UCLA

This dissertation examines how clinical uncertainty is managed within reproductive psychiatry, a nascent specialty at the intersection of reproductive health, and pharmaceutical medicine. I draw on over four years of ethnographic fieldwork at a reproductive psychiatric clinic within a Los Angeles teaching hospital, including observations of resident training, case conferences, and clinical appointments, alongside approximately 40 interviews with patients, residents, attendings, and therapists. I trace how toxicity operates as an organizing concept across three empirical sites: the professional socialization of resident psychiatrists, the cultural and biomedical frameworks that patients bring to clinical encounters, and the interactional tactics through which medical authority is maintained by clinicians. I argue that toxicity functions in this clinic as a boundary object—flexible enough to hold together what is biological and social, while retaining a sense of clinical urgency across contexts. In Chapter One, I trace a reversal in clinical psychiatric guidelines—from cautioning against psychotropic medication during pregnancy to recommending it—and show how resident physicians are socialized to manage the data inadequacy underlying this shift. In Chapter Two, I turn to the patient perspectives, who arrive already shaped by what I call toxicity imaginations: durable, culturally assembled understandings of exposure and risk that clinical encounters often compound rather than resolve. I find that this leaves patients to weigh the toxicity of medication against the toxicity of their own untreated symptoms. In Chapter Three, I identify two sets of tactics—outsourcing responsibility and repositioning danger as undertreatment—through which clinicians maintain treatment recommendations amid inadequate evidence. Together, these findings reveal what I call: biological logics that position the maternal mind as an environment of consequence for fetal development, and the eugenic logics they structurally enable—not reproductive prohibition, but optimization toward a child unburdened by the psychiatric condition of its mother. I argue that reproductive psychiatric patients are best understood as bellwethers of a broader cultural anxiety about chemical exposure, reproduction, and futurity, and that this dissertation contributes to medical sociology, science and technology studies, and feminist health scholarship.