Every woman who subjects herself to an induced abortion suffers the death of her own child. She is at risk not only for the surgical and medical complications of abortion—uterine rupture, sepsis, infertility, increased incidence of cancer. She is also at high risk for pathological grief, which often brings with it severe and long-lasting negative sequelae for herself, her partner, her surviving children and the whole of society. Grief following a death in the family is a universally accepted experience. A period of mourning following the loss of a loved one is a normal expectation in every culture. It is also generally understood that if this mourning process is blocked or impacted, there will be negative consequences. Shakespeare, in his tragedy Macbeth, says, "Give sorrow words, the grief that does not speak knits up the o'erwrought heart and bids it break" (Act IV, scene 3). Yet a mother's grief after an induced abortion has heretofore seldom been acknowledged.
The death of a child is perhaps the most difficult loss to mourn—even the death of a premature baby, a stillborn child, or a miscarriage. The medical literature in recent years has increasingly acknowledged the significance of perinatal loss for parents. Obstetrical journals describe "perinatal grief teams" consisting of nurses, doctors, social workers, clergy and volunteers who help parents cope with the loss of children who die in neonatal intensive care units. Parents are encouraged to name and hold their dead baby, and to take photographs. Religious services assist them in their mourning, and they are encouraged to bury the child with their loved ones in a family grave which they can visit as often as they wish.1
Abortion, whether spontaneous or induced, is part of the same continuum of perinatal grief. However, grief after elective abortion is uniquely poignant because it is largely hidden. There are no provisions made to assist the post-abortion woman in her grieving—she has no child to hold, no photographs, no wake or funeral, and no grave to visit. After an elective abortion, a woman typically finds herself alone to cope not only with the loss of the child she will never know, but also with her personal responsibility in the child's death with its ensuing guilt and shame. She may have difficulty understanding her ambivalent feelings—on the one hand, relief (often very temporary) that she is no longer pregnant, and, on the other hand, a profound sense of loss and emptiness. In her book, The Anatomy of Bereavement, Beverley Raphael explains, "A woman may have required a high level of defensive denial of her tender feelings for the baby to allow her to make the decision for termination. This denial often carries her through the procedure and hours afterward, so that she seems cheerful, accepting but unwilling to talk at the time when supportive counseling may be offered by the clinic."2 This may explain why research into psychiatric sequelae of abortion in the immediate post-abortion period often yields negative results.
The Emotional Effects
In the weeks and months after the abortion, feelings of sadness and guilt often threaten to overwhelm the post-abortion woman, yet society offers her no assistance in mourning—she is expected to be grateful that "her problem is solved" and to "get on with her life" as though nothing significant had happened. At the same time, pain and bleeding remind her of the assault on her body, the sudden endocrine changes cause her to become emotionally labile or unstable. She is poignantly aware of the date her child would have been born. Reminders threaten her defensive denial and repression all too frequently: anniversaries of her abortion, other children of the age her child would have been, Mother's Day, the omni-present abortion debate in the media, a visit to the gynecologist, the sound of the suction machine at the dentist's office, or the sound of a vacuum cleaner at home, a baby in a television ad, a new pregnancy, a death in the family, a film depicting prenatal development or abortion, or a pro-life homily. Any of these may trigger a sudden flood of grief, guilt, anger and even despair, which in turn, calls forth even more intense defensive responses.
The post-abortion woman's attempts to comply with society's expectations that she proceed with her life as though she had undergone an innocuous procedure are bought at great personal expense. She may turn to alcohol or drugs to get to sleep at night or to deaden the pain of the intrusive thoughts, which haunt her day and night, "I killed my baby! I killed my baby! I don't deserve to live!" Flashbacks to the abortion procedure may occur at any time. She may throw herself into intense activity—work, study, or recreation, or attempt to deal with her feelings of loneliness and emptiness by binge eating alternating with purging or anorexia, or by intense efforts to repair intimate relationships or develop new ones inappropriately, becoming sexually promiscuous, risking sexually transmitted diseases, and repeating pregnancy and abortion. Complaints of vague abdominal pain or pain on sexual intercourse may cause her to seek medical treatment from one physician after another unsuccessfully, and the very examinations to which she is subjected may cause flashbacks to the abortion experience. Her life spirals downward as her general health, personal relationships and job performance become more and more impaired. Discouragement, despair, clinical depression and suicide attempts often follow.3 Typically, in presenting symptoms over a period of many years, she is treated by numerous physicians and mental health professionals without ever receiving help for the root cause of her problems, her abortion or abortions. Psychiatric textbooks subsume all of the above symptoms under the diagnosis of a Pathological Grief Reaction.
Effects On Marriage And Subsequent Children
Short-term research into the psychiatric sequelae of abortion fails to document its devastating long-term negative effects on women and on their forming and sustaining stable spousal relationships, and of caring appropriately for subsequent children. They may have difficulty bonding with a new baby, or, conversely, become overprotective and inappropriately attached to the next child who bears the burden of replacing the aborted baby. These children are often referred to child psychiatrists because of separation anxiety, or because they are judged to be at risk for physical abuse. Couples may be treated for infertility or dysfunctional marriages, which stem from a previous abortion or abortions. Substance abuse, "burnout" on the job, psycho-somatic symptoms, eating disorders, chronic depression and suicide attempts which routinely bring women into psychiatric care can often be traced to an abortion experience several years before through a careful and complete history.
In addition to immediate intervention for the presenting problem, successful treatment of women who have suffered the tragedy of abortion requires that the underlying traumatic loss be acknowledged and appropriately grieved. Psychotherapy involves facilitating the work of mourning which has been so long delayed. Within a therapeutic relationship, the woman is encouraged to share her traumatic loss and to acknowledge her role in it. She is helped to share the mental image she has formed of her child—often one of a baby being torn to pieces or crying out in pain. As the grief work proceeds, her image is transformed into a less disturbing picture of her child at peace. She may name the child and arrange for a religious service to be performed for him or her. She accepts God's forgiveness and may be able to forgive herself and ask forgiveness of her child. Eventually she is able to put the child to rest in her mind. Only then is she free to resume her life productively—to make new relationships or repair old ones, to work, to play, and to be creative once again.4
With 30 million abortions in this country since Roe v. Wade, and the continuing rate of 1.5 million abortions per year, we can no longer deny the public health significance of their psychological and psychophysical sequelae. Epidemiological studies are urgently needed which are statistically sound and which follow women and men for at least ten years postabortion. However, it is axiomatic that the best treatment for any epidemic is primary prevention. Abortion is an elective surgical procedure performed on healthy women (pregnancy is not a disease). The immediate abolition of elective abortion would eradicate the iatrogenic epidemic of post-abortion pathology and would serve the best interests of women and society. In Evangelium Vitae (no. 99) John Paul II spells out the pastoral approach of the church:
The wound in your heart may not yet have healed. Certainly what happened was and remains terribly wrong. But do not give in to discouragement and do not lose hope. Try rather to understand what happened and face it honestly. If you have not already done so, give yourself over with humility and trust to repentance. The Father of mercies is ready to give you his forgiveness and his peace in the Sacrament of Reconciliation. You will come to understand that nothing is definitely lost and you will also be able to ask forgiveness from your child, who is now living in the Lord. With the friendly and expert help and advice of other people, and as a result of your own painful experience, you can be among the most eloquent defenders of everyone's right to life.
1. Wathen, N.C., "Perinatal Bereavement," British Journal of Obstetrics and Gynecology 97 : 759-760.
2. Basic Books: New York, 1983.
3. Speckhard, A. & Rue, V. "Complicated Mourning: Dynamics of Impacted Post-Abortion Grief," Journal of Pre- and Perinatal Psychology 8 : 6-12.
4. Angelo, E.J. "The Negative Impact of Abortion on Women and Families," in Post-Abortion Aftermath, Mannion, M. ed. [Sheed and Ward: Kansas City, MO, 1994].
E. Joanne Angelo, M.D. is Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and a psychiatrist in private practice in Boston. She is a Corresponding Member of the Pontifical Academy for Life. This article originally appeared in the November 1995 issue of Ethics & Medics, a monthly publication of the Pope John Center.
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