Sunday, April 1, 2012

Some thoughts on "Post-Abortion Trauma"

Trigger Warning: Not About Perfume. This piece is written in response to a panel discussion on Abortion I participated in recently at a local university. There were a number of issues I did not get to address, but promised students afterwards I would follow-up on. Because it may be useful to others, I am going to use this space to do that. For you perfumey types, I hope you'll indulge me.

I wanted to say a few words here about the concept of "post-abortion trauma" because it was referred to over and over during a panel discussion by the representative from Oregon Right to Life. The heavy reliance on this condition as one of the ills women suffer after abortions that mean we should make it illegal made me feel it was something I haven't really addressed in all my writing about reproductive rights, and I thought I'd throw it up here.

First, I think it's important to recognize that "Post-Abortion Trauma"/"Post-Abortion Syndrome" is not recgonized by the medical or psychiatric community at large as a medical diagnosis. It does not appear in the DSM-IV (last published in 1994) or in the more recent supplement (published in 2001). Further, the American Psychological Association and the American Psychiatric Association do not recognize PAS/PAT as an actual diagnosis or condition. It is not listed in the ICD-10 list of psychiatric conditions.

This is significant because the term was first coined in 1981 by Vincent Rue, a pro-life advocate, in testimony before Congress, which means the medical community has had over thirty years to determine if it exists. FN1. Indeed, Rue himself acknowledged in his original testimony that what he believed he was seeing was Post-Traumatic Stress Disorder, but choose to coin a specific term for PTSD as he believed it related to abortion. This does nothing for medicine; it is, however, one hell of a political strategy. In fact, most studies that try to replicate the results of surveys demonstrating the existence of this condition -- the hallmark of any scientific research being that the results are independently verifiable -- find that the alleged science supporting the 'syndrome' is largely without merit or foundation. FN2.

Science not withstanding, there are lots of women out there who have had an abortion, and who have also suffered (and perhaps continue to suffer) from trauma. And I think, if you really consider the issues, it is clear why.

One of my favorite quotes about reproductive issues actually comes from a Catholic Pro-Life Activist, Frederica Mathewes-Green. She said, "No woman 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."

Most women -- I won't say all -- but I can say most women, and certainly every women I have ever spoken to who has had the experience, has obtained an abortion because she was under duress prior to having the abortion. That may be because she has recently survived a sexual assault or because she is currently experiencing ongoing violence from an intimate partner in the form of non-consensual forced sex (i.e. martial/relationship-based rape or incest) or domestic violence or both. Other forms of duress include the inability to financially support the child due to severe and ongoing poverty that includes the threat of or actual joblessness, homelessness, hunger, and lack of physical safety. These are traumatic experiences in their own right. They require counseling in their own right. And particularly when they represent repeated or ongoing traumatic experiences, they tend to develop into Post-Traumatic Stress Disorder. This is a phenomenon medically and scientifically confirmed and well-documented among victims of domestic and sexual violence.
FN3.

Having an abortion is a difficult decision. I don't know a single woman who has taken it lightly. And yet, as someone who had one, and who needed counseling after, I can tell you with simple honesty that the trauma I needed counseling for was related to the circumstances that lead to my decision, not my decision to have an abortion. Had I never been pregnant, I still would have experienced PSTD and needed the intensive therapy I've received. When I grieve my situation, it isn't my abortion I grieve. I made the decision in the moment that was right for me; I don't think anyone I've known, then or since, thinks I would have been better served by having a child in those circumstances. What I grieve is that an entire community let my abuse, and my brother's abuse and my grandparents' abuse, go on for years without helping us. This distinction is an important one, because I suspect many women the Right/anti-choice advocates would like to diagnose with PAS/PAT are like me: women who experienced trauma they never received treatment for.

Further, I think it is critical to talk about even the small minority who might indicate that their abortion was a traumatic experience. First, any medical procedure can be traumatic, and I don't deny that. But imagine if -- every time a person had to have their appendix removed -- they had to face the following: taking time off work to travel a great distance to find someone to perform their procedure; extensive oppositional counseling they are required by law to sit through, despite already knowing they want the procedure to go forward; being sent away for up to 72 hours to 'reconsider' their decision to have the procedure; being called names and protested in writing and imagery each time they attempted to enter or exit the medical facility; not being able to tell people about the procedure for fear that they will be verbally and/or physically assaulted, disowned by their families and friends, thrown out of their homes, and shunned by their religious communities.

Abortions today happens in shame and silence in large part because anti-choicers are focused on 'personhood,' as though a pregnant woman is not a person; on the 'pre-born,' because they refuse to acknowledge that there is a period before viability wherein there is no distinct person, but rather a growing collection of cells that may one day be a person but at that time is dependent on a woman to survive; and on the idea that women who become pregnant were asking for it because they had sex.

There is incredible shaming that surrounds sex and anything that goes with it, from pregnancy (wanted and unwanted, because being a single and/or young and/or poor and/or unwed mother in this country isn't a status that is valued or protected by the same political activists who oppose abortion) to contraception for the purposes of preventing unwanted pregnancy or sexually transmitted disease to the consensual act of two people expressing physical aspects of love and care outside the bounds of marriage (some of whom are not even legally allowed to marry).

If women fifty or sixty years later still carry a degree of shame and sadness over an abortion, it likely stems from the circumstances that drove them to make that decision in the first place and the complete lack of support they received before, during, and after and/or a subsequent failure to obtain therapy for those related traumas. It is because she felt she could not honestly tell anyone she'd had sex, or been raped, and become pregnant without fearing of being called names or beaten or shunned or left homeless or even killed. And she had an abortion and continued to keep her silence because she lived in fear of being called names or beaten or shunned or left homeless or even killed. That is traumatic. The shamming itself is traumatic. The silence is damaging, deafening, to women who have abortions and the same silence likely only serves to continue the terrible circumstances that led her to feel an abortion was necessary in the first place.

[A woman] wants an abortion as an animal caught in a trap wants to gnaw off its own leg. Making hard choices because you have to in order to survive, to protect your physical, emotional, and mental safety for another hour, another day? That's traumatic. And it's related to the socio-economic circumstances that lead to abortion and the way abortion opponents work to shame and silence and punish the women who have abortions, not the abortion itself.

After having an abortion, a woman is often called: a baby killer, a murderer, a slut, a whore. She is told she will be going to hell, that her life and soul are forfeit. She is told she should beg forgiveness. She is asked if it is okay to kill her now, too. I've heard it all myself, some of it just this week in the wake of doing the panel. FN4.

But if a woman has the child, she is often still going to be called: a slut, a whore, a welfare queen, stupid, loose, and immoral. There is no winning position once unwanted pregnancy occurs. A woman with an unexpected, unwanted, and unintended pregnancy can only lose. That's the world we live in. It is a world that tells young women their greatest value is as an object of male desire and simultaneously punishes them for wandering into that trap or for trying to use that small wedge of power to save themselves.

If we want to start talking about kinds of trauma and naming psychoses as politically advantageous things, then I have an equally appropo name: "post-unwanted pregnancy traumatic syndrome." Because whether a woman has a baby or an abortion, if she is poor or undereducated, if she is unmarried, if she is dependent on social services to survive, and even if she is raped, she will be told it is her fault and she should be ashamed, most frequently by the people and organizations who claims to love her and have her best interests in mind.

Who wouldn't find that traumatic?

She heads for the clinic
and she gets some static walkin' through the doors.
They call her a killer
and they call her a sinner
and they call her a whore.
God forbid you ever had to walk a mile in her shoes.
'Cause then you really might know
what it's like to have to choose.

~ "What It's Like," Everlast

_____________________________________________
FN1. Vincent Rue, "Abortion and Family Relations," testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).

FN2. See:

~ NE Adler, HP David, BN Major, SH Roth, NF Russo and GE Wyatt, "Psychological responses after abortion" Science 6 April 1990, Vol. 248 no. 4951 pp. 41-44, DOI: 10.1126/science.2181664

~ Joyce, Christopher (1989-12-16). "Reagan's officials 'suppressed' research on abortion". New Scientist. Archived from the original on 14 March 2008.

~ Edwards, S (1997). "Abortion Study Finds No Long-Term Ill Effects On Emotional Well-Being". Fam Plann Perspect 29 (4): 193–194. doi:10.2307/2953388. JSTOR 2953388.

~ Steinberg JR, Russo NF (July 2008). "Abortion and anxiety: what's the relationship?". Soc Sci Med 67 (2): 238–52. doi:10.1016/j.socscimed.2008.03.033. PMID 18468755.

~ "Task Force on Mental Health and Abortion". American Psychological Association. Retrieved 2008-08-28.
Carey, Benedict (2008-08-12). "Abortion Does Not Cause Mental Illness, Panel Says". New York Times. Retrieved 2008-08-12.

~  "Is Post-Abortion Syndrome Just a Myth?," CBSNews, 2008.

~ "Abortion not seen linked with depression: Review of studies found no evidence of emotional harm after procedure," MSNBC, December 4, 2008.

~ Abortion Does Not Cause Mental Illness, Panel Says, August 12, 2008, New York Times, NYTimes.com.

~ The Emotional Effects of Induced Abortion, Planned Parenthood research paper and literature survey.

FN3. Jones, Hughes, & Unterstaller, 2001, has a good and accessible review of the supporting literature. Link also here. "HOPE for battered women with PTSD in domestic violence shelters" by Dawn M. Johnson and Caron Zlotnick is also an interesting article on PTSD and treatment as it related to intimate partner violence, which you can find here.

 FN4. To be clear, those sending me the emails don't appear to be associated with the university community, but random people who showed up. I can only assume they were brought out by the anti-choice organization's mailing list as their emails are riddled with the same language the official representative on the panel used.

8 comments:

Josephine said...

Diana, this is a very compelling piece and I appreciate you writing it here on your blog. You do an excellent job of pointing to the trauma surrounding - but apart from - the abortion itself. Abortion as the manifestation of trauma (my thought, perhaps not yours), the process of which is traumatizing.

You bring a unique perspective to the topic due to your personal experience, and I applaud your willingness to write about it openly, without apology or rationalization. Well done.

monster said...

Brava, sister.

ChickenFreak said...

You know how it is when someone explains something so well, digging into the nuances, that you don't have any immediate questions or quibbles but instead just take it in and chew on it for a while? This post is one of those occasions. But it was so very good that I felt weird not commenting, so here I am essentially commenting about not commenting. :)

Diana said...

Chickenfreak-

Thanks for stopping by. You're one of those readers who I feel like is a touch stone for my feminist ranting. So thank you for saying you felt agreement with what I wrote. I know if you feel good about what I wrote then I'm probably on the right track. :)

Diana

Diana said...

Josephine--

Thanks for weighing in. I appreciate the support, particularly right now.

Diana

Diana said...

monster-

Thanks! And thanks for reading.

Diana

Joan (Scentsate) said...

Not to mention anti-abortion politicians are usually also anti social programs to support unwanted children.

Diana said...

Joan--

That's one of my biggest pet peeves. The position of opposing birth control measures while simultaneously opposing social services is internally philosophically inconsistent.

If one believes the world a zero sum game, wherein there is not enough for everyone and we all must compete for basic needs, then the logical follows that the fewer competitors there are, the better off everyone is. You can horde your millions and refuse to pay reasonable taxes to support social services, but you are much less likely to end up in the French Revolution if you allow free acess to birth control.

Alternately, one can take the position that the world is non-zero sum when it comes to things like food, shelter, medical care, and education. In such a situation, you can argue for rampant population growth as a moral good, but you better be willing to be ready to hold every member of society accountable for helping to provide those basic needs for each new baby forced into the world.

To promote rampant population growth while denying a legal right to birth control? To force women who cannot afford to support themselves or their children to go forward with a pregnancy, then tell them once the baby arrives that the state's interest in the fetus ended the second it left it's mother's body? That makes no sense at all.

Thanks for raising this point. It's always worth mentioning.

Diana