Forensic psychiatry and coping with hard times: Q&A with Dr. Andrea Stolar

Editor’s note: This blog post is part of an ongoing Progress Notes series featuring individuals who work in clinical psychiatry. In the following interview, third-year medical student Jessica C. Sheu interviews Dr. Andrea Stolar.

Dr. Andrea Stolar is a forensic psychiatrist serving as the medical director for the Michael E. DeBakey Veterans Affairs Medical Center Veterans Court Programs and assistant dean of student affairs at Baylor College of Medicine. Dr. Stolar also helped create and currently serves as one of the medical directors of the Human Rights and Asylum Clinic at Baylor, which provides free forensic evaluations for individuals seeking asylum in the United States.

As a medical student interested in psychiatry, I have been fortunate enough to work with Dr. Stolar through the student-led Physicians for Human Rights chapter and other events, such as organizing a school-wide book discussion on Dr. Damon Tweedy’s memoir Black Man in a White Coat.

In the following Q&A, Dr. Stolar shares her professional journey and how she has been coping with COVID-19 and current social issues.

Q: Why did you choose to become a psychiatrist?
A: Psychiatry is the most fascinating area of medicine to me, because people are what drew me to medicine. To understand psychiatry is to understand people. One of the ways to think about psychiatric diagnosis is to consider the biopsychosocial formulation that really ties in all of the different facets of medicine.

With every psychiatric illness, there are always psychological, biological, and social factors that contribute to how it presents and manifests and how people respond to treatment. Psychiatry is also so broad, and there is so much we don’t know yet about the brain, the most complicated organ.

Another thing I’ve always been fascinated with is the idea of “Where does illness start and where does it end?” In psychiatry, you see this idea more often than in most other fields, as well as philosophical questions like, “What is or isn’t illness?” “When does sadness become major depression?” and “When does magical thinking become psychosis?” With a question like “When does ability become disability?” there are so many different social, biological, and psychological factors that contribute to why one person with major depressive disorder is able and another person with major depressive disorder is disabled.

Q: What is your area of focus?
A: As a forensic psychiatrist, the subject of law in psychiatry and using psychiatric expertise to answer a legal question is intellectually interesting. This also allows me to perform evaluations, which are what I find the most interesting in psychiatry. So much of forensic psychiatry is getting to know who the person is and what drives them.

Q: What would you say to someone interested in pursuing psychiatry?
A: It is the most fun field to be in and the most gratifying. There are many options regarding what you can pursue. If you are most interested in the biological aspects of psychiatry in medicine, there is the fascinating interface between how medical illnesses present as psychiatric conditions.

Take an endocrine elective and think about how hormones affect mental health. If you are interested in much more of the psychological end of things, the thinking process of psychotherapy and psychodynamic psychotherapy is intellectually gratifying. The breadth and flexibility of psychiatry allows you to take what you know and go anywhere. It really is incredibly flexible.

Q: What is the role of psychiatrists on a mental healthcare team?
A: It depends on the team. My team is interdisciplinary, but it is a different kind of team. The members of my team are judges, lawyers, probation officers, and social workers. Psychiatrists as part of a team at TIRR Memorial Hermann work with rehab specialists, occupational therapists and physical therapists. Psychiatrists at Menninger Clinic work with psychologists, neuropsychologists, social workers, and maybe music therapists.

If it’s a team where you’re able to look at someone and conceptualize them broadly from a psychiatric perspective – such as in the teams that I work in, a consultation-liaison team, or in a rehab unit – that comprehensive understanding of a patient is what a psychiatrist brings.

Q: In light of COVID-19 and current social issues, what are some ways you have been coping?
A: When I get really upset, I have to do something. For example, because of COVID, I was particularly concerned about the ability of people to get food. I was concerned about kids not getting food because of not being in school. I joined the Houston Food Bank and found the volunteer work gratifying. It feels good to do something to help.

When I was upset about what was happening with the demonization of refugees, I got involved with the team at Physicians for Human Rights to create the Asylum Clinic, which was my way to make a little dent.

The way I cope is to find something that I can do personally to make a difference, in a little way, so I can feel better.

Q: What advice would you give to others going through hard times?
A: If I get really anxious, I will go for a run – this helps to clear my head and helps me work through problems and come up with new ideas. I also do lots of baking, and I use this example because you have to stay focused on what you’re doing or you’re going to screw up. Baking helps me focus my anxiety in a productive way, because I can’t be ruminating about something if I’m having to follow a recipe and watch what I’m doing – and I get something nice out of it.

What can I personally do if I’m getting agitated about the things that I’m seeing? That’s part of educating myself. After I read the book about the Equal Justice Initiative, I made a donation, because I was impressed with the work that they do there. It’s just a drop in the bucket, but when you do something, it helps to focus the anxiety, either in physical way by doing something active, or in a productive way, where you feel like maybe the change is hardly anything but it’s at least something.

–By Jessica C. Sheu, third-year medical student at Baylor College of Medicine