Women suffer emotionally and mentally long after an abortion

The issue of the legality of abortion and disputes between anti-abortion and pro-abortion advocates have been a central focus of political discourse and debate for many decades and are likely to remain so for the foreseeable future.  

As opposed to many other political issues wherein there may be a reasonable compromise among persons of goodwill with realistic, rational expectations of the political process, this is not an issue in which any compromise is likely to hold fast or end intense dispute.

{mosads}I believe few would doubt that the central idea around which the debate focuses is the determination of when human life begins — at some point between the moment of conception and the time of birth. (For the purpose of this discussion, disputes regarding contraception will not be considered).

Many hold strong views regarding the definition of the beginnings of life based upon faith or purely moral/ethical considerations. Many hold strong views based upon scientific rationales derived from neurological/biological developmental data. Scientific reasoning and viewpoints may change as additional clinical information is gained and understood. Neurological/biological developmental knowledge, however, cannot definitively determine the beginning of an essentially undefinable term such as being human and will never convince those whose definitions of human life are based upon faith alone.  

In fact, for many persons with strong religious/moral beliefs regarding abortion, no amount of scientific knowledge of neurological development will deter them from experiencing a moral obligation to continue to seek legal restrictions consistent with their beliefs, i.e., no political or legal compromise solution is even theoretically possible.

It is not the purpose of this article to enter the debate on the beginning of life or the morality of abortion. Rather, it offers the perspective that the intensity of that debate has interfered with objectively understanding the emotional difficulties experienced by persons dealing with an unplanned pregnancy or a pregnancy that has developed tragically disastrous medical complications. This refers primarily to the pregnant woman, but one must also consider the emotional experience of the biological father, other family members, and even children within the family unit who may become aware of the situation.

Some persons who are fully determined in their belief that abortion is morally wrong under any circumstances will have no overt qualms or ambivalence regarding refusing to consider such a procedure, even to the extent of medical risk to the pregnant woman. On the other side of the spectrum, there are women who are so confident in viewing abortion as a personal medical decision regarding their own body that they will consider or undergo the procedure without any recognized conflict or indecision.

But emotional reactions do not necessarily follow either religious/moral convictions or clinical rationales.

At the time of the decision, a woman (or family member) who would never consider an abortion may not be in the position to fully appreciate the emotional stress, strain and conflict that might entail from raising the child or giving the child up for adoption. It is not a time when the complete impact of practical, family and/or financial pressures (in the case of raising the child) or feelings of loss or guilt (if deciding upon adoption) can be fully appreciated or anticipated.  

Similarly, the woman (or family member) who has no ethical qualms regarding an abortion procedure may not understand that despite her philosophical position, she may experience grief, loss and/or guilt later (at times, not until another child is born).

In either situation, while professionals involved in the medical and/or adoptive process may provide support, it is infrequent that any necessary emotional support or mental health intervention will continue for a significant duration. In the absence of serious symptoms of depression or distress, the emotional assistance rarely consists of anything more than basic support and perhaps some cognitive-behavioral therapy.

However, what may well be needed in either case is a deeper counseling/therapy to address complex and very painful feelings of sadness, grief, guilt, or anger — and at times, to address significant symptoms of anxiety or depression. The experience may also revive previously repressed emotions related to earlier losses or traumas, as well as earlier feelings of deprivation, anger, or guilt.

Further, the basic support generally offered rarely takes into account emotional reactions of other persons within the family unit who might benefit from counseling. In particular, other children may learn of what occurred and might have misconceptions or their own (misplaced) fears or guilt. They may also be struggling to understand and make sense of the decision regarding the pregnancy and the consequences of that decision.

This is not an argument for or against the legality of abortion procedures nor is this a comment upon moral or religious convictions. However, I can state unequivocally that, not infrequently, I have seen deleterious unexpected (and often delayed) emotional results from decisions made regarding abortion, with that suffering and distress becoming lost or not acknowledged due to pressure from others based upon political or philosophical arguments.  

Regardless of a person’s faith or belief system; regardless of a person’s cognitive/clinical understandings – human emotions cannot be predicted. Under the stress of making such an important decision, both the short-term and (more frequently) the long-term emotional consequences are often overlooked and ignored. This can lead to ongoing emotional distress with awareness of the connection of pain and conflict to the circumstances. It can also lead to symptoms of anxiety, depression, substance abuse or other mental health issues that are not consciously connected with the experience. These problems may arise in the woman who was pregnant and may reverberate disruptively within the family unit.

The political and philosophical arguments regarding abortion will not be resolved in the foreseeable future. Nevertheless, they must not interfere with recognizing, acknowledging and attending to the serious human, emotional and mental health needs of persons who undergo the procedure or are involved in a situation wherein the possibility of abortion is even a faint consideration or an unspoken option.

David M. Reiss, M.D., psychiatrist, private practice, San Diego, CA.

The views expressed by contributors are their own and not the views of The Hill.