The Frontier of Women's Healthcare : Dr. Crystal Schiller

In this episode, I interviewed Dr. Crystal Schiller, a clinical psychologist specializing in women’s mental health. She studies how hormones trigger changes in mood over the course of the reproductive life span—during the menstrual cycle, pregnancy, postpartum, and the transition to menopause. She is also passionate about teaching others about the impact of hormones on mood and tools that have been scientifically shown to help.

Transcription

Transcribed by Sarah L. Miller (she/her), Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill

JP: So Robin, a PhD student in your lab, suggested I interview you, and I will say that I did a little bit of research on your career path and your work, and I’m really excited to learn more. One more thing I want to say before I start the interview: Robin just absolutely glows up when I bring you up, and as someone who has mentored and as someone who understands how important mentorship is I think it’s amazing that Robin thinks so highly of you.

CS: Thanks so much for having me. I’m delighted to be here today.

JP: I know you spent a lot of time in school in Iowa, right? But can you fill in the blanks for me? Were you born and raised in Iowa? How did you find your way to UNC?

CS: Yeah. So I was born in Cedar Rapids, Iowa, which is a town that is on the eastern side of the state. Most people have never been there. It is, you know, a small, a small town. And the school I went to growing up was originally founded as a school for kids who were growing up on farms. It was like a rural area that developed a little bit more over time. So I lived in a neighborhood, not on a farm when I was a kid. And continued to grow up there until I was in high school, and my dad took a job in Kansas City. So we moved to Kansas City between my sophomore and junior year of high school. So I finished up high school in Kansas City, Kansas and then wanted to go back to Iowa, cause that was my, you know, area for college. And my grandmother was getting older and needed some help. So she lived nearby the university. So I decided to return to Iowa, and I would go visit her on the weekends when I was in college to help her out. She was a farmer. Both sides of my family, both my parents grew up on farms in central Iowa, and they come from a long line of farmers. I think that’s where I got my work ethic from. It’s served me well.

JP: Yeah!

CS: But anyway, so yeah, I’m Iowa born and bred and went to undergrad there. They had a great psychology program. Really fell in love with psychology. I was premed and psychology in undergrad. And thought from the time I was really young that I would try to be a pediatrician or a family doctor, and that was sort of my plan. And then I took a class on psychology in high school in Kansas City, and I remember the teacher saying, women are twice as likely to experience depression as men. And I remember thinking like no way that cannot possibly be true. All the women in my life are strong, you know. They’re all farmers, or grew up on farms right? And in that environment, the women really hold everything together. They were the ones who were raising all the kids. My mom grew up without indoor plumbing. You know, like making the meals.

JP: Was it a woman professor or a man professor?

CS: This is a high school psychology class, it was a male teacher.

JP: Oh wow, yeah.

CS: And I just remember thinking, like, I don’t believe it like that can’t possibly be true. And so then I looked into it more, and thought like, this is a cool and interesting thing to look into when I go to college. So, at Iowa, even though I was planning to go to medical school, I thought, you know well, you have to select a major that’s not pre-med. So it could have been like biology or chemistry, or whatever. But I really loved that psychology class so I thought, Okay, here’s my opportunity. I’ll study psychology, really learn more about this, and figure out what it’s about. So that’s where it started.

JP: And now you’re at UNC, so how did you get there?

CS: Yeah. So I did my undergrad degree in psychology and pre-med. And during my junior year of college I thought, you know, I just love these psychology classes like, I don’t want to go to med school I want to go to grad school for psychology. And at the time the undergraduate advisors–they probably still tell people this–if you want to go to med school, you gotta volunteer at the hospital. And the University of Iowa is similar to UNC in that they have a hospital right on campus. So I signed up to volunteer at the hospital my first semester of college and the way it worked at the time in the volunteer program is you sign up, and then they randomly place you into like a place in the hospital, and the place that I got randomly assigned to work as a volunteer was on the psychiatry floor. And they had an eating disorder unit. And there my job was to tutor the patients as they were staying on the eating disorder unit for long term treatment. So they were missing school, and my job was to help tutor them in the school that they were missing. And I became really interested in why all the patients were girls.

JP: Yeah.

CS: So I thought, you know, similar to that psychology class in high school like, what is it about being a woman that like puts people at risk–

JP: Right.

CS: –for these specific mental health conditions and like, is it because of their hormones? Or is it something else? And so then there was this sort of confluence of events. There was a professor who was coming to Iowa at the same time I was graduating. And so I was looking to go to grad school, but I knew I needed to take some time and figure out what I wanted to do. So I applied to work in her lab and got a job as a research assistant working with her. And she generously offered to let me do a project. And so I started out as a research assistant working on her trials, but also doing this little side project to understand how hormones regulate eating behavior in women with bulimia.

JP: Wow.

CS: Yeah. So that’s what I was doing initially. And so I was there for a while at Iowa. I got into grad school with her to continue to do that work and stay in their clinical psychology program. And then you know finished that project that became my Master’s thesis. So we found in that study that hormones estradiol and progesterone change over the course of the menstrual cycle in really predictable ways in all people for the most part. But really, interestingly, in women with bulimia those predictable hormonal changes triggered binge eating

JP: Wow.

CS: And the really interesting thing to me was when I looked at the data from the control subjects–the people who didn’t have eating disorders–hormone changes over the course of the menstrual cycle were causing changes in their mood symptoms. So even though they weren’t depressed, they didn’t have eating disorders, they were still reporting day to day changes in mood that were predicted by their changes in hormones.

JP: Interesting.

CS: And so I thought, like gosh, this is so interesting like it’s broader than eating disorders, it’s broader than depression, like. How are hormones changing our, you know behavior, our thoughts, our emotions, day to day and like, how do we understand that in the context of mental health? And so at that point I also switched advisors—

JP: Hmm.

CS: –and began working with somebody who studied postpartum depression. And so then I started applying some of this work that I was doing with hormones to the postpartum depression space. And that ended up being my dissertation. I did some human studies looking at changes in hormones day to day at the end of pregnancy, through the postpartum period, and how that predicted mood changes. And then I also did some animal model research.

JP: Wow.

CS: Because hormone stuff was expensive, so I couldn’t do like a real big clinical trial or something. So I learned the animal model methods and did some rats–studies in rats–where we administered hormones and looked at how it changed behavior.

JP: Awesome.

CS: Yeah. So then, in clinical psychology training programs, you have to do a one year internship at the end of the PhD, where you, similar to like a medical residency match system, where you apply to about 15 different internships and then you get matched with one. So I did my internship at the Medical University of South Carolina in Charleston.

JP: Oh okay, so it wasn’t just straight Iowa to UNC.

CS: Yes, so I was in Charleston for a year, and did full time clinical work there and then knew I still wanted to study hormones and mood. And the person, like biggest name in the field who was doing this work and had been for many years was at UNC Chapel Hill as the–he was the department chair of psychiatry at the time, David Rubinow. And so I just sat down with my dissertation one day and started going through my reference list and contacting like cold emailing the people I had referenced–

JP: Yeah.

CS: –in my dissertation who were doing this work. And they all kept pointing me back to David Rubinow, like he’s the guy–

JP: Wow.

CS: –that he should be working with. So I started contacting him, and he was ignoring me.

JP: Ghosting you.

CS: No, yeah. He was a busy department chair. He didn’t have a postdoc training program. He didn’t have a lab because he was not doing his you know, research at that point because he was an administrator. And so he just didn’t have anything for me. And so I just kept emailing different people at UNC trying to get in here somehow, because this is where the cool stuff was happening, as far as I was concerned. And he knew the field that I wanted to be in. And so finally, my mentor at Iowa contacted him and said, Look, you just gotta respond to her one email like so she can just like—

JP: “I promise this is worth your time.”

CS: Yeah, like she can take your no and leave if it if it’s really a no.

JP: Right, right.

CS: So we scheduled a call and on the phone I still remember him saying, Oh. Oh, yeah, this is exactly the thing I do. Like you’re interested–

JP: Oh my God.

CS: –in the thing I do. And I was like, Yeah, I’m really interested in how hormones trigger depression in women–

JP: Yeah.

CS: –and like using experimental models to understand how that works. And so we said great come on up to Chapel Hill, and we’ll talk.

JP: Yeah.

CS: So I drove up to Chapel Hill like on the fumes of my bank account. Because of that I’ve been a grad student for a long time, and internship was, you know, it doesn’t pay well, so. And moving across the country was expensive. And so it was just like I’ve gotta figure this out. I want this to work so badly. And I had other had another position somewhere else that was on offer, and was interviewing also at Penn to work with Neil Everson, who’s another like really prominent fantastic researcher in this field. So I really only had good options based on that approach that strategy of like, just cold emailing.

JP: Yeah, not a bad problem to have.

CS: Yeah, right? So, but I came up here and he said, Oh, this is great like you’re poised to do this work, and you want to do this work. So why don’t you come up and do your postdoc here? So offered it to me on the spot, and I was like, How do you say no to that? That’s great, you know. So then we moved up here, and I postdoc’d with David for 2 years and then wrote a grant to get a career development award which allowed me to transition to faculty. And I’ve been here ever since.

JP: Awesome. So what other titles do you hold? I know you’re a director of a certain internship program, right? Can you tell me a little bit about that?

CS: Yeah. Yeah. So I mentioned that internship program that I was in. I’m now the director of the psychology internship–

JP: Cool.

CS: –program at UNC. We have 14 interns in our program. I’m also the associate director of the UNC Center for Women’s Mood Disorders. So David Rubinow, my former mentor–well, still mentor, he’s still around–he founded the Center when he came to UNC. And now I’m helping direct it.

JP: Awesome.

CS: So yeah, those are my 2 primary roles.

JP: Awesome. Alright so I will say, you know I’m approaching this interview as a man who does not have any experiences in what you research. But I think it’s really important to be educated on the topics that you’re researching. And I just wanna make sure that my listeners who can relate or can’t relate learn something from you. So can you tell me more about the research that you do now and what you do?

CS: Yeah. So I’m still doing that same thing that I set out to do initially, which is really understand why women, and people who are born or assigned female at birth, have an increased risk for certain kinds of mental health conditions. So I’m still studying depression and mood disorders. I’m collaborating with some folks on eating disorder research still. But ultimately my research attempts to understand how changes in hormones during certain reproductive windows–whether it’s the menstrual cycle, puberty, pregnancy and postpartum, or the transition to menopause–how hormone changes during those times trigger depression and anxiety. And so in order to do that, we use experimental models, which means that those rat studies that I was doing in grad school. Now, we’re applying those same methods in humans. So we give people medications–hormone treatments–and look at how that changes their brain function, the brain structure in some cases. How that influences neurotransmission and how that can explain why some people are more susceptible to depression than others.

JP: Wow, that’s amazing. So how do you envision your work and the work of others really being incorporated into just general women’s healthcare? I think it’s a super important area, you know, it reminds us of the lack in exploration in women’s healthcare experiences that, for example, black women may encounter when they’re looking for healthcare answers. Like, how do you envision all this fitting into, you know the big chunk of healthcare?

CS: Yeah, exactly. It’s a really important question and something that I feel really fortunate to be able to do both. So I have this program of research, and have many amazing mentees and colleagues that I’m working along with. And then we also have our clinical footprint as well. So we have a psychotherapy program for pregnant and postpartum people. And that is an outpatient program. We work closely with psychiatrists and OBGYNs. And then we also have an inpatient–one of the only perinatal psychiatric inpatient units in the country–

JP: Wow.

CS: –where we can treat women who are experiencing severe mental health conditions during this period of time. And then we’ve also recently started a menopause clinic so that we can implement some of this with women who are transitioning to menopause. And there’s–as you alluded to–there’s been a real dearth of research in some of these areas. Particularly in perimenopausal mental health, but also in other areas–puberty being an important one of them, adolescents. And understanding what are the triggers or neurobiological mechanisms whereby women going through these periods of time begin to experience depression and other mental health symptoms. And then what can we do about it? And so we’re really trying to push that forward while simultaneously bringing those insights that we gain in our research directly into our clinical practice. And so I think you know for me it’s really important to be able to do both of those things. And so in our menopause clinic, for example, part of my role is as a psychologist, and I mainly supervise trainees doing this work. So our psychology interns and postdocs are seeing patients. But we’re talking with patients about how these hormone changes are impacting their symptoms and what we know based on the research tends to work for specific, like types of symptoms. And depending on when their symptoms onset relative to the menopause transition, what kinds of hormone options might work. And then what we know about psychotropic medications, and how these things can work together to really treat the individual from a sort of personalized medicine approach. So that’s kind of my focus now is bringing these pieces together. Yeah.

JP: Yeah. Have you ever thought about like patient comfort in terms of your client work? Right? Because I feel like these questions are coming from the idea that we can improve the overall experience of women when they seek healthcare, and I feel like it’s not just the clinical part, but also, you know, how can you get as many people as you can into the clinic to make sure that they feel that they’re taking care of, so that they feel comfortable in really working with y’all? Because I think that is also an important part of it. Is there anything that y’all are doing on that end?

CS: Yeah. Yeah. So we recently did a focus group with African American women who are transitioning to menopause to ask them some of these questions. Like, what are the barriers that you see to care? What are the things that make you feel more comfortable or less comfortable seeking care in a medical setting? Because it is a big hospital system that I work in.

JP: Yeah.

CS: And then also, like what are the pros and cons for you personally of participating in biomedical research? And it was really informative and has helped us think about the kinds of work that we’re doing and the methods we use and how to make this more accessible to more people and more welcoming to more people. And so, I think, to some degree, the individualized approach is really important in understanding a person’s not only biology, but also culture–

JP: Yeah.

CS: –and cultural life experiences, and how these things come together to contribute to symptoms that people may be experiencing. And you know, I think, another–well, few other things–one is that not all of this is maladaptive.

JP: Right, right.

CS: So like our hormones change over the course of our lifespan. Even for men, they experience hormone changes in testosterone and estrogen like so men have estrogen, too.

JP: Right.

CS: And that isn’t really focused on or talked about that much. But so How can we understand this from a sort of multidimensional perspective? How can we communicate it in a way that’s helpful to other people? How can we combat misinformation that’s out there? Because in this sort of lack of–historic lack of attention to women’s health, it’s created sort of a vacuum.

JP: Right.

CS: And so there’s a whole bunch of companies and individuals who are looking to capitalize on this need for information and treatment. And so that has led to a proliferation of–I don’t know, devices and medications and all sorts of like over the counter supplements that have no scientific background of like ever having worked.

JP: Yeah.

CS: So yeah, like, people are spending extraordinary amounts of money on this stuff and coming in saying, Well, it’s pointless. I’m suffering and nothing works. And I’m like, Well, you haven’t actually had any kind of evidence based treatment yet, you know.

JP: Right, right.

CS: One of the things we’re doing to address that is we started a seminar series that’s public facing. So far everything’s been on Zoom, we’re gonna do some in person stuff coming up, too.

JP: Awesome.

CS: But just to like spread the information that is available–high quality information. And hopefully, it’s accessible to most people. But we’re just trying to get quality information out there.

JP: Yeah, so can I share an excerpt from one of my listeners when I mentioned that I was going to interview you?

CS: Yeah!

JP: So she’s explaining how she, you know, got her first period when she was 13, and she had really really heavy periods and bad, really bad cramps, right? And she kept going to her doctor, and he kept saying, You know, take more Advil. And it got to a point a couple years later, when finally, you know, she was told to take birth control, and from my understanding, birth control can do a lot to an individual, right? So like–I don’t know–how can we combat this logic from practitioners? Do you think you know, this means that we should really try and diversify science, right? Like, let’s get more women in the clinic that are, you know, clinical psychologists and doctors. Let’s get more first generation students and get more people that you know have these experiences in these settings. So what do you think?

CS: Yeah, I think that’s definitely part of the solution is really making a place for everyone to do this work.

JP: Yeah.

CS: Because I think that lived experience is critically important in designing studies and thinking about what matters and how you know everything from like, how do we create a space that’s welcoming for you as the patient? But not designing a space because that’s what I know, or what I think is best, right?

JP: Right.

CS: Having more people at the table in making those decisions from all different walks of life, whether it’s race and ethnicity or socioeconomic status, ability, and you know, lots of different perspectives, I think, makes our clinic and research and situation more welcoming to the people who need it most.

JP: Yeah.

CS: I also, though, think that it’s our responsibility along the way to also be engaging the community that we’re trying to serve and really hearing their perspective and bringing their voices into the work that we do. And also educating ourselves, you know, reading firsthand accounts and really understanding, you know, the history of this, you know, situation in our country. Like I think it’s on us as providers to combat the historic wrongs that have been committed against communities of color. And to really understand, you know, it wasn’t all that long ago–

JP: Oh yeah.

CS: –that black women were being experimented on in OBGYN. And so like no wonder there’s mistrust against the medical community.

JP: Right.

CS: And I think that’s a real barrier to providing high quality care.

JP: Yeah. And I think it’s–a lot of the problem, too, is just the lack of the historical context in our curricula. Right like I think it was just last year that I learned that 31 states still have sterilization to be legal. You know what I mean? like it’s just things like that where it kind of slips under the radar. And I’m like, okay, there needs to be something going on. Like, we need to have classes in our training that can supplement, you know, not just the practical stuff, whether it be in psychology or in my case computational biology. But I need to know, you know, context of things. How can I make science more diverse? And how can I bring more people in and communicate it better to build that trust?

CS: Yeah.

JP: So how do you think countries, or how do you think this country or institutions have historically failed researching women’s healthcare or menstrual related disorders in general? Because I feel like you can name maybe a couple of the top of your head, I’m sure of that.

CS: Right well, I have lots of opinions about this, and I have to be careful about what I say here, but I think—

JP: And you don’t have to say anything that’s uncomfortable.

CS: Women haven’t been at the decision-making table for all that long.

JP: Right, right.

CS: So it’s easy to not see things that are not reflective of your own experience.

JP: Right.

CS: And so it’s part of human nature to assume that everyone is like me, and therefore I’ll study–I’ll fund the things that are important to me. And if all the Me’s who are making decisions about funding are white men, you know, some of the priorities that may be important to people who don’t share that identity are just not known.

JP: Right.

CS: And so I think for a long time I think it just wasn’t seen as important. And so I think there’s more recognition now that these things are important to study. They are important not only for women and children, but for the health of our nation.

JP: Right.

CS: And so it’s of critical public health importance to study women’s health and to understand how hormones influence our lives. What causes postpartum depression? More and more people are now coming forward in, you know, the public sphere to say that they’ve had postpartum depression. And that is important, because it not only impacts the individual who’s experienced it, but also their children and families. And so I think it’s really important for us to study. But I think—so that’s one reason. And then I think within women’s health, postpartum depression has gotten more attention than the others because of that connection with the offspring that I mentioned.

JP: Right.

CS: And so we, as a culture, don’t like talking about women’s periods. We don’t wanna hear about aging bodies. And so like in this menopause sphere, a lot of this is still really understudied and largely ignored.

JP: Yeah. So how do you think we can normalize those those conversations surrounding things related to, you know, women’s hormones and cycles? Because, again, another thing that a listener brought up was that she remembers passing out in one of her AP Physics classes, and they all freaked out when she mentioned that it was cramps, even the 40 year old teacher that was there. So how can we normalize these things in school, in the workplace? Like again, I just feel like there needs to be some type of–I don’t know like, add it to our classes or something. I’m unsure. What are your thoughts there?

CS: Yeah, I mean for me, I can’t control what they’re going to cover in schools. I’d love for this to be part of the curriculum.

JP: Right.

CS: You know, in some schools, it is, to some degree. Like you learn anatomy and physiology and girls get pulled aside and are talked to about periods and how to manage their like self care around that. But like, why should it be separate, you know—

JP: No, right, right.

CS: –and like boys, learn about it, too? And you know, I think part of this goes back a long time in our country to like the Puritans, and all of that–

JP: Right, right.

CS: –like we don’t have these things, and I think that influence is sort of still with us today. But it’s a normal part of life. And so for me, like I said what I do to try to move the needle on. This is just normalize it in the spaces that I’m in.

JP: Right, right.

CS: So you know, like it’s still taboo in psychology even to talk to people about their sexual health. And so that’s something that we incorporate into our clinical assessments is like, how is that going for you and the various aspects of how sexual health changes over the lifespan, too. And so I think the more we are willing to talk about it and talk about it wherever we go. People become more open and it becomes less stigmatized.

JP: Yeah, definitely. So can I ask you about your motivations? Because I feel like, you know, I know you’re writing a book. You know, just glancing at your websites. I know you are doing all this amazing research, you’re directing a whole program. How do you balance all that? And like, what keeps you going?

CS: Yeah, it’s a good question.

JP: Because I’m not gonna lie as a 3rd year PhD candidate, I mean, I love my project, and I love UNC, it’s just like… Academia is beating me down, and I’m doing my best to stay in it because I love this, the work, I’m doing. But, man, it is so hard.

CS: It is hard, it is hard. And I think it’s hard in large part, because as a graduate student, you’re really not making any money.

JP: Oh yeah, that is my biggest stressor.

CS: And yeah, no one’s doing this work for the money. But like, if you can’t even afford to live?

JP: Exactly.

CS: That’s the most draining thing, like while you’re trying to do something really important and creative and solve a big world problem like you’re worried about making your rent. And that I think that sucks so much. So I think the thing that motivates me the most is working with people who have been told, Yep, this is just part of life. There’s nothing you can do about it, like you just have to suck it up and get through it.

JP: Yeah.

CS: You know, or like, here, just take more Advil, or whatever.

JP: Right, right. Or like PMS is something you inevitably get. You just have to wait it out, good luck.

CS: Yeah it’s just part of life as a woman, right? That’s the thing that gets me out of bed in the morning to do this work. Like I don’t want to–if I can help people get information that they need to feel and do better. Like that feels so important to me. I’m willing to work around the clock on that. And kind of I do. But I also have kids and a family.

JP: So how do you balance that? That’s an amazing thing.

CS: I, in graduate school, learned about this psychotherapy approach called acceptance and commitment therapy that’s all about really being present. Like in every moment using mindfulness—

JP: What’s that called? I’m gonna write this down.

CS: Acceptance and commitment therapy. And there’s a part of it that’s based on Buddhism.

JP: Okay.

CS: And so I–in this type of therapy, like the whole premise of it, is like you’re supposed to walk the walk before you can talk the talk. So—

JP: Right, right.

CS: –anything you ask the patient to do you must do yourself, and that changed my life. So I try to be really radically present with my patients, in my research, with my kids. And that’s the only way I can do it.

JP: Yeah.

CS: All these things like. So when I’m with my kids I’m like, really, with them, like I’m looking at their smile or smelling their hair, or whatever you know, they’re little still, so I can do that—

JP: That’s an amazing thing.

CS: But you know we go to the trampoline park and jump on the trampoline together for like an hour and a half. Or we, you know there’s a place nearby you can ride roller coasters, so we’ll go do that together or play mini golf. And I just leave all the work stuff behind during that time.

JP: That’s amazing. Yeah. So you touched on your motivations a little bit and really, it’s just your drive for helping others it seems like. What are some things–I mean, this could last an hour, really–but like, what are some things that you really want to get it out, like just information? You know, it could be about your research, just women’s health in general. What do you want to share?

CS: Yeah so hormones–ovarian hormones, reproductive hormones, sex steroids. Those are sort of synonyms in some cases for females. But these hormones are critically important in understanding our emotions and our behaviors. They regulate so much of our behavior. So they regulate our reproductive behavior, our eating behavior, our emotions, and they have to in order to allow us to survive and reproduce. And so it is typical for our hormones to influence how we think and feel day to day. And I think so many people think like there’s something wrong with them if they have that experience, and that is totally normal.

JP: Yeah, my partner says that a lot.

CS: Yeah, exactly! So that’s normal. And it’s also part of our culture to feel ashamed about it.

JP: Right.

CS: And so that’s the thing that I most want people to know that like it’s normal to have changes in mood. It’s normal for that to happen in the course of your menstrual cycle, during pregnancy, during postpartum, and during the transition to menopause. The great news is that we have really great treatments and tools to help people through that. If it’s really causing you problems, you know, there’s a lot of great evidence for things that we can do that make a big difference. And I never want people to feel like they have to suffer through that alone.

JP: Yeah. So for those listening like, what would you recommend to them to do? Would you encourage them to speak to their, you know, personal decisions? What would you say?

CS: Yeah. So this is where it gets tricky.

JP: Right.

CS: So because, as we talked about sometimes, physicians will say, Well, this is just a part of your life, and you just have to deal with it. Or here’s an antidepressant, good luck to you.

JP: Yeah.

CS: And that’s not the kind of healthcare that anybody deserves. And so part of it is finding a good physician that’s willing to work with you. And so that could be a family physician. For younger folks, it could be a pediatrician. It could be a psychologist. It could be an OBGYN. But somebody who is knowledgeable of the literature, who’s kind of up on, you know, the latest science and is open minded and will actually listen. Physicians–the way medicine works now is that they’re scheduled in half hour, or even less like 15 minute, appointments with patients all day every day. And they just don’t have time to really sit and listen. And so it’s the rare physician that’s gonna really sit and make sure that they’ve listened to understand the patient perspective. And if you can find that person that’s what you need. At UNC, we have a Center that focuses on this. So we have, as I mentioned, those clinics. So patients in North Carolina can come see us. We offer video visits, as many do now, since Covid happened. And so that means getting access to experts a little easier. But my hope is like by doing all of this public engagement and the dissemination of the research and the book, and like all this stuff, that eventually like you won’t need an expert.

JP: Yeah.

CS: This won’t be fringe. It’ll be part of like mainstream, like medical treatment.

JP: Yeah, I’ll tell you right now. I’ve been, I mean, I’ve talked to a lot of grad students at UNC, and they’ve been asking me like, Oh, who are you interviewing next? And I mentioned your name and what you do, and all of them are just like Whoa, really, that sounds really cool like that’s something that I haven’t really, you know thought to even research, or like care to listen to, you know. So I’m actually really excited for this to go out because I just think your research is really cool.

CS: Thank you.

JP: And Robin hypes it up all the time, and we spread you know the work that you do everywhere in Carrboro and Chapel Hill it feels like.

CS: Great, yeah and you mentioned birth control pills earlier, too. And you know, I think a lot of people come to me thinking like, should I go on birth control pills? Like, will that fix everything? Or should I go off birth control pills, cause maybe they’re super horrible and dangerous?

JP: I know there’s a lot of fear surrounding that.

CS: So yeah, yeah, exactly. And unfortunately, the answer is, it depends.

JP: As always.

CS: Yeah, yeah, there’s huge individual variability in response to hormones. And some oral contraceptives are better than others. Some IUDs are better than others. And it also depends on an individual’s vulnerability. So some people are more sensitive to estrogen. Other people are more sensitive to progesterone. And so I think the biggest take-home for that is to notice how it makes you feel. Like if you start an oral contraceptive, and it makes you feel bad, like trust that feeling, even if your doctor says like, no, it shouldn’t impact you that way. It probably is true that it is impacting you that way. And so a good doctor will help identify like there’s all different kinds of oral contraceptives. There’s all different kinds of antidepressants. Like all these different things, and, like a good doctor, will help you find the mix or the drug that will work for you. And then there are psychologists like me who specialize in this and treat people so that they don’t have to take any medication.

JP: Yeah. that’s awesome. So is this all stuff that you’re gonna mention in your book? Can you tell us more about your book, or is that kind of secret? Is it secret?

CS: No no, it’s not a secret! It’s like a side project that I’m like slowly making progress on over time. So it’s not like impending like, it doesn’t have an impending publication date. It’s sort of like—

JP: Yeah.

CS: What am I super stoked about writing about today? And like, how will that end? Right?

JP: Yeah.

CS: So yeah. But it’s just like the stuff we’ve talked about today, like, what are the biggest myths around women’s mental health and hormones? And how can I help provide people with information? Not only to reduce some of the stigma and shame, but also that’s actionable that people can put into practice in their daily lives. So that’s really what the book is about.

JP: Yeah, that’s awesome. One quick question about you personally. So have you ever experienced misogyny throughout your scientific journey? And if so, how have you dealt with that? Because I would imagine, you know, dealing with the stuff in your research and like knowing that not a lot of people are studying what you’re studying. What has that experience been like?

CS: Yeah, yeah.

JP: You don’t have to call anyone out obviously.

CS: No, no, I’m not going to. Yeah. It’s inherent in our system.

JP: Yeah.

CS: The academic system is, was built by and for men.

JP: Yeah.

CS: And even like the internship system that now I’m upholding, right, requires people to move across the country–

JP: Right.

CS: –for really minimal stipend in order to get their PhDs in clinical psychology. And I think when that system was created, most of the students were single males with disposable incomes. And that’s just not the state of our field anymore.

JP: Right.

CS: So like that doesn’t work for women with children and families–

JP: Right.

CS: –at all. And I think that’s a huge barrier to success in the field. And that’s just one example of many. There are historic pay differences for women doing this work even at UNC compared with men.

JP: Right.

CS: And on scientific review committees still. I–at the NIH, I’m invited to be on study sections. And my role really is to explain to the other reviewers why the women’s health studies are important. Because it’s still seen as a niche.

JP: That’s so wild to me. If you could rewrite–if you were the NIH director or the president of a major society, how would you rewrite the system such that you know this doesn’t have to be a niche thing anymore, quote unquote niche thing? Like, do you have any ideas on policies, you know, that could change the state of this? Or because in my eyes, we’re gonna have to–I mean, this is how I think about everything–tear everything down and build it.

CS: Yeah, yeah. Yeah I mean if you were gonna design a system from ground up, it wouldn’t look like the system we have.

JP: Exactly.

CS: We have the system we have, and so like, how do we fix it? I think I think it’s a good question. I don’t know that I have any like magical answers to it—

JP: Yeah.

CS: But I think there’s misogyny baked into all aspects of our culture that we just don’t have control over changing at the drop of a hat.

JP: Right.

CS: The NIH actually has been putting into place some policies to address this. So there’s this requirement that studies include both women and men, and look at sex differences regardless of the topic.

JP: Did they do the same for mice and rats, as well? Cause I know I read something about how a lot of mice and rat [studies] today they’re mostly male, but—

CS: Right, and so they–yes, that is a part of the review process for non-human models as well now. And you know, it’s gonna take time because like you said historically, all those studies were done in male rodents—

JP: Right.

CS: –and a lot of drug development studies have been done only in men. And so we need to start looking at that like, how do pharmacokinetics of certain drugs work differently in women? And are the dosing recommendations correct for women based on the studies that were done on men? And so I think the NIH is trying to address some of this now. But it’s a big system, and there’s so many people involved, and changes happen slowly over time. But what I can say is, I feel really fortunate to be doing this work at this time in history because there have been funding allocations for women’s mental health by the NIMH and special calls for proposals that focus on menopause and postpartum period. And I think there’s much more interest in this topic and willingness to fund it. But I always am quick to remind people that you know half the population is women. So it’s not a niche topic.

JP: Right, right.

CS: And many people menstruate. And many people experience pregnancy, postpartum. And half the population, at least, will go through menopause. And so it’s not a niche area.

JP: Yeah, right right. Yeah, I’m just curious because I’m starting an internship at the NIH this Friday, and I have no experience in science policy. It’s just something that I’ve always been interested in. And I just wanna know how– what’s that term, how the cookies are made, how the sausage is made, basically, right. So I don’t know. I’m just trying to think of ways to figure out what is out there, and what really needs to be looked at.

CS: Yeah.

JP: So as a graduate student, I think this will be really fun, you know, looking at policy stuff.

CS: Yeah. And I think you know, even in the absence of working at the NIH, there are all sorts of opportunities to engage in advocacy for graduate students and for professionals. So in North Carolina, there’s the North Carolina Psychological Association and graduate students can join for free—

JP: Oh wow.

CS: –and participate in advocacy days where the APA will help teach you basically how to talk to your Congress person, and then they’ll schedule meetings for you to talk to them–

JP: Oh wow, that’s awesome.

CS: –and tell what’s important, you know, from your perspective. Like, what should they be funding in terms of research or training programs and that sort of thing. So I’ve done that to some degree, too. And it’s really interesting. You do get a little bit of a behind the scenes peek of how that sausage is getting made. But you know it’s interesting to think about like what matters to these folks, you know, like your senator or your representative and like, how do you pitch what’s important to you in a way that can feel important to them as well.

JP: Yeah definitely. So I have one more question before we move into some fun questions. So what kind of legacy do you wanna leave at UNC? Like, what is the ultimate end goal? And like, you know, I think you touched on this a little bit. But–

CS: Yeah, oh gosh! I mean, if I could wave a magic wand, I really would love for people to have access to high quality information and healthcare so that they can make decisions about how to be well. Like radical wellbeing is what I hope my legacy can be. And I’m trying to like break down those pay walls that exist around medicine to provide information directly to the people who need it.

JP: Right, cool. And then sorry, I guess I have one more question. CS: Yeah!

JP: Do you have any like huge projects moving forward? like? What do you think is the next big thing? If you have any.

CS: I have lots of things that I’m sort of working on. But one is this access to care issue, and how do we provide access to high quality care in this area–women’s mental health—that isn’t cost prohibitive to people. And so working on innovative care delivery models. So in one project, we’ve trained doulas to provide behavioral activation therapy which is a type of therapy that’s been shown to be really effective for postpartum depression. That’s just one example. We’re using technology to do this, as well. And try to really make this accessible. Because I think so many people are just looking for answers, you know?

JP: Right.

CS: Like is this normal? Is it okay? How do I fix it? And like, I said, there’s a vacuum that’s been created where lots of misinformation is flowing, and I hope to be able to address that in some way with some of the projects I’m working on now.

JP: That’s awesome. Alright, ready for a couple fun questions real quick?

CS: Sure.

JP: If you have the time?

CS: Yeah yeah, I have time.

JP: Okay. So let’s say that you were able to wave the magic wand, and you know we have the ideal Dr. Crystal Shiller world out there. What song are you playing in the car repeatedly?

CS: Oh, man. Okay. My favorite song that just always makes me so happy is that remix of Higher Love by Whitney Houston.

JP: It’s such a bop, it’s so good.

CS: I know!

JP: What do you like doing outside of science? So I know you talked about, you know, spending time with your kids. But do you have any hobbies–reading, crocheting or rock climbing, or–

CS: Yeah. Oh, so this past year I’ve gotten serious about my physical health. In my family, my mom’s side, all of the men have dropped dead of heart attacks, and my mom had a heart issue a couple of years ago that required surgery. And so I realized, like my stats are not too good if I want to live a long time. So I have been weight training twice a week.

JP: Oh awesome!

CS: Yeah, at this local gym that’s really great. And I run now 3 days a week. So I guess that’s a hobby, although, like I wouldn’t consider myself like a fantastic runner. But I do it a lot, so I guess that’s something. And I usually take my dog with me, so that makes it enjoyable. Trail running in the woods with a giant lab shepherd mix is sort of, I guess, a hobby of mine. I love reading fiction.

JP: Any recommendations? My partner is a huge fiction lover.

CS: Yeah, I’m lately obsessed with Ann Patchett. So I read her most recent book, Tom Lake, and then just started reading everything else that she has ever written. So that’s where I’m at. I also really enjoyed the book Lessons in Chemistry.

JP: Oh! Yeah yeah yeah!

CS: Kind of a science–ladies in science book. So that was cool. Yeah. And then stuff with my kids. So they’re doing all kinds of cool stuff, one of them–well, both of them are into soccer, and one of them needed a coach. So I was coaching soccer for a while.

JP: Oh wow! Cool.

CS: Yeah, so I did that for 4 seasons. My 7 year old’s ability has surpassed my own so now he has leveled up to a better coach. But as I’m watching that from the sidelines now.

JP: That’s awesome.

CS: But we practice at home a lot. And yeah, they’re into all sorts of dinosaurs and video games, and so–

JP: No baseball or anything? I played college baseball, and I coach at Chapel Hill High School so–

CS: Oh cool!

JP: I was wondering if they wanna play, if they would like a baseball coach, let me know.

CS: Alright well I’ll keep that in mind. They haven’t transitioned to baseball because soccer occurs at the same time as baseball.

JP: Oh, right! Baseball is also a little more boring. I feel like soccer is–there’s a lot of running around, you’re always doing something. Baseball’s a little more like, you know you’re just standing around for majority of it.

CS: Yeah, that was my sport though growing up–softball and tennis.

JP: Oh, really? Yeah, nice. Were you middle infielder? Or what were you?

CS: Shortstop.

JP: Yep, same here. Shortstop, second base, yeah. Did you get into the pickle ball scene yet, or no?

CS: Yeah, a little bit. So they were taking tennis lessons, but my youngest has decided that pickleball’s more his speed. So we do that.

JP: I was gonna say that I love pickleball. So I’m glad that you have the baseball-pickleball-tennis connection there.

CS: Yeah, yeah, for sure.

JP: Cool.