The Persistence of the Toxic Imaginary: Contamination Politics and Epigenetic Logics in Reproductive Psychiatry

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 6. Reproductive and Women's Health

Abstract

Pregnancy in the contemporary United States is increasingly governed through discourses of toxicity, risk, and individual responsibility. While scholarship has examined environmental exposures and consumer practices, this paper extends analysis to an emergent site of reproductive knowledge production: the reproductive psychiatric clinic. As psychiatric medication use during pregnancy rises and guidelines shift toward encouraging treatment, reproductive psychiatry has become a key arena in which competing understandings of fetal protection, maternal responsibility, and mental health are negotiated.

Drawing on 24 months of ethnographic observation and interviews in a U.S. academic reproductive psychiatric clinic, I examine how toxicity operates as a moral and epistemic framework within psychiatric care. I argue that reproductive psychiatry actively reorganizes reproductive knowledge by reframing toxicity across pharmacological, relational, and temporal domains. Clinicians treat toxicity both as a measurable medication threshold and as a broader psychosocial condition encompassing stress, relationships, and structural inequality. Patients, however, arrive with preexisting “toxic imaginaries” shaped by public health messaging and maternal ideals of purity, leading many to self-taper medications or experience treatment as morally fraught.

A central tension emerges in temporality: clinicians frame medication risks as bounded within the perinatal period, whereas patients imagine toxicity unfolding across their children’s lifetimes, drawing on popularized epigenetic narratives of intergenerational mental health. This mismatch intensifies maternal responsibility rather than resolving uncertainty. Psychiatric medication becomes a uniquely moralized exposure—neither avoidable nor fully safe—requiring patients to reconcile fetal protection with self-preservation.

By centering psychiatric care, this study shows how reproductive knowledge is co-produced across clinical expertise and lay moral frameworks. The persistence of the toxic imaginary demonstrates how historical contamination politics are reworked through contemporary psychiatric and epigenetic logics, expanding the terrain of maternal responsibility and illuminating reproductive psychiatry as a critical site where risk, care, and motherhood are renegotiated.

Author

• Charlotte M Abel, University of California-Los Angeles