KELLY, NINETEEN YEARS OLD, JUST HAD AN ABORTION. SHE got pregnant during the summer, while traveling. Something must’ve happened to the condom.
The boy goes to school in Canada. They had known each other for a week when, at a party, the two of them drank too much. When Kelly got home, her period was late, but with everything she had to do—move, unpack, and decide on classes—there wasn’t even a moment to think about it. Anyway, why should she worry? They had used protection. A few weeks passed; still no period. A nurse at the campus health center had this news: her uterus was enlarged; Kelly was seven weeks pregnant. Sure enough, the blood test was positive.
From that moment, Kelly told me, she was clear about how to proceed. Since she had no particular religious beliefs and believed wholeheartedly in a woman’s right to choose, there was never any question for her. She phoned the boy, but he didn’t say much; he sounded more shocked than she was. Calling back the following day, he said he’d support her decision; he wanted to send a check, he even offered to come be with her. But Kelly said no. Not that she couldn’t use the money—she had to put the four hundred and fifty dollars on a credit card. And it wasn’t that she didn’t care for him—not at all. In fact, she explained, that’s the worst part of this whole thing for her: she did like him, quite a lot. Before this awful mess, she had hoped to see him over Thanksgiving. But now everything between them was different; their relationship was so awkward and strained that it seemed unlikely that would happen. So, Kelly explained with sadness, it just felt better to handle it alone.
Kelly turned to Planned Parenthood, where she learned there were two kinds of abortions, surgical and medical, and that each had pros and cons. Overall, the counselor said, they were both very safe—many times safer than giving birth. Psychological problems afterward were rare, she explained, and most women felt relieved. Kelly decided to have the medical abortion, in which pills are taken to cause miscarriage. Even though it could take a few days, it would happen in the privacy of her apartment, and she’d have some degree of control over events. Now it’s over. She feels relieved, but she also feels sad, guilty, and alone. Kelly would rather not speak to the boy, and she’s at odds with her best friend. She’d been depressed before all this, and now she is more depressed. Could I prescribe some medication?
Before her psychiatric evaluation, Kelly had met with one of our psychologists. I pulled up her records on my computer: “This student is dealing with depression, feelings of loss and isolation,” read the assessment, “as well as recovering from a recent medical problem.” What? A “medical problem”? My first thought was, The therapist is protecting the student’s confidentiality; my second, that the therapist perceived the abortion to be a minor event. Either way, it surprised me, and I made a mental note to find out what it was all about.
Now, all this was taking place in the days following Hurricane Katrina. As a provider of mental health services, I was bombarded with information about the anticipated psychological fallout of the disaster. Professional newsletters and Web sites were filled with grim predictions about expected rates of post-traumatic stress disorder, or PTSD, in survivors. Health-care professionals in every location were reminded of the importance of early diagnosis and treatment. They were urged to be on the lookout for “stress reactions”: shock, anxiety, irritability, insomnia…
You might expect the target audience of this information campaign to have been limited to the survivors of the tragedy, but that would be incorrect. The American Psychological Association, for example, reached out to everyone—or at least, everyone who watches television: They warned on their Web site: Images of this catastrophe, even when viewed from far away, may cause feelings of “vulnerability.”
On my campus, there was another angle: You may not have experienced this disaster firsthand, the counseling center’s Web site pointed out, but you may be struggling with “issues highlighted in the aftermath of Katrina: inequity, race, social class, the inadequacy of our emergency preparedness and our institutional response.” You may therefore feel frustrated, angry, and helpless, so we welcome you to join us in a series of meetings focused on Katrina, where you can “work through” your thoughts and feelings.
It seemed as if, following this hurricane, my colleagues in the mental health field were determined to find each and every individual experiencing even the slightest distress, and to reassure them: your reactions are normal, your tears and insomnia expected. You are not alone. Here are tips that will help you get through the days ahead, numbers you can call and a Web site you can visit, and here’s when you need to speak with a professional. And to the credit of many government and social service organizations and individuals, it seemed they wouldn’t stop until the job was done.
In my opinion, it was overkill, but it was well intentioned. We in mental health know that for some people, trauma will have profound consequences. We have seen how depression, fear, guilt, flashbacks, and irritability can interfere with daily life. We know too well the toll it can take on relationships, work, and physical health. Some survivors may turn to self-destructive behaviors in an effort to dull the pain: drug use, alcohol, gambling. Some will attempt suicide; a few will succeed. We know, too, that reactions to trauma may be complex. Psychogenic amnesia exists—that’s when people don’t recall details because doing so would overwhelm them. A soldier may survive the battlefield or a woman a rape, and initially appear to cope well. Only later—maybe years later—may they begin to dwell on what happened, to obsess and dream about it. Finally, we understand that as a person ages, earlier traumas will be reexamined and appraised from a new angle, depending on subsequent events: marriages, divorces, births, miscarriages, infertility, menopause, loss of loved ones.
Hurricanes and terrorist attacks make headlines; other traumas happen behind closed doors, and wounds are hidden due to shame and fear. This, we know, can be particularly destructive.
This is why psychology reaches out to survivors of trauma, because for many the process of speaking about it, sharing details, having an opportunity to openly grieve, mourn, question, and be angry, allows healing to begin. It’s a process through which the victim should feel endorsed, and supported. Ideally, this work is done with others in the same position, people who have “been there.” This can be enormously helpful, even lifesaving. And we need to identify the minority with more serious symptoms and bring them into the system for evaluation and treatment. It’s a public health strategy, part of the ABCs of psychology.
Of course, not everyone who survives a traumatic event develops symptoms of a stress disorder. Most don’t. But because we can’t predict too well who will and who won’t, we want to alert everyone, just in case, because when this occurs, it can be debilitating. It only makes sense.
That’s why, when evaluating a new patient, we always consider the possibility of trauma or abuse in her past. If she has come in for ADD or Internet addiction, it makes no difference; we must ask: Have you been though any major trauma? Were you, or anyone in your family, the victim of sexual, physical, or emotional abuse? We do this because many people won’t say unless specifically asked. And if we miss this portion of her history, it’s a major oversight.
Now here’s what I don’t understand.
There are over a million abortions in the United States each year, and 52 percent are in women under twenty-five. 1 Most women having early abortions do not seem to have lasting emotional difficulties, 2 but many do. Even the study quoted by Planned Parenthood, in support of their statement that “most women do not experience psychological problems or regrets two years after their abortion”3 indicates that after two years 28 percent of women reported more harm from the abortion than benefit, 19 percent would not make the same decision under the same circumstances, 20 percent were depressed, and 1 percent had post-traumatic stress disorder. 4 College campuses must be teeming with these women. The study also reported that younger age predicted a more negative response to induced abortion, and that with the passing of time, negative emotions like sadness and regret increased, and decision satisfaction decreased. That is, more women reported sadness and regret two years following an abortion than one month after the event.
Now, I don’t know if Kelly will end up with long-term symptoms or not, but why is there an assumption she’ll be fine? Why does student health not schedule a post-abortion follow-up, to check on how she is coping? 5 Why are women like Kelly sent home from Planned Parenthood knowing what to do in case of fever or heavy bleeding, but without a number to call or a Web site to visit if she is distressed? 6 And why, if she is seen in the future at the campus counseling center, will she surely be asked whether she was ever beaten or neglected by her parents, but not if she ever had an abortion? 7
Let’s say for the sake of argument that we dismiss the women with “only” sadness and regret, and consider a conservative estimate of 1 percent of women with post-traumatic stress disorder. Still, with over one million abortions annually, that’s more than ten thousand women a year. Since the Roe v. Wade decision in 1973, that’s a total of 420,000 women in the United States who may have PTSD related to abortion. 8
Where are these women? Where do they go to talk? What number do they call, what Web site do they visit?
Some of them are logged on to afterabortion.com, “a neutral, non-political, non-religion based, non-judgmental place for women to communicate with each other after an abortion.”9 This is a remarkable site. Women from the United States, Canada, England, Ireland, Australia, Sweden, and elsewhere are here, providing to one another what psychology does not: a forum to share experiences, a place to find validation, support, and advice. “You can always come to this site,” one member tells another, “because we are in different time zones. So when you need to talk, there’s almost always someone, somewhere available.” “Regardless of whether your abortion was 3 weeks ago, 3 years ago, or 30 years ago,” the home page states, “you can find other women who understand.”
It’s a busy place: there are almost 90,000 threads, over 600,000 posts, and 1,000 new posts are added daily. There are chat rooms and on-line recovery groups. It’s like a twenty-four-hour hotline, or a never-ending group therapy session. One of their rules: no discussion about politics or morality.
One support board is for women who are seriously grieving: “Here you can discuss the intense feelings of loss, regret and despair that linger when you have an abortion and later either regret it or are feeling haunted by the what-ifs.” The thread titles are filled with urgency: “Need help—NOW!!!”; “I’m losing it…”; “Suffocating”; “Can’t breathe”; “Tears won’t stop”; “Oh man can it get any worse?”; “Sad Scared Alone”; “Breakdown”; “Someone please please help”; “Numb”; “Why??????????”; “Can’t do this anymore.” It goes on and on; there are over seventeen hundred threads here.
PTSD is diagnosed when specific symptoms are present following an intensely distressing event. Typically, the traumatizing event is military combat, rape, assault, kidnapping, an accident, a natural disaster, war, or torture. But it could also involve seeing someone severely injured or killed. The immediate response involves intense fear, helplessness, or horror.
Following the event, some—but not all—people re-experience it in dreams, flashbacks, or on the incident’s anniversary. The reexperiencing causes severe distress. Some victims feel numb, detached from reality and other people. They may not be able to recall details of the event, or they may be unable to forget them. Some will avoid thoughts, activities, or places that remind them of the event. They may be excessively moody or angry, overly sensitive, and unable to sleep or concentrate. When a survivor of a traumatic event has suffered for at least one month with reexperiencing, avoidance of stimuli, and hyperarousal, she qualifies for a diagnosis of post-traumatic stress disorder. When these symptoms occur following an abortion, some have called the condition post-abortion stress syndrome (PASS). 10
Many women on afterabortion.com write about the people, places, or things that remind them of their abortion, causing deep pain; these are “triggers.” Sensitive to the need of members to share experiences, but mindful of the possibility their entries will cause distress to others, the site uses “trigger warnings.” Members are advised:
A trigger warning serves as a heads up that the post contains some possibly upsetting material. Triggery subjects include, but are not limited to, pregnant women, children, clinic protestors, insensitive people…anniversaries, etc. Many of the ladies (and guys!) here are feeling down and can be easily upset. Trigger warnings are advanced warning NOT to read if you’re feeling sensitive or easily upset. If you feel your post may be upsetting to others, you may add a trigger warning. On occasion a moderator may add one for you, if they determine that it’s necessary.
Reading the board on triggers provides a glimpse of the agony that an ordinary day can bring some women who have had abortions. Maternity stores, baby clothing, strollers, and cribs; kittens, puppies, a pregnant friend, a child calling “Mommy”; the abortion date, the due date, Mother’s Day; a happy family, a kite, a song, biology class, a museum exhibit, a pro-life demonstration, a bumper sticker, menstruation, the sound of a vacuum cleaner. Many are young women in high school or college. They describe being “triggered” by a movie or TV show they are watching with their parents or boyfriend, and having to hide their sorrow and rage. No wonder they log on to this site—to find an international sisterhood, company for their misery.
And they really are there for each other—listening, soothing, and sending hugs. Here’s how they sound: “Yes, I too had the same thing, same vision, same, same, same…. O hun, I can see why that is so upsetting…. You have every right to feel upset and angry…. I can totally relate…yep, me too!! Horrible isn’t it?…The only advice I can give is chocolate. Lots and lots of chocolate…my heart is with you…. Oh sweetie, I am so sorry for what you are going thru, I’d be crying too…. PM or email me anytime…(((((hugs))))))…I hope you are OK…You poor thing. But you are strong and we are all here for you…. Hang in there, ok?…I’ve noticed that drinking warm milk when I’m really upset sometimes helps to calm me down….”
For anyone still wondering how an abortion might, for some, fall into the category of a traumatic event, read on. But be advised, the material you are about to read has been given a “trigger warning.” It will be difficult to absorb, even for those who are not survivors of trauma.
The following phrases are from a message board whose topic is medical abortion, the kind Kelly had. Posting here are women who saw a fetus in the blood clots and tissues they passed—a tiny head, the beginnings of arms and legs. They had not been warned of this possibility beforehand. Listen to them speak: “It’s been a year and a half, but I can still remember how it looked and felt…. I held my baby in my hand…white, like mucus I thought at first until I looked closer and my mind accepted what I was seeing. Head, eyes, nose, arms, fingers…I cried over it, kissed it…*sigh* that was the worst part of all…I remember seeing the embryo…clear as day, I knew what she was. I couldn’t fool myself. I stared at her for the longest time…felt like eternity. I will never forget that sight as long as I live….”
“I saw every little feature perfectly…it was very, very tiny…just stared at it…. was in shock…shut off my thinking…it was surreal…like I was trapped in a horror movie…can’t lose the image…won’t stop replaying in my mind…haunting me…horrifying…reminded every day…it’s what I see when I go to bed…can never un-see what I saw…see it every day in my mind…can’t lose the image…don’t know how to deal with this…haven’t told anybody…horrifying…nightmares…lots of nightmares…”
One woman wrote, “I can’t even believe I’m typing these words.” And I couldn’t believe I was reading them: ghastly accounts of seeing the fetus and not knowing what to do. “I had to dispose of it myself and I couldn’t think of anywhere to bury it that I could be sure an animal wouldn’t dig it up…didn’t know what to do…should I save it…bury it…flush it…didn’t want to flush it,…couldn’t think of what else to do…was so horrified, I couldn’t move…I was guiltridden for years about putting it in the toilet, but I didn’t know what else to do…wish someone had said there was a chance I would see it clearly and that I should prepare myself for what I was going to do…left mine in a cardboard dish…wrapped her in a piece of tissue and put her in the bedpan…wish I’d taken her and buried her properly…wish I would have buried mine, but I was too young and too stupid…if only…can’t forget just flushing my baby away…I will never forgive myself for this, never ever…”
As a psychiatrist, what do I learn from this Web site? First, I see in these women what I see in many of my patients—exceptional strength and courage. They continue to function, even with their hideous flashbacks and raw emotions. Somehow they go to school and work, cook meals, drive carpool. To me, they are heroines, no less than anyone else who gets up each day with a broken spirit and heart and finds a way to survive.
Second, many women here have textbook cases of PTSD. Some have severe cases, and would benefit from therapy and medication. A few are hopeless and suicidal, and sound to me to be in need of hospitalization.
It’s disturbing that these women are neglected by mainstream mental health. I am dismayed to learn they have nowhere to turn but a Web site. I am alarmed that girls and women being prepared for abortion are left unaware of the possible scenarios ahead of them. It’s fine to reassure that the majority will do OK, but since when, in medicine, do we omit giving a heads-up regarding worst-case scenarios, however unusual? When I prescribe a medication with a one-in-a-thousand chance of causing a dangerous rash, my patient must be made aware of the risk. Isn’t it a matter of informed consent?
I remind you that most of the million abortions performed each year are on single women under the age of twenty-five. 11 It’s bad enough that we have no campus outreach to them, like we do for victims of abuse or date rape. What’s worse is when one of these women does walk through our doors for help with depression, an eating disorder, or insomnia, we don’t routinely ask, “Have you ever been pregnant?” and we’re satisfied to assume her symptoms are due to other stressors in her life: school, finances, conflict with parents.
The woman herself may not know—or want to know—the source of her pain: she may genuinely believe her symptoms “came out of nowhere.” Didn’t everyone say that following the abortion she’ll feel relieved, that the sadness will be short-lived, that there are essentially no long-lasting effects? If there are others like her, where are the posters and fliers on campus, affirming her feelings and listing times and locations of support groups? And finally, if she sought help at the counseling center and the professional with a degree didn’t even ask about it, doesn’t all this support her denial: My crying spells, insomnia, and falling grades aren’t related to my abortion…right?
“I meet young women who dissolve into tears at the mention of a previous abortion,” wrote a women’s-health nurse for students at a large urban university. 12 In her article “The ‘A’ Word,” she described how her patients felt so stigmatized and traumatized that they couldn’t even say “abortion.” Of course, she bothered to ask—as a nurse, it’s routine. So why isn’t it for campus therapists?
Because it’s not politically correct. Campus counseling doesn’t want to take the risk of suggesting that abortion can be traumatic—that’s a word reserved for victims of rape, abuse, harassment, or natural disasters. So while everyone is bewildered at the mental health crisis on our campuses, not one voice suggests that perhaps the aftermath of abortion contributes to the staggering statistics. I see no attention given to the topic in the journal or annual meetings of the American College Health Association, or in the book out of Harvard mentioned earlier about the campus mental health crisis. 13 Neither do I find “The ‘A’ Word” anywhere on the American Psychiatric Association’s Web site focused on college mental health issues. 14
One woman, who was shocked at the lack of “emotional aftercare” following her abortion, put it well: “When I got my abortion, I was really mad at the feminists. You gave me this choice—great! But then I’m on my own afterwards? What’s up with that?” A coordinator of a Reproductive Rights Action League explained, “There have been moments where the movement has been scared to say that abortion may have emotional effects.”15
Moments? What an understatement! In nearly every medical, mental health, and women’s health organization, the denial of the trauma of abortion is entrenched dogma: the experience is just not that big a deal. 16
Shock, denial, numbness, distressing memories, flashbacks, avoidance, irritability, poor concentration, nightmares? These don’t occur following abortion. So concluded a psychologist involved in the study done by Surgeon General Koop on the health effects of abortion, at the request of President Reagan. “We searched and searched and searched,” he said, and there was “no evidence at all for the existence of the ‘postabortion syndrome’ claimed by some right-to-life groups.”17 The surgeon general himself may have seen it differently: in a letter to the president he stated that most of the research was “flawed,” that there was insufficient evidence to draw conclusions, and that more research was needed. 18
“The best studies available on psychological responses to unwanted pregnancy terminated by abortion in the United States,” concluded a landmark American Psychologist article, “suggest that severe negative reactions are rare, and they parallel those following other normal life stresses. The time of greatest distress is likely to be before the abortion…abortion is usually psychologically benign.”19
Planned Parenthood considers symptoms of trauma following abortion a “non-existent phenomenon” circulated by “anti-family planning extremists.”20 They quote psychological research to support their belief that abortion is “a positive coping mechanism”: “For most women who have had abortions, the procedure represents a maturing experience, a successful coping with a personal crisis situation…. Women who have had one abortion do not suffer psychological effects. In fact, as a group, they have higher self-esteem, greater feelings of worth and capableness, and fewer feelings of failure than do women who have had no abortions.” On a Web site for teens, Planned Parenthood explains, “Abortion is a very safe procedure. It’s about twice as safe as having tonsils removed.”21
The American Psychiatric Association agrees. Introducing an article entitled “The Myth of the Abortion Trauma Syndrome,” a vice president of that group began, “This is an article about a medical syndrome that does not exist.”22 She argued that while women may experience an abortion as a loss, and thus feel sad afterward, a feeling is “not equivalent to a disease,” and that transient feelings of stress and sadness should be distinguished from psychiatric illness.
It doesn’t sound to me like the girls and women posting on afterabortion.com are experiencing “transient feelings of stress and sadness.” It sounds to me like they are falling apart. Even Hillary Clinton, on the anniversary of Roev. Wade, said abortions are a “sad, even tragic choice to many, many women.”23 Does she know something that the American Psychological Association and Planned Parenthood don’t?
It’s worth recalling at this point that PTSD itself was conceived in more of a sociopolitical climate than a medical one. In its infancy, it was considered by some in psychiatry an unfounded diagnosis, arbitrarily making the normal reactions of soldiers returning from combat into a mental disorder. 24 And since its official recognition by psychiatry in 1980, the definition of PTSD has been continuously redefined and broadened, so that currently many more people now qualify for the diagnosis, not fewer.
PTSD was first defined as resulting from an event that “would evoke significant symptoms of distress in most people, and is generally outside the range of usual human experience.”25
In 1994, the criteria for PTSD were loosened. The event didn’t have to be “outside the range of usual human experience.” Instead, it just had to be “traumatic.”26 With that adjustment, the prevalence of PTSD automatically increased; some mental health professionals questioned this process. 27
The broadening continued. The event that originally had to be “outside the range of usual human experience” has come to include many types of widespread occurrences. As a result, the terms trauma, distress, horror, are watered down. Thus one report argues that victims of sexual harassment may meet diagnostic criteria for PTSD, and another claims that it is found in gynecological patients due to “insensitive obstetric care” or “hostility on the part of clinical staff.”28 When it comes to horrors, that’s a long way from My Lai and Auschwitz.
Given the watering down of PTSD and the trend toward including more and more victims under its tent, it is all the more surprising that psychology refuses to acknowledge the trauma—the real trauma—of abortion to some women. With therapists reaching out to victims of every sort of natural and man-made disaster, child abuse, bullying, harassment, domestic violence, and boorish gynecologists, how can it be deaf to the anguish of tens of thousands of women, wounded and grieving, who huddle together in cyberspace? 29
Jilly says it’s about politics and money. She’s afterabortion.com’s creator and owner, “a prochoice woman,” as she describes herself, “who believes abortion should remain legal.” But Jilly also believes in PASS, because, she writes, “I have experienced it myself.” Jilly has done her homework, and knows what she’s talking about.
She compares PASS with two other emotional conditions unique to women: postpartum depression and premenstrual dysphoric disorder (more commonly known as PMS). Both are officially recognized as serious health issues, with pharmaceutical companies eager to fund research and conferences. Women with these diagnoses get support and medication, and their insurance pays for it. Jilly explains:
There is nothing political about postpartum depression or a menstrual period. Every woman, Christian, atheist, prochoice, prolife, gets their period. And a prochoicer wouldn’t complain about women getting treated for postpartum depression, or say that it hurts the cause of women’s freedom of choice. A prolifer would not use postpartum depression as a way to try and discourage childbirth, and say that childbirth or menstruation “hurts” women, or that childbirth is “killing” women…. Those issues are non-political women’s health issues. There’s no “bad side” to be on with these problems.
…With post-abortion stress syndrome, it’s very different. If a woman suffers from PASS…the concern for her actual health problem disappears, and she becomes a pawn in the rhetoric of the abortion war. She gets no official treatment or support…. She gets told what she is experiencing does not exist, or “only happens to women with previous psychological problems.”
There’s no medical research done on PASS, Jilly goes on, because there are no grants from pharmaceutical companies.
The drug companies that fund medical research that allows a disorder to be diagnosed and “medically accepted” will not go anywhere near research for PASS. Why? Because they don’t want to touch the political suicide that anything related to abortion is…. Why jeopardize the profitability of all their base drugs by looking into something controversial that may bring them protests and boycotts from both sides of the abortion war, regardless of how their research turns out?
…The prochoice majority says PASS “does not exist” and that antiabortionists are using it to try and scare women away from abortion, and to try and influence lawmakers that abortion is dangerous. The prolifers agree that PASS exists, but they use it (as the prochoicers fear) as a way to discourage abortion, and as a way to help revoke abortion rights. The woman who is suffering is left alone as the two sides argue, and the medical community stays out of it.
I couldn’t have said it better myself. The medical community is staying out of it, despite evidence supporting Jilly’s position. 30 And the women who are suffering pay the price—victims a second time.
Getting back to Kelly, what can we say at this early point about how the abortion will affect her in the future? She has a history of depression and no social support: these place her at some risk for long-term problems. On the positive side, she had clarity about her decision—no apparent confusion or mixed feelings—and the abortion did not go against her beliefs. She made the decision independently and was able to choose when and where it would happen. And what may be most important, she now recognizes her distress and has come for help.
But there is someone overlooked in this discussion, an essential participant in this drama, who is strangely anonymous and peripheral: “the boy.”
From the little I know of him, and excusing his behavior while intoxicated, he sounds like a decent person. He took responsibility, offered to pay, and even volunteered to come be with Kelly during the difficult time. Sounds like this was a significant event for him, and I wonder—how is he coping? What are his thoughts and feelings? What are his background and beliefs? Who is he talking to?
Now that I think about it, what’s it like for any boy or man? How does it feel to be told: I conceived with you, and now I’m getting an abortion—this is just to let you know. What’s it like to have someone else—sometimes someone you barely know and may never see again—decide the fate of a clump of cells that could become your child?
This is an overlooked subject: the man’s response to abortion. Forget about psychology’s denial of women’s negative reactions—at least they consider the possibility. But the emotional reactions of men to abortion? It’s not even on the radar screen. 31
A search of the subjects “men” and “abortion” on the social sciences database on psychINFO produced thirty documents. Eleven of these addressed the topic of men’s reactions to their partner’s abortions; the others focused on other issues such as attitudes and decision making. Compare that with the number of documents about “bullying”: 1413; “harassment”: 3522; “multiculturalism”: 2277; and “abuse”: 47,129. As with the nameless young man in Kelly’s tale, we just don’t know what the story is with the hundreds of thousands of boys and men involved in an abortion each year.
There is only one academic nonpartisan book devoted exclusively to this topic. 32 It didn’t come from the mental health field; it was written by a sociologist and a poet/ writer, both male “abortion vets,” both ardently prochoice, who wanted to understand “this confusing and troubling experience—perhaps the least well known and least understood of any challenges in a man’s life.” In their own words:
Looking back on it now, I recognize I had been little prepared for the complex reality of an abortion…. Because I was very upset by my partner’s fright and bewilderment, I had rushed to assure her of my total support. But in the process, I had rushed right past the task of gaining any insight into my own confused feelings and ideas. (Arthur Shostak )
I have explored the world of abortion enough to know that men are seriously affected by their abortion experiences and that their memories are extremely sharp and cogent…. Although there are a variety of social-political responses to the subject of abortion in America, I have been most impressed by the lack of response to the often forgotten partner…. Like many men…I chose to get my abortion experience behind me. I failed. (Gary McLouth)
These two, motivated by the memory of their own ordeals, studied a thousand boys and men whose girlfriends, fiancées, or wives were having abortions. 33 The men completed a 102-item questionnaire while in the waiting rooms of thirty abortion clinics around the country. The results indicated that many, if not most, men seated in those waiting rooms were quietly enduring considerable pain and turmoil: 80 percent thought either “occasionally” or “frequently” about the child that would not be born; 47 percent agreed with the statement, “Males involved in an abortion have disturbing thoughts about it afterwards”; 91 percent would have liked to join their partner in the recovery room; 75 percent of men had talked to no one about the crisis other than their partner; 74 percent were interested in some form of counseling; 54 percent would have liked a group session with other men; and 91 percent “were emphatic about their desire never again to be in this situation.”34
“Little wonder,” one of the authors concluded, “that 80% of the 1000 males referred to their vigil as the longest, hardest half day of their lives…an encounter, never forgotten, with that ‘dark involvement with blood and birth and death.’”35
The same authors surveyed seventy-five men whose abortions had been months or years earlier. So much for the belief that time heals all wounds. Whereas only 3 percent of waiting-room men thought the abortion would contribute to the breakup of their relationship, 25 percent of the postabortion men thought it had. The 47 percent who thought that day that they’d have disturbing thoughts afterward? With time, the number of men with those thoughts was 16 percent higher. Overall, an astonishing 60 percent of men described still having occasional thoughts about the fetus: “We heard, over and over again, of day and night dreams of the child that wasn’t born, and about fantasies of their adequacy as new fathers—though all emphasized the effort they made to consciously control these mental maladventures.”
Some believe that men are at greater risk than women after an abortion. They point out that men more often blame the unwanted pregnancy on their own character, leading to more guilt and depression. 36 They mention the social sanctions against male grieving, and the tendency of boys and men to react with denial and distancing, instead of asking for help. There is also the perception of being helpless, with nothing to do, and of abortion clinics ignoring them and their needs. Add to that the difficulty many males have dealing with intense emotional situations, the pressure to appear strong, the desire to focus on their partner’s needs, and the secrecy and isolation, and you have the makings of a burden too heavy for most mature adults to bear, let alone those still on their way.
Other studies support the findings that some men experience significant suffering after an abortion, and recommend that boys and men be included in abortion center counseling. 37 A Los Angeles Times survey found more regret and guilt among postabortion men than postabortion women, and half the calls to a postabortion counseling hotline in the Bay area are from men. 38
Here’s what it was like for the sociologist researcher to interview some of these postabortion men:
Scores of males…have told me I was the first person they had ever told of their part in an abortion months or even years before. Many cried with the relief disclosure and processing makes possible. We would sit in the back of a dinner [sic] in a booth I had “reserved” for an hour’s interview, and still be there hours later, with crumbled Kleenex tissues strewn about, and a sympathetic waitress hovering nearby to keep the coffee cups filled.39
It would appear reasonable to suggest that for some men, abortion leaves scars. And with an average of one million abortions a year, even small percentages—and the limited data we have suggests they may not be that small—translate into a considerable mass. But what hope do these men have, if postabortion women with full-blown PTSD don’t exist for the mental health field?
Will someone please explain to me, why does psychology, in its quest to identify and counsel every victim of possible child abuse, sexual harassment, or hurricanes, 40 leave no stone unturned, and then go berserk at the suggestion that maybe, maybe, some—not all, but some—women and men hurt for a long, long time after abortion, and they too need our help? 41 Will someone help me understand why seeing your home destroyed by water automatically places you at risk for a psychiatric disorder, but having your pregnant uterus emptied “by gentle suction,”42 or flushing your fetus down the toilet, well, that brings relief?
I’ll tell you why. Because it’s not politically correct to consider abortion to be more than a medical procedure: the removal of “tissue” or of “uterine contents.” If some people hurt following abortion, if women can get PTSD and men mourn silently for years, then that means sometimes it’s bad, like war or hurricanes. And if you are in the mental health profession and want to keep your job, you’d better think long and hard before you say that.
Were it not so necessary for psychology to remain politically correct, the emotional fallout of abortion might be seen differently. In Japan, abortion is a social necessity and a relatively noncontroversial issue. 43 It is not a private choice that is either right or wrong, but a responsible, practical decision made with the well-being of the nation in mind.
Buddhist folklore holds that the soul of a fetus lives in a kind of purgatory where it is unable to be reborn. 44 Parents can save it through mizuko kuyo, a ritual in which the fetus is memorialized. It’s a popular thing in Japan, and you’ll see simple shrines erected by the side of a road, as well as elaborate, expensive ceremonies in temples. You might also see the statue of Jizo, the guardian of aborted fetuses, placed on an altar in private homes.
Ceremonies in temples are public affairs. Whole families come, register, and pay for the service, which is performed by Buddhist priests and takes about forty-five minutes. Everyone recites these verses, presumably what the fetus would say if it could:
I was invited [in]to [the] lives of Father and Mother,
Lived within Mother’s womb for days and months,
During the time that I was continuing to grow,
I had requested the kindness of my parents,
I disobeyed that kindness,
So I was brought out by the midwife with the body lost
Father help me and mother help me too.
Help give the soul, whose power is limited and voice cannot speak
In order to not become a soul lost in the darkness.45
The abbot explains to the families how the ritual helps the soul of the fetus and exonerates the guilt of “those who come with heavy heart of regret and ambivalence.” A study of over a thousand participants of mizuko kuyo found that some of them had been performing the ritual for over thirty years. Some Japanese medical professionals now acknowledge the possibility that abortion may cause grief—a recognition that has not been met with controversy.
Psychology can learn from this. Our culture is stuck in a rigid, polarized view of abortion and its aftermath. It’s either right, without victims or fallout, or it’s wrong. It’s either constitutional or it’s unconstitutional. This works at church or in court, but not in my line of work. People are more complicated than ideology, and psychotherapists are supposed to know that. The inner life is a fluid tangle of wounds and fears, longings and dreams. A pregnancy is a new, enormous relationship, 46 if only a potential one: I could now be a mother, a father; and an abortion is the decision to end that relationship, that possibility. These are tremendously profound and complex issues for women and men. To suggest that pregnancy and abortion do not touch essential parts of us is to deny our depth and sensitivity, and to diminish the awe and magnitude of creating a child. To compare an abortion with a tonsillectomy—as a procedure you go in for, take a Tylenol, and get on with your life—is a hideous defamation of us all.
We see that when politics and ideology are removed from this debate, as in Japan, the needs of postabortion men and women can surface and be acknowledged. Healing can begin. What appear to be two contradictory truths can be grasped, without one denying the legitimacy of the other. The same abortion may bring relief and lasting pain. The decision that seemed best in college may be perceived as tragic at menopause. It is our job in psychology to provide—how did Jilly describe her Web site?—a neutral place of healing. How can we do that, when the profession is aligned ideologically with one side, and makes pronouncements like “abortion is for the most part benign”? How will patients see therapists as neutral when even our definitions of “trauma” and “horror” must be politically correct? One can only imagine how it feels, for a woman harrowed by flashbacks of fetal parts, to learn that mental health experts consider her experience “nonexistent.”
Our job is not to proclaim whether abortion is good or bad; our job is to ask, and listen. Let our patients come and tell us what abortion has been like for them.
If psychology were truly concerned with all victims, not only those that advance their ideological agendas, their outreach would include individuals traumatized by abortion. The APA would acknowledge these men and women, and deplore their revictimization by agenda-driven groups who render them invisible. It would enthusiastically promote new treatment techniques, drawn from the ancient wisdom of Buddhism and the ritual of mizuko kuyo. Enterprising psychotherapists would import statues of Jizo, and patients would set up altars where they could express regret and ask forgiveness. Professional mental health organizations would insist that commercial abortion providers, who make sizable profits, provide comprehensive counseling before and after their services. It would make sure that a diagnostic category exists in the Diagnostic and Statistical Manual of Mental Disorders that describes their condition, for legal and insurance purposes. And finally, it would caution every psychologist, psychiatrist, or social worker to fully explore the abortion question when evaluating any patient, male and female, lest they risk underestimating—or missing altogether—what for some is an open wound, a wound as bad, maybe worse, than the memory of a hurricane.