The Clinician Cameo is a monthly interview series with a clinician in the Brown Department of Psychiatry & Human Behavior (DPHB).

Joanna MacLean, M.D., is the director of women’s behavioral medicine at the Women’s Medicine Collaborative at Lifespan and an associate professor of psychiatry and human behavior and of medicine. 

MacLean talks with DPHB about her “niche” field of psychiatry, the nuances of pregnancy and parenthood, and her return to competitive tennis after a 20-year hiatus.

You earned your undergraduate and medical degrees at Brown. Are you a Rhody by any chance?

I’m not sure if you’re a true Rhode Islander unless you’re born here, but I moved to Rhode Island when I was three. So I’m mostly a Rhode Islander.

Do you know any hidden gems in our state?

I know the area around Middletown and Newport pretty well. My favorite beach is Second Beach. It’s a nice long beach for walking right near Purgatory Chasm. Right next to that is the Norman Bird Sanctuary and Sachuest Point [National Wildlife Refuge]. There’s lots of really nice walking and access to nature.

Your area of expertise – reproductive psychiatry – may call to mind postpartum depression and anxiety. But how is the field defined, exactly?

Reproductive psychiatry focuses on the unique mental health needs of people who have psychiatric symptoms related to reproductive cycle transitions. That means the diagnosis and management of mood and anxiety symptoms that occur around the menstrual cycle, across pregnancy, in postpartum, and during the perimenopausal years.

It’s also a subset of women’s mental health, which can include issues that tend to be more specific towards women, such as trauma-related experiences, or even psycho-oncology related to gynecologic or breast cancer.

You serve on the National Taskforce on Women’s Reproductive Mental Health, which addresses gaps in reproductive psychiatry education. What are those gaps, exactly?

Reproductive psychiatry doesn’t have a formal fellowship track, so it’s still a pretty niche field and rarely included in residency didactics. The task force’s biggest project has been creating a national curriculum for reproductive psychiatry. The curriculum is free, evidence-based, and pretty foolproof. Anyone who doesn’t consider themselves a specialist can open a facilitator’s guide and lead residents in a didactic. 

Any resident who goes on to practice clinical psychiatry is going to have patients who are pregnant or dealing with reproductive cycle transitions, so they need to know how to manage these patients appropriately. 

Given its rarity, how did you find your way to reproductive psychiatry?

My first exposure came as a medical student. I was at Brown doing an art therapy research project on an inpatient psychiatric unit. One of the patients was a woman who was pregnant, and her outpatient psychiatrist advised her to stop taking medicine. She subsequently got very depressed and jumped out of a high story when she was eight months pregnant. She lost the baby and suffered a significant traumatic brain injury. That was a pivotal moment for me.

In my third year of residency, I asked to be placed in an OBGYN practice and started a postpartum support group there. In my fourth year, I took on a role of chief of women’s mental health and trained with experts at MGH’s Center for Women’s Mental Health who were gracious enough to take me on. 

What are common misconceptions when it comes to reproductive psychiatry?

So in the case I mentioned earlier, the psychiatrist heard the patient was pregnant and their impulse was: Medications aren’t safe in pregnancy, therefore you need to stop. I think there’s more awareness now of the risk of medication versus the risk of untreated illness. But for many years – and still in many places across the country – that hasn’t necessarily been understood. The consequences can be so serious for entire family systems.

Did experiencing pregnancy yourself change your perspective on the field in any way?

Honestly, I think the main effect is that I’m able to speak in a more genuine way with my patients. I no longer feel that bit of impostor syndrome: “I’ve heard about what it must be like to have sleep deprivation or do night feeding shifts.”

We don’t typically disclose our lives to patients. But I think it can help with rapport building if they’re confident you understand them on a level that goes beyond being a medical professional. If they ask, I’m generally happy to share that yes, I’m a mother, and yes, I have three children.

Another part of your non-professional life is that you’re a competitive tennis player. What does that look like?

“Competitive” makes it sound like I’m on the ATP tour. This is the USTA – the United States Tennis Association. If you’re a kid getting into playing competitive tournaments, you’d start off with the USTA. There are adult leagues, too – women’s teams, men’s teams, mixed teams, and something called tri-level where players at three different [skill] levels create a team.

I had played tennis growing up and in high school and then stopped for twenty years. When COVID hit, I was bringing my kids to their tennis lessons, thinking, “Why am I watching them play tennis? Why aren’t I playing, too?”

I developed a great rapport with a woman through a clinic I was in, and we started playing doubles together. She and I won our level in Rhode Island, then advanced to regionals, then sectionals. The winners of each level in New England form a tri-level team that goes to nationals together.

So in March 2023, our team went – my partner, me, and five other women.

We won! The amazing thing is that by the time we got to nationals, my partner was actually six months pregnant. We got an extra trophy for the baby.

Do you have your trophy on display?

Initially, I did because I said to my kids, “This is your trophy, too.” Nationals had coincided with my kids’ spring break, so it became this fun family trip to San Diego. They were able to run out on the court and everything.

But I read somewhere that with kids, it’s important that awards aren’t central. So now it’s in my room.

How do you manage working a demanding job, co-parenting three kids, and playing competitive tennis?

A lot of what I do in my work is talk with mothers about the transition to parenthood. There's a grieving process for the identity you had before kids and a process of deciding what parts of that identity you’re going to try to integrate into your life with kids.  

You have to practice what you preach, right? For me, during the pandemic, being a mental healthcare worker and having three young kids at home, it was wonderful to have something outside the house that brought me joy. 

Logistically, I’m playing tennis one evening a week after the kids go to bed. At some point in the season, I was playing twice a week. But it’s not a huge time investment, really.

Plus, my kids got to be a part of it. Hopefully, when they think back to this, it will be: “That was actually pretty wild that my mom had a full-time job, was able to take me to all my sports and activities, and still did her own things, too.”