I am a woman, a psychiatrist, and an administrator. I have been a woman for more years than I choose to admit; I have been a psychiatrist for 22 years; and I have been an administrator of a state mental health agency for 15 years.
It follows, therefore, that my opinion of women psychiatrists as administrators may be prejudicial; yet, if experience truly is the best teacher, it also will be knowledgeable.
Twenty years ago, the chance of a woman psychiatrist's having the opportunity to serve as administrator of a mental hospital was very remote. The chance of a woman's becoming a mental health director was almost nonexistent.
Since the role of the woman in society has been so ingrained in the minds of past generations, the change has been despairingly slow.
I am sure that you are as aware as I am of the inuscule role women played outside the home for generations. Teaching, nursing, and a few such professions eventually fell into the categories that women could, according to society, satisfactorily fill. These professions tended to simply extend the mother role that women had long been expected to fill.
Until recently, however, we have not been offered the opportunity to pursue other endeavors. We were expected from early girlhood to assume the stereotyped identity of a female person. It has taken us years to reach the position of being accepted for our capabilities - not for our femininity.
There really should be no need to discuss "Women Psychiatrists as Administrators." We are regressing when we divide psychiatrists into the categories of men and women. I would feel more at ease with the topic of "Psychiatrists as Administrators." We all have the same training, and to draw an invisible line between men and women psychiatrists is difficult for me.
In Careers in Psychiatry it was stated that crucial to the success of mental health programs in communities, cities, and states is the administrative psychiatrist, who combines clinical experience with a flair for management, planning, budgets, and administration. It is his job to supervise all aspects of mental health service, whether it be a small clinic, a state hospital, or a statewide system of clinics and hospitals. Usually he can no longer afford time to be a clinician, pressed as he is to handle and solve a myriad of daily as well as long range problems of people, money, and facilities. It is he, in essence, who provides the framework within which clinicians operate - and without which no great university-clinical structure could exist. His skills should include those of an executive and a psychiatrist. '
During my years as director of the West Virginia Department of Mental Health, our progress has been more than adequate. As far as I have been able to ascertain, being a woman has never interfered with the program or with the administration of mental health services in West Virginia.
Invariably, when things go wrong in an institution administered by a woman, the administrator is confronted with the question: Has this happened because I am a woman, or would it have happened to any administrator in this position? I think this is true whether the program being administered is small or large - and whether the woman is running a hospital unit, is head of a clinical team in a mental health center, or is the person functioning as second in command. When things go wrong with the program, questions will be raised about the woman administrator. This will be true even though she herself may be able to ferret out the solution to the problem; others, she realizes, will still draw their own conclusions about whether or not the problem would have happened had a man been in charge. This is one of the extra risks a woman administrator must face.
She also must make sure that problems do not flourish in the organization primarily because of the preconceived ideas of others about women in administration. This is changing gradually as more and more women are becoming administrators; however, it has not been eliminated by any means.
As the authors of ". . . Bird of Passage" have noted, any mental health director must constantly expect attacks. But it is not enough merely to be an administrator capable of warding off attacks, they noted - one must also be a psychiatrist. Perhaps the relevant passage is worth quoting:
There is little doubt . . . that the director [of a mental health institution] should be a qualified psychiatrist. . . . The argument that [he or she] should not be a physician but rather a businessman because "large sums of money are involved" is analogous to saying that airplanes should be flown by mechanics because they are powered by complicated engines.
The mental health director, however, must be more than simply a trained psychiatrist. [They will] head operations that are comparable to the largest of the states' industries, with a total manpower of approximately 300,000 employees. They must therefore also have administrative skills and a knowledge of personnel, purchasing, budgeting, and all that goes with these functions.
An additional important qualification for any director who hopes to retain his job for more than a few months is knowledge of and sophistication in practical politics.2
Ulett and his associates go on to quote a remark once made to them by the governor of their state. "In such a public job you awaken each morning fully expecting an attack - you only do not know from which direction it will come."
And, as these authors point out, the director's job is neither secure nor (at least by private-practice standards) lucrative. In their state, directors had been holding their jobs for an average of less than five years, and their salaries averaged $27,000.
The authors conclude by asking: "What kind of masochist, then, takes this job."2
Well, women do. And there is no reason for assuming that a woman psychiatrist cannot competently fill the role of administrator. In Problems of Psychiatric Leadership it is stated: 'The psychiatric clinician-executive is imaginative and creative - not an obsessional detail man but an individual with vision that is expressed in action. He is capable of decisiveness, free from ambivalence and self-doubt. He has ambition, which he translates into effective action. This calls for aggressiveness and self-assurance, as distinct from mere self-seeking and an orientation to power. "3
There is nothing in this description that tends to eliminate women psychiatrists. We are capable of decisiveness, we do not possess selfdoubt, we are ambitious, and we are certainly self-assured.
It seems to me that many women possess several personality traits to a greater degree than their male counterparts - such things as even temperament, understanding, and compassion. These traits are important for the success of any psychiatrist-administrator.
Basically, the intellectual faculties of both sexes are the same. 1 think it is a myth that women necessarily are better at attending to details. Women are as capable as any other administrators of filling in the gaps that they themselves have. In other words, they choose staff who possess qualities or skills in which they are lacking and that complement them. Women are more vulnerable after having selected these people; they are most vulnerable in the area of seeing that the persons selected actually carry out their obligations.
Psychiatrists as administrators, whether male or female, are concerned about mental health and the goals of better programs, better facilities, innovations, etc.
Today, all areas of psychiatric practice are open to women, and the number of women in the field is increasing. In the area of administration, however, I have found little evidence of a significant increase.
Of a total A. P. A. membership of 23,256, there are only 2,902 women members. Today, 30 state agencies are headed by psychiatrists, and only two of these are women; yet there are fewer limitations on where a woman can go in psychiatry than in other fields. Women also have been more readily accepted in the administrative aspects than in other medical areas.
There have been instances where my being a woman has been a distinct advantage. Often, in meetings primarily composed of men, 1 have been asked my opinion or given the floor while others as knowledgeable as I have waited. This, of course, happens only once in a committee, and it is then up to the woman psychiatrist to offer advice that is both relevant and concise. If she does, she will be treated as a member of the team henceforth. So it is imperative that you be productive when given the opportunity.
Some of my associates have said, "Had you been a man, you would have been fired a long time ago," while others have offered, "If you had not been a black woman, you would have been replaced long ago." These are only conjectures. Perhaps they have some relevance; but if I had not done my job well, I would have been "gone long ago" regardless of my race or my sex.
A woman psychiatrist as an administrator is an excellent concept. We control most of the wealth in the world, head major corporations, chair news programs in television - so why not administration?
As in any other area, some will succeed while others will fail; some will thrive on the challenge while others will shrink from it. However, it is an area well worth the effort. After 15 years, I can earnestly say to all women psychiatrists that if you are strong and anxious to meet a challenge, administration is a wide-open field.
However, it is well to recall during times of stress and doubt the words of John F. Kennedy: "All this will not be finished in the first one hundred days. Nor will it be finished in the first one thousand days, nor in the life of this Administration, nor even perhaps in our lifetime on this planet. But let us begin."4
1 . National Commission on Mental Health Manpower. Careers in Psychiatry. Washington, D.C.: American Psychiatric Association, 1968, p. 90.
2. Ulett. G. A.. Schnibbe. H., Ganser, L J., and Thompson. W. A. Mental health director: Bird of passage. Am. J. Psychiatry 127 (1971 ), 1550-1554.
3, GAP Committee on Therapy. Problems of Psychiatric Leadership, Volume 8. New York: Group for the Advancement of Psychiatry. 1974. p. 945.
4. Kennedy. J. F. Inaugural Address. January, 1961.