Sexual Harassment Still Occurs in Psychiatry, Says Women’s Caucus Leader

When we talk about sexual harassment, it is important to differentiate it from both sexual violence (sexual assault and abuse) and institutional gender bias (the presence of institutional hindrances to the progress of women as compared with men). Yet all three experiences undermine the well-being of women psychiatrists.

I mentioned to my husband that I was writing an article about sexual harassment. He quietly asked me about my own experiences in medicine. I was caught off guard when I teared up at the end of my narratives.

I was taking a physical diagnosis course at a community hospital, where an attending was teaching me how to use the ophthalmoscope. As he moved that piercing light toward my eyes, he leaned over and began to kiss me. He then pinned me against a wall, which I finally leveraged by pushing against it to spring free. That was a sexual assault. Regrettably, sexual assault, including rape, occurs at alarming rates and does not spare women psychiatrists. According to a 2014 report by the Centers for Disease Control and Prevention, 1 in 5 women has experienced an attempted or completed rape in her lifetime. As we psychiatrists know, sexual violence has ravaging psychological effects on those who endure it, regardless of their profession.

Sexual harassment is more subtle, but it also is commonplace and consequential. A survey of women in academic medicine in JAMA in 2016 found that 30 percent of respondents said they had experienced sexual harassment. Of those women, 59 percent perceived a negative effect on their confidence, and 47 percent said the experiences had negatively affected their career advancement. These data are sobering, but so is the impact of these incidents on a woman’s inner life. I can describe that impact firsthand.

As a third-year medical student, I was excited about my first clerkship. After several years of classwork, I was eager to start working with patients. On the first day of my surgery rotation, I reported to duty with great anticipation. The team of men to which I was assigned seemed like an amiable group. At the beginning of rounds, they handed me a piece of paper that I eagerly anticipated would include all the on-call information for the clerkship. As I took the paper, I realized that they were all laughing mockingly as I gazed at an anatomically detailed drawing of male genitalia. The senior resident laughed and said: “Here, honey. Deal with this!”

I felt flushed and humiliated, and my internal elevator dropped 10 floors. They thought it was a funny joke; I felt diminished. I sensed that they had little respect for me as a young colleague. What started out as a triumphant day in my career turned into an abasement.

Like many other women, I told no one but my best friend. Why? I felt that I had no agency in that situation. I didn’t want to jeopardize my career with the men who ran the men’s club I was trying to join. I thought harassment was on the list of things I was required to put up with to become a doctor. Furthermore, I had been socialized to protect men and not hold those who erred accountable for their actions. I internalized the experience: I felt shame when I even imagined reporting that I’d been mixed up in such a thing. I left the rotation with my honors grade, a grade that was likely abetted by my silence. Telling this story years later made me tear up because I observed in the rearview mirror my trusting and confident inner spirit getting hurt by these men who held the power at the helm of medicine.

Fast forward a few decades. Last week I informally asked 20 colleagues in the APA Women Psychiatrists Caucus whether they had ever experienced or were currently experiencing sexual harassment. We had recently discussed the fact that most of our male colleagues treat us with respect, so I was hoping for a silent inbox—but my email alert kept pinging. Sadly, women in APA do still experience sexual harassment. Twelve women wrote to describe episodes that included unwanted sexual advances from supervisors; requests to perform sexual favors from colleagues; professors stroking their body; men in their program whistling at them or commenting publicly on their anatomy, marital status, or pregnancy; and male colleagues rating their appearance or photograph on a numerical scale. One member’s own therapist came on to her sexually, and another member’s career-planning dinner at a married attending’s home devolved into an unwanted sexual advance. Women psychiatrists who complained about this demeaning behavior often found themselves cast as harridans. Women also reported countless examples of pervasive institutional gender bias, an important topic to cover in another article.

Years of sexual misconduct in medicine have gone underreported and unpunished, and it has worn us women down. Could our decisions to keep silent and file away the hurt have fueled unproductive behaviors in ourselves like underconfidence or overeating or shame in our bodies? What can we do right now to help women psychiatrists and trainees (who are particularly targeted, according to statistics)?

First, as a society we need to dispossess ourselves of the notion that a woman’s healthy sexual self is somehow up for grabs—a commodity that is accessible to men at their whim because it gives men pleasure, even when we do not want to participate.

Next, women psychiatrists in all working environments need a safe space to tell their stories and report unwanted behaviors. Our silence has been broken. Please report these behaviors now for all of us who at previous points could not. Insist on well-established guidelines on sexual harassment and consequences for transgressors.

At APA, let all genders sound the clarion out of this silence and lead the way at this watershed moment in our history into a new culture of respect and protection for our own women members. ■