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. Lisa Dixon. Dr. Dixon is the Edna L Edison Professor of Psychiatry at the Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Hospital. She directs the Division of Behavioral Health Services and Policy Research within the Department of Psychiatry. Dr. Dixon is an internationally recognized health services researcher with over 25 years of continuous funding from the National Institute of Mental Health and the VA. She oversees activities for the New York State Office of Mental Health in implementing evidence-based practices for persons diagnosed with serious mental illness.

Transcript for Audio

Dr. Lisa Dixon (00:00): I think mentorship is so critically important. It makes the experience, whether in school or in a career, personal, human, also funner, and it helps you individualize, I think, your path.

Dr. Anjali Gupta (00:32): Welcome to the Women in Psychiatry Podcast by the American Psychiatric Association's Women Psychiatrists Caucus. I'm Dr. Anjali Gupta, President of the Women Psychiatrists Caucus, and I'll be interviewing women psychiatrists across the country who lead in a variety of ways so that we can hear their stories and learn from their insights.

(00:54): Thank you for for joining us today, and I have the pleasure to be here today with Dr. Lisa Dixon, Editor-in-Chief of Psychiatric Services and a national leader in numerous ways.

(01:06): Hi, Dr. Dixon. Thanks for being here today.

Dr. Lisa Dixon (01:10): Hi. Thanks for having me.

Dr. Anjali Gupta (01:12): So just to start out, going back many years in your journey, who or what inspired you to go to medical school?

Dr. Lisa Dixon (01:24): Well, it's a story with two polls, a happy poll and a not so happy poll. Probably the most important influence was the experience in my family. I really hadn't given medicine much thought. I certainly hadn't given psychiatry much thought until one of my siblings basically developed schizophrenia in college. It's hard to describe how alarming and scary schizophrenia as it's unfolding in a family member or someone I was very close to, what it's like when you don't know anything about it, when it's not ... The word was still split brain.

(02:28): So when my brother became ill and I got introduced regrettably to a whole world that was important, challenging, and scary, frustrating, and potentially positive in the sense that maybe I could make a difference. So I had this experience in my family, and then on a slightly brighter note in certain ways, I took a course in college in the sociology department, and the lecturer, the teacher was Paul Starr, who I believe is now at Princeton, though I'm not sure. He wrote a book that in retrospect I think was the foundation of the course and it was the social transformation of American medicine.

(03:33): I was never really a biological scientist. I was always more of a social scientist. That was my identity. I was an economics major at college. This book and this course, and this professor opened my world to understanding healthcare and medicine in a way that made sense to me really as a product of social, biological, political influences, and that among other things. Health and healthcare, so complicated, so much about culture, so much about who we are and who we take care of.

(04:25): So when I understood through this course that healthcare was actually in my space, I was like, "Okay." So I had this one experience where my brother was actually getting sicker, and then I was understanding that an approach wasn't simply how I understood medicine at that point, which was you go to the pediatrician, they take your weight, they give you medicine, and whatever.

(04:58): So I think those two things converged, and I wound up, since I had not taken any pre-med courses in college and I probably had never even been in a hospital for a long, long time, I said, "Well, I am going to take pre-med classes over the summer and another year." I also worked as a unit clerk at what was at that time the lying-in hospital in Boston, which I think subsequently became part of the Brigham and Women's. Anyway, and then I applied and then fortunately got in and here I am.

Dr. Anjali Gupta (05:41): I'm so sorry about your brother. It sounds like that was a contributing factor to you applying. Did you go to medical school then? Did you know that you wanted to be a psychiatrist at that point?

Dr. Lisa Dixon (05:56): Oh, yeah, no, there was no chance I was going to be anything other. Obviously, you never know. You're sure of something and then it totally becomes the opposite in life, but at that point, I was really interested in psychiatry and I was interested in mental health and I was interested in public health.

Dr. Anjali Gupta (06:19): So when you think of those early years of medical school and residency, as you consider mentorship, what comes to mind for you?

Dr. Lisa Dixon (06:31): I think mentorship is so critically important. It makes the experience, whether in school or in a career, personal, human, and also funner. I don't know. Funner, more fun? It helps you individualize, I think, your path. So I think that when ... Also, a key thing about mentorship In my experience is you have access to someone who, if they're mentoring effectively, believes in you. I always feel like for me at least, I'm much more likely to take on something if someone believes in me.

Dr. Anjali Gupta (07:45): Well said.

Dr. Lisa Dixon (07:46): So I think mentorship has real value in so many ways.

Dr. Anjali Gupta (07:52): So did you have women mentors or role models as you were going through those early years?

Dr. Lisa Dixon (08:00): I had mentors, both men and women, who were mentors. At that time, there were fewer women in medicine and healthcare than there are now, but I had a ... Actually, way back when I was an undergrad, I took a course at the school of public health and there was a woman instructor or teacher in that course. I don't think she actually knew that I was her mentee, but I was. I looked up to her. Certainly in residency, there were several women psychiatrists who helped me along the way, but I will say that I think now there are a lot more possibilities for mentorship than there were then.

(09:00): I was also in this weird health services space, which wasn't ... If you're in health services space and you're in a school of public health, it's one thing, but if you're in a school of medicine, the public health approach and thinking is not quite as accessible.

Dr. Anjali Gupta (09:23): So you are an accomplished researcher, national leader for schizophrenia research. Tell us a little bit about that. When in your career did you know you wanted to go that route, and how did you go about doing it? What type of research background did you get?

Dr. Lisa Dixon (09:45): In certain ways, I shouldn't be able to answer that question. It should have been a much more gradual and slow moving, but in fact, when I was a third year resident, I had no research background, none, whatsoever. We were required, this was at Cornell Payne Whitney, to do a research project as a resident. So I wound up connecting with some younger faculty, Gretchen Haas, Peter Wyden, and John Sweeney were all young faculty at Cornell at the time, and I connected with a project that Gretchen was doing, adding an interview, some interview questions about substance use to a ... I think it was even a first episode study. I don't remember all the details, but I was able with my mentors to identify a gap in this protocol. So I became a part of this consecutive admission assessment study of people with early psychosis.

(11:12): I will never forget on Thanksgiving vacation, it must have been in my fourth year, maybe it was my third year, but looking at the data. I was like, "I don't even care of Thanksgiving." I was at the computer. This was just the coolest thing I'd ever seen.

Dr. Anjali Gupta (11:37): Do you remember what about it what was so cool?

Dr. Lisa Dixon (11:43): We finally had some data to back up our observations because prior to that, there really wasn't a very significant big literature on the dual diagnosis of substance use and mental health disorders, at least not in the space of mental illness that I was living in, which was, again, severe mental illness.

(12:07): One of the first papers from that study was in the American Journal of Psychiatry. That was how it was not really ... Now, of course, there's been tons of important research, but we even asked what people use, their reasons for use. Now, you couldn't get away with asking about reasons. It wouldn't be considered valid, but we were just trying to understand the phenomenon.

(12:34): So I had this really positive experience, both in terms of the interpersonal aspects of it working with young faculty who are very, very supportive. Peter Wyden, he had done some work. We wrote a paper on educating residents about extrapyramidal symptoms. So this was all very, it was like, "Oh, I can do research but still focus on questions that matter to me." I didn't need to know 500 mathematical equations that I just, my eyes glaze over. Further, I didn't actually need to know where the hippocampus was, which I was not very good at either.

(13:18): So anyway, but I could find ... So I had this incredible combination of becoming a part of a larger study so that I had results and having just my little piece of it and mentors who understood how to give me that little piece while maintaining their thunder for the overall grant. It was very clinically relevant and had face validity. So I really think that was a transformative experience, and I loved the writing part of it too. I thought, "Well." I really loved the ... Love isn't quite the right word. I appreciated. I was frustrated, but I appreciated the challenge of really trying to write well and write clearly. People always make fun of me because I write very short. I don't write long things, maybe sometimes to a fault. So that was like, "Oh, this is something I can do."

(14:39): So then, of course, getting started, really, I didn't know the first thing about research really. So I knew that I was going to need to do more research training. At that time because of family issues, I was going to be moving down to the Washington Baltimore area and I looked at NIMH and I interviewed there. I remember that because when I was there to interview, they were all playing basketball. It was very weird. All these guys were on the basketball court, and I was like ... It just so happens that I'm a pretty good basketball player because I have three brothers and I played a lot of sports as a kid and I could hold my own on the basketball court. I'm short, but I don't know, the whole thing didn't feel quite right.

(15:51): I ended up going to the Maryland Psychiatric Research Center. So I went to MPRC to do a research fellowship. I was on a particular unit that I can only say in retrospect wasn't a great fit for me because, again, it was a different kind of research. It was much more ... It wasn't health services research, it was more like mechanistic, biologically framed research.

(16:22): So I wound up actually being a little bit miserable, but then being moved to a different research group within MPRC, and it was fantastic, it just changed everything. Then when I was just relaxing one day and I got the Maryland Psychiatric Society Newsletter and they were looking for a psychiatrist to head up this new research study for homeless adults with serious mental illness that there was a clinical intervention, it was actually assertive community treatment, which was going to be the experimental condition and usual care plus access to some housing resources was going to be the alternative condition.

(17:15): I immediately applied for that position and was able to cut a deal. I would do this and I would work with the administrative head of the team who was from the homeless provider community, but I wanted to have a role in the research. That was the deal. I would do all the clinical management, whatever. It was the best. It was totally transformative not only because of being a part of this incredibly exciting research study, but also because that team, as it was conceived by the authors of the grant, included consumers who were peer providers.

(18:00): This was not done. This was before peer support workers and the two ... There were several folks over the course of the life cycle of the project, Craig and Glenn and Bill and others,. who taught me so much about working side by side with people who have lived experience. Then also, there was a family outreach worker, Betty Stewart, who also was identified as a family member with experience. So it was so interesting and effective and really was a game changer.

(18:46): My research journey was a little ... I know I'm probably taking up the whole time here with this story, but there were several missteps along the way. One of the things I always take away from that is the crisis opportunity. If I hadn't really disliked the first job, I wouldn't have gotten to the second job.

Dr. Anjali Gupta (19:07): Right, and embedded in all of that were some transformative mentorship experiences within, it sounds like, your early journey.

Dr. Lisa Dixon (19:18): Mentorship, not just in a funny way, the peer and family support counselors or members of our team, they taught me. In some ways, they were mentoring me, and as well as, of course, the more conventional mentors who are up the ladder.

Dr. Anjali Gupta (19:42): Really great point. So you touched on that being the start of obviously a very amazing career. Those initial years, those early career physician years can be tough both for women and for men, but particularly for women balancing personal and professional lives. Often they're launching professional careers at the same time as they're stepping into new roles, relationships or parenthood. Any advice or tips for women?

Dr. Lisa Dixon (20:23): It's such a personal experience, but I think that maybe the best I can do is to say have your North Star, what you think is important and stick to it.

Dr. Anjali Gupta (20:37): I think that's so insightful.

Dr. Lisa Dixon (20:45): I have two children. I wanted children. I would not have pursued any job where I felt that I could not get the support that I needed in that space. I was lucky. I didn't have ... Things went relatively smoothly for me in that space, and we had enough resources to obtain childcare that we could trust, but there's certain things that are just non-negotiable. If you know that in your heart, then you'll be much better able to strategize and negotiate. You'll always have to strategize and negotiate. There's always five other agendas that aren't yours.

(21:37): So it's making sure that you're negotiating and according to what your priorities are. You may need to give a little at times. I'm not saying that you should be rigid, but know where your lines are and remember that, again, a bad thing can happen, a good thing can happen from a bad thing. You quit something or you don't think it's going to work out, and so you say, "I'm going to do something else," and then that's something else can end up being the best thing that you couldn't even have anticipated.

Dr. Anjali Gupta (22:19): I always love to say that when one door closes, another one opens and you don't know that when you're-

Dr. Lisa Dixon (22:26): Yeah, no, that's exactly, exactly right. If you don't close the door and you just keep it open or you try to keep it open, then you're fighting about keeping it open. You're not living.

Dr. Anjali Gupta (22:39): Yeah. Absolutely. So you were a program director in the past. Are there things in residency we can be doing to prepare women for work-life integration challenges or the gender inequities that academic medicine still has?

Dr. Lisa Dixon (23:00): I think there definitely are, but what I would say is this. I would seek expert consultation in that. Particularly now, I don't know all the issues, I don't know all the rules, so I never hesitate to consult with people who would know more than I would about a particular topic. That would be something that ... There are things that I might be insensitive to just because of who I am and how I approach things, and these can be very gut-wrenching issues.

(23:42): So I think there's always things that you can do, and I would just say not just for women, but for people, particularly when you're talking about family. People have created all kinds of families now and in an unbelievably wonderful way. So all, whether you're a man, a woman, don't identify as either, you should be able to have a way to optimize your family and parenting roles within the work.

Dr. Anjali Gupta (24:27): Really good point. So you have had a number of leadership roles over your career. What have been some of your favorites, and which do you think stretched you the most or contributed to the most growth?

Dr. Lisa Dixon (24:43): Well, I think every single one of them has stretched me, but I'll identify two other than my current role. One was being training director for that period of time at Maryland. Actually, when Maryland became the combined Maryland Shepherd program, the programs were merging, there was a shift to more of a competency-based curriculum. I didn't know what I was doing. It was the end of my K award, and the previous training director had been there for many years. I didn't realize that a lot of my time wound up being spent on administrative issues.

(25:34): I came in with all these ideas about training and curriculum, and it was very just an active, a little bit of a chaotic time in residency education at our institution. I realized that also when you're in charge of things like this and trainees, you end up also having to deal with the problems as opposed ... Absolutely, most of the residents are just amazing and you just want to sit and listen and hear them process and think, but of course, in every program, in every environment, there's people who are struggling.

(26:22): I realized the administrative lead really has to do that well, that that in some ways is more important and gives more exposure than helping the strong folks. I just had no experience with that and I to learn. It was also just a very large residency program, and residency was changing. I realized it was going to be hard for me to develop my research career in that space, but because of those challenges, I think I learned more in that four or five years than I could ever have dreamed, and it taught me so much about being an effective administrator that I wouldn't trade it for the world and meeting people like you and other residents. I still have this image of the office and meeting with the chiefs and-

Dr. Anjali Gupta (27:26): Barbara sitting out there.

Dr. Lisa Dixon (27:27): Yeah, right. So that was one leadership role that I think was really valuable for me. The second is being editor of the journal. I have always loved this journal from ... When I interviewed for the position, I just ... It's really the journal that I always read, not when I was five, but when I started to pay attention to these things. It just touched on everything that I thought was important about psychiatric services and psychiatry and psychiatric services delivery. I love the journal. I love the support. I love the people I've met, being able to see the full range of scholarship. I've been able to create some tracks like an early career advisory group and some other policy advisory to bring the academic publishing to the challenges of training and policy a little bit more, a little closer. I've met so many people through the journal. So those would be the two that are in some ways stand out.

Dr. Anjali Gupta (28:54): Okay. So now that we're talking about the journal and publishing, let's talk about women in authorship, specifically first and last authors. What are the challenges women face and any tips you have for women interested in publishing more?

Dr. Lisa Dixon (29:12): I think that with respect to publishing, I think women ... It's hard for me to make generalizations about women this or women that, so I just want to talk about people. Then I do think for certain of these issues, women tend to have more of a hard time than men, but if you're going to publish, for the most part, you're not really paid to do it. So it often will come out of your own time, and that becomes a structural issue that can often be a problem for women if they have primary childcare, child responsibilities. You don't have that extra two or three hours. I think that is really a problem to the extent that writing and authorship is not often built into the jobs that we have. It's done on your own time.

(30:18): I think also that it builds on relationships and, "Oh, you want to co-author this with me? Do you want to do this with me?" I think women tend to get fewer of those extensions or invitations. Now, I don't have data for that, so I can't say for absolute sure. I think, again, we still see women grossly underrepresented in academic positions suggesting to me that they either don't care to play the game or don't know how to play the game. So again, even the format of your question, first and last authorship, many people, and I suspect more women than men, don't understand why you're even asking me that question. Why first and last authorship may matter, that it reflects leadership and responsibility. So I think there's a lack of opportunity, there's a lack of knowledge, and perhaps also a lack of maybe less interest. You're making decisions and setting priorities.

Dr. Anjali Gupta (31:35): So as you think back on this tremendous career that you've had, what comes to mind as key contributors to your professional success?

Dr. Lisa Dixon (31:47): Again, I think so much of it comes down to opportunities. I have to say, when I look back, I've changed course a little bit every seven or eight years or every five to 10 years. I got bored or was going to be moving or wanted to try something different or there was a natural cycle. So I think that being in an academic department allowed me to grow. Look, that's not the only model. People can be supervisor and then run the residency clinic and then become associate training director and so forth, and then keep taking on different responsibilities.

(32:39): I have a young colleague who is literally doing that right now, had a pretty significant administrative role, and she did a great job. Now, she got a bigger one and she's leaving, and we're sad to see her go, but she's doing the right thing.

Dr. Anjali Gupta (32:57): Well, and shifting and taking on new roles are always to keep it fresh and, like you said, keep growing and trying new things.

Dr. Lisa Dixon (33:11): And being able to say, "I don't know what is going to come next, but something will." In my experience, you don't have to force it if you just keep your eyes open. It fundamentally comes down to, again, this notion, for me at least, of the North Star, what really matters to you? What is your mission? When you're hopefully older and looking in the mirror or not, what did you accomplish, and is the choice you're being given now, will that increase the chance that you'll feel like you've accomplished what you set out to accomplish or will it detract from it? Even if you don't immediately know how, it will.

Dr. Anjali Gupta (34:11): Well, thank you, Dr. Dixon. This has been wonderful chatting with you, and I really appreciate you taking the time to share your story and so much insightful advice. Really appreciate it.

Dr. Lisa Dixon (34:25): Well, thank you. This was really fun. I have to say it's really fun to see you many years later. I was your training director for a short period of time, and now look at ... This is an awesome series and asking awesome questions that I think are really going to help people as they move forward and reflect on their careers.

Dr. Anjali Gupta (34:48): Thank you.

Speaker 3 (34:52): The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.