Assured of herself and her future in medicine when she arrived at college, Sansea Jacobson allowed a love of literature to guide her studies and put the premed dreams to bed. Realizing in her first consulting role that it was the people she was serving not the project’s outcome, she got back on the track to the helping professions and has helped those inside as well. Find out how listening to the narrative and reacting with empathy can create meaningful linkages.
Guest Sansea Kaphan Jacobson, Dartmouth ’96, was assured of herself when she arrived at college, pre-med bound. But then she found Sanborn Library and let her love of literature guide her studies and put the pre-med dreams to bed. She took advantage of the corporate recruiting process to find her first job after college in the IT consulting world. She found, however, that she was more interested in impacting the people she served than the project outcomes. She decided to get back on track to the helping professions.
After completing the post-bac courses necessary for med school, she had the opportunity to work in a hematology lab at the NIH. An astute mentor told extrovert Sansea that she would likely prefer clinical oncology than the pathology in the lab. So, she pursued this line of work in medical school and found herself bedside with dying patients. The psychiatry rotation showed her that it was really the psychology that had drawn her to that work.
Her career now encompasses clinical work with teen experiencing anxiety and suicidal thoughts, but she also advises residents and fellows and mentors them through the psychiatric program. When one student asked about her medical center’s wellness education efforts for her fellow practitioners, Sansea realized that it was up to her to lead the program and model what wellness looks like. In this episode, find out from Sansea how listening to the narrative and reacting with empathy can create meaningful linkages on ROADS TAKEN with Leslie Jennings Rowley.
About This Episode's Guest
Sansea Jacobson is Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, Co-Chair of the UPMC Graduate Medical Education Wellness, Environment, Learning, and Living Committee and program director of child and adolescent psychiatry fellowship at Western Psychiatric Institute & Clinic of UPMC, where her clinical and advocacy efforts are focused on the prevention of suicide in youth through her work at the Services for Teens at Risk (STAR) Center. Through her multi-faceted work, she has become one of the pioneers in a field devoted to reforming our relationship with media in order to promote positive mental health messaging for our nation’s youth.
Executive Producer/Host: Leslie Jennings Rowley
Music: Brian Burrows
Find more episodes at https://roadstakenshow.com
Email the show at RoadsTakenShow@gmail.com
Sansea Jacobson: I’m coming into this field and boy is this is hard. And in fact, I thought maybe it's too hard. Like maybe I have to pick a different field. But then when I got to psychiatry, I had that same experience in the rotation where I was like, oh, this is that intense thing that I experienced with that patient. And it was really beautiful.
Leslie Jennings Rowley: Assured of herself and her future in medicine when she arrived at college, Sansea Jacobson allowed a love of literature to guide her studies and put the premed dreams to bed. Realizing in her first consulting role that it was the people she was serving not the project's outcome, she got back on the track to the helping professions. Find out how listening to the narrative and reacting with empathy can create meaningful linkages ...on today's ROADS TAKEN with me, Leslie Jennings Rowley.
Today, I'm here with Sansea Jacobson and we are going to talk about paths to wellness and wholeness and helping others. So Sansea, welcome to the show. Thanks so much for being here.
SJ: Oh gosh. Thank you so much for having me.
LJR: So I start this the same way every time. And I ask the same set of two questions, which are: when we were in college, who were you? And when we were getting ready to leave, who did you think you were going to become?
SJ: You know, um, I've been listening to your podcasts and they're fabulous. And I've been thinking about this question quite a bit because, you know, frankly, I think I left high school with a really strong sense of who I was. I had a really amazing family and upbringing. I grew up in Vermont and I'm very grateful for all the people who were part of my childhood.
And so, when I came to college, I thought that would just continue. And I don't think I knew who I was actually at that point. And frankly, I'm really not sure if I know now, but I will say I started as a freshmen who didn't go on a freshman trip. I was in Vermonter living in New England.
LJR: You already knew the outdoors. What do you need that for?
SJ: A, an injury, a soccer injury just before going to college. And I thought, well, you know, I, I wanted to try out for the soccer team and I didn't want to ruin those chances. And so I missed out on that cool opportunity. So when I got to campus, I felt like, Ooh, everyone already knows each other.
SJ: I had an injury, a soccer injury just before going to college. And I thought, well, you know, I wanted to try out for the soccer team and I didn't want to ruin those chances. And so I missed out on that cool opportunity. So when I got to campus, I felt like, Ooh, everyone already knows each other. And I really don't. And you know, and I went in thinking I was going to be pre-med and yet I wandered towards Sanborn and English literature classes and a different experience than I thought I would. I thought I would be a soccer player and I mostly just kept the bench from levitating off of the ground and had to leave that and went and rowed and I did become an English major, but then I corporate recruited into the IT industry.
And so long-winded answer to a shortish question is I don't think I knew who I was. I do know though that the amazing people on the path, including my professors, teammates, my sorority sisters, you know, my dorm mates all of those amazing friends and relationships I had throughout college were the foundation of a really amazing, amazing experience.
And Tubestock and Sophomore Summer, and my semester abroad studying Shakespeare in English lit and all of these late nights with EBA chicken sandwiches, I hold very fondly to this day. So when I launched off, I think I was on an adventure that I wasn't sure.
LJR: I know that the IT consulting thing was rather short-lived. And so I know where you are now. You had thought you were going to be a pre-med. Did you start that? And so you had a science foundation? Were you still doing that without declaring a stem major? How did that work in terms of getting the medical background?
SJ: I went in as a bio major and then that switched quickly to a minor and I never finished my pre-med requirements. So yeah. Decided to leave that behind. I wasn't going to become a doctor like I thought. And so it wasn't until later that I revisited those thoughts and I did, I just, because I was so confused about what I wanted to do, I just took advantage of Dartmouth's really cool corporate recruiting experience and landed myself at a company called Micro strategy. That was a whirlwind of two years. Wouldn't trade it for the world, but certainly not what I'm doing now.
LJR: Right. So how did that time—either just the time itself being time or the experiences in those two years—help you crystallize the kind of path you did want to pop yourself onto?
SJ: I look back on that. I was looking at photos just to sort of get me back in the space for this interview. I was so young. In fact, when I corporate recruited, I wasn't even old enough to drink in public yet because I had skipped a grade when I was in kindergarten. So I was just really young. You know that experience, I think, mostly just helped me grow up. You know, I had to travel alone and learn how to fake it until I made it. And, you know, I wasn't really that savvy with it, but I was a consultant and I learned how to try to understand what my clients wanted and deliver that with the help of the people in the background who really worked quite savvy with it.
And I loved that time and I built amazing friendships and really I carry to this day. And yet what I realized was that I loved helping the people with the outcomes more than I really cared that much about the outcomes. And I realized that the industry that I probably needed to land in had to do more with helping people.
And so I remember. I went to the CEO of the company. And I was about to tell him that I was thinking about leaving. And he went on this rant about how people shouldn't leave his company, because it was so amazing. They were going on such an amazing ride right now. And why would anyone leave? And he said, the only reason why I could ever imagine anyone leaving is if they were going to go to medical school.
And I was like, okay, well, that's what I'm going to do. Well, that that sealed the deal we've been seeing, like, okay, crazy people make the jump and I'm, maybe I'm not so crazy.
LJR: So you did decide, but you needed to probably do all that post-bac stuff to get yourself ready.
SJ: Right. And, you know, and I put it in my application to Goucher College, which wasn't far from where I was living down in DC. I just figured I was signing up for a two-year program to get my prereqs done. I didn't realize it was competitive. And yeah. So in fact, I got waitlisted and I thought, oh, no, like, I guess I really have to try. And so I went back and I kind of begged that I was like, please take me. I'm serious. Like, this is my only choice to do this and actually live this lifelong dream that I left by the wayside. And they did take me in thankfully and I did the two-year program. And that was the beginning of my journey into medicine.
LJR: And that journey has taken you in, in different ways, in different pathways, but let's just talk about that first. The med school experience, residency, how did each little step kind of give you more clarity to where you were going to be ultimately?
SJ: Yeah, you know, we had to do a year in between post-bac and then into medical school. And so I thought, well, I'll use this year wisely. I lived near the NIH. And so I just cold called a bunch of labs and asked if I could join for a year and was accepted into a heme-path lab. And if you know me, I'm, I'm pretty extroverted. And so being with pathologists was delightful. They thought I was very quirky and talkative and we really liked each other because I think we were just like such a different breed of human being. But I love my mentors there and they, you know, really got me very interested in the field of oncology.
And I thought, you know, perhaps I don't want to be looking under the microscope, but you know, one of my mentors there, she said, you know, the process of dying is still part of living. And, you know, that really hit me hard. And I thought, yeah, you know, now if you have the innate ability to talk to someone when they're facing their own mortality, not everyone has that. And maybe that's a gift. And so I thought I should be an oncologist because I wouldn't mind talking to someone who's facing their own mortality. And so I decided to go to medical school with the intention to become a hematology oncologist and work with lymphoma patients and do that. So that's what I thought I was going to do when I applied to the University of Pittsburgh, that has an amazing cancer institute.
LJR: Yeah. But then there's the rotation period, which often becomes someone's “oh, I thought I was going to do one thing,” right? So what were you introduced to then?
SJ: Exactly. So I was doing work with patients. I was bedside with patients who are suffering with graft versus host disease, which at the time we were doing stem cell transplant for a variety of different cancers. And it's really beautiful to be able to receive a donor's bone marrow, basically to be able to survive your cancer. Unfortunately, for some patients, their body would reject that and then they would die a pretty terrible way. It was almost like burns on the body and it was very, very sad. Those patients who experienced that rejection of that treatment when they didn't survive was just really, really, really heartbreaking and that, and so I would sit bedside with those patients. And I remember one in particular, I was about to go on a vacation in California and you know, I knew when I came back, she wouldn't be alive anymore. And I asked her if I could bring her anything back and she said, yeah, “You can bring me a stone” and stones were something that were really important to me. I grew up on Lake Champlain and have collected stones. Come to my house there are stones all over the place. And so that was really beautiful. And I have my stone from her and she didn't survive.
And, you know, and this was just like, oh wow. You know, like I'm going into this field. And boy, this is hard. And in fact, I thought maybe it's too hard. Like maybe I have to pick a different field. But then when I got to psychiatry, I had that same experience in rotations where I was like, oh, this is that intense thing that I experienced bedside with that patient. And it was really beautiful and interesting and connected and it felt important. So I realized it wasn't really the, you know, oh, the, the procedures and the blood counts and the this-and-the-that that I loved of hematology oncology. It actually was the psychology of it. And so it was pretty easy decision when I finally got to psychiatry that that was something that was going to speak to me.
LJR: Yeah. And so that was the path and like the clinical part of it. And the practice part of it is one part of your being a doctor. But over these many, many years, you've kind of morphed that to add other skills that might come easily to the extrovert part of you, but hard to the other parts of you. So you're now kind of advocate, educator, all kinds of things. Talk to us about how you see yourself now as a doctor.
SJ: Yeah, well, you know, I basically have three buckets to my career right now. So my clinical bucket is only 30% of my work week. So I work with suicidal teens in a center called STAR. It was created by one of the world-renowned experts, David Brent, in teen suicide prevention.
And so I'm really fortunate. There it's a both research and clinical center to think differently about how to support teenagers who are struggling with depression and anxiety and suicidal thoughts. And I've been there since I was a resident and I never left started back in, gosh, 2007 and that's been the work that I've been doing clinically.
And I love it. I've never been bored a day. The stories are always unique and helping those kids is deeply rewarding. And so I love it. But one of the other things that I also loved when I was a trainee, was taking my love for psychiatry and bringing it to others. And so that was the educator side of me. And so when a job came up to actually do that professionally and take, you know, almost half of my career at that time to be an educator, a program director or training director for psychiatry in child and adolescent, I took it. It's like a royalty job. Those don't come up very often. And so I was actually on maternity leave when I was offered that job, which is funny actually, because someone, an old mentor, had said to me you might not want to have kids too early in your career because you won't be taken seriously enough. And here I was like, literally on a nine-month maternity leave and they're asking me to do my dream job. So anyway, lesson learned, you know, live the life.
LJR: That’s right. Live your life.
SJ: So I love that job. And so I have trainees, I'm basically like a principal, so I help guide them through a five-year program in psychiatry and child psychiatry. And that's delightful. So that's the second bucket.
And then the third bucket is my physician wellness gig. So I was hired with a plastic surgeon to have us co-chair something called the well committee. And we are in charge of the 2,000 residents and fellows across the University of Pittsburgh Medical Center to help try to bolster physician wellbeing. And it's a challenging job. You've probably heard a lot about burnout, not just in the medicine industry, but you know, everywhere. And so really figuring how to help them, physicians, become more satisfied with their careers, that they're really doing what they set out to do, that they're more efficient and effective and finding meaning at work and that that's not leading to burnout because of the factors that seem to. So, anyway, that's a challenge.
LJR: So I'm, I'm sure this, the gestalt of this is that one plus one plus one does not just equal three. It's a much bigger job and much bigger life. And of course, interconnected. So, let me just take apart a couple of those, because they're all fascinating aspects of what you do and what you've chosen to do. And I'm gonna start with the last one that you just talked about, the wellness of the profession of physicians. In your other line…lines of work, you're really thinking about yes, there's this symptom, but I'm not just treating symptom, I would imagine; you're really looking at root cause. And how do we get at the illness? Not just the symptom, right. And so is it, do you have a sense right now, or an impact right now on things like curriculum and expectations of the medical profession or of a system that you're trying to work on? Or are we just at the phase right now of symptom management?
SJ: Yeah. Right. Great, great, great question. So, you know, because I'm the psychiatrist in the room at these wellness meetings, I think they expect I'm going to walk in and talk about mindfulness and make everyone meditate and do all of that. And like, I stay so far away from that. Because frankly, when we did that approach with residents and fellows initially years back when I started this journey, they…it made them even angrier.
LJR: I don't have time to meditate.
SJ: Like, if I'm going to meditate, do it on my own time. Like, are you kidding me, right? And I don't blame them. I think I would feel exactly the same way. You know, obviously one of the most important jobs I did upfront around physician wellness was making sure that physicians had easy access to support and mental health care. That's I mean, that's a given and I felt passionate about that, but that doesn't cure the issues that are contributing to the stress and the burnout in my profession. And so, you know, the delight of working with our committees is thinking about how do we change the culture of medicine, right? There was a great article in New York Times now several years ago, talking about, you know, the type of people who go into medicine will do more and more and more because that's how we're wired. You know, it doesn't feel right to say no.
LJR: Well, and you said it earlier, you said this was this intense thing and I was drawn to it, you know, like it's the intensity of it. And the fact that it's complex and hard. So it's not like you're shying away from complex, hard, and complex.
SJ: Yeah. Yeah. But you know, while we're doing intense, hard and complex, the electronic medical record system shouldn't work. [LJR: Right.] And you should get paid if you're working more than a hundred percent of your time for the time that you're working and there should be. You know, healthy, nutritional food options when you're working in the middle of the night to support people who are unwell and, and there should be ways that you can support your own family and have lactation options and child rearing options when you are the frontline worker during a pandemic, right? And so the wellness work is really advocacy work. It's quality improvement work. It's rabble-rousing work. And I like that.
LJR: Yeah, I can tell, I can tell. And I mean, there are so, so many things fundamental to the health professions that, you know, we've just structured it a certain way and the expectation…it's interesting that you started with this oncology background, because I will say from an outsider who's been looking at a lot of tangential things to the medical professions, it seems as though there is a very one track mind still that, you know, “first do no harm” means we're not going to talk about death. We're not going to talk about the ultimate bad things. It's just all about like, what can we do more and more and more and more and more. And so it's interesting that you came from that kind of background and were able to sit and say, I'm helping dying people. And there is something, as you said, the process of dying as part of the process of living. So kind of that big picture thing that we need to dismantle of it's not all about cure; it's about the holistic thing you're now looking at as the holistic person, as a doctor. So I think you're well suited for this. It just seems like, and you understand that you love this intensity of thing. So there's a balance. It's a tricky thing.
So what we haven't talked about though, is that yes, now you're dealing with adult doctors. But your clinical work and, and your training has been in talking to younger people and that we've all been those people, but there's a particular, you know, set of challenges. And I can imagine that you've seen that in spades this year. So what can you tell us for those of us who might, might not have been completely healed from the wounds of our childhood or we're rearing children in that adolescent stage now. Are there things that you've seen through all of your lenses that are just like the big insights that you want everyone to know or feel?
SJ: So I have two amazing boys. They are 10 and almost 13 and I feel like, you know, I have to make a million little decisions every day and I know they're not all right, right? But I can say from working with teens who are struggling with mood and anxiety for the past decade plus is that, you know, the time that you spend that is mindful and connected with your kids, where you really just allow them to let you know what's on their mind that you sit without technology in front of either of you and share those moments are the moments that are important, right? Literally put your technology down. You know, in those moments when your child doesn't have technology in their hand, be able to really hear them, what's on their mind. What are their friends interested in? What are they thinking about? And to reflect back to them that you hear them, you know, to validate—like maybe you don't agree. But to validate that they have their own experience and that you hear what that experience is literally just telling them that you hear them can be deeply important, connecting for you as a parent to your child. And that's the kind of foundation that we all need so that, you know when they are in trouble, when they are starting to struggle, they might look to you as opposed to just their peers, you know, when things aren't going well. So that open dialogue from early and just keep it going and making that space to have conversations as deeply important.
LJR: I'm in the monosyllabic phase right now. Yeah. Uh-huh. Yeah. I just persist, but it's like, okay, if I just get a one syllable at a time, we'll, it'll take longer, but that's okay, right?
SJ: The fact that they actually are responding to you is more important than you know They're not always a hundred percent in their dark room with the little lights in the background.
LJR: Right. Yeah. Sansea, you just talked about putting our devices down, which means you know that we actually spend a lot of time on those devices. And much of that is I know, as a parent, I'm thinking about the media, that my kids are consuming, that I'm consuming, and you've done a little bit of work in that. So can you talk to us about how you've kind of become a media advocate through some of your writing and educating?
SJ: Yeah, absolutely. This has been sort of fun actually. I posted the Facebook rant back in 2017 and this was immediately after the release of the Netflix series, 13 Reasons Why. If you're not familiar with that show, just ask any teenager about it and they can tell you. It was actually, right, the most tweeted show from Netflix. I think in the first week it had like 3.6 million tweaks and like everyone was watching it across the world, frankly, in a certain age group. And so why was it so controversial? Well, it actually the protagonist Hannah Baker, there was a three-minute scene that basically ignored all media guidelines and it showed her graphically ending her life by suicide.
I work in suicide prevention. And so I know that dramatic portrayals of suicide on screen can increase risk for contagion. And I got really, really concerned about it and I watched all 13 hours and then I wrote this op-ed called 13 Reasons Why We Should Be Concerned. And that was the beginning of a journey.
And, you know, while I was doing advocacy work to try to get education out there to help teachers and parents and kids know how to handle what was, what they were seeing in the media, my researcher, friends were doing amazing acknowledgement of this is concerning; we better look at this strategically and with evidence-base and sure enough, there were 1.5 million more Google related searches in the first three weeks following in the show and then would have been expected and like, like 26% of them, I think were actually “how to commit suicide.” And, and in fact later the research showed that. There was a 28.9% increase in completed suicide by youth in the month following the show and 195 additional deaths than expected and in the nine months following the show.
So anyway, obviously, I mean, these, these numbers are like in my head because, like, I was like, please, someone listen, right? Like we're talking about this in psychiatry. We're screaming from the rooftops that it's not okay, but we needed media to listen. And I was able to befriend this really wonderful man named Carl Kurlander. He was the screenwriter for St. Elmo's Fire and Saved by the Bell. And here in Pittsburgh, there aren't a lot of Hollywood people in Pittsburgh, but he's one of them and he helped me get connected and start building relationships with people in, in entertainment media, so that we could have a more positive relationship and understand each other.
And it's been great. And in fact, Netflix did remove that three-minute scene but also we're working to try to promote media that more accurately depicts teen struggles. And a model help-seeking and show that, you know, that what they're struggling with is treatable and the treatments are safe and that, you know, it's okay to seek help and that adults and parents are not inept and they're here to listen, right? But you gotta pair up with people who are cool and I'm not cool. So we have to find media people, and it's been, it's been really delightful.
LJR: So again, that's part of your advocacy work. But I know that the advocacy work that's been really also very meaningful to you has been with your fellow medical practitioners. So talk to me a little bit about the work you've done. And, and where you see it going and the impact that you've been having.
SJ: Yeah. So I recall a medical students asking me what our program was doing in terms of wellness. And gosh, I don't know, this was maybe seven years ago or so. And. I started to launch into what a connected and amazing community we are and, you know, all these positive things. And then I just looked at her. I was like, you know what, we're not really doing anything formal. And back then, like wellness meant yoga and broccoli. It didn't mean anything else. And so that was the beginning of my journey. And I remember going to my colleagues and saying, you know, it seems like this wellness thing we need to adopt into this idea. And they were like, not it.
LJR: Finger to the nose.
SJ: Yeah, finger to the nose. Like, I definitely drew the short straw there. And I, you know, and I was like, really? I have to do this, you know? And I was going through a really challenging time in my life. My then-husband at the time had developed a very connected relationship with his now partner. And you know, and I was facing the dissolve of my family and I was crying at work because I had these, you know, four- and seven-year-old little boys and, you know, and a marriage that was falling apart.
And I was like, really? I don't think about anyone else’s wellness.
LJR: But often we want to, you know, we teach what we need most of all, right?
SJ: Yeah, no, I did. I, I sought therapy and I went on this wellness journey and I took care of myself. And, you know, my new reality is I actually ended up going on you know, years later now went on a dating app and met a very nice Dartmouth business graduate here in Pittsburgh. And so now we're like the Brady Bunch. He's got three kids; I've got two. We've been dating for three years and, you know, my new reality is great. But boy, to get to this point in my personal space and then in my professional. Yeah, it hurt. There was a lot that was really, really challenging.
And yet, you know, we know from research that sharing our help-seeking behaviors, our vulnerabilities are, you know, that we are not perfect in the field is helpful for the next generation of physicians. And so I tell the story of, “Hey, I got my own therapy. I got my own treatments. I'm thriving now. It's great. You should do it too. No big deal” is going to help the next generation of medical students and residents when they're struggling. And so hopefully this podcast adds to that too. Thank you for letting me share.
LJR: Yeah, Sansea, it's amazing. All the things you're able to pack into a 24-hour period and a career. But when you look back at yourself finding Sanborn and making a conscious decision: “Oh, you know, I thought I was going to be a doctor. Nope.” Was that in that period of time necessary for you and, and what didn't, you know, then that, you know now, or what did you know then that you keep with you now? What's that reflection piece for you?
SJ: There are a lot of things in my life that I did that weren't part of the straight line to who I am today. But I, you know, I say to my kids all the time, I'm divorced, you know. And I say I wouldn't change a step of the way, including marrying their father and having those two, you know, amazing little boys…including being an English major and really understanding narrative and thinking about language in this important way, because what do I do every day, right? I think about people's narratives. You know, and then learning how to write, you know, and to teach. Those are things I do every day now as a clinician educator, and as an advocate. It was actually a Facebook post that I wrote about that show 13 Reasons Why that actually. Launched me on a two year media journey and had I not been an English major and someone who liked to write vent with words, I wouldn't have had that really interesting career experience of advocating for safety in media for our kids. So, you know, I think I wouldn't trade it. I wouldn't trade any of it. And I'm grateful for it all because I think it makes me who I am today.
LJR: Yeah, well, we'd love who you are today. We love who you were, and I'm just so pleased that you are able to come on and share your journey, or at least this phase of the journey, ‘cause it sounds like you have lots of different pieces of a rosy for follow on here on it. So thanks so much for being with us.
SJ: Absolutely.
LJR: That was Sansea Jacobson, Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, Co-Chair of the UPMC Graduate Medical Education Wellness Committee and program director of child and adolescent psychiatry fellowship at Western Psychiatric Institute and Clinic of UPMC, where her clinical and advocacy efforts are focused on the prevention of suicide in youth through her work at the Services for Teens at Risk (STAR) Center. Through her multi-faceted work, she has become one of the pioneers in a field devoted to reforming our relationship with media in order to promote positive mental health messaging for our nation’s youth. We're proud of the media that we produce each week and we hope you will share our show with others and join me, Leslie Jennings Rowley, on future episodes of ROADS TAKEN.