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September 2013 Bulletin: Women in Medicine

Carol Cooperman Nadelson M.D.: A Pioneer in Changing the Face of Medicine

Carol Cooperman Nadelson, M.D.

— Carol Cooperman Nadelson, M.D.

My desire to become a physician began with the terminal illness of my grandfather when I was a child. At that time medicine was not an acceptable career goal for a woman. I found support for my aspirations in the very few role models available, from some of my teachers and family, and from the heroines of literature and history, including Nancy Drew and Marie Curie.

Applying to medical school was discouraging. Explicit and implicit quotas existed, based on gender, religion and background. My interviewers were convinced that women would 'take up a place' in medical school and never practice medicine, especially after they had children. This belief justified questions from them about my social life, contraceptive use and plans for marriage and family. Despite my academic performance and record of leadership among my pre med colleagues, 99% of whom were men, I was accepted at only one medical school; I had applied to 24.

Being admitted to medical school in the late 1950s was the first hurdle. All 8 women at University of Rochester College of Medicine and Dentistry would meet in the 'ladies lounge', a pink locker room, where we shared our humiliations and victories, sometimes in tears and sometimes with humor, as we encouraged one another. We believed that we should be grateful to have been accepted and that we had to prove ourselves worthy. We learned to ignore pornographic slides during lectures, and frequent taunting. My search for an internship in medicine repeated my medical school application experience. Despite an outstanding record, only my own medical school was willing to take a chance on me.

When I recount some of my experiences to students, their incredulous expressions are a measure of how much has changed in a relatively short time. To recreate the views of the era, I am reminded of a Harvard Professor of Medicine who, when asked a question about a woman patient in 1965, stated "women are not like normal people".

During the 1960s and 1970s, the civil rights movement and the increasing force of feminism sparked social consciousness and activism. These societal forces affected medicine and stimulated discussion about how women physicians could transform the care of women and the practice of medicine. It was in this context that my career as a faculty member at Harvard Medical School and a psychiatrist at Boston's Beth Israel Hospital began to take shape.

At this time I had married and faced the struggle of all women with career aspirations, balancing family and professional life. A small group of women physicians, pregnant and meeting for lunch in the hospital cafeteria, generated a plan to start a day care center in the medical area. At the time there was no day care available. We brought our vision for childcare and the realities of this daunting project together and I took on my first leadership responsibilities as President of the newly created Center. We found a setting, collected furniture, battled hostile colleagues and local authorities, and succeeded in founding a superb cooperative day care center, which still exists in this community.

One of my mentors, Malkah Notman MD, and I shared a vision about women's health and reproductive rights, and began to work closely together. In those pre Roe v. Wade days, we joined with physicians from several specialties and a diverse group of clergy. We founded Pregnancy Counseling Service to provide counseling and resources for women with unwanted pregnancies. Our work with obstetrics and gynecology included seeing young rape victims. Recognizing that little was known about their care, we started an interdisciplinary group of colleagues and persuaded the hospital to support us in opening a Rape Crisis Center. In addition to the clinical services we provided, we studied the psychological repercussions of rape and abuse. From post rape responses we conceptualized Post Traumatic Stress Disorder (PTSD) to include trauma that was not primarily a post combat response as we had been taught, but resulted from other trauma as well, including rape and abuse.

We continued to study and write about the challenges, conflicts and achievements of women in medicine. Our publications bridged psychiatry, psychoanalysis, social policy and medicine. Our first book, The Woman Patient: Medical and Psychiatric Interfaces, launched a series of edited volumes exploring women's health and mental health. It was considered a landmark volume and it defined our careers, our 45 year collaboration and the field of women's mental health.

The civil rights movement profoundly influenced Harvard Medical School. When, in the late 1960s, Dr. Leon Eisenberg was appointed Chair of the Admissions Committee he, together with like minded faculty, set out to reconsider the decision making process and the criteria for admission. To my surprise, he appointed me, a newly minted Assistant Professor, to the Committee and to Chair a section of it. He believed that as we increased the numbers of minority students at HMS we must also increase the numbers of women students.

As I progressed in my career I was fortunate to have several leadership opportunities. I was elected the first woman President of the Massachusetts Psychiatric Society. It led to other organizational leadership positions, and to the development of a national profile in psychiatry. Then in 1984, I was elected the first woman President of the American Psychiatric Association (APA) in its 144 year history. My victory was a clear statement about changing values and expectations. My presidential year required leadership with an enormous, at times staggering, range of controversies and crises. Among them, I dealt with international conflicts regarding human rights abuses and the problems of chronic mental illness, debates about psychiatric diagnosis, treatment, and education, and concerns about changing values in medicine. I also was able to add women's leadership to the agenda of the APA. I am proud that in 2009 the APA elected its 8th woman President.

When I was appointed to lead the American Psychiatric Press Inc. (APPI) in 1986, it was a fledgling enterprise and I had no experience running a publishing company. Among my goals was to encourage women to write and be the 'experts' in their fields. I was startled by the small number of women who volunteered and how many, when asked to write a book or article, told me that they didn't have the expertise. I was dedicated to opening opportunities and encouraging women to accept them. It was immensely rewarding for me to see APPI grow to be the largest publisher of psychiatric books in the world, with many women authors and editors.

By the late 1990s women were entering a wide range of specialties, but their careers did not advance in the same way as did men's. They remained concentrated in the lower academic and leadership ranks. They continued to experience discrimination, harassment and inadequate mentoring. In addition, the demands of motherhood continued to slow career progress. A study of academic women at Harvard Medical School found that women with children were underrepresented at the rank of professor, but women without children were as likely as men to have attained that rank. Although there has been substantial progress, by 2013 women continue to represent a small portion of senior medical leadership.

With increased commitment to bring my activist soul to help develop women leaders in medicine, in 1998 I accepted a newly created position as Director of the Office for Women's Careers at Brigham and Women's Hospital (BWH). The stimulus for this office came from a faculty study revealing inequities between men and women in salary, promotion, visibility, leadership, mentoring and academic support. The Office has provided opportunities for discussion of career family balance and life cycle issues, developed programs to enhance skills in negotiation, leadership, mentoring, professionalism and a range of other areas, fostered better communication and networking, lobbied for more progress on the academic promotion of women, salary equity, transparency in leadership opportunity, annual career reviews, an endowed chair in women's health, parental leave and day care.

There has been significant progress in the advancement, influence and visibility of women in leadership positions. We have established a Center for Faculty Development and Diversity at BWH so that all of our faculty can benefit from and expand on what we have learned and helped create. But, we still have work to do!

While the stumbling blocks to gaining entry to medical careers, experienced by the pioneers were overcome, the slow progress of women in leadership positions in medicine leads to the conclusion that cultural change is necessary if women are to be significantly represented. As Nancy Andrews, Dean of Duke University School of Medicine stated: "Medicine remains a profession designed by and for men." To transform this requires that both men and women be at the table together. Women must be visible, persistent, vigilant and self-confident. They must be willing to recognize opportunities, accept challenges, take risks, collaborate and lead.

Dr. Carol Cooperman Nadelson is a Professor of Psychiatry at the Harvard Medical School and founding director of the Partner's Office for Women's Careers at Brigham and Women's Hospital in Massachusetts. Born in Brooklyn, N.Y. Nadelson graduated magna cum laude and Phi Beta Kappa, with a degree in biology, from Brooklyn College in 1957. She attended the University of Rochester College of Medicine and Dentistry, where she obtained her M.D and was elected to A.O.A. She was the first woman president of the American Psychiatric Association and editor-in-chief of the APA Press. She is a recipient of the Elizabeth Blackwell Award for contributions to the cause of women in the field of medicine, the Alexandra Symonds Award outstanding contributions to psychiatry and significant leadership in advancing women's health, as well as the 2009 Alma Dea Morani, M.D. Renaissance Woman Award recipient by The Foundation for the History of Women in Medicine (FHWIM). She is a Fellow of the American Academy of Arts and Sciences.

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