Paula Jean Winkler Clayton, MD (1934-2021)

February 2022

EDITORIAL: Paula Jean Winkler Clayton, MD (1934-2021)

Vol. 34. No. 1
Charles L. Rich, MD
Lynn A. Cunningham, MD

Paula Clayton, MD, died in Pasadena, California, on September 4, 2021. Paula enjoyed tremendous success in academic psychiatry. It wouldn’t be possible for us to adequately review all the ways her career has influenced American psychiatry. Instead, we will highlight a few of what we consider to be her most significant contributions.

Paula graduated from the Washington University School of Medicine in 1960 and completed her psychiatry residency there. She joined the faculty in 1965. In 1969, Paula, George Winokur, MD, and Ted Reich, MD, published Manic Depressive Illness, her first book. It is a meticulous, scholarly work that set the bar high for the rigor required to establish valid psychiatric diagnoses. Throughout her career, Paula pursued the quest of refining psychiatric diagnoses. The list of her collaborators over the years is a “Who’s Who” of scholars in this arena.

In 1968, Paula began publishing the results of what may be her most enduring research contribution. She elected to study bereavement as an easily definable event that predictably makes people sad. The goal was to see how that sadness compared to “endogenous” depression. Paula concluded “…the normal depression of widowhood is different from clinical affective illness…” The key word here is “normal.” She described many complex details about the differences between normal grief and what now might be called “major” or “clinical” depression. Paula’s study of bereavement continued throughout her academic career, even in her later years at the University of New Mexico (2000-2006).

Another of Paula’s major interests was suicide and suicide by physicians. In the mid-1970s, some studies suggested there was a higher-than-expected rate of suicide among physicians, especially among women. Paula and her colleagues interviewed virtually all female physicians in St. Louis as well as a control group of female PhDs. They found a much higher rate of depression than expected among female physicians. Of course, because the gender distribution of medical students in the United States has changed dramatically since the 1970s, this finding is outdated. Nonetheless, depression and suicide among physicians remained a recurring theme throughout Paula’s career. The culmination of her interest came during her term as Medical Director of the American Foundation for Suicide Prevention from 2006 to 2014. Among many other achievements, she was instrumental in producing 2 educational videos about physician and medical student depression and suicide. Paula was persistent in her efforts to educate the public about the importance of recognizing and treating depression as a major means of preventing suicide.

In 1980, Paula became the first woman chair of a psychiatry department in the United States at the University of Minnesota, a position she held for 19 years. In addition to fulfilling a multitude of administrative and teaching obligations, she continued to expand her research collaborations both in the United States and beyond.

One international connection that stands out was with Professor Jules Angst, MD, in Zurich, Switzerland. Now 95 years old, he is still hard at work! When he learned of her death, he wrote “I will evoke only 1 aspect of Paula’s long, active life, namely her contribution to depression and suicide research and her energy and skills in furthering the clinical research of others.

“In the mid-1960s, completely independently of each other, we (Jules Angst and Carlo Perris in Europe and George Winokur, Paula Clayton, and Ted Reich in the United States) contributed to a historic shift in the conceptualization of depression by separating unipolar depression from manic-depressive illness on the basis of genetic studies.

“It wasn’t until the 1980s that we collaborated and published together, mainly on topics of premorbid personality and suicide, the latter being a constant theme of Paula’s scholarly work. But above all, I would like to stress the transatlantic scientific links. Thanks to her energy, initiative, and ability to get things done, Paula built bridges between the European and American research communities. This transatlantic research cooperation involved exchanges not only with Paula in Minnesota and George Winokur in Iowa, but visits, lectures, workshops, consensus conferences, and brainstorming sessions in US federal institutions and in hospitals and university departments throughout the United States. All this contributed to the dissemination and the appreciation of our clinical and epidemiological research in Switzerland.”

Paula and George Winokur maintained a close relationship even as they pursued their own department chair paths in Minnesota and Iowa. They believed strongly in the importance of maintaining the integrity of psychiatry as a medical specialty. In 1987, Paula and George edited The Medical Basis of Psychiatry, which has been revised 3 times over 29 years. After George died in 1996, Paula collaborated on the 3rd and 4th editions with her colleague, Hossein Fatemi, in Minnesota.

Paula was active in numerous national professional organizations and served as president of several. She was always supportive of the American Academy of Clinical Psychiatrists (AACP). In 1983, she and her department hosted the 9th annual AACP meeting in Minneapolis. Paula always accepted invitations to speak at our annual meetings.

As a tribute to Paula’s contributions while at the University of Minnesota, the current Chair in Psychiatry, Sophia Vinogradov, MD, wrote “Dr. Clayton continues to influence the faculty, staff, and trainees of the Department of Psychiatry at the University of Minnesota through the leadership legacy she leaves behind, and through our main conference room, which is named in her honor.”

History will determine the extent of Paula’s role in changing American—and world—psychiatry. We are sure her place is secure, and that she will rate among the most influential forces of the past 50 years.


Charles L. Rich, MD
Founding Editor
Annals of Clinical Psychiatry

Lynn A. Cunningham, MD
Founding Member and Past President
American Academy of Clinical Psychiatrists