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

08/21/2019

As she pursues a career in academic medicine, Saint Louis University graduate student Michelle Bach is uncovering the ways that gender and bias influence mental health diagnoses. Now, with support from a national fellowship, as part of her dissertation research, she is reimaging the ethics behind psychiatric care and mental health care settings to improve patient care.

Michelle Bach

Doctoral student Michelle Bach is pursuing a combined M.D./Ph.D. degree from the Albert Gnaegi Center for Health Care Ethics. She recently received an American Fellowship from the American Association of University Women (AAUW) to support her dissertation research. Photo by Amelia Flood

Bach’s research recently received an American Fellowship from the American Association of University Women (AAUW), which will allow her to complete her dissertation, “Disorder and Beauty: Seeking New Ethical Resources in Psychiatry.” The fellowship honors scholarly excellence and aims to tackle barriers women face in education.

“It comes down to working towards an ever-improving model of psychiatry that reduces suffering while affirming the people who suffer,” Bach said.

The Orlando, Florida native was drawn to the prestige of the Albert Gnaegi Center for Health Care Ethics – the center’s program consistently rank among the best in the nation – and to the diversity of research topics and methods graduate students pursue in and out of the center’s classrooms.

“I chose to pursue a Ph.D. in bioethics out of a conviction that examining our moral and philosophical commitments is just as relevant as biochemistry or immunology to providing truly good medical care to patients,” Bach, who is pursuing a combined M.D./Ph.D. degree in health care ethics, said. “Time for reflection is sparse in medicine. The dual degree track has given me time to think deeply about what the practice of medicine can and should be.”

Learn About Bach’s Award-Winning Work

Tell us more about your fellowship project.

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.

What are you investigating in your dissertation?

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.

Why does this research matter?

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.

What are the stakes of your project for the wider community?
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?”
What has been the most compelling part of your research to date?
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.
How does your work align with SLU's Jesuit values and Ignatian mission?
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.
How are you sharing your work with others in the field and in the wider community?
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.
How do you see this research and the fellowship informing your future career and life plans?

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.
How have mentors here at SLU nurtured your work?
 

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.

Founded in 1818, Saint Louis University is one of the nation’s oldest and most prestigious Catholic institutions. Rooted in Jesuit values and its pioneering history as the first university west of the Mississippi River, SLU offers nearly 13,000 students a rigorous, transformative education of the whole person. At the core of the University’s diverse community of scholars is SLU’s service-focused mission, which challenges and prepares students to make the world a better, more just place.