Dr. Paola Dazzan is a reader in the Neurobiology of Psychosis at King’s College London’s IoPPN and an Honorary Consultant Psychiatrist at South London & Maudsley NHS Foundation Trust. Her main area of interest is the application of brain imaging to the study of the early stages of psychosis. Paola was named Psychiatric Academic Researcher of the Year 2014 by the Royal College of Psychiatrists at the RCPsych Awards 2014.
“…You have men around you who are much more used to promoting themselves and their careers, and as a result both men and women around you will then think of the men’s names, just because they are more prominent…”
First interested in psychiatry
I went to medical school in Italy and then I started doing psychiatry after that. I’ve always been very passionate about psychiatry since I was in high school (what would be A-level equivalent in UK schools).
It was really my curiosity about the mind and how the mind works that got me into it. When I finished medical school I was really happy because it was time I could get on with that I really loved – which was psychiatry- and I had an opportunity to come to the UK with a fellowship for a period of six months.
I went to the Institute of Psychiatry and the Maudsley Hospital. I realised it was a wonderful place to pursue an academic career and that’s when I decided to stay. So I did my training in psychiatry at the Maudsley Hospital, and then I did my Ph.D. [Doctor of Philosophy] at the Institute of Psychiatry, now the Institute of Psychiatry, Psychology & Neuroscience, and that’s why I’m still here.
Fascinated by every single of psychiatry
I loved psychiatry, although the idea we have about what psychiatry is before we start is very different from what it is in our everyday lives as clinicians. When I started doing psychiatry in my specialist training I was fascinated by every single aspect of it.
One that I found really intriguing was the area of psychosis – these are disorders where people may find it difficult to stay in contact with the world around them, and typically present with symptoms like hallucinations, which is for example, hearing voices when nobody is around, or delusions, which are very unusual beliefs that are held very strongly, even in front of evidence to the contrary.
Understanding how disorders develop
I found fascinating trying to understand how these disorders develop, and why in some people. The fact that they usually develop in people who are very young I found really interesting because I would sometimes see people developing these disorders, finding it very difficult to complete their studies, to get on with a normal life, finding a job, or finding a partner and having a family.
That’s why I developed more and more interest for these disorders and for the idea of trying to do something for these young people at the time when the illness typically strikes, usually between 18 and 25.
My day to day work and research
In my everyday work life, what I do is to conduct research to try and understand what factors make some people more vulnerable to developing these disorders and to do quite poorly, because some people do get better, but there are a number of people who don’t get better.
So what I’m trying to find out in my everyday working life is what makes some people less likely to recover, so that we can hopefully try to identify these people earlier on and help them with a more appropriate type of intervention, or a more intensive type of intervention, to help them get on with their lives as much as possible.
I do this by conducting studies and projects where we involve large numbers of people with these disorders and then try to understand if there is anything that we can see in their presentations that can help us predict how well they will do later on.
It’s a very rewarding area, because we see how keen these people and their families are to understand more about their illness, and to make sure there are new avenues to treat these disorders.
One in four of us is affected by a mental disorder: Removing the stigma
How to remove the stigma around the issue of mental health is a very difficult question. This is true not just for psychosis, but for all mental disorders, and if we think about the fact that one in four of us at some point in our lives experiences a mental disorder, we realise that there is a real need to remove the stigma associated with these. One in four of us will have a problem at some point that is about mental health and they may contact a health professional for it.
I think talking about it is a very good way to remove the stigma, and we have made huge progress for example in depression and getting people to talk more about depression. I think talking openly about what we have and what we are experiencing is important.
Most people recover from their mental disorder
I think another aspect that is very important is to make sure that people know that having a psychiatric disorder doesn’t necessarily mean that it’s forever. Most people recover from their mental disorder and I think this is a really important aspect. There is still a large number of people that think “if you have a mental disorder it is forever”, when this is not necessarily the case. So sending this message across is also important.
We also have a number of treatment options nowadays. We have better medications for example for depression. We have psychotherapy, which is now more accessible even in the community.
Removing the stigma is about knowing more about the illness, knowing more about what the outcome of the illness is, and what are the treatment options. We should talk more about this.
It’s not your fault
I also think part of removing the stigma is about removing that sense that if you have a mental illness it’s your fault – that it’s because you’re not strong enough, because you didn’t make enough effort. So for example with stress in the workplace – it’s about challenging the assumption that you were not putting in enough effort or resources into making sure that you did better.
I think this is really important because you do that – you put everything you can into getting over stress and getting over difficult situations, but difficulties do happen anyway and they are not necessarily under your control nor your fault.
Pressure on new mothers
One of my areas of interest is also mental disorders in women who are pregnant or who are in the post-partum period. We see that a lot of women are really worried about saying openly that they are feeling down after having had their babies, and there is a lot of pressure from society on new mothers to be happy: “You’ve had a wonderful pregnancy. Your delivery has gone well. Your baby is wonderful. How can you say you are low? How can you say you are sad?”
There is this pressure that they should be happy, so they feel like a double failure because they ‘should’ be happy and they are not happy. This is terrible because it makes women hide their emotional state and not to enjoy what in reality should be a wonderful moment in their lives. It’s really important that as a society we understand that it’s not necessarily something you have control of and it’s important that if you feel that way you are free to say that and seek help for it, as the consequences can be negative for mothers but also for their babies. There is certainly more recognition that the early years are important for future mental health, and recognition that preventative strategies are important. The importance of research in this area has been certainly recognised for example by the strategy of the UK Medical Research Council.
Sitting on boards and groups – getting involved and putting your name forward
I have become more involved with professional boards and advisory groups. These came about in different ways. One of the most important ways, and I recommend this for every woman in this type of career, is the importance of a mentor, who can advise you, encourage you or point out options for you. I certainly started to cover a couple of these roles through my mentor who works in the same area of research and pointed out new options to me.
The other way is not to be too shy and to put your name forward. I think this is a problem for women in general. We tend to sit back and wait for people to realise that we are good at doing our job. I think it’s important to put our names forward and not to think, “I’m too junior for this. I don’t have enough expertise.”
Sometimes I found I had to push myself forward and thought “OK. Well I’ll try and I’ll see if people will vote for me” (if there’s an election involved or if there is a selection of a different type). This has become the other way in which I’ve become involved with many of these roles, by being elected!
Finally, it is also through forging true collaborations with other scientists, working together and make your work known. When you develop relationships with other groups, they often want you for their scientific advisory board – for example for a project they are building – because they value your opinion and your contribution.
The greatest challenges I’ve experienced as a woman working in psychiatry
The biggest challenges that I’ve experienced are probably the same experienced by any woman working in science – not just psychiatry. The challenges have been again to recognise that you need to put yourself forward more. You need to advertise yourself more and the challenge has been that this doesn’t necessarily come naturally, especially for women.
You have men around you who are much more used to promoting themselves and their careers, and the result is that both men and women around you will then think of the mens’ names, just because they are more prominent. Men tend to be more involved in things because they are much better at promoting their work and themselves. Women who do this are often perceived negatively, as arrogant or aggressive.
I think this has probably been one of the major challenges for me, recognising it’s not necessarily that I’m not senior enough, or I don’t have enough experience for a certain thing, but that maybe I should promote myself in a different way. I know this is very debateable because, well, why should this be the way? Why should this be the correct way?
In the future for the women to come this will be less of an issue, but for me growing up as a professional in my generation, it has been one of the major challenges. We need to work towards changing the system to make sure it doesn’t only recognise self-promotion and this is what we are trying to do!
Developing the next generation of psychiatrists
It’s crucial that we try to develop the next generation. In psychiatry in particular we have a real crisis, as you probably know, in that medical students don’t often pick psychiatry as their specialty of choice. This is a shame because, as I always say to my medical students, the brain is the most noble part of the body, so this is what they should be most fascinated about!
I try to promote it with the medical students, and also with my trainees, and I’ve got a number of Ph.D. students who are medically trained and they are specialists in psychiatry. Even now, they are important to me because these are the people who bring you the new ideas and they are the people who can see things in a different way from you. For me it’s the most stimulating part of my work, having these people around me who have a different perspective, and I love that.
Looking at things in a different way and bringing new ideas to the table
One of the best aspects of working in academia is having younger people around as they bring new ideas to the table, and unless you have them around, you’re stuck with the same vision. It’s important that you let them have a setting in which they can discuss their ideas, in which they can develop their confidence, and feel respected for what they are doing and what they believe in.
You have to help them through understanding that unfortunately in academia the reward is always rather delayed. You go through many rejections – your paper is rejected or your grant is rejected and you only know months later. You need a lot of motivation to keep going through this, so it’s important for me to make them understand that they shouldn’t lose confidence in themselves, even when they’re faced with rejection.
Passionate about Athena SWAN – changing culture so everybody can flourish
I think this is true for any academic, male or female, but in parallel to this there is the Athena SWAN initiative that I’m very, very passionate about. I’ve been involved with Athena SWAN now for about three years, since the very beginning of our initiative at the IoPPN, and I’ve now become vice chair of our team because it’s something I believe can make a real difference.
Apart from changing some institutional processes – for example making things more transparent, making sure everyone is a valued member of the academic faculty – there is a general sense of changing culture and becoming more aware of differences in the workplace, such as the ones that I mentioned earlier: knowing for example that women are not as keen at self–promoting.
As an institution we have a responsibility to ensure everybody can flourish, to make sure that the environment in which we work is an environment fit for everybody, no matter what your style is, and I think with Athena SWAN we have really started to make this change.
Second wave of attention to gender issues
We’re going through a second wave of attention to gender issues. After the feminism of the 70s, for many, many years we were silent. Maybe we thought the work was done and that it was now up to us to advance through the system – to work outside the home and progress with our career. But we’ve really started to realise again that things around us have not moved as quickly as we thought they were going to move, and therefore we need to push this process again.
We need to push it at all levels and we need to understand more about the system, and we need to make sure it’s not just one style of leadership that’s the accepted one, the one that allows you to make a career in academia.
This is why Athena SWAN is important: now when there is an opportunity, like an award, people are more aware of the gender differences that can affect who is put forward. The bottom line is that an environment like this will eventually benefit everybody, not just women. It will benefit men and women in the same way.
Advice to women and girls looking to learn more about psychiatry: Don’t be shy and don’t give up!
I would say that if you have an interest in psychiatry, please do pursue it. Psychiatry it’s a wonderful area of medicine. If you want to know more, don’t be shy – approach people. Academics are very open and very keen to help, so even if it is just about sending an email to somebody, do that directly, and people will reply.
Look for work opportunities. We have ad-hoc work opportunities and placements. Sometimes we have people doing GCSEs or A-levels who come to us for a week or two, for example to do a placement, or through our Biomedical Research Centre which offers some awards for pupils from local schools. These are for young people to come and spend time with us and learn what academia is like, and what it’s like to do a research project for example. So either keep a look out on our website or approach one of us directly. You will be amazed by how friendly academics are and how stimulated they are by young people.
Don’t give up! That’s my advice!
Going for gold
The Athena SWAN work keeps me very excited. I’m very excited about the next step. We got a silver award this year and we are working towards a number of initiatives that we will implement in the next couple of years. My passion and my energy is going into trying to make the next one an application for gold, rather than a silver renewal. We’ve got a lot to do for this!
In terms of my research, it’s really about continuing with my projects, getting funding for them, and make sure we disseminate what we find to the community because this is what we need to keep doing as researchers!