Post-Abortion Grief, Part II: by Anne Lastman

This is the second part of an article by grief counsellor, Anne Lastman.Click hereto read the first part.

It has been argued that controlled and wanted pregnancies will mean no unwanted child and no battered, abused, neglected or psychologically abandoned children. Yet the reality is that there is no evidence to support this. However, there is evidence that child abuse is increasing (1981, Ney, 1997). A Norwegian study has found that the lesser type of child abuse has increased markedly and major type of child abuse has doubled over the past 10-year period. Child abuse is the result of many factors, however one of these factors is poor bonding between mother and infant (Ten Bensel & Paxson 1977, Ney, 1997) The bonding process may be disturbed by a number of factors including post partum depression, and further there is evidence that women who had previously undergone an abortion procedure became depressed during the next wanted pregnancy.

Recent study from China confirmed that there is a difference between abortion and miscarriage and next pregnancy. The authors Huang, Hao,Su, Kun, Huang, Xing, Cheng, Xiao, Xu, Zhu, Tao, stated that “abortion represents a complex biological and psychological event, which is regarded as a difficult and distressing life event for a woman” (p51) These authors continued that for “many women an abortion may represent the loss of a future child, of motherhood, and part of self and it may engender doubts regarding the ability to procreate” (p51) Indeed these researchers suggest that “parental response to loss can extend to subsequent pregnancy” or even their ability to carry another child to full term.

It was found that perinatal losses interfere with woman’s preparation (psychologically) for the next pregnancy thus it appears that abortion of one pregnancy interferes with bonding of the ensuing child (Colman & Colman, 1971; Ney, 1997).

A plethora of studies has shown that abortion causes psychological sequelae. That it is more damaging to women than presently recognised and accepted. Abortion is and remains a disenfranchised (Doka, 1989) procedure because it is still taboo and not within the range of normal accepted behaviour within society.

The sudden realisation that the abortion has meant a death of one’s own child threatens the individual’s own idea of self worth (Reardon, 1987). One’s own idea that the world is benevolent (Janoff-Bulman, 1989). That people (including the medical profession-abortion provider) are benevolent (Janoff-Bulman, 1989, Parkes, 1988) and the impact of such an understanding complicates further their grieving process (Sanders, 1988). This is due to the “human element” aspect of the stressor, abortion (DSM III R-1987, abortion removed as a stressor in DSM IV) that is, the decision-making which is involved in this event (Friedman et al. 1974). To complicate further the grief process, (Sanders, 1988; Prigerson et al., 1999) and assist to alleviate the possibility of PTSD, abortion compromises the normal rituals which society has developed as an aid to detachment (Freud, 1917; McAll & Wilson, 1987) from the lost one and begin the process of living without that ‘other’ though with continuing bonds. (Klass, Silverman & Nickman, 1996)

This type of bereaved individual may not receive societal or communal support because abortion remains contentious, painful, unrecognised, unacknowledged,and shameful and thus disenfranchised (Doka, 1989) and by its very nature will have its supporters and non supporters. Indeed with an abortion there will not be the formal leave taking because of the manner of disposal of fetal remains and the reality of the subject remaining taboo. This then disenfranchises (Doka, 1989) the experience and the woman’s grief responses and contains it within the knowledge of the abortive woman and perhaps one or several other individuals. (Raphael & Misso, 1993).

Understanding post abortion trauma and grief and the social context of this experience Raphael et al., (1996) states “provision of any preventive intervention needs to take account of the atmosphere and social processes that emerge following the traumatic event” (p464). For the post abortive population the atmosphere and social processes are those of silence and because of this, as Raphael et al continue, “often traumas do not provoke widespread interest particularly if only one or a few people are involved in each trauma.” (p465). The experience of abortion is usually an individual experience, and a politicised experience, and because of this, the mental health and grief profession are slow in interest in this area even though collectively post abortive women and those experiencing psychological sequelae is substantial. Indeed the number of traumatised women (of some men, Shostack, 1984.) exposed to this type of trauma is larger than any of the large scale disasters “ and for this reason individual traumas present a greater public health challenge than disasters do.” (Norris, 1992)

The degree of public support and the acknowledgement that the experience was a traumatic one and the support community offers may be a significant factor in the healing process or alternatively absence of support adding more trauma to the already traumatised (Raphael, 1996). This concurs with Doka’s (1989) findings that abortion being a hidden and unspoken about loss, ensures that the event remains unvalidated and therefore unsupported, contributing to the added severity of the trauma.

Abortive traumatised women live within a societal context which is not necessarily negative but ambivalent and as such remain part of a group of traumatised but not recognised (Doka, 1989) as such. This is because their experience and subsequent needs are not identified as those of someone who has been exposed to a traumatic event. This then leads to the misdiagnosis, wrong diagnosis and unnecessary suffering because interventions have not been devised and put in place. Abortion, a stressor outside of the normal day-to-day experience (DSM-III R, 1987) and a contributing factor in the decline in mental health of women, has little attention paid to it and no intervention strategies in existence.

The economic factor, that is, the strain on the mental health budget can only be guessed at. Both the psychological and monetary cost to the community by way of depression, mental disorders, suicides, litigation as in the “Ellen” case in Victoria in 1998 (see Herald Sun, Sept. 29, 1998) hospitalisation and subsequent loss of income and/or potential income can only be estimated. Post abortion trauma and grief does not stand-alone but long term-unexpressed grief over what the woman considered was a traumatic experience serves to paralyse potential and to devalue the life of the woman sufferer.

Community education of the possible effects of abortion, both to the woman, man, family and society, cannot take place when the procedure is enshrined in law as it now is in many states in Australia and around the world and because it is enshrined in law and demanded as a right it is automatically assumed that it is a “good thing” and therefore understanding of its effects becomes impossible.

Public education via the medium of schools, community programs, health department, Cancer Council, remains in slow motion for the reasons of the ongoing debate and disagreement over the very existence of this particular type of grief. There is ongoing debate on the abortion breast cancer link (Brind, et al 1996, LanFranchi, ), abortion suicide link (Gissler et al. 1996, David, et al., 1981 Reardon et al, Coleman 2011) abortion substance abuse link, (Reardon, 1987) abortion and relationship breakdowns link (Rue, 1985; Reardon,1987: Ney, 1997; ). Whilst these debates continue only limited exposure of this information is possible as formal inclusion into both secondary and tertiary education system cannot be sanctioned as indeed with other mediums of disseminating information.

Improving public knowledge of those in the community to deal with or even recognize and support those traumatised, and where necessary refer to professionals, also becomes difficult because of the nature of the distress and the need for this experience (abortion) to be kept a family secret (Webster, 1991). This is disturbing as Nagy-Boszmormenyi (1983) posited a concept, which he termed “invisible loyalty” which he describes as a continually repeated action in order to achieve reparation, or perhaps as Schutzemberger, (1997) calls the Anniversary Syndrome.” Abortion is an issue, which has attached to it “invisible loyalty” and as such becomes difficult to deal with, but further to devise preventive education programs for dissemination within the local community and the broader human community.

Whilst abortion has all the hallmarks of a traumatic experience and the possible development of PTSD, a major mental health disorder, societal knowledge, consensus and a uniform response remain elusive. Again while post abortion trauma is a serious mental health issue, outside of the mental health profession it remains little known understood or disseminated , and within the mental health profession its existence is shrouded in silence still to be fully accepted, though of recent times, the venerable and esteemed Lancet Journal has acknowledged the need for care viz:

Lancet Journal Challenges the APA on Need for Counselling after Abortion

Tuesday September 2, 2008

“The fact that some women do experience psychological problems after a termination should not be trivialized. … Women choosing to terminate must be offered an appropriate package of follow-up care, which includes psychological counselling when needed.”

Today we know that the immediate response in the aftermath of a traumatic incidence and the speed and quality of care is thought to reduce the likelihood of future mental health problems and to this end crisis intervention programs are of value (Raphael, et al. 1996) However, response to the traumatic experience of someone who has undergone a procedure which challenges their intrinsic worth, and whilst having ambivalent feelings, or religious values conflicts, and from this, develops long term mental health problems, becomes difficult. However preventive measures in the form of knowledge about the procedure, about the likelihood of possible future difficulties, knowledge about the possibility of increased risks in breast cancer and psychological dysfunction; these measures, which can assist the women to carefully think about this life altering procedure, will be of value and should be recognised as valuable.

In conclusion the mental health of women has declined and continues to decline. Breast cancer in women has markedly risen and is rising. Suicide amongst the youth and the generation which accepted abortion and the pill (55-65 yrs) is high . Substance abuse and eating disorders abound and marriage and news in the area of family breakdowns is pessimistic. It is time that the contentious issue of abortion and its effects on the mental health of women, men and society is researched more and public knowledge about its effects is increased. It took many years for Post Traumatic Stress Disorder to be recognised as categorisable condition so it is conceivable that it will take time to also reach a consensus about the traumatic effects of abortion. To identify high-risk women and advise them of the potential risks involved in their decision. National abortion policy is built upon the understanding that abortion is a “safe” procedure.

However, if this is the case then policy must be reviewed as it is increasingly clear that abortion is not a safe procedure either physically or mentally, and indeed it appears a dangerous procedure to women, men, children and society . In the meantime reducing the risks by introducing “informed consent laws” and having made available “cooling off period” so that the information given may be understood before their final decision is made is of utmost importance. Having protective measures in place to protect vulnerable women from being coerced into the procedure for the benefit or convenience of others is important. Ensure the availability of affordable effective therapy programs for those already traumatised or those who will continue with the procedure even after effects are explained to them. Encouraging health professionals and those in clinical practice to inform female patients presenting for abortion about the possibility of post abortion trauma, psychosis, grief, and assistance in the training of health professionals in the skills of diagnosis and treatment of Post Abortion after effects would go a long way towards redeeming the existing clime and remove from it the legitimacy accorded to it in recent law changes.

The abortion decision is always situation specific, but a human person’s conscience is not and the conscience with maturity suffers as a result of a decision made or forced in a time of stress. The difficulties which are encountered, or considered as difficulties and therefore requiring abortion as a solution, will not be thought so in a different time. However, the decision once made cannot be reversed, and the anguish of regret which the conscience experiences will not subside without some form of help, forgiveness. The memory of an intentionally lost child always remains as an event shrouded in darkness and one which should never have happened.

Anne Lastman is a qualified sexual abuse and post abortion grief counsellor with two decades of experience. She is based in Melbourne, Australia and actively studies and counsels men and women affected by their experiences with both abortion and sexual abuse, as well as lecturing internationally on these topics.

You can read more about Anne’s work here at her website, Victims of Abortion.

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