>>WOMEN IN PSYCHIATRY: PERSONAL PERSPECTIVES

This is the last in a series of biographies excerpted from the new book Women in Psychiatry: Personal Perspectives published by American Psychiatric Publishing. The book was edited by Donna M. Norris, M.D., Geetha Jayaram, M.D., and Annelle B. Primm, M.D. The book may be ordered here; APA members are eligible for a discount.

Having the Courage and Conviction to Succeed

by donna m. norris, m.d.

“I’m Just a Lucky So-and-So,” a popular Duke Ellington song from 1945, was one of my childhood favorites. At the time, my mother humorously compared the tune’s dissonance with our family’s stressed economic situation. But the lyrics were prophetic about my future.

In public school in Columbus, Ohio, I recall my fourth-grade teacher asking us, “What do you want to become when you grow up?” Classmates ahead of me answered with their lists of hopes, and the teacher nodded affirmatively. When my turn came, I said, “I want to become a doctor.” The teacher seemed puzzled. “Well, you should choose something that is more likely for you, a Negro, to achieve, such as training to become a teacher or a nurse.” As other classmates turned to stare, I experienced a mixture of emotions: surprise and embarrassment. Though very much aware of race and segregation, I had never viewed them as limiting my achievement. But my shock at hearing this from my teacher made me question my long-held dream of becoming a physician.

Where did this idea about medicine come from? There were no doctors in my family and only one African-American general practitioner in my neighborhood. Very few persons of color were subjects in my schoolbooks. Most of my high school classmates went straight to marriage or blue-collar jobs. I attribute the idea that I could accomplish something so far removed from my environment to the support of my deeply spiritual family, my friends, and my unwillingness to allow others to limit my aspirations.

Path to Equal Opportunity
“Education and hard work are the keys to opportunity” is a familiar mantra among minority populations seeking to build better lives for themselves and their families in this country. My family worked actively in the church and set me an example of leadership within its nurturing environment. Volunteer service by church elders, most of whom had little formal education, was valued, and it allowed these men and women to achieve a measure of status and respect within the African-American community that was not possible in the outside world. My church, like others in the community, was also a gathering place for politicians of all racial groups seeking the African-American vote. These early experiences likely ignited my interest in understanding more about the influence and power of politics in all aspects of American life. When I graduated from high school, the question was not whether to attend college, but which college and where. By the 1960s, most white majority colleges accepted a limited number of black students. But many African-American families, mine included, were concerned. Would these schools be fair in the treatment of their children and nurture their academic success?

My family encouraged me to attend Fisk University, one of the historically black colleges, in Nashville, where I had relatives. At the time I arrived, Nashville, referred to as “the Athens of the South,” was still a segregated town beset by sit-ins at the lunch counters and demonstrations at the department stores. The Fisk campus, in contrast, was a bustling educational environment. Although most student activity was confined to the campus, the richness of the liberal arts curriculum offered by a devoted and racially diverse faculty was without boundaries.

Whenever perceived injustices are not readily addressed, I am reminded of the saying “things are not always fair.” When I was applying to medical school, I knew it would be a long shot, not just because of the academic rigors but also because of the expense. I could not afford even the application fees to Howard University College of Medicine and Meharry Medical College. For me, the least-expensive medical school would be Ohio State University College of Medicine. My internist quietly informed me that he was barred from attending this school because of quotas limiting admissions of Jews. Nonetheless, he encouraged me to apply. As expected, the interviews with the medical school admissions committee were stressful. They inquired about my motivation for a medical career and my personal life plans. One member suggested that if admitted, I would take up a slot for a man, who, he noted, would likely have a longer and more productive career. When accepted, I applied and was named one of the two semifinalists for a privately funded scholarship. Although told that my academics and interviews were superior to those of my male classmate, I was informed that he would receive the grant because he was male. Today, few would be so bold as to verbalize such flagrant gender bias.

My arrival at medical school was a major cultural change for me, and in looking back I believe that it was also a cultural shock for many of my classmates. The shock for me related to the lack of diversity, and for others, it was, perhaps, the presence of diversity. This was a historic class for the school, including the largest number of women—13, less than 10% of the freshman class. These women quickly bonded. Four other women and I rented a house together, formed study groups, and stuck together throughout medical school. At first, I did not fully appreciate that many of my classmates were limited in their life experience with women and others of diverse minority, cultural, and ethnic groups. Later, some shared with me that they had never attended school with or ever personally known a Negro person. For many, their world—education, religious life, housing, and socialization—was separate and segregated in different respects from my experience.

There was much to learn: the complexity of disease processes, the scientific and medical terminology, medicine’s hierarchy, the cultural dimensions of the patients and my fellow classmates, and how I fit into this complex schema. Early on, I noticed that things that were funny to me did not strike the same humorous note with my classmates. I truly missed my college friends, with whom I was so in tune that we could just give a look and understand each other without any verbal explanation. Humor can be an adaptive response to manage anxiety situations, but I also observed another sort of “humor,” not funny but hurtful and demeaning, that was often shared in the closed group between physicians and students. Their jokes were often at the expense of illiterate and economically disadvantaged patients regarding their particular cultural practices. I reflected on my position as having a foot in both worlds but without much power in either. There were many valuable lessons learned in those days about how to manage myself within the differential power setting of being an “only one” in a group: the only woman, the only African American. At that time, the women’s liberation movement was gaining momentum, but there was little in the literature about negotiating these challenges. Now, a rich body of scientific work written by women is available regarding the dynamics of working in predominantly male groups.

My dream then was to pursue a career in pediatric medicine, not psychiatry. In my community, psychiatry was not well respected, and I had never met a psychiatrist until I arrived in medical school. Several life experiences were important in focusing my interests in psychiatry and in learning more about human behavior and personality development. One of these was that as a medical student, I worked with a patient on the consultation-liaison psychiatry service who had attempted suicide by handgun and sustained injuries that left her unable to pursue her vocation. Severely depressed and hopeless about the future, she faced a life of blindness following her suicide attempt. The therapeutic challenge was to build a bridge of hope for the future. Following this work, my supervisor strongly urged that I consider a career in psychiatry. This encouragement was the beginning of my interest in this field.

Mentorship, Leadership, and the 21st Century
As I made my way through medical school, residency, and early and mid career, struggling to achieve balance with marriage and motherhood, many wonderful mentors encouraged me and helped me negotiate the challenges of race and gender and prepare for the leadership roles I have been fortunate to hold.

In May 2010, APA’s Committee of Black Psychiatrists honored me as the Solomon Carter Fuller Award recipient, which required a lecture presentation at the APA annual meeting. In preparation, I interviewed leading African-American and white American psychiatrists regarding their perspectives on racism in American psychiatry and the sociopolitical changes that have occurred before and since the life of the first African-American psychiatrist, Dr. Solomon Carter Fuller. One member of this distinguished group noted that although there has been great progress in this country, “race is one of the most important issues . . . facing the world as we enter the 21st century.”

With respect to African Americans and leadership, the historical fact of slavery adds additional complexities to how our voices are heard and understood. These experiences are unique and should be understood in the context of an important history that is a powerful reminder of the realities of life for African-American women in American society.

To return to the song with which I started these reflections, I have indeed been lucky. The most important piece of luck was to have a wonderful extended family who enabled me to seize the opportunities presented, to accept and manage the challenges that might seem beyond my grasp, and to understand that the world, while not always fair, can be a place of excitement and learning and holds a treasure of life experiences.

Donna M. Norris, M.D., is senior editor of the volume Women in Psychiatry: Personal Perspectives, from which the extracts in this series have been drawn. Dr. Norris is an assistant clinical professor of psychiatry at Harvard Medical School and a distinguished life fellow of APA. Her leadership and governance roles in APA have included secretary-treasurer, Area 1 trustee, Assembly speaker, and long-time membership on the Budget Committee.

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