Finding Our Place: Gender Harassment of Women in Academic Psychiatry

Consider the following scenario:

Is this behavior illegal? Should a formal complaint be filed? Would anything change if there was an investigation? What are the consequences for women on their team if they stay silent? I’ve heard similar stories from colleagues, and I have been exposed to such behavior myself.

Answer: It could be gender harassment, a form of sexual harassment (see Table 1). This sounds like a hostile work environment. Many cases, such as the example above, can be confusing. Definitive knowledge of whether this behavior meets criteria for discrimination or harassment is not required to report the behavior or file a complaint. The response to the complaint is dependent on the individual institution.

Women have been graduating from medical school since the second part of the 19th century, yet our field is still dominated by men. Although the representation of women among junior faculty has increased in academic psychiatry, numbers diminish with increase in rank. In 2019, 34% of women held the rank of professor, compared with 49% for associate professor, 59% for assistant professor, and 66% for clinical instructor. Only 23% of all psychiatry chairs were women in 2019, and men earned, on average, 11% ($53,400) more than their female peers, according to a 2021 report in Academic Psychiatry.

In 2018, the National Academies of Science, Engineering, and Medicine (NASEM) released a comprehensive report examining sexual harassment of women in academic science, engineering, and medicine. This report concluded, “Gender harassment is by far the most common type of sexual harassment,” as opposed to unwanted sexual attention (such as sexual advances, including assault) and sexual coercion (when favorable treatment is conditioned on sexual activity).

Gender harassment involves “[v]erbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one gender.” It includes “behaviors which communicate women do not belong or do not merit respect.” Although many think of gender harassment as a lighter type of harassment, “gender harassment that is severe or frequent can result in the same negative outcomes as isolated instances of sexual coercion.”

In 2022, the Association of American Medical Colleges (AAMC) published an analysis of sexual harassment among U.S. medical school faculty, with a focus on gender harassment. The AAMC survey collected data between 2019 and 2021 and had over 13,000 faculty respondents. Among psychiatry faculty, 32.3% of women and 14.1% of men endorsed behaviors specifically associated with gender harassment in the past 12 months. The most common experiences reported by women in psychiatry were referring to the female gender in “offensive, insulting, or vulgar terms” (22%) or putting women down or behaving in a condescending way because of their gender (22%).

The AAMC report found that “faculty of all genders who experienced harassment were less engaged, less satisfied with their medical school as a place to work, and less likely to stay at their institution” and “women who reported experiencing harassment had the lowest engagement across all measures.”

Gender harassment is not unique to women. Men in our field are also subjected to gender harassment and may be more likely to leave their place of employment compared with women after experiencing harassment. An alliance between all genders and community building can therefore be powerful antidotes to the deleterious effects of gender harassment.

The AAMC and NASEM reports provide a useful starting point. Part of the challenge is the lack of data on gender harassment in academic medicine, including psychiatry. Without specific data, how can we develop evidence-based solutions? If these issues remain shrouded in secrecy, it will be difficult to move forward. The AAMC report outlines strategies, including specific examples at different medical schools, for preventing and addressing sexual harassment at an institutional level (see Table 2). Every department of psychiatry should make an impactful effort to measure and reduce gender harassment in the workplace. Identifying and addressing inequities and barriers to the advancement of women is crucial to reducing gender harassment.

At this time, even when reported, incidents may be handled behind closed doors and do not necessarily receive wider attention within or beyond the academic community. In 2019, in a noteworthy exception, multiple current and former employees, including women physicians, at the Mount Sinai Health System in New York filed a lawsuit alleging workplace discrimination and retaliation (the defendants have denied any wrongdoing). This case provides an opportunity to understand the experience and consequences of gender harassment for women in academic medicine.

The plaintiffs described working under a male superior with relatively few years of experience who had been hired against the advice of a search committee. The plaintiffs alleged there were repeated instances of a male supervisor screaming at them while the director observed without intervening, normal differences of opinion among women staff being cast as “catfights,” and leadership positions being filled overwhelmingly by men compensated with higher salaries than female counterparts, among other allegations. As reported in the October 21, 2020, STAT, the plaintiffs described themselves as having been “demoted from leadership positions and assigned menial tasks” and “emotionally and psychologically scarred” by the experience. They contended that the majority of the eight plaintiffs had their “careers derailed.”

Despite barriers, women psychiatrists continue to provide excellent clinical care, advance the field through research, and train the next generation of practitioners. The situation will change only when we, regardless of gender, demand change.

I share my own perspective on this topic, bearing in mind that my experience is limited, in part, as a cis-gender, heterosexual, Asian American woman in her mid-30s. There are many other identities and experiences to consider in how we can increase inclusiveness and equity.

At my own hospital, I stare up at a wall covered with dozens of photos of past medical directors and framed portraits of pioneers in the field. There is one woman. What happened to the others?

While women in academic psychiatry have made significant strides, gender harassment persists. It is likely that nearly a third of women psychiatrists reading this article have experienced gender harassment. How long will this continue, and what will it take for us to act? National and global trends are suggestive of a potential stagnation or backsliding for the advancement of women. The good news is, and history has showed us, that when women advance, it leads to long-lasting change that improves everyone’s lives.