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EVA CESKOVA

Interviewed by Andrea Tone

Paris, France, June 21, 2004

AT: My name is Dr. Andrea Tone and I am participating in the ACNP oral history project. This morning, we are interviewing Eva Ceskova. It is the 21st of June, 2004. We are at the 24th CINP Congress, in Paris, France. Thank you so much for agreeing to be interviewed. I’d just like to start by asking you how you got interested in psychiatry.

EC: Psychiatry was, for me, always a challenge, because there are many unknown things about the brain. It was an unknown territory, I would say, it was a challenge for me. It was an adventure.

AT: Can you tell us a little bit about your background? You grew up in Czechoslovakia?

EC: Yes, I grew up in Moravia. It’s part of the CzechRepublic in the south, close to Vienna. My father was a general practitioner (GP) and my mother was a nurse, so, I was educated in a doctor’s family.

AT: So, at what point did you know that you wanted to go to medical school?

EC: You see, I decided to go to medical school quite early. At first, I didn’t know what to do, because I was afraid of not being able to be like my father. He was a fantastic doctor and I wanted to be also very good at something. But finally I decided to study medicine at Masaryk University of Brno. During my studies I was thinking about specialization. Because I don’t have the necessary skills I couldn’t do for example surgery. It’s a very hard job. So, I was looking for something challenging, and it was psychiatry. And, also, my best friend went through a psychotic episode. It was, for me, a big experience, and, so, I decided to go into psychiatry. In fact, I started to go to the Department of Psychiatry at the University of Brno in 1967 while I was still a medical student. I continued in the Department as an assistant physician and rose on the academic ladder to become associate professor, professor and head of the department. Looking back at those years, the best position for me was the position of associate professor because I had a lot of time to do work that I felt was useful. It was wonderful. Now, I have many administrative responsibilities and it’s not easy for a woman to be in such leading position in the CzechRepublic.

AT: We were talking about that the other night. Take me back to when you first started going to medical school. Did a lot of women go to medical school at that time? Did a lot of women choose psychiatry?

EC: Not a lot of women. Women choose usually less large specialties, and in general usually don’t choose science. There might be historical reasons for that in my country; men want to have women home with the children. It’s changing. The younger generation has started to change this tradition. But, it’s quite difficult to change the tradition because it’s pretty hard to find any help for housekeeping.

AT: Were you regarded as kind of a revolutionary in the 1950s? What was the attitude toward you when you started out as a female psychiatrist?

EC: I was very happy with my colleagues in those days. My mother was looking after my children. So, it was easy for me. And my father supported me, economically.

AT: Why did you choose the particular area of research you pursued within psychiatry?

EC: I loved chemistry, biology and I succeeded to get a WHO scholarship in the USA in 1980. It was a scholarship in psychopharmacology at the Tennessee Neuropsychiatric Institue of Vanderbilt University under Thomas Ban. And I found psychopharmacology challenging and interesting. I was delighted to follow the progress in the field. We now start to know the brain, what the brain does, and this is very exciting.

AT: The clinical trials you were engaged in, were they in schizophrenia?

EC: They were investigations in psychosis, schizophrenia, and affective disorders primarily. .

AT: Can you tell us about your Nashville experience?

EC: My first impression about the United States was that it’s a big place with many, many cars. People were smiling most of the time, and most people were hospitable. They took care of me, probably because it was rather unusual to see a lady from Czechoslovakia who decided to come to Vanderbilt. I was thirty-two at the time, married with one child. So, it was fun.

AT: Did your child come with you to the United States?

EC: No..

AT: Did you like Vanderbilt?

EC: Yes, and I was working hard. But I had also an opportunity to travel around the United States. My favorite city was San Francisco. I loved it more than New York. San Francisco was for me something very special.

AT: So, what would you say you benefited most from your stay in the United States?

EC: The access to information. I could get whatever scientific journal I wanted. It was fantastic. I made so many copies of papers that I sent two big boxes home. In the CzechRepublicI couldn’t get information, scientific information. So, I was so happy about that. It helped me to write my thesis about the treatment of manic states. So, it was wonderful. I spent all the weekends in the library.

AT: When you were in the United States, what would you say the chief differences were in the treatment of psychosis? Is there such a thing as a Czech tradition in psychiatry that’s different from, say, the American tradition or the UK tradition or the German tradition?

EC: I don’t think so. You see, in the United States, forty years ago, there was a strong psychodynamic movement which possibly led to a different approach in the treatment of psychosis, but, basically, now, the treatment of psychosis is the same here and in the CzechRepublic. We have the same drugs in Europe, especially in the Czech Republic that you have in the United States. Since the FDA rules are stricter than the rules of our drug regulatory agency, we have some drugs earlier than you do. But, the treatment approach is the same. In the United Statesyou have some institutions at the top which are able to generate the necessary money to get good people and to create for them a terrific condition for scientific work. In my country this is not the case. As Head of the Department I have to do everything myself. Since my secretary does not speak English, I have to write most of my letters myself.

AT: Could you tell us something about your Department?

EC: In the CzechRepublic there are only six university departments of psychiatry. My department has one hundred-twenty beds. Our department of psychiatry is quite new. It is in a very nice thirty-five years old building that was designed for a psychiatry department. We have the neurotic patients are on the top floor. The second floor is for psychotic disorders and so on. It is a wonderful building with teaching facilities, labs, and everything. We have a division for psychotics, a division for children, a day clinic, a division for neurotic disorders, and a crisis intervention center. It is quite difficult to manage it.

AT: Administratively?

EC: We have to do many things that are waste of time and take us away from patient care. I would like to spend more time with patients. I love my patients but I have only one-day for outpatients, for my faithful patients. I would like to teach more. I love to teach. It’s my hobby I would like to continue teaching as long as possible. .

AT: Are you in contact with the other department heads? .

EC: Thirty-seven years ago, when I started, there were not so many psychiatrists in the CzechRepublic and we all knew each other. Fortunately, all the heads of the departments are my good friends. It has some advantages and some disadvantages. The CzechRepublic is a small country.

AT: What would you say the chief change has been to the practice of psychiatry with the unraveling of Communism? Did that have any impact on treatment or psychiatry as a profession?

EC: In my opinion, no. But a great advance is that the young psychiatrists can travel, can go abroad and can get much more information. So the possibilities that are changed; they are much better for young doctors now. But, basically, we are treating patients in the same way.

AT: Is it harder for patients to get treatment for economic reasons?

EC: Treatments, hospitalization, drugs are still free of charge but this is changing. There are discussions in the Czech parliament that the patient should contribute or to pay something for their hospitalization..

AT: Now, I read, it’s possibly wrong, so correct me if I’m mistaken, that in Communist countries psychiatry was politiczed and it was questioned why people should have psychosis, depression, or anxiety when Communism is sort of taking care of everything. Were these disorders concealed for political reasons, or, were people if they suffered from these disorders treated as compassionately as they were in other countries?

EC: It is exaggerated that psychiatric diseases were concealed for political reasons. . But, it’s true that now, people are more informed about psychiatry, generally. The CzechRepublic is more of Central than Eastern Europe and has a long tradition of excellent education, including medical schools. Communism was not able to spoil that. There are always some people who are suffering from personality disorders, who are very difficult to treat under whatever regime.

AT: You don’t think there was a problem ever with under treatment or failure to treat people, in general, because psychiatry was seen as at odds with Communism?

EC: I don’t think so. It is related more to the attitude towards psychiatry in general, but this is changing. For example, many depressions are now treated by GPs, and GPs have as access to some psychotropic drugs. They can prescribe antidepressants. So, the situation is changing and psychiatry is integrating with general medicine. We need collaboration also with other specialists. An obvious case for this is depression. We know that many somatic illnesses are connected with depression and vice versa. So, there are many common factors.

AT: A lot of research in psychiatry in Western Europe and the United States was industry driven. How does that work in the Republic of Czechoslovakia?

EC: It is the same.

AT: How did you become Chair of your Department? How long have you been Chair?

EC: I was appointed Chair in 1992, ten years after the velvet revolution. At that time I was forty-eight years old and very naive. I had two priorities: my family and psychiatry. I was associate professor of psychiatry, and I have never been a member of any party. So, I was the only one who fulfilled the criteria for the position. It was funny. I was afraid of it, really, I was.

AT: How come? Why were you afraid of it?

EC: Because it was a great responsibility. My predecessor was my teacher, an excellent psychiatrist. Our department was one of the best in the country. But, I’m quite happy now, because I think I’ve educated several young psychiatrists, who will be able to continue my work. I can retire and I’m sure they will be successful. I was the only woman in the CzechRepublic who became Chief of a psychiatry department.

AT: You were the first. Did you feel that added a certain burden, that you were a role model? That you had to be a pioneer for all the women?

EC: You see, I had no idea what it was about. I was associate professor, so I had to be appointed professor first to be accepted as head of a department by the other department heads. And it was a very hard job to become accepted by them.

AT: Can you tell us more about that, how it’s been to be the first woman doing this?

EC: Being a woman has also advantages. For example: I could say what I wanted, because men, in or culture don’t take woman talk seriously. I’m fifty-eight years old now; I’m old enough to say what is on my mind. And as I told you, the chiefs of all six departments in the CzechRepublic are now my friends. We know each other very well. So, they accepted me. It is funny that my husband has never accepted that I have the position of professor of psychiatry.

AT: What do you mean by that?

EC: He doesn’t accept that women could be good in such a position. My husband thinks that women doctors are not good and women psychiatrists are the worst.

AT: How come? Why are women psychiatrists the worst?

EC: In the CzechRepublic, as everywhere else, women had to fight for their rights. And we were successful. But thinking is changing only slowly. In the United States woman are much more emancipated, although the emancipation of woman seems to me is exaggerated and commercialized.

AT: That’s great. Do you think that there are a lot of men who like your husband still wrestle with the role of women?

EC: Yes, especially in the older generation. At home I have to do everything. I look after two children; I have no time for TV, books, but it was my choice. Now my son is 21 and my daughter is married. I am a grandmother so I feel more comfortable.

AT: Maybe it’s harder for women because they have more responsibilities to juggle. It’s interesting because the perception in the west is that, especially, during Communism, women and men were educated equally. They were encouraged equally.

EC: Oh, it’s true that they were educated equally.

AT: Looking back at your career, which still seems like it’s got a ways to go, if you’re only fifty-eight, what are the contributions that you’ve made that you’re proudest of?

EC: I think I’m proud of that I succeeded to educate and train many psychiatrists. Unfortunately many psychiatrists of the young generation are interested only in making more money. Many of us from my generation feel that only a few are ready to make any sacrifice.

AT: But, for you, there’s something about a passion or calling. Do you think you’ve been able to inculcate that sensibility in the younger generation, or at least instill in them?

EC: Oh, yes. I think to be a doctor one needs to be of a certain type of personality. The same applies for teaching. You can’t teach if you don’t like to communicate.

AT: Any regrets, looking back? Are there thing you wish you’d been able to do that you haven’t been able to do?

EC: I don’t think so.

AT: Looking at your career, do you have any other things you wish you had been able to do but weren’t able to do? Regrets?

EC: I don’t think so. In the CzechRepublic we have more connections with Germany, Austria, France, also, historically, and in terms of the quality of education, than with Eastern Europe. .And, so, I feel being more West than East. Yet, I had also opportunity to participate in an international clinical trial with clozapine organized by Russian psychiatrists.

AT: So, you have opportunity to collaborate in studies organized in the West and in the East.

EC: I had seen the US and Russia, two very big countries, separated by the Iron Curtain. In the United States, I bought a newspaper and I have read the stupidity about Russia and in Russia, it was the same vice versa. Now, it’s great that we have communication with both. It’s really a big advantage.

AT: The opening up of the knowledge.

EC: Yes.

AT: Is there anything else you’d like to add before I stop this tape?

EC: No, no, no, thank you very much. I have not so many opportunities to practice my English. I can read very well, but to speak, it’s complicated for me. That’s all. I have; nothing is left.

AT: Thank you so much. I think, in some ways, Americans are embarrassingly behind in that we do not have the same language skills that people in other countries have. We just assume that English will take us everywhere. It’s very arrogant.

EC: No, I don’t see it like that.

Eva Ceskova was born in Znojmo, Czechoslovakia (Czech Republic) in 1946.