Background and Research

       I am a broadly trained medical anthropologist with research experience in the US (urban community psychiatry, human population genetics, and chronic pain centers) and internationally (Haiti and the French West Indies). My work has been supported by the National Science Foundation, National Human Genome Research Institute (an R01 grant), National Institute of Mental Health, Fulbright Foundation, and the Wenner-Gren Fund for Anthropological Research. For over two decades I have studied the ethical dimensions of health care in their full cultural context. As an ethnographer, I explore how local moral orders are produced and disrupted in the face-to-face encounters of clinical work.  What ordinary people say about the ethical stakes of treatment illustrates on-going social debates about the meaning of care and the fair distribution of medical resources.

    My new book is called "Everyday Ethics:  Voices from the Front Lines of Community Psychiatry"  (University of California Press 2013). This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system.  Drawing on years of fieldwork in a community psychiatry outreach team, the book traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates.  At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice.  The experiences of these clinicians pose a single overarching question:  how should we bear responsibility for the most vulnerable among us? 

      I wrote the book to advance the dialogue between bioethics and medical anthropology, but also to raise the general awareness of public sector psychiatry. The needs of people with severe symptoms and profound social marginality call for more resources and greater moral imagination among all citizens.  But the retrenchment of the state, as well as the stigma attached to mental illness,  make their suffering even less visible. Such contradictions drive my current research project about the possibilities of reforming -- and rethinking -- the public sector mental health system.

    I am a Professor in the Anthropology Department at the University of Wisconsin-Milwaukee, Adjunct Professor of Bioethics and Medical Humanities at the Medical College of Wisconsin, and Core Scientist in qualitative methods at the Center for AIDS Intervention Research (Department of Psychiatry, Medical College of Wisconsin).  I am also privileged to participate in several Milwaukee-area mental health advocacy groups.