kind of in an equipoise position about it, it might be okay.
might not be okay.
So I think, right, the primacy of the doctor patient relationship is one thing that Ithink a lot about.
(11:42):
Confidentiality is very, very difficult.
Being able to protect privacy is very difficult.
Thinking about the repercussions of not having sufficient privacy, the stigma and theimplications for people's lives.
On a much bigger scale, I'm worried about equity and the fact that it's
(12:10):
Many people who develop mental disorders aren't able to work, aren't able to advocate forthemselves, aren't able sometimes to care for themselves, make decisions.
There aren't sufficient resources, facilities, workforce to take care of them.
So it's really a profound social justice issue, the lack of adequate resources and supportfor people with mental illness.
(12:33):
And then if you put on the perspective of the world,
and you see the disease burden, disability associated with mental disorders andneurocognitive disorders with the aging of our population.
You can just see the weight of these things.
Then intersect on that, people without resources, people who feel marginalized, it's clearthat there are many people.
(13:02):
even in this difficult situation, have a little bit more privilege.
And there are a lot of people who have a lot less access to resources.
So I think there's a lot there.
And I've already alluded to how the scientific neglect of mental disorders to me is aprofound issue.
We have so much investment, billions and billions of dollars of investment in certainmedical conditions, cancer, and...
(13:28):
And more power to them, have no, I'm not trying to take away in any way.
I'm just trying to advocate that mental disorders are profoundly disabling, are lifethreatening, are devastating across generations.
They deserve societal investment too.
So give me a day, I'll tell you more.
There's so many ethical issues, but those are the kinds of things that I spend my timethinking about and trying to address.
(13:52):
Yeah, and I want to follow up on a couple of those.
I know that you mentioned just the workforce.
About half of physicians experience symptoms of burnout.
And we know there are upcoming anticipated physician shortages.
(14:13):
Physician well-being feels like a moral issue, a financial issue, a public health issue.
Ethical responsibilities do institutions and healthcare leaders have to support thewell-being of healthcare workers.
Yeah, it's a great question.
you know, for people who are really interested in this, there's a lot that's been done.
(14:33):
There's a lot out there in the literature.
The AAMC in particular, the Association of American Medical Colleges has done quite a lotlooking at the determinants of burnout.
And, you know, two thirds of those are institutionally driven.
You know, the context in which people provide care.
(14:55):
I think, you know, years ago, I
first started studying medical student healthcare and medical student wellbeing.
It was one of the early people working in this field of professional wellbeing.
And at that time there really was less recognition of the institutional factors.
was more like a moral failing if you got burned out.
(15:18):
Don't you know that you should be inspired and that you should be tough, superhuman to bein this privileged role?
We've come a long way since then in terms of recognizing our own humanity and being selfcompassionate.
And I do worry sometimes, know, being a physician is always gonna be hard.
(15:42):
It's always gonna be meaningful, but it's always gonna be hard.
And I think we kind of sanitize or wish that everything was perfect and it could be all, Idon't know, lovely.
But if we're going to be with people who have these profoundly disabling conditions or theextremes of life or dealing with grief and trauma and loss, it's going to be hard.
(16:08):
So I think I emphasize that because there's a certain amount of insight that we all needto bring to the task of being a physician and the human condition and being right next to
that and the wisdom of pacing oneself and
safeguarding oneself to be ready for that work.
(16:29):
But there is a lot that institutions can do to create a platform of support and compassionacross teams, communication, sufficient staffing, a milieu in which perfection
(16:50):
isn't expected.
Mistakes are understood to be sometimes things that occur and that we respond to supporteveryone when there's a mistake.
So anyways, there are a lot of things that institutions can do.
And the only other thing I want to comment about this is I'm so tired of the term burnout.
I don't like deficit framing.
(17:10):
I like finding sources of resilience, finding sources of professional fulfillment, finding
empirically derived solutions to help us learn how to sustain ourselves.
And I do think, I do want us to look at the unvarnished truth that burnout exists, but Iwould also like us to elevate the positive aspects of being a caregiver.
(17:39):
We're the luckiest people in the world.
We're educated, we're supported, we're given a privileged role in society.
And so we do have some responsibility to keep focused on the positive and the ways inwhich we can serve and support others.
And I do worry that we get a little caught up in this negative negativity.
(18:00):
And my gosh, after the pandemic in particular, you know, no harm, no foul.
It's understandable.
But as I look to the future, I really would like us to figure out how to build in apositive way toward the future.
so that we can support others without exhausting ourselves.
(18:21):
And I also think it's a richer conversation about wellbeing to discuss fulfillment anddiscuss all of that and not just eradicating burnout, right?
It's a richer conversation.
So as we think about system level changes, for instance, in terms of enhancing wellbeing,
(18:51):
efficiencies in the work environment that could also improve work life integration andimprove kind of that spillover if there's more efficiencies.
What are your thoughts on work life integration?
It's a topic that is very important and women is a topic in terms of dissatisfaction.
(19:18):
So, reason women physicians exit.
What can we do to enhance work-life integration for men and women?
Yeah, you know, so it's interesting.
My father was a physician.
My stepfather, really, I consider my father was a physician a long time ago.
And, you know, he lived in the hospital for like years when he was doing his training.
(19:42):
He had zero roll strain, zero.
He was a physician, period.
And it's interesting to think about
how as we've tried so hard to live a complete life and be a, you know, fulfillment in ourhome life and fulfillment in our professional life and seeing them as different has
(20:10):
actually paradoxically brought some new challenges.
I'm not recommending the old model, but I think it is worth reflecting on how
I almost see it as another kind of perfectionism.
We're supposed to be perfect in our roles as physicians and we're supposed to be perfectin our roles as mothers, spouses, daughters, sisters, best friends, et cetera.
(20:33):
And if you create, we just let go just a little bit and not be quite so demanding ofourselves.
so I'm not sure I have any insight that anybody else would have on this.
I would just comment that in my life,
I've had worse role strain and exhaustion at certain points and less at other points.
(20:59):
I've had adapted work styles where I worked like a fanatic at work and then I went homeand I stepped completely back.
Didn't do any work.
And then I've had other periods where every spare minute I would go in the other room,have to work on the computer, take a phone call, et cetera.
And it was
integrated kind of in terms of it being from a time perspective.
(21:23):
And so, and probably the, the time when I have the least roll string in my life wasactually after I lost my husband, I lost my husband.
It's a fairly, fairly young mother with a bunch of kids.
And before that, it was really interesting.
I had to be a perfect woman, know, perfect mom, perfect this perfect that.
(21:48):
And then I was in a more male oriented field, right?
And at that point, actually, I was a chairman of psychiatry at a medical school where myfirst leadership retreat, there were 43 men in me.
I was the only female in the room.
I've been kind of a first female in some ways.
(22:08):
But after I lost my husband, it was very interesting.
I didn't feel as guilty about holding a role that some might view as more typically
a role held by men, especially at that time.
It's a little bit less a problem now.
Kind of all my roles just came down to one, to take care of my family, to be a goodmother.
(22:30):
I had to go to work and I had to take care of everybody in my world.
And part of that was the job I had allowed me to do that.
And it was interesting to not have roles during anymore.
I was almost like I didn't realize the burden I had had, the guilt I felt being a littlebit late, being a little bit, not being fully present, fully accessible, fully every
(22:55):
single minute, every single day.
It was like I could give myself some space to just be who I needed to be just to getthrough the day and to take care of the people and all that.
So I don't know if other people are going to have a moment where
there's some pivot or some difference.
(23:16):
For you and for the listeners, I remarry, I have an incredibly lovely husband, I have morekids, my life is lovely.
But it was interesting to have this sudden shift and to recognize more of what I'd beencarrying before that moment.
And I don't know if people could do a thought experiment or some way of suddenly shifting.
(23:42):
their mindset or their self reflection, and maybe let go of some of it that we put onourselves.
We put I don't mean in a blaming way.
It's natural in response to the kind of social pressures we feel.
But if there's just a way somehow to step out of it and then choose or be in it or not, orat least be self reflective with some of those pressures that we feel.
(24:07):
Yeah.
so insightful you know I am just thinking as you're saying that you know is that is thatis there a role for coaching to kind of come out of the way that you normally see things
and kind of maybe see them from a more compassionate way or self-compensation
(24:33):
I'm a big fan of coaching.
I like coaching.
I have this wonderful coach.
had, I don't know, when we're in psychiatry, we learn a lot of skills that translatebeautifully to administration.
So a lot of things about administration are pretty natural for me or pretty easy or I canuse my skillset and work through it.
(24:54):
But I did have a challenge that I was really struggling with.
And anyways, I got this coach.
He was wonderful.
and he had this Buddhist training and we would talk about things.
But one time he had me do a kind of visualization exercise, you know, where I could haveimagined and I was relaxing and I was like, know, well, I become a bird.
(25:16):
I'm a bird.
I'm a bird flying around and there's a storm coming.
And what do do?
I fly higher.
And what we ended up doing was talking about that because that's totally what I do.
If there's a conflict, I pull up and understand the full context.
(25:39):
I don't see conflict.
I pull out of it.
And it was just a really great way to get insight about my own adaptive style aroundcertain kinds of conflicts.
It was incredibly useful for
the work I did with this coach around the one particular issue I was struggling with atthat time.
(26:00):
And I think if you have a really good coach, just like if you have a really good, I don'tknow, therapist or psychiatrist or whatever, they can bring you out of your usual
defenses.
In residency, we had this wonderful therapist who taught us imagery techniques.
And in that case, it was interesting.
We were walking, we're walking in a river, beautiful green.
(26:22):
sky is shining, blah, blah, blah.
You look down, you find a box, you open up the box.
Well, what did I found?
I found a compass.
And I think about that all the time.
I had a thing in my life I was struggling with.
I was thinking which way to go.
I found a compass.
So if you work with somebody really good, a coach or a therapist, you can shift out ofyour usual defended place and think differently.
(26:49):
So I like your suggestion that way.
think the other guided imagery coaching exercise is the future self, you know, when peopleare struggling with clarity in choices and things.
Have you ever done that?
So I coach faculty here at Georgetown and I've done that with a few people and there theseaha moments of it's pretty neat.
(27:17):
Isn't it neat when people are like way smart and they're thinking all the time and they'reself observing and yada, yada, yada, but you can disrupt it and do something.
So thank you for doing that.
I think that's great.
I bet your, people really, really appreciate that experience with you.
think it's what you just said with administration.
think the coaching piece, trained as a psychiatrist comes a little more naturally.
(27:45):
Yeah.
And also you value insight.
value how that shift can make a difference in people's lives, which I don't know, from adistance might seem a little, I don't know, corny or not as impactful.
But if you're with it, you know, really with a person who's in that experience, it reallydoes make a difference.
(28:07):
Well, and the premise of coaching, really like to the premise is that the person in frontof you is whole and capable and has the answers within them.
And you're simply giving them props and exercises for them to come to the answers theyhave within themselves, which is also.
(28:32):
The next way to think through it.
Yeah, getting at that deficit thing we were just talking about, right?
Viewing people in a more complete, you know, prepared sort of way.
So I would love to hear you lead in so many different ways.
(28:53):
I'd love to hear some of kind of your insights in terms of women in leadership.
know, it's so nice for the younger generations to be able to look up and see people likeyourself.
and you know and know that there are amazing women leading in these ways.
(29:17):
Having said that there's also more work to be done in this area.
What do you think about as you think about departments and institutions looking to promotemore women into leadership?
What advice would you give or what are your
thoughts?
a lot of different thoughts.
(29:38):
I mean, I've ended up in leadership roles because I'm a responsibility seeker.
You know, I'm, in fact, I'm comfortable with competition and kind of, I don't know,whatever sports analogy there might be, but I, I naturally shoulder responsibility.
(30:00):
And, and I'm more comfortable
when I'm shouldering the responsibility than sometimes when I see other people doing it.
You know what I'm saying?
maybe it's a little, I don't know, self-aggrandizing, I'm not sure, or maybe controlling,but it's just when I'm in a situation, I step up, I like responsibility, I feel solid
(30:29):
holding responsibility.
And I actually prefer being behind the scenes.
I have visible roles and maybe that'd surprise people, but it's not my preferred place.
I'm much happier holding responsibility and I don't care where I am kind of on theplatform for that.
(30:49):
So I guess the first thing would be to understand kind of what your motivation is and whatmakes you comfortable, what makes you uncomfortable.
I think a second thing is
You know, I did not see people who looked like me in positions above me.
And I don't know if I'm just clueless, but that didn't bother me.
(31:13):
It was more that if I could see a way that I could hold responsibility and bring aboutbetter things or protect certain things that matter to me, that felt okay, you know.
So I think I was not as sensitive to certain
I don't like a lot of visibility, but I don't think I was as sensitive to some of thethings that other people worry about.
(31:42):
Do I look like the other people in the room or do I fit in or am I supposed to be here?
I kind of just didn't have that.
I had a little bit of imposter syndrome, but I wasn't really preoccupied with that.
was more, my gosh, this matters.
And if I don't do it, who will?
(32:04):
My psychology is a little bit more like that.
And the other thing I would say about myself, and I think it worked out well in the end,but it could have not gone well, was my interests were pretty diverse.
So I developed skills in medical education, in consult liaison psychiatry, I got trainingin child.
(32:32):
general adult and child psychiatry.
I started doing research on informed consent.
I also in it, well, I first did medical student healthcare and resident healthcare andphysician wellbeing.
And then I was doing informed consent and vulnerable populations.
And then I was in New Mexico.
(32:54):
So I was doing rural health disparities and.
And there were all these things with genetics.
And so I was doing genetics innovation.
I, you know, I am very comfortable with multiplicity.
So, but I was doing a lot, a lot of different things.
My first job was part time and I was carrying all these different kinds of things.
(33:14):
And I think objectively,
my advances in each individual area did not go as quickly as someone who just had a narrowgoal, was really goal-focused and just ran in one area.
But that was okay with me.
(33:35):
I was loving it and doing good work and holding all these things.
And then I started seeing all these connections that were really exciting about
you know, what context creates vulnerability?
What context creates strengths?
How is a medical student with an, as an overlapping role as a student in a patient kind ofsimilar to some of the things that people who were employed and then their boss asked them
(34:01):
to do genetic testing for their job.
How is that similar to a recognized vulnerable population like an imprisoned justiceinvolved person with mental illness?
I mean, I just could see all these connections.
So it was fun for me, but I think it's contrary to the advice, know, go narrow, go fast,just focus on one thing.
(34:24):
And I just didn't do that.
I'm very comfortable with multiplicity.
But what it meant was then I built a big skillset.
I built a lot of areas of knowledge, huge networks of friendships.
So I had, you know, I have a whole ton of friends that are researchers and I have a wholeton of friends who are educators.
I, you know, I...
(34:44):
it ended up having all these wonderful, it bore so much fruit, but it was contrary to themaybe the advice, career advice that you would get.
And I already mentioned my first job out was part-time and people would say, can you beserious about academics if you're part-time?
And I'm like, watch me, it was kind of my response to that.
(35:07):
I didn't feel the need to explain it really.
And then,
Over the arc of my career, all the pieces came together.
So, you know, the administrative skills, skillset, content expertise and clinicalresearch, education, all these different pieces.
And then now in this last, I've been a chair for a long time now, but these last manyyears, I've kind of drawn upon all those experiences in these leadership roles.
(35:38):
Well, and as you what we're going through it, it sounds like you must have really knownyour North star.
Like you really were grounded in this is these are the things I want to do and it's okay.
And you know, I think sometimes the linear the linearity and the kind of what you shoulddo confusing for folks, but it sounds like you
(36:06):
able to just be true to what you wanted to study and what you wanted what you wereinterested in and some of the rest of it.
I mean, think so.
I mean, if you if you I've had a very unexpected career, right?
I mean, if you told me that I would be the chair at Stanford, you know, leading thisphenomenal department, I would not have believed you.
(36:32):
mean, I would tell you I would be like running something.
I'm sure of that, because that's just how I'm built or carrying a lot of responsibilityfor sure.
But
That's part of what I love about academic medicine and academic psychiatry is there are somany ways to serve and contribute.
(36:53):
There's so many paths, for example, to leadership, but there are so many ways, I mean,look at you, so many ways to serve in your clinical capacity, then use that strength to
support others in some way, and then to further lead at a national level with all of thattogether.
think academic medicine is phenomenal.
(37:13):
It just is wide open.
So there's a lot of creativity.
And I guess I would hope that people who are listening would exercise that, know, see thatas something that they can do, not be cookie cutter in terms of, don't know, I do
inpatient psychiatry, let's say, or I do this or I do that.
Like forget all that, but put it all together and feel that you can.
(37:38):
And the other thing is, you know, I...
you talked about my undergraduate, you know, I've always loved writing and you know, look,all day long now I'm working with words that, know, with my editing roles and in academic
medicine and with APA publishing.
And so it comes around.
(37:59):
I guess that would be the other piece of advice is you don't have to do everything, everysingle thing, every single moment, every single time, or you'll lose it forever.
That's not how it is.
can weave it, you can do part-time, you can do full-time, you can do this kind ofactivity, and just you can hold it and bring it together.
And all these passions and loves, that's another thing about psychiatry that I love, allthe things that make us who we are are things we can connect with others around, and you
(38:26):
can bring that to the work itself.
it's, to me, it's just a wonderful, a wonderful profession.
And I think that for women of younger generations who might be starting out or trying tofigure this out, it is really helpful to have someone like you, you know, just reiterate
(38:48):
that it to follow kind of your heart and, you know, meander if you need to a little bitand do things that you enjoy.
Yeah.
But now I'll say the tough part of it.
mean, but you also have to be a little bit tough.
You know, let's let's be pragmatic here.
You have to build certain skill sets if you want certain kinds of roles.
(39:11):
So passion and authenticity are the to me are preconditions.
But it's good to be smart and strategic.
So, you know, because I've had I've had the hard side to
I've had, you your, you know, part time mommy, you don't get an office and a computer.
(39:36):
You're, I don't know, you're not serious, you're part another one, you're part time,you're not serious about an academic career, you know.
Another big one that a lot of people in psychiatry, you're in psychiatry, you're not aserious physician, you know, there's all kinds of ways that and
(39:59):
How did you navigate some of those films?
Yeah, I don't...
Sometimes I get mad, you know, like make me mad, you know.
I was like, you raise a bunch of kids and write an R01 and then tell me who's seriousabout doing research, you know.
(40:19):
But I can't stay in that place very long, you know, maybe get me over a littlemotivational hump or something to put a little extra work into something.
But I think the rate limiting steps that I see for a lot of people are speaking skills,financial skills.
(40:44):
I'll say writing skills, but writing skills as applied in lots of different ways.
So grant writing or publications or whatever.
Figuring out how to leverage power is...
So I was in New Mexico.
And a lot of people didn't think highly of New Mexico.
(41:07):
I went there because it was a place where I felt like I could make a difference.
I mean, I feel like I've had the best training of anyone I know because the patients wereso extraordinarily ill.
I really, really learned a lot.
But so, you know, it kind of got my backup that people didn't understand what anextraordinary place, the extraordinary training.
(41:32):
And so, you know, I would do things that would bring visibility to the excellence of theprogram I had in New Mexico.
So I don't know, I think I was strategic.
You know, I learned, I'm good with money and I learned about budgeting and you know, I'mnot scared of money.
don't view it as the, I view it as a path toward good, not a source of evil or whatever.
(41:56):
So I really encourage people to understand.
you know, how money works, how resources work, how to leverage resources to accomplishsocial good.
And you don't learn that in medical school, something, it's a skillset you have todevelop.
really encourage people to learn how to speak comfortably and clearly about complexthings, how to write.
(42:20):
If you want to be a researcher, how to write grants, how to write papers, you know, there,there are these kinds of threshold skills.
And I wouldn't have the career I have unless I was able to acquire them.
I did do some professional leadership.
I'm interested if you did too.
I did do some professional leadership training things.
I had kind of a mixed reaction to some of them.
(42:44):
But what I did do is I met kind of other people who maybe were recognized for theirpotential, leadership potential.
And so talking with them, networking with them, that was always valuable.
Even if I thought the program, like, oh my God, I went to one program and there was thisperson wearing a very loud outfit and she said, oh, the key to leadership is you have to
(43:09):
have a very big watch and a hairdo that people remember.
And I was like, give me a break.
And I was like, wow.
And I always have a hairdo that people will remember.
to me, it was so contrived.
You I didn't like that.
So, you you're gonna get, you're gonna...
You're going to have your own opinion about what material is presented, but meeting otherpeople is always, always valuable.
(43:33):
And I think that even for professional meetings and other places, there was the content,is great, but also meeting people and connecting with people.
Yeah, I think getting involved.
sorry, I was just gonna say, I do think getting involved with professional societies isreally critical for all the things we talked about, know, self care, kind of calibration
(44:00):
in the world, you know, being somebody, my God, what job did they offer you on the EastCoast compared with the Midwest compared with the West Coast, you know, supporting one
another, writing letters from one another, nominating each other for awards.
you know, comparing notes and supporting one another when you go through difficult lifeexperiences, those are incredible relationships and friendships.
(44:24):
So I think that's another protective and supportive factor for sure in my career.
And I hope others would pursue those.
Dr.
Roberts, feel like I could talk to you for another hour, but your time is up.
It has been just fabulous to listen to your pearls of wisdom.
And so I really appreciate you taking the time with us today.
(44:47):
Thank you so much.
I'm very grateful for the conversation.
you.
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