Drs Robinson and Stotland respond
We appreciate the depths of feeling and the personal and professional experiences of the writers of these letters. In the space allowed here, we can make only a few major points.
According to the Guttmacher Institute, approximately one-third of women in the United States have abortions before the age of 45. Therefore every psychiatrist who treats women should be aware of the literature on the psychiatric aspects of the procedure.
There is no credible scientific evidence of a discrete psychiatric syndrome caused by abortion. Women react to abortion, as to childbirth, with a wide variety of emotions—including sadness, guilt, and a sense of loss; the predominant reaction is one of relief. These emotions can be contradictory, and they often change over time. Emotions are not psychiatric syndromes or disorders. Neither is regret a psychiatric disorder. There are many decisions in each of our lives that we come to regret—sometimes bitterly. This does not always mean that the decision was the wrong one given our situation and knowledge at the time.
We acknowledge that some women may become upset or even depressed around the time of an abortion. The circumstances that lead a woman to have an abortion may be traumatic and these circumstances, rather than the abortion itself, may cause the woman to feel distressed.
In addition to domestic abuse, abandonment, and insufficient social and financial support, there is evidence that anti-abortion misinformation and clinic demonstrators exacerbate the stress of having an abortion. The evidence that assertions about “abortion trauma”are politically motivated comes from the anti-abortion literature itself. Making a distinction between religion and science denigrates neither.
Lastly, we strongly object to being labeled “pro-abortion.” Since 1973, The American Psychiatric Association has advocated for the right of each woman who alone can assess the situation in which she finds herself pregnant and make decisions about that situation. The APA has also advocated the importance of that right to her mental well-being. Each of us and the APA are pro-life, when it comes to:
• The lives of the hundreds of thousands of women who die or who are grievously injured by unsafe abortions in places where they cannot obtain safe ones.
• The lives of the children for whom they are already responsible.
• The lives of women whose pregnancies would trap them in abusive, even life-threatening, conditions.
We are advocates for the lives of the children they already have because these women were able to make decisions that allowed them to create circumstances in which they can love and care for those children.
Readers of Psychiatric Times who are interested in more extensive reviews of the literature may wish to consult the very extensive report published last year by the American Psychological Association.1 They can also read a review performed by a committee of the Group for the Advancement of Psychiatry (a committee of which we were members), recently published in the Harvard Review of Psychiatry.2
1. Major B, Appelbaum P, Beckman L, et al. Mental health and abortion. Available at http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf. Accessed October 20, 2009.
2. Robinson GE, Stotland NL, Russo NL, et al. Is there an “abortion trauma syndrome”? Critiquing the evidence. Harv Rev Psychiatry. 2009;17:268-290