Abortion Trauma Syndrome – A Different Perspective
As an active member of the “anti-abortion movement,” I read the article “Abortion Trauma Syndrome”1 in the September issue of Psychiatric Times with great interest.
I was mildly surprised that a piece such as this appeared in the news section rather than as an editorial. I was much more surprised, however, that a statement so final and definitive as “abortion does not cause psychiatric damage” (emphasis mine) was quoted in the article, which then went on to discuss the multi-flawed nature of the research that currently exists for or against this postulation.
For those who are open to a more in depth discussion about this issue, I would like to propose a thought experiment. Is there anything else in all of human existence that one could substitute with complete confidence for the word “abortion” in the above quote, given the complexity of the human psyche? Can we say with absolute certainty that any other type of surgery or medical condition or treatment can never cause psychiatric damage? If the physical and mental changes associated with pregnancy, the post-partum period or the menstrual cycle itself can be accepted as sometimes having psychiatric sequelae, why should we be so quick to exclude abortion from consideration?
The feminist writer Frederica Mathewes-Green2 once wrote “No one wants an abortion as she wants an ice cream cone or a Porsche. She wants an abortion as an animal, caught in a trap, wants to gnaw off its own leg.” It seems that the evidence for such a perspective may be mounting over time. A pro-life organization called Priests for Life has recently initiated a campaign called “Silent No More” where they help to connect individuals grieving over a past abortion with resources for healing. So far about 4,000 people have registered on the campaign Web site and many have posted about the specific negative psychological and other consequences of their abortion.3 In addition, a post-abortion healing weekend retreat program, Rachel’s Vineyard, has helped over 60,000 women (and men) in various countries since 1995 with the pain they are experiencing after a previous abortion experience (the retreat’s cost averages just over $100 per person)4 Can we discount the possibility of any psychiatric illness caused or exacerbated by abortion for all of these 60,000 or more people?
Another pro-life organization, Feminists for Life, has identified evidence of an appalling lack of “choice” on our nation’s college campuses for many pregnant students whose health insurance plans do not cover prenatal or maternity care and who have no family housing or child care services available to them on campus. Given such circumstances, is it any wonder that about half of the 1.2 million annual U.S. abortions are performed on college-age women?5 Are all of these women really “choosing” abortion as freely as we might like to believe? If they aren’t, does that alter their risk of future negative repercussions?
While it may be true in some cases that abortion is being used as a political football, we all know that this does not mean that either side of the debate is completely wrong. More research is needed to know the whole truth, but some basic facts are easy to overlook when considering a topic as controversial as abortion. One point worthy of keeping in mind is our knowledge that having a minor child at home is often a protective factor against suicide. Another may be whether psychiatrists themselves are taking the time to elicit a history of abortion or assessing for any possibility of a connection to other symptoms or behaviors during the patient interview. Subjects such as a past abortion are not necessarily likely to be brought up spontaneously by a patient; the examiner may have to ask about this directly. In neither Kaplan and Sadock’s Comprehensive Textbook of Psychiatry6 nor Kaplan and Sadock’s Synopsis of Psychiatry7 is there any reference to asking the patient specifically about a past abortion (or any prior pregnancy) experience in the interview section. I think it would be safe to assume that the question is rarely asked in clinical practice. Is it possible we could be missing something as a result, especially given the frequency of abortion?
The pro-life community acknowledges that there are some women who believe that their abortion was the right decision and show no evidence of any negative psychological effects afterward. On the contrary, there are certainly some women who suffer very intense grief and depression after an abortion. A recent case with some notoriety involved a British artist, 30-year-old Emma Beck, who hung herself in early 2007 shortly after aborting the twins she was carrying (at 8 weeks’ gestation). Her suicide note read, in part, “I should never have had an abortion. I see now I would have been a good Mum. . . I was frightened, now it is too late. I died when my babies died. I want to be with my babies . . . they need me, no-one else does.” The coroner later remarked in reference to the case “It is clear that a termination can have a profound effect on a woman’s life.”8
Both personal and professional experiences have proved to me the wisdom of the coroner’s comment. On September 4, 1993, at age 17, I aborted my first child at 5 weeks’ gestation. Like Emma, I feel that I died, emotionally, that day, and I have never been the same since. I had functional impairment for several months afterward, with symptoms including nightmares, flashbacks, panic attacks, significant guilt, a severely depressed mood, crying spells, impaired concentration, insomnia, anhedonia, decreased libido, fatigue, irritability, anger, a loss of interest in most of my regular activities and other symptoms that I managed to hide from everyone because my fear of someone finding out about the abortion outweighed all of my other concerns at the time.
I can say with certainty that if I had been evaluated by a psychiatrist both before and after the abortion I would have met criteria for at least one psychiatric illness afterward that I did not have before the abortion. It took many years before I was gradually able to admit to myself, and others, that I had made a horrible mistake. To truly accept complete responsibility for permanently destroying such a vast reservoir of potential for growth, development and meaning in my own life (and the lives of others) as was contained in that tiny “clump of cells” required gradually breaking through many layers of denial and defense mechanisms.
Every time I see my 2 beautiful toddler-age daughters, I ruminate about how their lives, and mine, would have been better had I given them the opportunity to know their sibling, who would now be 15. Every time I hug or kiss them I think about the child I will never get to hug or kiss. Is this indicative of any psychiatric “damage”? Who can definitively say? I have been raped, severely physically abused, and came near death after a freak accident that permanently disabled me, but my abortion is by far the most traumatic experience of my entire life.
All I know for sure is this: I am a mother, wife, family medicine physician, and psychiatrist. I received a full scholarship to college – several colleges, actually. I have a house, 2 cars, a dog and 2 great jobs. A lot of people might look at me and say that I had a “better outcome” because of my abortion, as the original article implied is the result when a woman who chose abortion later finishes school or has a better financial status than a young mother. But I would gladly give every title, every possession, and every penny to my name in return for the opportunity to once again be that terrified 17-year-old on that cold exam table, sobbing, waiting for the doctor to come in, and to choose what I knew in my heart was really the right thing to do.
Andrea Chamberlain, MD
Dr Chamberlain is an adult psychiatrist who is establishing a practice in Florida.
1. Kaplan A. Abortion trauma syndrome. Psychiatric Times. 2009;26(9):1, 8-9, 18.
2. Mathewes-Green F. Real Choices: Listening to Women; Looking for Alternatives to Abortion. Ben Lomond, CA. Conciliar Press; 1997.
3. Priests for Life. Silent No More Awareness Campaign. 2009. http://www.silentnomoreawareness.org/about/. Accessed October 26, 2009.
4. Rachel’s Vineyard Ministries. 2008. http://www.rachelsvineyard.org. Accessed October 6, 2009.
5. Feminists for Life. Women Deserve Better than Abortion. 2009. http://www.feministsforlife.org. Accessed October 6, 2009.
6. Sadock BJ, Sadock VA, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
7. Sadock BJ, Sadock VA. Kaplan and Sadock’s Synopsis of Psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003.
8. Artist hanged herself after aborting her twins. Telegraph.co.uk: News. 22 February 22, 2008. http://www.telegraph.co.uk/news/uknews/1579455/Artist-hanged-herself-after-aborting-her-twins.html. Accessed October 6, 2009.
A DSM Diagnosis By Any Other Name
Regarding the article “Abortion Trauma Syndrome” by Arline Kaplan, I would note the irony of the claim that this syndrome is “conceived by anti-abortion activists to advance their cause,” given the obvious pro-abortion attitude of everyone associated with Kaplan’s article.
Would not the reader be expected to doubt the validity of the article if the reviewers and presenters had been so clearly opposed to abortion as they are instead in favor of its availability? Kaplan might have provided at least one researcher an opportunity to rebut the primary content of the article, rather than allowing Drs Stotland and Robinson to make their comments unchallenged.
Whatever the politically correct view of the APA and Psychiatric Times regarding the impact of abortion, my own clinical experience (which I don’t think is unique) is that most women who have been subjected to this procedure are left with emotional scarring and are reluctant to even discuss the event in retrospect. If this occurred as a result of any other cause, there is no doubt in my mind that there would be a DSM-IV diagnosis of some kind for it (especially given the proliferation of diagnoses in that manual).
Robert Murdock, MD
Political Agendas Make For Poor Science
“Abortion Trauma Syndrome” provides a case example of how the scientific distortion is just as bad when the agenda is coming from the left as when it comes from the right.
Whereas the article correctly points out that pro-life forces previously twisted isolated findings to imply that all women who have abortions are psychologically scared, it fails to point out the methodological problems with work by researchers such as Gail Robinson. Almost every argument that Dr Robinson makes concerning abortion trauma has also been made in an attempt to refute the existence of PTSD as a whole.1 Statements such as “among women who have a single, legal, first-trimester abortion of an unplanned pregnancy for nontherapeutic reasons, the relative risk of mental health problems is no greater than the risks among women who deliver an unplanned pregnancy,” involve such a convoluted control group as to belie the face validity test. In other words, it makes it obvious they were looking for a particular outcome. The fact is that soldiers who deploy to combat zones have mental health disorders that are similar to those who do not deploy,2 but clearly some soldiers do come back with PTSD. Similarly, anyone who has actually worked with patients would realize that some women are traumatized by having had an abortion, just as some are traumatized by being forced to have a child for whom they did not plan.
Rather than trying to advance a particular political agenda, our role as psychiatrists and researchers should be to help patients recover from their mental anguish—whatever its cause.
— MD, PhD (Name withheld by request)
San Diego, CA
1. Summerfield D. The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ. 2001;322:95-98
2. Larson GE, Highfill-McRoy RM, Booth-Kewley S. Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect. Am J Epidemiol. 2008;16:1269-1276.