Latest / The Medical Mind / Women Psychiatrists Caucus Chats: Words of Wisdom with Dr. Carol Bernstein
Transcript
- 0:00I think I would want to have reached out more.
- 0:04Your generation in women I see now, they're much more apt to say, can I come and talk to you?
- 0:09Can you help me out?
- 0:10I mean, I never had those kinds of mentoring experiences or sponsorship experiences until later in my career.
- 0:20I just didn't have it.
- 0:22So I would encourage young people to reach out to mentors, to reach out to people they admire and respect.
- 0:30Welcome to season two of the Women Leaders in Psychiatry podcast by the American Psychiatric Association's Women Psychiatrists Caucus.
- 0:40I am Dr.
- 0:40Anjali Gupta, president of the Women Psychiatrists Caucus, and I will be interviewing women psychiatrists across the country who lead in a variety of ways so that we can hear
- 0:51their stories and learn from their insights.
- 0:54I have the pleasure of being here today with Dr.
- 0:56Carol Bernstein.
- 0:59Dr.
- 0:59Bernstein is professor
- 1:00and vice chair for faculty development and wellbeing in the departments of psychiatry and obstetrics and gynecology at the Albert Einstein College of Medicine.
- 1:10She has held a number of leadership roles, including director of residency training in psychiatry, associate dean for graduate medical education, and past president of the
- 1:21American Psychiatric Association.
- 1:24She is active in many national psychiatric associations in addition to the APA.
- 1:29which include the American College of Psychiatrists, the Group for the Advancement of Psychiatry, and the American Board of Psychiatry and Neurology.
- 1:38Thank you so much, Dr.
- 1:39Bernstein, for being here today.
- 1:41My pleasure.
- 1:43So I thought we would get started just trying to understand what, how did you get here?
- 1:51What inspired you to pursue the field of psychiatry?
- 1:55Well, it's, do you want the conscious or the unconscious reasons?
- 2:01I'll give you both.
- 2:02So I was a late starter to medicine.
- 2:05I was out for seven years between college and medical school.
- 2:09And when I entered, I had actually had some experience in psychiatry, but I was not planning to pursue a career.
- 2:16In fact, I didn't like my rotations.
- 2:18I started in internal medicine and in the middle of my internship,
- 2:24I got depressed as many people do and started to talk to some of my mentors at Columbia where I'd been a medical student and decided I'd apply to two programs.
- 2:35So I did and I got, and by the time I was accepted, I was ambivalent.
- 2:41I was really loving medicine.
- 2:43I wasn't depressed anymore.
- 2:44I was feeling better.
- 2:46But the real reason I think that I went into psychiatry had to do with the fact that my mother had bipolar illness.
- 2:53and that I really needed to understand what happened to her.
- 2:58So that was the unconscious motivation.
- 3:00It took me a long time to really talk about this.
- 3:04And I actually regret that I didn't make more of a statement about my own experience when I was president of the BAPA.
- 3:12I think it was an opportunity lost to help stigma.
- 3:17So I appreciate you sharing something so personal.
- 3:22How did you understand it before you came into the field?
- 3:26What was your understanding of what of it all?
- 3:30my mother's illness.
- 3:31I had no idea what had happened to her.
- 3:34It happened after I started college.
- 3:37It was very abrupt.
- 3:38She became a person I didn't know.
- 3:40I mean, in fact, I think she was probably chronically depressed most of her life.
- 3:45There is actually also a big uh family history on her side of the family of bipolar illness that people didn't know what it was.
- 3:54uh
- 3:55And I believe that when I started college, my recollection is that my dad finally got her to see a psychiatrist and he put her on antidepressant medication.
- 4:05This was in the sixties.
- 4:07And I suspect that that triggered a manic episode.
- 4:11But when she was in a manic episode, was something I had never seen before.
- 4:16And in retrospect, I've come to also understand the impact of depression on children, you know, when you have a mother who's depressed.
- 4:25So.
- 4:25That was all after the fact.
- 4:28Yeah, and again, probably so enlightening to make sense of something that you had experienced.
- 4:35um So then you started at Columbia and you're still in the New York area.
- 4:47How has the field changed in your time since you've entered?
- 4:54What are some of the bigger changes that you've seen?
- 4:57It's been dramatic in that the, remember, it was probably in the nineties, it may have even been in the eighties when Paul Fink was president of the American Psychiatric
- 5:10Association.
- 5:11And his theme for his meeting was stigma.
- 5:15And I was very involved in, I wanted to reduce stigma.
- 5:21One of my early roles with the APA was on the public affairs committee.
- 5:25I wanted to talk.
- 5:26and to educate people about it.
- 5:28And the shift in public perception and certainly among medical students has been dramatic.
- 5:35I mean, you know, mean, I COVID was contributory, but this was happening anyway.
- 5:40And of course there was the greater understanding that this sort of, don't wanna say the movement away from psychoanalysis, but the understanding of how the fact that many of
- 5:51these disorders are brain disorders.
- 5:54as well, mean, you they're multifactorial as everything else is in medicine.
- 5:59And I think the world's understanding of the significance of mental illness has really improved dramatically since I began in the field.
- 6:11And I remember in the early nineties when I chaired the APA committee on medical student education, everybody was all upset because there were so few students going into
- 6:21psychiatry.
- 6:22And now,
- 6:23you know, it's quote the new derm, you know, anyway, I mean, I'm just, laughing, but now the, you know, I'm working at Einstein and you know, the Dean of Students is telling
- 6:34students who are applying in psychiatry that maybe they want to consider double applying because they may not get in.
- 6:40This is unbelievable to me.
- 6:42And some of it's lifestyles, some of it's the fact that we can spend time with our patients.
- 6:48I think as primary care has gotten successively squeezed,
- 6:53psychiatry has become much more appealing that way.
- 6:55I think the advances in our understanding of the brain have really helped in understanding all of that, but it's been quite amazing.
- 7:04And of course, the brain is the final frontier of medicine.
- 7:08So that also, you know, and also many medical students are coming into medicine having majored in cognitive neuroscience when they were in undergraduates.
- 7:18So there are a lot of factors that are involved.
- 7:21Certainly the pandemic, you know, put this information all on steroids, if you will.
- 7:29Yeah, and what do you see as some of the most effective strategies in reducing stigma?
- 7:35ah I think stories are really important.
- 7:39I think authentic stories are important.
- 7:42I think having leaders, as I was saying to you earlier, even my disclosing my own depression, my family's experience with mental illness, that as we talk about that and as
- 7:55people hear about it from people that they admire and respect, that that will do a lot to reduce stigma, uh probably more than anything else.
- 8:05And I think we have to bring mental illness still out of the shadows.
- 8:10And certainly in medicine, we know there's still an enormous amount of shame and embarrassment about having to admit to a psychiatric illness.
- 8:20Yeah, which m actually brings me to another topic that I know you have been really invested in, which is well-being um of the healthcare workforce.
- 8:32So as we consider faculty well-being, what are your thoughts?
- 8:38What are the hurdles that remain?
- 8:41um Unfortunately, I think there are still a lot of hurdles.
- 8:45I actually came to Einstein from NYU where I had been working in GME to try to focus on the faculty and their wellbeing because I saw that we were protecting medical students.
- 8:57We're still even protecting house staff.
- 8:59But when it came to the faculty, it was a different story.
- 9:02And I think unfortunately, the corporatization of American medicine is a big contributor to why the faculty
- 9:10are so burned out and so disconnected from the meaning and importance of their work.
- 9:17It's not an easy answer to say that the system has to change, but the system really does.
- 9:22And to the extent that institutions are focused on profit over people, that's gonna continue to be a big problem.
- 9:31Now, the good news, the good news is, if we can look at it that way, is there are potential opportunities with AI
- 9:39I think like that we could even, you and I could have this conversation on a podcast and an AI could extract the information that was most significant and lay it out for us as
- 9:49much the way that we could do that with notes with our patients so that we're not treating the chart, so that we're not caught up in Epic and other uh electronic health record
- 10:00issues.
- 10:00And so that we can really spend the time with our patients that we want to and that we think is so important
- 10:08to the health and wellbeing, not just of the workforce, but of the people we treat.
- 10:14Well, and you know, as we think about wellbeing, I think in the past, there's been a lot of focus on kind of the individual and, you know, the individual factors and resilience.
- 10:29But as we think about this more and talk about this more, there's also a number of systemic factors that are contributing that are trickier to address.
- 10:41um
- 10:43Right now I know there's a lot of talk about efficiency in the government, but as we extrapolate that and think about efficiency in our work environments and what would that
- 10:57look like to shake them up, um because a lot of that inefficiency produces longer work hours and increased workloads for faculty, which directly we know affects wellbeing.
- 11:12think that you're correct about that and that to the extent that we can use AI to help with those inefficiencies, to help with the bureaucracy, to help with the regulations,
- 11:23that will dramatically improve the wellbeing of our workforce who really want connection, meaning, value in their work.
- 11:35I mean, that's really the difference.
- 11:37I always bring up this analogy of Navy SEALs, my fantasy, you know,
- 11:42They work together as a unit, as a community.
- 11:46The work that they do is really important and valued.
- 11:49And their hours and their challenges are enormous.
- 11:52And medicine is not for sissies, shall we say.
- 11:56And I often say to my house staff and medical students, working in medicine is not the same as working at Google.
- 12:03It just isn't.
- 12:05We're not gonna have fancy.
- 12:07places to work and free meals and all of that.
- 12:10It's not gonna happen.
- 12:11And dealing with people who are sick is taxing.
- 12:15So we do need the individual, there's a Yerkes-Dotson curve that I often talk about that plots uh stress against performance.
- 12:25We need to sort of get up there and maximize performance.
- 12:30We don't wanna send people over the edge.
- 12:32So that's the individual part.
- 12:35uh But on the other hand,
- 12:37As you mentioned, there are all of these issues within the system, the focus on the dollar, churning out more visits.
- 12:45My own PCP, this is not mental health, but my own PCP just left the faculty practice because he couldn't see his patients the way he wanted to.
- 12:56Of course, it's now a concierge practice, which is not great, but I decided I'd try it, just see if it was worth the money.
- 13:05I can write to him and in two minutes I get a response, you know, because he's not tied up with all the miscellaneous, not relevant work, you know, the non-physician work that we
- 13:17talk
- 13:17Yeah, so, you know, I know you've also been super involved with medical students, with education, with residency training.
- 13:28And we know that our trainees are at highest risk uh when it comes to burnout and in terms of thinking about wellbeing.
- 13:43What?
- 13:44For that group specifically, do you think have been some of the advances and what is the work that remains for the residents in particular?
- 13:54Well, I think the destigmatization of mental health is really important.
- 14:00My colleague, Laurel Mayer and I have often choked about maybe we should really put all of the house staff on a little dose of SSRIs, maybe.
- 14:09It'd be interesting to do an RCT on that, but I don't think we ever could, a randomized control clinical trial.
- 14:16uh
- 14:17But I think to the extent that there's reduced stigma and there's much more conversation about reaching out when you feel overwhelmed and need help, I think that's all really
- 14:27good.
- 14:29On the negative side, I worry that things become cut and paste and that people don't have um agency over their work and the meaning with their patients.
- 14:42We did work terrible hours when I was an intern, it was awful, um but...
- 14:48The care that we gave to our patients really mattered and we felt responsible for them.
- 14:53And that helped reduce burnout, even though the hours were really bad.
- 14:58So I think we've over-corrected a bit and we need to back it up some because what's happening is these kids are graduating from residency training and they take one look at
- 15:09the workplace.
- 15:10Then they say, I'm out of here.
- 15:13I don't wanna stay in academic medicine.
- 15:15I don't wanna work in a system.
- 15:17I'm gonna open my own office and not accept insurance.
- 15:20I mean, that's what's happening.
- 15:22And I'm very concerned about that because our healthcare systems that are attached to medical schools are really the places for our marginalized and underserved patients.
- 15:34And they're not gonna get any services if everybody goes and opens an office and sets up a concierge practice.
- 15:41So what do you think is important for students and trainees starting out to know about pursuing a career in mental health?
- 15:50Well, first of all, that I think it's a different time.
- 15:54So it's great.
- 15:55People won't be saying, why did you choose psychiatry?
- 15:57That's gonna be important.
- 16:00And as I said earlier, as the brain is the last frontier in medicine, think that they should, I mean, one of the things I used to say about psychiatric practice was the more
- 16:13you do it, the more interesting it gets because you'll see how unique each patient is.
- 16:19I think that may be a little bit different with especially procedurally oriented specialties where proficiency in getting the procedure right is really important and
- 16:29consistency and our universe is much more open than that.
- 16:34And of course the time and the knowledge that we have of our patients.
- 16:39So another leadership role that you held was being past president of the American Psychiatric Association.
- 16:47What do you remember as being one of your biggest challenges you faced in that role?
- 16:52uh It's very clear what my biggest challenge was there.
- 16:57I had invited Desmond Tutu to be our convocation speaker.
- 17:04And much to my shock, um there were members of the APA community who were very upset about this because they perceived him as being anti-Semitic.
- 17:16They didn't know him.
- 17:17This is all sort of, and this was, you know, 10 years ago before we had
- 17:20all of the fake news out there that exists today.
- 17:26I mean, this was before.
- 17:27And I was, I had always prided myself on being able to communicate with people.
- 17:33And I would talk to people and I would say, but don't you understand?
- 17:36He's a Nobel laureate.
- 17:38Have you ever met him?
- 17:39And eventually they, people, they took out ads in psych news and said, he should be disinvited.
- 17:48We're gonna boycott the meeting.
- 17:50And I was horrified.
- 17:52And uh one of my friends said to me, Carol, you really have to address this.
- 17:57I kind of didn't want it to explode in the media.
- 18:00And I remember thinking, I felt for Obama, you see what distortions can happen.
- 18:05And that was again, early on.
- 18:09so I wrote a piece explaining my viewpoint and he ended up coming and it was a remarkable event and a wonderful experience, but it was...
- 18:20it was very telling to me about how when you put yourself out there in leadership, become the, know, transference is pretty powerful and you get a whole lot of things dumped on you
- 18:33that you don't control.
- 18:34And I think it's, you know, it's probably why I'm happy.
- 18:37You know, I've sort of been there, done that now.
- 18:39And I want to go back and to do the real stuff and work on the ground, for example, with the students where I feel I can have a much more authentic and meaningful
- 18:50role, which is what may be gravitate towards graduate medical education and medical training in the first place.
- 18:58So, you know, knowing what you know in that leadership role and you've held a number of other leadership roles with the APA, as the organization continues to think about
- 19:09relevance in these changing times, what do you think are some of the important key issues to consider?
- 19:17Well, I think it's challenging now because everybody's concerned about money and joining all of these professional organizations is costly.
- 19:27And in the old days, academic medical centers used to pay for people to belong to things and they don't anymore.
- 19:35So it's really a question of how important do you think it is for medicine and psychiatry in particular to have a voice, if you will, in the
- 19:47public health, the public and the political arena to talk about the importance of mental health, to educate people about this, to advocate for our patients who are still the most
- 19:59marginalized in all of the patients that we see and to continue to work hard to make sure that there's appropriate reimbursement for services.
- 20:12mean, just, you know, there was a hole to do in New York.
- 20:15just today over the person who uh had a choke hold on a psychiatric patient who then died and he was acquitted.
- 20:24That was the jury decision, but mentally ill people need a lot of services and we need to be able to advocate for them and we need to be able to do it in a meaningful, political
- 20:36and outspoken way.
- 20:38And we need the national organization.
- 20:41Even our subspecialty organizations, which is what people join the.
- 20:45you know, consultation liaison, child psychiatry, et cetera, they're smaller.
- 20:49know, there is really strength in numbers, which is why actually the AMA is important as well.
- 20:56I mean, I think doctors and psychiatrists in particular really need to have a voice uh in how we take care of our patients.
- 21:06So as you've held a number of leadership roles, what have you learned about yourself as a leader?
- 21:15Well, I actually took this leadership course, executive leadership in academic medicine, ELAM, which is for women, which is, the best leadership thing I ever did.
- 21:28And I like to say that it's the gift that gives, that keeps on giving because at this stage of my career, I really do understand the different roles, the different strategies
- 21:41that
- 21:42you know, what things work and what things don't.
- 21:45I can, and I've lived it.
- 21:47And for me, it's important for me to live these experiences as opposed to just read about them.
- 21:54um And I think that that's really important to do going forward, that we have to share our experiences about this and move on.
- 22:08In what ways do you think we can support more women in leadership?
- 22:13Women need to be in leadership.
- 22:15I mean, what I was saying before about strength in numbers with the AMA, unfortunately, there's still this academic pyramid.
- 22:24I think there are more women than men in medical school these days, or if not, it's certainly even.
- 22:30It's really even.
- 22:31But somehow, there is still this pyramid where people at the top are not, women are not at the top, women and minorities are not at the top.
- 22:42And what you really need though is enlightened leadership.
- 22:47And I think there are women and people and minorities who are not support, who are not, you know, don't have uh a way to look at things from a new perspective.
- 22:59And there are white men who are allies, who can do good things.
- 23:03And it really does have to do with changing our understanding of power structure.
- 23:08And I think that a big problem for women is that
- 23:12we're still in these dual roles that even though men are much more involved in childcare and in the home than they used to be, no question, hugely better.
- 23:21And I know a lot of women who are chairs of departments, deans who have house husbands, know, somebody's kind of got to do that.
- 23:30But our system is not set up to help people with issues of childcare and elder care that we all face at some point.
- 23:41one way or the other.
- 23:43And we don't have guaranteed uh maternity, paternity time off.
- 23:51We don't have time for family time off in general.
- 23:55All of those things are important for the society.
- 23:58And I think because women have traditionally had those roles that until that system really changes, it's gonna be very hard to have more women in power.
- 24:08And I think...
- 24:09that women in general, and these are generalizations, are more collaborative, they're less hierarchical, which doesn't mean to say that there aren't hierarchical women and that
- 24:19there aren't collaborative men, but in general, if you look at the hunter gatherer issues from the distant past, that's where biology does play a role.
- 24:34So I think until that changes, it's going to be very hard and that women will not move up the leadership ladder because they're going to say it's not worth it.
- 24:43I don't want to give up the time.
- 24:45My family is important.
- 24:46My personal life is important.
- 24:48And these roles demand that I give all of that up.
- 24:53So we have to do a better job with that before I think it's going to be possible for women to really.
- 24:59Women need to, we're half the sky.
- 25:01We need to.
- 25:03you know, we have to help change the world.
- 25:05So as you consider your journey, what, like, kind of knowing what you know now, what would you tell your younger self?
- 25:16Um.
- 25:17I I would tell myself to pay attention to how other people see you because we often, think women more than men have a tendency to ah not value our contributions as much, not value
- 25:38the assets and the strengths that we bring to situations.
- 25:43People have always perceived me in a certain way that,
- 25:46You need therapy, you need to understand how your outer self and your inner self need to come together better.
- 25:52I think I would want to have reached out more.
- 25:56Your generation in women I see now, they're much more apt to say, can I come and talk to you?
- 26:02Can you help me out?
- 26:03I mean, I never had those kinds of mentoring experiences or sponsorship experiences until later in my career.
- 26:12I just didn't have it.
- 26:14And I think I was reluctant to even to reach out to men in power, men who could have supported me and could have helped me.
- 26:23just sort of stay, you know, I got, I managed to still advance, but I don't think I got as much support as I could have if I had reached out.
- 26:36So I would encourage young people to reach out to mentors, to reach out to people.
- 26:42they admire and respect.
- 26:44Everybody likes to be approached for giving support and help.
- 26:49I love to really help my students and my residents move forward in their careers.
- 26:56And now fortunately, I'm in a position where I can do that.
- 26:59People will, and I will also say not, uh you know, as I mentioned earlier, transference is really important and the fact.
- 27:09that I was president of the APA, as opposed to the experience itself has helped me later on.
- 27:15It's given me a greater sense of security about my own abilities.
- 27:20And it's made people look at me differently.
- 27:22I keep saying I'm the same person.
- 27:24I don't get it.
- 27:25Why are you, you know, just because I held this position, you think I have something to offer, but I had something to offer before.
- 27:33But it is true that as you move up in leadership, you know, there's a...
- 27:39There's an aura that comes around you that you can use for the benefit of others if you want to do that.
- 27:46Well, and I think a few things that you said just resonated with me and made me um think about kind of the course of people's journeys, right?
- 27:59I think sometimes as you move forward and you have these experiences and you do different things, you get more comfortable reaching out to people, right?
- 28:10But I think sometimes in those,
- 28:13early parts of a career when you don't yet really maybe have that same confidence, reaching out to someone seems like a very daunting task.
- 28:23And of course, you know, I graduated medical school in the 90s, know, pre social media.
- 28:32reaching out really meant like going up to someone.
- 28:37And I think these days one of, you know,
- 28:40The great things about social media is that there is this accessibility to reach out to people, not only at your institution, but across the country in a way that seems, um you
- 28:56know, you can do it on your time.
- 28:59You can do it 24 seven.
- 29:02You can do it in a very non-threatening way to, you know, to reach out.
- 29:07um
- 29:08to someone, I think it's a real advantage.
- 29:12I'm gonna put in a Luddite plug here.
- 29:14Part of the way that I advanced was that I got involved in national organizations and that's how I met people.
- 29:23And while you're right about social media, we are so flooded that it may be difficult for someone to pay attention to you on social media.
- 29:35And that's where the in-person connections that we lost during COVID that are coming back now are so important.
- 29:42because you meet face to face at and that that was really I mean I got involved in the APA assembly and I got to go to Washington and so I met people and that then just played on
- 29:54itself.
- 29:54So I would encourage people to do that and to look for people who can be in sponsorship roles.
- 30:04I had a uh lovely young woman from Canada came up to me at the.
- 30:09Association for Academic Psychiatry meeting, someone had encouraged her to talk to me because she was doing wellbeing work in Toronto.
- 30:16And she was afraid to come, you know, oh my God, can't, how can I come up?
- 30:21And we met and I said, oh, this is great.
- 30:25And why don't you come to this ACGME Symposium on wellbeing?
- 30:28She was so grateful, but I'm like in this position now where I can do that.
- 30:34And I will do that for your listeners.
- 30:37I mean,
- 30:38It's really what I feel I can contribute at this stage of my career.
- 30:43And I have enough knowledge and enough connections to be able to do that.
- 30:48Amazing.
- 30:48um So you've done so much in the course of your career.
- 30:55Are there boxes that remain unchecked?
- 30:58The things that you still like have on your list to do?
- 31:04It's probably a little late for the have on the list.
- 31:07I never did seek out being a chair or being a dean.
- 31:12I probably could have done it if I were a little bit more confident, although I'm not sure.
- 31:18don't know uh really what, you know, I don't know whether I could have made a difference in that way.
- 31:25I like to think that I would be able to have done that.
- 31:29um
- 31:30there was something else that you made me think of that just sort of flew out of my head about, oh, boxes unchecked.
- 31:38That's probably some of um it.
- 31:42ah it's just, I'm trying to focus on what I have done and the fact that I want to continue to do it.
- 31:52That for me, retirement isn't a thing.
- 31:56I don't think I want to do that.
- 31:58I think other people do.
- 32:00Maybe if I had developed more hobbies when I was younger, I haven't.
- 32:03I work was sort of what it was.
- 32:05And I like people and I like interacting.
- 32:08So uh that's been really important for me.
- 32:12And just understanding that there's no right way you really have to find your own path.
- 32:22know, pay attention to your inner self.
- 32:25You know, the things that matter to you, the things that you enjoy.
- 32:28I like to say to people, if you really enjoy doing something, if you really get gratification out of it, you're probably gonna be good at it.
- 32:37You know?
- 32:38So true.
- 32:39And I'll say one other thing.
- 32:41I used to think my life was just a series of serendipitous events.
- 32:48Serendipity does play a role, but it's not the only thing.
- 32:52It's the combination of serendipity with what your own talent and your own work is all about.
- 32:59You can't control the serendipity part, but you can take advantage of things when they come their way.
- 33:05And that's important to do.
- 33:07And that was an interesting lesson.
- 33:09mean, when I spoke, when I won the Alexandra Simmons award and I had to think about what I wanted to talk about.
- 33:17And I thought, well, people want to know about my career.
- 33:20How did I get there?
- 33:21And I was like,
- 33:22Well, it was just luck.
- 33:23I was just the right person in the right place at the right time.
- 33:26Well, some of that, but not all of it.
- 33:29So it's really both things.
- 33:32Well, thank you so much, Dr.
- 33:33Bernstein.
- 33:34It's been so fabulous to have you on and to hear your words of wisdom.
- 33:39sure I really enjoyed it and I'm sure everyone else will learn a lot from you as well.
- 33:46Well, I hope so.
- 33:47And I'm really out there to try and help the next generation.
- 33:50So pass that along.
- 33:54Thanks
- 33:55The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent the views of the American Psychiatric Association.
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- 34:12um
- 34:13For having a medical emergency, please contact your local emergency response.