SLU Doctoral Student Wins Fellowship to Study Intersection of Gender, Health Care Ethics

Have you ever heard someone described as “borderline?” Such comments get bandied about to describe celebrities and bothersome co-workers, to explain upsetting behavior or dismiss a person as “crazy.” Yet even among medical professionals, the term “borderline personality disorder” can be used as shorthand for “difficult to deal with.”

With three-quarters of borderline diagnoses going to women and girls, some scholars argue that the borderline label is used to imply “non-compliant female.” The imprecise use of “borderline” is an example of a larger problem of diagnosing personality disorders within psychiatry. Because personality disorder diagnoses pathologize people’s personalities, and perhaps a substantial portion of their very personhood, the issue of hidden value judgments arises.

In my dissertation and this research, I examine value judgments inherent in personality disorder diagnoses without recapitulating anti-psychiatry arguments. Instead, I use philosophical, feminist and bioethical approaches to examine the deep-seated values that allow psychiatrists to make reasonably coherent judgments of personhood. I mine those values for untapped ethical resources that will help psychiatrists improve opportunities for healing.

In particular, I argue that psychiatry is indebted to aesthetics; this does not render psychiatry unscientific but rather reveals new pathways for aiding patients in shaping a good and satisfying life. By recognizing the aesthetic commitments inherent to but hidden in psychiatric practice, we can reimagine tools for care that move beyond the mechanistic.

The importance of this project is that it proposes a unique way to circumscribe the province of psychiatry while simultaneously opening up new avenues for relieving suffering.

Our focus on the patient is re-attuned from labeling what’s wrong to envisioning possibilities for beauty and completeness.

Personality disorder is currently a contentious topic within psychiatry, and so sorting out the ethical relevance of personality disorder diagnoses is timely. But I would also argue that psychiatry as a whole is in flux, and we need to better articulate what defines psychiatry's borders and what the goals of psychiatry are. I'm looking at personality disorder as a test case or a limit case to better understand the ideals of psychiatry as a whole. Basically I'm asking, “If we treat personality disorder like this or that, are we promoting the type of psychiatric practice we want?”

I'm fascinated by the gendered aspects of psychiatric diagnoses, both in current and historical medical practice. I'm doing a graduate minor in women and gender studies, and I love using the feminist theory I learned there. Feminist literature offers such rich theory of the body and mind; it really fits beautifully with bioethics and the philosophy of medicine.

I resonate with the Jesuit practice of finding God in all things. I believe it is vital that we see that the beauty and goodness of God's creation is very much at work in the lives and minds of those who face mental illness. It's easy to see psychiatric wards and prisons – where most American mental health care occurs – as all ugliness; but we can find goodness and beauty in those places and we can make those places more conducive to life.

I recently presented on my dissertation research at the conference for the International Academy of Law and Mental Health in Rome, Italy. I have also presented on this topic at the “Psychology and the Other” conference in Cambridge, Massachusetts. I've presented and published on other topics in psychiatric ethics not directly related to my dissertation.

A fellowship from the AAUW means a lot to me because I hope to work in academic medicine and, while the number of female physicians is increasing, academic medicine leadership is still heavily male dominated.

Studies show that women receive less institutional support and are much less likely to remain in academic medicine, achieve senior rank or be placed in senior leadership positions relative to male counterparts.

I am really excited to have the support and camaraderie of the amazing female scholars and academic leaders in the AAUW. Not only have I gotten support for my project, but I feel like I've been introduced to a whole network of role models.

 

All of my professors at SLU have helped me develop my ideas, but I have to give special thanks to Erica Salter, Ph.D., Kimbell Kornu, M.D., Ph.D., and Jeffrey Bishop, M.D., Ph.D.

I also want to thank the Department of Women and Gender Studies for their outstanding courses, and for the opportunity to collaborate with and learn from the department's students and professors.