Dr Philbin Bowman is an independent consultant psychiatrist at Dublin Well Woman Centre. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Dr Philbin Bowman's story
In 1985, 16 years after my graduation in medicine, I wrote an article for the Irish Medical Times entitled "How to become a psychiatrist - the female model". I likened myself to a single cell under the microscope, describing how that cell had to adapt and modify its growth to survive some extremely challenging environmental conditions.
It started subtly in my years as an undergraduate in the first half of the 1970s, when a growing awareness of seemingly disconnected observations lay like pieces of a jigsaw waiting to be put into place. I began to notice that the further one advanced in medical school, the rarer women lecturers became, until by hospital consultant level they were, with one or two exceptions, invisible. It wasn't until 1982 that those pieces of the jigsaw fell into place when the results of a survey of graduates, from the three Dublin medical schools there were in the early 1970s, was published.
It described their plans, their problems and their prospects: one third of the graduates were women and the picture described was bleak. Only 26% were in full-time posts, 43% were working part-time - mostly in sessional posts not recognised for higher training - and 31% were unemployed. Their career difficulties arose "not on marrying, but on having children". Yet of all the women surveyed, 97% wished to continue in medicine and identified a need for part-time career posts and child-care facilities.
A quarter of my year were women. One day I had overheard someone commenting that the Professor of Medicine believed women shouldn't study medicine, yet occasionally on ward rounds a consultant might comment that the symptoms of a particular patient might be attributed to 'spinsterhood', so clearly there were disadvantages to either state! Then there was the strange experience, on placement in the maternity hospital, where all the patients were women and all the consultants were men, there because of the only difference between them - they could not experience pregnancy or give birth! With whom was a female student to identify?
Yet, in the general hospital, where the risk of pregnancy might be a complicating factor for a medical or surgical patient, discussion of contraception apparently did not fall within the ambit of medicine at all but belonged to the even more exclusive field of Moral Theology. I recall a case conference in my final year when a female patient - admitted for investigation of a renal condition - was discovered yet again to be pregnant. The first independent clinic to prescribe contraception had just been opened: her consultant, with a mischievous smile, naming the location of the clinic, asked "Should we send her to Merrion Square?'" The response was a room full of uneasy laughter.
So as a woman, it was preferable not to study medicine, or if one did, not to aspire to a consultant post, not to marry too young or to remain a 'spinster', not to have children too early or to consider contraception and risk postponing having children too late. Yet my mother was a professor and head of the Department of Chemistry in University College Dublin: one of only three women professors and the only one with children. She had never expressed any of these conflicts, and my sister and I presumed that any career would be open to us.
With my mother as my model, I confidently proceeded to embrace as many of these roles as possible. I married after my 4th year exams, and 15 months later, in January of my final year, my first son was born. When I graduated in June 1969, with first honours in psychiatry, I had a six-month-old delightful baby boy and was, unexpectedly, three months pregnant. I was a perfect example of why women shouldn't do medicine!
Presuming that, in the circumstances, my teaching hospital would be unlikely to offer me an internship, I applied to a public hospital for my compulsory intern year. Receiving the application form my attention was drawn with disbelief to a line at the bottom of the page in heavy black print stating: 'Only unmarried women or widows are eligible to apply for an internship'. How could the state that subsidised my six years of medicine declare me ineligible to complete the mandatory seventh? (This reflected the law, not rescinded until 1973, that all women in public posts must retire on marriage).
The consultant in my teaching hospital who had earlier raised the question about referring his patient to the family planning clinic, instead of referring me there also, proposed that I could replace interns on their fortnight’s break, which I did until my baby daughter was born in December. But with two babies, born in one year, it became clear that the required one in three nights on duty was not an option.
For the following two-and-a-half years I immersed myself in their development, consoled to discover that Piaget, the developmental psychologist had based his life's work on the observation of his own children. I was also invited to join the newly formed Irish Women's Liberation group, composed mainly of women journalists and women involved in politics. Two of the most influential books I read were The Female Eunuch by Germaine Greer - whose confident and amusing company I had been lucky enough to enjoy when spending a summer as an au pair in Venice - and Betty Friedan's hugely influential book The Feminine Mystique who described the deep malaise of American housewives as 'The problem that has no name'. I learned that my own experience, far from being unique and an indication of my personal inadequacy, was echoed by women in law, politics, education, literature and in the home.
When my daughter started creche, I applied and was accepted to do a Masters degree in the Department of Psychology in Trinity College. For the first time in my education, thinking critically was not only encouraged, but rewarded. The published version of my thesis entitled, 'The Sexual Attitudes and Contraceptive Practice of Single Women with No Marriage Plans' received considerable attention in the press, at conferences and was discussed in one of the Irish Parliament's protracted debates on legalising contraception.
It was now six years after my graduation in medicine: this time the Professor of Medicine, in contrast to his earlier overheard comment, welcomed me back into the fold. Updating my textbooks, I joined that year's final three months prior to their graduation, and was then offered an internship in neurosurgery, followed by completion of my remaining months in Medicine. Finally, I was on the path to specialising in psychiatry, obtaining my first training post with the Professor of Psychiatry in University College Dublin; 15 months later I passed part one of the Membership exams.
It was then my turn to support my husband, a current affairs radio and television journalist whose PhD was at a crucial stage. I worked, unpaid, on two clinical research studies and, when things eased, I returned to a full-time post as registrar in Child and Family Psychiatry. When I and a fellow registrar left on maternity leave together, we received a call, a week before our return, to ask if we would like to share a post together. Job-sharing, for women with children, was the gateway to specialisation which had been identified by women graduates in the Irish research study referred to. I had fantasised about it when reading of an intern post in Oxford being shared between two married women. It took us five minutes to say 'Yes'.
Deciding to move from Child and Family Psychiatry in 1988, I did not expect that one of my special interests would follow me on my return to General Adult Psychiatry. My publication that year was entitled 'Asperger's Syndrome and autism: the case for a connection', [British Journal of Psychiatry, 152, 377-82]. It was prompted by Lorna Wing's 1981 seminal publication in the Journal of Psychological Medicine, entitled 'Asperger Syndrome: a Clinical Account’, a condition which for many years had haunted child and adult psychiatrists alike. In the intervening years the incidence has gone from 1/1000 of the population to 1/65-100 as we have begun to understand how females differ from males in their presentations -and in their ability to mask their symptoms. In my practice for the past 20 years increasing numbers of women who have either been misdiagnosed in childhood, or never referred for assessment, are presenting, very often when one or more of their children has been diagnosed on the spectrum. The discovery that at last they have an explanation for struggles for which they have blamed themselves, now changes their lives and those of their children. They too can identify with Betty Friedan's description of the 'problem that has no name'.
In 1983, 20 years after entering medical school, I became a member of the Royal College of Psychiatrists. It too was a long journey but I had reached my destination. It was one of the very special days of my life.