Chapter 1: Introduction
In 1973, abortion was made legal. It has become one of the most controversial issues in the United States. Pro-Life and Pro-Choice advocates produce statistics endorsing their views to garner public support for their agendas. This research project seeks to go beyond the issue of legality or appropriateness of abortion and to study the women who have been affected by abortion. David Reardon, one of the stronger voices for the pro-life movement, is the director of Elliot Institute. Reardon’s research is examined in the review of literature along with other major pro-choice organizations such as the National Abortion and Reproductive Rights Action League (NARAL) and the National Abortion Federation (NAF).
The number of women adversely affected by abortion varies in degree and intensity; the present study will focus on women who present symptoms that are characterized as Post-Abortion Syndrome (see Appendix A). The diagnostic classification of Post-Abortion Syndrome (PAS) has been suggested, but has yet to be empirically validated and recognized by the American Psychological Association (APA) and incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Most studies are unsure of the exact proportion of the population affected by post-abortion syndrome (Reardon, 2000; Lewis, 1997). The present study does not assume that all women who have an abortion suffer from PAS. This study is focused upon gathering information that may help clinicians identify symptoms and prevent the trauma. The study described is a post-hoc investigation into the symptoms of stress experienced by women during post-abortion adjustment.
“In 1972, the year before the Roe v. Wade decision, approximately 1 million illegal abortions were performed in the United States alone” (Stotland, 1992). Today, about 3 million women per year in the United States have an unplanned or unwanted pregnancy, and approximately 1.5 million of these pregnancies end in elective abortion; one in five women in the United States has an abortion during her lifetime (Butler, 1996). Abortion clinics perform approximately 1.8 million abortions a year, and at an average cost of $400 dollars each, which represents $720,000,000 a year– roughly two million dollars a day (Selby & Bockmon, 1990).
A study recorded in the Archives of General Psychiatry acknowledged that 1.4 percent of a sample of women who had abortions two years previously were diagnosed with PAS by Dr. Brenda Major. With about 40 million abortions all over the world, this could amount to a potential of 560,000 cases of PAS. Many believe that studies of this kind may be the beginning of discovering how significantly abortions affect women’s lives (Reardon, 2000).
Selby & Bockmon (1990) gave diagnostic criteria for post-abortion syndrome that are based on the APA guidelines for post-traumatic stress disorder and those developed by Vincent Rue (Appendix A). The criteria given by Vincent Rue from the diagnostic criteria for PTSD have not been fully recognized by the American Psychiatric Association (APA). This diagnosis has not yet been listed in the DSM manual, although abortion is listed as a psychosocial stressor. Post-abortion syndrome (PAS) is made up of a predictable pattern of symptoms that occur as a result of the abortion experience. Impairment from the disorder can range from mild to affecting almost every area of the woman’s life (Doherty, 1995).
Post-abortion syndrome, according to Selby & Bockmon (1990), is a disorder brought about by stress resulting from the abortion itself that the woman is unable to process. This is similar to with post-traumatic stress disorder, recognized by researchers Freed & Salazar, 1993; Selby & Bockmon, 1990; Doherty, 1995; Boyland, 1992 as resulting from a particular stressful event that occurs in a person’s life (see Appendix B). In post-abortion syndrome, that event is the abortion experience, or the intentional destruction of one’s fetus or Product of Conception (POC).
Some women who have experienced this procedure suffer trauma during and afterwards that cause them to re-experience the event through “flashbacks.” Re-experiencing the abortion can take several forms such as having recurrent, intrusive recollections or dreams of the abortion or the child. The difficulty the woman has dealing with these symptoms may lead to denial or avoiding any memories of the event, which is a particularly strong component of PAS. By avoiding emotions related to the abortion, the woman may also experience diminished interest in significant activities, feelings of detachment or estrangement from others, reduced capacity for feeling or expressing emotions, reduced communication and/or increased hostile interactions, and depression. These symptoms also include hyper-alertness, sleeplessness, memory impairment, and concentration difficulties, all of which can be intensified by exposure to reminders of the abortion (Selby & Bockmon, 1990).
Post-abortion syndrome has not been clearly defined as a diagnostic classification and for that reason it is often confused with other post-abortion experiences such as post-abortion stress. Defined, post-abortion stress is “a stress reaction experienced by some women after abortions.” The onset of this reaction can occur immediately after the procedure or several years later (Freed & Salazar, 1993). They link it closely with PTSD, just like post-abortion syndrome. In their comparison of terminology, Freed & Salazar (1993) suggest that post-abortion stress and post-abortion syndrome are dealing with the same symptoms and therefore the same illness (Freed & Salazar, 1993; Mannion, 1994; Speckhard & Rue, 1993).
Some of the symptoms that are associated with post-abortion stress include the following: anniversary syndrome, anxiety over fertility, avoidance behaviors, eating disorders, inability to bond with your children, preoccupation with becoming pregnant again, psychosexual disorders, and sudden, uncontrollable crying (Freed & Salazar, 1993). These symptoms parallel those given by Mannion (1994) although he labels post-abortion trauma as being post-abortion aftermath. Some of the symptoms he lists include complicated and unresolved grief, emotional conflicts, identity crisis, and disrupted relationships.
Women with PAS experience feelings of alienation, isolation and horror over having experienced an abortion. This death event, for many women, is so traumatic that their fears about the abortion experience reoccur and disturb their daily life. Some of those fears include: fears about what happened to the aborted child, fears about one’s own body, fears about one’s sanity, fears about one’s spiritual standing, and fears about being socially ostracized or branded as a deviant if others knew about the abortion (Doherty, 1995).
Psychological complications found after the abortion experience have been divided into three kinds: post-abortion distress (PAD), post-abortion psychosis (PAP), and post-abortion syndrome (PAS). According to this categorization, reactions fall into post-abortion distress if symptoms occur within three months of the abortion and persist for no more than six months. Post-abortion psychosis is characterized by chronic and severe symptoms of disorganization and significant personality and reality problems; this is considered a very rare condition. As stated previously, post-abortion syndrome, labeled as a type of PTSD by Vincent Rue, (Doherty, 1995; Selby & Bockmon, 1990) includes symptoms that may be delayed six months or more after the event (Doherty, 1995). It is important to note, however, that these symptoms would not be expected to appear if the mother did not develop an attachment to her child and/or recognize the death of the baby/POC either at the time of the abortion or a later date (Speckhard & Rue, 1993).
Traumatic events have the capability of destroying an individual’s core assumptions about reality. In PAS it is common for clinicians to encounter a woman who has experienced a significant alteration of her primary beliefs of safety, trust, worthiness, meaning in life, pleasure, self-image and degree of relatedness or connectedness to others. It has become generally accepted that PTSD stress reactions are more persistent after an event where human beings are perceived responsible for what has occurred. Survivor guilt, shame and a chronic inability to forgive oneself and the need to punish are some of the commonly found barriers to healing in this situation (Doherty, 1995).
Smith (1995) recognizes the dilemma in social circles regarding abortion and expresses concern that both sides ignore the ramifications that this event has on the life of a woman before, during, and after the abortion procedure. In her estimation, the Pro-Choice lobby believes that women are in complete control of their bodies and should be able to make a decision about abortion without any moral conflicts. Meanwhile, the Pro-Life lobby stigmatizes women who have chosen abortion as cold and uncaring.
The trend in society today calls for women to see abortion as a harmless procedure and a good choice in many circumstances. Media sources and even pregnancy clinics that provide abortions will often portray abortion in this manner. Freed & Salazar (1993) also mentioned Pro-Choice and Pro-Life viewpoints and recognized the strain society places upon women as they make this difficult choice. They focused on Pro-Lifers claiming that the woman has committed murder and Pro-Choice advocates stressing the importance of women’s choices and that women should be able to have an abortion, forget about it, and get on with their lives.
One question often asked about post-abortion syndrome revolves around two questions: who is affected and how many are affected? Most research studies agree that teenagers, women who have abortions later in the pregnancy, women who already have children, women who feel pressured by circumstances, and/or women struggling with value conflicts all are at a higher risk for developing PAS (Freed & Salazar, 1993; Mannion, 1994). However, estimating the number of women who suffer from PAS has proven to be a difficult task. The great emotional, social, and political controversy surrounding this issue and the hesitation to discuss symptoms of PAS are keeping women silent. These factors have impeded the development of statistical surveys describing this phenomenon (Selby & Bockmon, 1990).
In studies done immediately or shortly after the abortion procedure, forty-five percent of the women reported satisfaction even up to several months following the procedure. Ten percent, though, felt that they would benefit from counseling because of feelings of guilt and remorse. Other studies have found fourteen percent of women post-abortion feel as though they were emotionally unbalanced and seven percent were impaired enough emotionally to disrupt their daily functioning. Twenty-one percent were found to be depressed after the abortion, but this group also had problems occurring before the abortion as well. These studies only begin to give indications of the fact that abortion does, to some extent, affect women post-abortion (Doherty, 1995).
Reardon (2000) indicates that researchers need to address the issue of informing women of the possible risks involved in choosing abortion as their method of contraception. Some of his suggestions included pre-consent information concerning some of the psychological reactions as well as individualized counseling for what he defined as high-risk patients. The assumption being that when a woman is aware of the consequences of her actions, she can weigh the benefits and drawbacks of the abortion. Research proposed here attempts to focus upon the differing symptom patterns experienced by women in the process of recovery. This information is a necessary first step toward the development of comprehensive educational and counseling programs for women at risk.