Psychiatric and Personal Reflections on Abortion

PSYCHIATRIC VIEWS ON THE DAILY NEWS

Of course, I could never have had an abortion. I am a man (he/him), so I have had to try to learn—both as a psychiatrist and as a man—what that might mean entail and, now, how to comment. After all, this is a psychiatry and society column, so how could it then ignore one of our major current societal issues that seems to have so many social psychiatric considerations?

My direct personal and professional involvement with abortion, limited as it is, goes back more than 50 years ago. While I was in medical school, my wife became pregnant, a pregnancy not planned. Abortion never entered my mind and was never brought up by my wife, nor anyone else. I then had the good fortune to be the primary caregiver of our darling daughter during the day of her first year of life while I was home doing my research project.

A couple of years later, I was in my second year of psychiatric residency training, which was a year before Roe v. Wade. I saw a number of women seeking an abortion, which could be obtained if it was psychiatrically risky to continue the pregnancy, or something like that, as I cannot recall the detailed criteria. With supervision, I approved them all, although I never knew the outcome of any of these decisions. I felt helpful and believed that this was the right decision all around, but with some guilt about the potential child.

I have tried to keep up with the recent media discussions about our abortion laws and the possibility of change in some states. However, by far the most informative and moving article that I read was by Merritt Tierce in yesterday’s Sunday New York Times Magazine, “The Abortion I Didn’t Have”. In the article, Tierce discusses the reasons that she, 19 years old at the time, did not seek an abortion with her first unplanned child, as well as the ensuing repercussions for her life and that of her son. She then had a second child out of more overt choice, and then 2 abortions. Clearly, this was not a simple process for her, nor probably other women, based on her discussions of what she considered the complicated, ambivalent, and often contradictory benefits and drawbacks of her first decision.

That article led me to double-check what our professional American Psychiatric Association organizations have said about abortion. The last action that I found for the APA was in May 2018 and was titled a “Position Statement on Abortion.” It clarified that careful research has indicated that having an abortion is generally not associated with any increase in psychiatric symptoms in the woman. However, that is a generality and there can be a range of abortion aftermath responses. The statement then goes on to its primary position that “abortion is a medical procedure, and a decision about an abortion should be between a woman and her physician.”

The longer American Psychological Association commentary on “Abortion and Mental Health” was from around the same time, June of 2018. Theirs also reviews the science, including on the child’s future, and that “Unwanted pregnancy has been associated with deficits to the subsequent child’s cognitive, emotional and social processes.”

Both of these research findings regarding the woman and the child helped assuage my earlier residency guilt. The American Psychological Association policy comes out similar to that of psychiatry, and includes their subsequent and ongoing advocacy and legal action on abortion.

Out of many controversial Supreme Court decisions over the past 50 years, this one seems distinct in its viability. Why might that be? It is literally a life and death issue. However, any changes in Roe v. Wade can be a precedent to reconsider other decisions.

For some, this abortion decision is simply a yes or no. However, for me as a psychiatrist and as a man, it is not. All of these experiences and considerations leaves me with 8 tentative—indeed very tentative—conclusions as to what I currently think may be the major mental health implications for mother and child:

• Do what is practically and psychological possible to not develop an unwanted pregnancy.
• There are invariably complex psychological reasons to have or not have an abortion, and at times of unresolved ambivalence, therapeutic discussion may be indicated.
• It is virtually impossible to compare the outcome of the abortion choice with the path not taken, so it is important to try to come to peace with the final personal decision.
• Having inadequate and difficult-to-access abortion services seems to be a sign of misogyny, and poor women will be the most affected.
• If our abortion laws are changed, they should be done very gradually and in a manner that allows some comparison with outcomes related to the prior law.
• As the Preamble and Section 7 of The Principles of Medical Ethics states about our responsibility to society, abortion is an ethical matter for us.
• Given the cracks occurring in Roe v. Wade, it seems that our professional societies’ views on abortion need updating.
• Our professional societies and ourselves need to educate the public about the mental health implications of abortion, especially in regards to children of unwanted pregnancies.

On Friday, the Supreme Court is supposed to meet to hold a preliminary vote on their decision. What will they—and we—say?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times^TM.

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