Paula Clayton

Abstract

Psychiatrist who sought to destigmatise mental illness. Born on Dec 1, 1934, in St Louis, MO, USA, she died of complications from a non-COVID-19 viral infection on Sept 4, 2021, in Pasadena, CA, USA, aged 86 years. Paula Clayton was the first female chairperson of a major psychiatric department in the USA. Yet it was only one breakthrough in her trailblazing career. “As the first woman chair that was very important, but she advanced the whole field”, said Elke D Eckert, Professor Emeritus in the Department of Psychiatry at the University of Minnesota in Minneapolis, MI, USA. “She had a number of firsts that were really important. She and colleagues applied really rigorous research methods to studying psychiatry, especially depression and bipolar disorder.” Clayton completed undergraduate premedical studies at the University of Michigan in Ann Arbor in 1956 and then enrolled in the Washington University in St Louis (WUSTL) School of Medicine, MO, USA. She had a child during her fourth year of medical school and “that determined, then, my choosing psychiatry over [internal] medicine”, she recalled in a 2010 interview. The Department of Psychiatry at WUSTL was at the vanguard of efforts to bring more scientific rigour to the diagnosis of mental illnesses and “the classification of psychiatric disorders when there was none”, said S Hossein Fatemi, Professor of Psychiatry and Neuroscience and Emeritus Bernstein Professor in Adult Psychiatry at the University of Minnesota's Department of Psychiatry. Among Clayton's mentors at WUSTL was George Winokur. Students in the department were trained using a model that emphasised the importance of data, alongside clinical interviewing. That early education shaped Clayton's career, as “she would remain incredibly focused and data driven”, said Steven Zalcman, the Chief of the Adult Pathophysiology and Biological Interventions Development Branch in the Division of Translational Research at the US National Institute of Mental Health, Rockville, MD, USA. After Clayton became an instructor in psychiatry at WUSTL in 1965, she and Winokur collaborated regularly, including work confirming “there were two very different types of mood disorders: unipolar depression and bipolar disorder, characterised by episodes of mania with or without depression”, Zalcman said. Promoted to Associate Professor in 1972 and Professor in 1974, Clayton was also known for her research on schizoaffective disorders and on bereavement. “She was the first person to demonstrate, through research, that bereavement, while phenotypically mirroring the symptoms of depressive illness, is a distinct, non-clinical entity”, Zalcman said. Clayton, whose mother and grandmother were active in the women's suffrage movement, received her appointment to chair the University of Minnesota's Department of Psychiatry in 1980. Clayton quickly set about bringing equality to the department, Eckert recalled, including raising female faculty members’ salaries to match their male counterparts. She was also intent on elevating the department. “With her presence and through talking to the department heads, she won some space for more research from the department of internal medicine”, Eckert said. “She helped the department become relevant.” Clayton stepped down as chair in 1999, but was later recruited to join the American Foundation for Suicide Prevention (AFSP) in New York City as Chief Medical Officer. Zalcman said it was a natural fit. “She had contributed substantially to the formulation that suicide is largely the result of unrecognised and untreated mental disorders and that a disproportionate percentage of completed suicides are by individuals suffering from serious mental illnesses, usually depressive illnesses”, Zalcman said. When she joined AFSP in 2006 the foundation was beginning to mobilise chapters around the USA to deliver community-based suicide prevention services. Those chapters were often organised by “lay people who had lost a loved one or had struggled themselves”, AFSP chief executive officer Robert Gebbia said. Clayton created a package of programmes to train the chapter members and “give them the content knowledge they needed about suicide, its causes, and how to prevent it”, Gebbia said. She also linked the institution to the International Academy of Suicide Research. The two organisations now host a biennial research summit. “At the end of the day, Paula was an educator”, Gebbia said. Clayton is survived by her daughter, Clarissa, her sons, Andrew and Matthew, and seven grandchildren.