In 1980, the year that gave us CNN, Dr. Paula J. Clayton made news by becoming the first woman to chair a department of psychiatry in the U.S., at the University of Minnesota School of Medicine. She would hold this position for almost 20 years, before joining the faculty at the University of New Mexico School of Medicine as a professor of psychiatry.
Clayton is an internationally recognized researcher in psychiatry, known for her studies on mood disorders and bereavement. She was the first to define mania and schizoaffective disorders—co-authoring the first textbook on mania, Manic Depressive Illness, in 1969—and was one of the first Americans to describe the separation of mood disorders into bipolar and unipolar illnesses. In the late 1960s and early 1970s, she published landmark research on the symptoms and course of bereavement.
In 2006, Clayton joined AFSP as medical director, overseeing its research grants program as well as the development and implementation of its education and prevention programs. Before her retirement in June, AFSP sat down with Clayton to discuss her past achievements and the future of suicide prevention research.
AFSP: You attended the Washington University School of Medicine in St. Louis in the mid-1950s. How accepting were medical schools of female doctors?
Clayton: At that time, the number of women entering medical school was small. I was one of two women in my class. Medical schools were reluctant to accept women because there was concern that women would not go on to practice or enter academia once they married and started families. I was very fortunate that Washington University took a chance on me.
AFSP: Where did your general interest in psychiatry, and specifically mood disorders and bereavement, come from?
Clayton: When I was a second-year medical student we were given a course in psychiatry so that we could work on an inpatient unit the following year. It was very interesting watching depressed patients being interviewed and being asked about being suicidal. It was really amazing to me. I liked psychiatry. When I graduated, I had had a baby, and I decided I couldn’t do internal medicine, and to me psychiatry was the closest thing to internal medicine, and I didn’t have to be on call every-other night. So I chose psychiatry. During my residency, one of my patients had been admitted to the hospital after his wife died, and that started my first interest in bereavement. Parallel to that, I accompanied my teacher, George Winokur, in a study on manic depressive illness. These interests were all born during my residency.
AFSP: After completing your residency in psychiatry at Barnes and Renard Hospitals in St. Louis in 1965, you were appointed to the faculty of psychiatry at Washington University.
Clayton: It was an exciting time. The University was at the forefront of a movement toward a medical, research-focused model of psychiatry. The premise was that they were medical disorders of the brain, similar to disorders of the body such as diabetes and heart disease.
AFSP: Does that same premise hold today?
Clayton: Yes, and it should when understanding death by suicide. That’s what makes AFSP unique in the suicide prevention arena. We believe that recognizing and vigorously treating mental disorders will be one of the ways to decrease suicide.
AFSP: What is the difference in our understanding now of bipolar and unipolar illnesses as risk factors for suicide, compared to then?
Clayton: In most countries, people with major depression or unipolar depression have higher suicide rates. In this country, it’s a little more controversial. The belief is that bipolar illness is more likely to lead to suicide, so it’s still not decided after all these years which one is more prone to have someone die by suicide. I believe that because bipolar is such a discrete illness compared to depression—depression is much broader and affects many more people—it’s harder to understand the pathophysiology of depression. We’ll have better answers from bipolar before we do major depression.
I believe we are on the verge of finding places in the brain we can target with medications that may relieve suicidal ideas quickly. Not permanently, but quickly."
AFSP: You have been AFSP’s medical director for seven years. What accomplishments are you most proud of during your tenure here?
Clayton: First, the wide range of programs that we have developed for use by our local chapters across the country. From the program we developed for primary care physicians on recognizing and treating depression, to the films we’ve made for varying audiences, from Struggling in Silence, about physician depression and suicide, to More Than Sad and Living with Bipolar Disorder. I’m proud that we initiated and funded a pilot study that collected data on suicide attempts from three psychiatric emergency rooms and whose results are now awaiting publication. I'm also proud of our collaborative study that looked at treatment of complicated grief in survivors of suicide loss, and our groundbreaking efforts to reduce suicide among lesbian, gay, bisexual and transgender individuals.
AFSP: What do you find most hopeful in the field of suicidology?
Clayton: We have to continue to educate people that mental disorders are treatable and that you should seek help if you are suffering, but I do believe that people are accepting that more, especially young people. I think young people know what depression is—they might even have friends who have been treated for depression, so I think the public is becoming more knowledgeable. The emphasis on means restriction is also becoming more obvious and people are beginning to talk about bridge barriers, gun safety and packaging of medications. I believe we are on the verge of finding places in the brain we can target with medications that may relieve suicidal ideas quickly. Not permanently, but quickly. There will be treatments that will be available when you are suffering that will give you relief almost instantly. I think that’s on the horizon and is very promising.
AFSP: Anything you would like to say to a girl growing up in St. Louis today who wants to become a doctor?
Clayton: Go for it. It’s a great profession. Your options are limitless, you never need be without a job, and the joy of seeing patients get well is so rewarding: I longed to write a novel about their bravery. Plus academia and the research community offer support and informed criticism that really help advance your career at any pace you choose.
Paula J. Clayton Research Fund
AFSP has created a research fund in Dr. Clayton’s name to improve the treatment of mental disorders and to prevent the tragedy of suicide. Click here to make a contribution.