Psychiatric News June 3, 2005
Volume 40 Number 11
© 2005 American Psychiatric Association
p. 16
Editor Raises Psychiatry's Profile on Women's Issues
Aaron Levin
A psychiatrist named to head the Journal of Women's Health will
apply her profession's integrative perspective to her new post.
Susan Kornstein, M.D., of Virginia Commonwealth University's (VCU) School
of Medicine in Richmond is the new editor in chief of the Journal of
Women's Health, the first psychiatrist to hold the position, and she's
trying hard not to think about how one more task will fit into her day.
The journal will continue its interdisciplinary approach to women's health
as it addresses wider issues such as "the fragmentation of women's
health care, under-funding of research, and the trivialization and
politicization of women's health issues," wrote Kornstein and her VCU
colleague and new deputy editor, associate professor of internal medicine
Wendy Klein, M.D., in an editorial.
In choosing Kornstein, the journal's board of editors recognized not only
her personal skills and abilities but also acknowledged psychiatry's place
among obstetrics and gynecology, endocrinology, and internal medicine in the
spectrum of women's health, said APA President Michelle Riba, M.D.
"Susan will bring incredible energy, thoughtfulness, and diligence to
her role as editor," added Joel J. Silverman, M.D., chair of the
Department of Psychiatry at VCU, in an interview.
Kornstein already holds joint appointments in psychiatry and obstetrics and
gynecology at VCU and is the first full-time, tenured woman professor in VCU's
psychiatry department. Her day is the familiar round of the academic medical
center: meetings, running research protocols, seeing patients, more meetings.
She's served as a principal investigator on more than 50 studies of
premenstrual syndrome, anxiety disorders, sexual dysfunction, insomnia, or
depression and co-edited Women's Mental Health: A Comprehensive
Textbook (Guilford Press, 2004).
She is also president-elect of the International Society for Women's Mental
Health, director of clinical research for VCU's Department of Psychiatry,
executive director of the VCU Mood Disorders Institute, and a co-founder and
executive director of the VCU Institute for Women's Health, designated a
National Center of Excellence in Women's Health in
2003.
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Susan Kornstein, M.D.: "We still know far too little about gender
differences in health and disease."
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When the Journal of Women's Health began publication 14 years ago,
the field focused on reproductive health, and the journal broke new ground in
its broader view of women's health. Editors have usually come from internal
medicine or ob/gyn. Today, the journal encompasses aspects of health that are
expressed differently or respond differently in women, as well as those that
are unique to women, said Kornstein in an interview. They include bone and
breast health, reproductive health, cardiovascular disease, endocrine
disorders, and mental health. Yet information on women's health has been
limited because women were too often excluded from clinical trials out of
concern for pregnancy or menstrual status.
"We still know far too little about gender differences in health and
disease. Such knowledge should permeate all research and medical education and
will result in improved health care for both men and women," said the
editorial.
Depression, which is twice as prevalent among women as men, is a good
example of those differences, Kornstein said. Men display more classic
neurovegetative symptoms such as insomnia and loss of appetite and weight,
while women show more reverse vegetative or atypical ones, such as increased
appetite and weight gain. As her research has shown, men and women respond
differently to treatment, too. However, at this point, she said, there should
not be separate formularies for each sex, but rather consideration of both
gender and menopausal status among other factors in choosing medications.
The broad, integrative perspective offered by psychiatry may prove valuable
to the new editor, said Linda Chaudron, M.D., M.S., an assistant professor of
psychiatry, pediatrics, and obstetrics and gynecology at the University of
Rochester, in an interview.
"Psychiatrists have the opportunity to look wholly at women's
health," said Chaudron. "Many of women's mental health issues are
connected with their physical and social health, so people working in women's
mental health have to work as collaborators with ob/gyns, internists, and
others."
Kornstein has been running hard since her undergraduate days. She completed
a seven-year combined B.Sc./M.D. program at Brown University, winning two
piano competitions in her free time. She had no initial inclination to
specialize in psychiatry.
"I thought about surgery and didn't do any psychiatry until my fourth
year, but then I loved it," she said. She did a fellowship in
consultation-liaison psychiatry, focusing on plastic surgery, interviewing
patients before and after their operations. In plastic surgery (which she
calls "psychotherapy with a knife"), psychological evaluation is a
key, she said. "It's important to sort out who is and who isn't an
appropriate candidate."
She started a psychiatric society for medical students at VCU to give them
the chance to explore the profession earlier in their careers and to help them
overcome the same biases about mental illness that are present elsewhere in
society.
Kornstein attributes many of the improvements in patient care in recent
decades to the influx of women into the profession, changes that benefit both
women and men.
"The traditional approach to the doctor/patient relationship was
hierarchical; now it's more collaborative," she said. "We do more
now to educate patients about their illnesses and their treatment options and
then decide together with the patient about what is the best
course."
That collaborative, integrated approach to patients and their care is
intrinsic to psychiatry, she said, and is something her specialty can
contribute to the journal's readers across the profession.
"It's important when psychiatry can take a leadership role beyond the
confines of psychiatry," Silverman said.
The Journal of Women's Health is published by
Mary Ann Liebert Inc. and is posted online at
<www.liebertpub.com/publication.aspx?pub_id=42>.
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American Psychiatric Association.
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