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

Rachel Ruderman-Looff, M.D., is a psychiatrist with the Lifespan Adult Gender and Sexuality Behavioral Health Program and a clinical instructor in psychiatry and human behavior. 

In this interview, Ruderman-Looff talks with DPHB about her passion for the history of medicine, the state of LGBTQ+ mental health, and the social quirks of growing up a triplet.    

You majored in the history of medicine in college. What drew you to that intersection of subjects?

I went into undergrad thinking I’d major in biology but became more and more enamored of history after taking classes in the history of medicine department. I created a concentration for myself in 20th century patient activism and did research around breast cancer activism and the women’s mental health movement of the 1970s. I even went to Cambridge [Massachusetts] to interview some women who had been involved in the lesbian chapter of Our Bodies Ourselves.

Initially I wanted to get a PhD in history, but then I realized I wanted to be part of the frontlines of determining how medicine could continue to shape social activism and increase equitable access for everyone. 

As a trainee in the Brown general psychiatry residency, you developed lectures on the history of psychiatry for the program. How did that come about and why was that important to you?

I created two lectures as part of the residency’s LEAP [Leadership, Education, Administration Program] program, which provides extra time and support for academic projects. 

In the history of psychiatry, there have been a lot of treatments that were well-intentioned but created harm, whether we’re thinking about lobotomies or diagnosing homosexuality as a pathology or some of the medications that have had serious side effects. Understanding the history of psychiatry is understanding why those treatments were proposed, what people's intentions were, and what we can learn from that. It should inform how we talk about our proposed treatments with our patients now – really making sure that we’re engaging in shared decision making.

A historical perspective can also get us thinking about how we’ve collectively created an environment where it’s difficult for folks with severe mental illness to have a meaningful quality of life. As psychiatrists, we should be thinking not only about how we can individually intervene for our patients, but also about our role in terms of broader social activism. 

Does your interest in history come out in other ways?

I’m guilty of purchasing way too many books about history. Plus, my wife has a PhD in women’s studies, so we have a lot of overlapping interests.

You currently work as an outpatient psychiatrist at Lifespan’s Adult Gender and Sexuality Behavioral Health Program. What’s the specific value of a clinic that specializes in LGBTQ+ mental health?

Our clinic was started to meet the treatment needs primarily for trans and nonbinary folks, so our focus is on increasing access to gender-affirming care. But we also treat any psychiatric needs for folks under the whole LGBTQ+ spectrum. 

When people feel they're in a place where they don’t have to explain themselves and trust that we’ll know the right questions to ask, it can go a long way toward easing any anxiety they might feel about that initial appointment.

Over the course of their history, LGBTQ+ people in the U.S. have faced everything from pathologization by the medical establishment, as you mentioned, to an overwhelmingly hostile society. At this particular moment in time, when LGBTQ+ people have more legal protections and mainstream acceptance, what are common issues they may come to you with?

For a lot of people, it’s still validation that their identity is as legitimate as anyone else’s and validation from their families and people close to them. One of the things I talk about so often with my patients is how to increase affirming, supportive social connections.

Also, even though there are a number of legal protections now, the reality is that things are still very tenuous. The media is full of the uncertainty that exists in the world. That can absolutely weigh on people and affect their well-being.

Do you see generational differences in your LGBTQ+ patients?

My patients probably range from 18 to 72. I’ve had the privilege to work with some older patients who are starting their gender affirmation journey later in life. They may have lived through periods that were less supportive and that’s impacted their access to supportive relationships, particularly in their nuclear families. At the same time, I think we can all appreciate the ways in which it’s so challenging, whether you’re LGBTQ+ or not, to navigate identity formation as a young adult.

Where do we still need to go in terms of LGBTQ+ mental health?

It would be amazing if, in the future, a clinic like ours didn’t need to exist because LGBTQ+ people would be assured of compassionate care wherever they go. It’s also important to make sure we protect access to evidence-based gender-affirming care. 

Anything else people might be interested to know about you?

I was born and raised in Lexington, Kentucky, and I’m a triplet – one of three sisters. We were built-in best friends growing up, which was excellent, but also tends to insulate you a little bit. You don’t have to learn how to put yourself out there and make friends. But overall, highly recommend! 

One of my sisters did her undergrad at Brown, so I had spent some time here and was always very jealous of her time in Providence. My wife and I love Rhode Island and we’ve decided to make our life here. I actually convinced one of my other sisters to move here last year, so I’m pulling everyone to Rhode Island.