Patty's dried tears had left streaks of black mascara beneath her hazel eyes. Fleeting, nervous smiles of relief danced awkwardly across her downcast face, alternating with expressions of sorrow. Patty had waited thirteen years to have another person validate the anguish she suffered after an abortion. At long last she was in a room full of women and men who were divulging kindred stories of agonizing heartache. Reflecting on her own silent struggle, Patty shared her experience:
I thought that if I had an abortion everything would be over with and my life would go back to normal. That's what everyone at the clinic promised. But now I know that after an abortion your life is way different.
My abortion didn't end my pain . . . it began it. For the longest time I thought I must be completely nuts. When I tried to confide in friends about my anguish, they shook their heads with disapproving looks. It made me feel so alone, so weird. Sometimes I felt like I was going crazy.
Patty had believed the myth that abortion is nothing more than the removal of a "blob of tissue." Indeed, some abortion clinic counselors tell women that abortion is about equivalent in terms of pain and risks to having a tooth pulled. If this were true, Patty concluded, then she must be crazy to feel the way she did.
Her sense of feeling "crazy" and "weird" was intensified by the fact that none of her friends were able to accept her emotions as valid and legitimate. Their "disapproving looks" convinced her that she had to bury her "crazy" emotions deeper and deeper. Sadly, burying negative emotions to please others simply prolonged her suffering.
Patty's experience is typical of millions. Most women seeking abortions do not anticipate or understand the potential severity of the psychological problems they may later face. The false expectation that abortion can simply "turn back the clock" leaves women totally unprepared for what may follow.
The tragedy of this false expectation was well described by one woman's "letter to the editor," in which she wrote:
I am angry. I am angry at Gloria Steinem and every woman who ever had an abortion and didn't tell me about this kind of pain. There is a conspiracy among the sisterhood not to tell each other about guilt and self-hatred and terror. Having an abortion is not like having a wart removed or your nails done or your hair cut, and anyone who tells you [otherwise] is a liar or worse.1
As a society, we don't understand abortion. We debate it. We pass laws about it. We argue about it as a moral and political issue. But we don't understand it as a life-changing experience. In that latter regard, grief after an abortion is neither expected nor permitted in our society.
This is a great national tragedy and a central concept of this book, so I will repeat it. Grief after abortion is neither expected nor permitted in our society.
In this chapter we will briefly look at how casual assumptions, bad science, and abortion politics have contributed to the false notion that abortion has few, if any, psychological risks. In the next chapter, we will examine why the women who do experience severe emotional problems after an abortion are often condemned to suffer in silence, without the support of friends, family, or even professional therapists. Then, in the following chapters, I will describe specific types of post-abortion problems I have treated in my clinical practice to illustrate why this problem is so important to individuals, families, and our nation.
Because abortion is legal, it is presumed to be safe. Indeed, it is commonly identified as a woman's "right." This right, or privilege, is supposed to liberate women from the burden of unwanted pregnancies. It is supposed to provide them with relief, not grief.
Indeed, while more than one in three women will immediately experience feelings of grief, loss, or depression after abortion, the majority of abortion patients report feelings of relief.2 This is because most women feel a tremendous amount of tension before their abortions. They are nervous about the abortion itself. They may wonder whether or not they are making the right choice. They may feel pressured by circumstances or people that make the pregnancy a problem in their lives.
Immediately after the abortion, the finality of that moment invites a release of these tensions. It's over with. It's done. It's time to put it all behind you and go on with your life. For most women, all the tensions associated with the pregnancy and their fear of having an abortion recede, at least temporarily.
At the same time that abortion relieves this stress, however, it can also plant the seeds for future stress. As will be discussed at length in later chapters, unresolved memories and feelings about the abortion can become sources of pressure that may erupt years later in unexpected ways.
In part, this is because abortion touches on three central issues of a woman's self-concept: her sexuality, her morality, and her maternal identity. It also involves the loss of a child, or at least the loss of an opportunity to have a child. In either case, this loss must be confronted, processed, and grieved in order for the woman to resolve her experience.
Few women sort through all of these issues before their abortions. Instead, during this period of crisis when their futures appear threatened or uncertain, there is a tendency to rush to "get it over with," so most women simply put these other these issues "on hold." This is why immediate feelings of relief are no guarantee that problems will not surface later. Unresolved emotions will demand one's attention sooner or later, often through the development of subsequent emotional or behavioral disturbances.
This view is supported by the observations of Dr. Julius Fogel, who is both a psychiatrist and an obstetrician and who has personally performed over 20,000 abortions. Though a long-time advocate of abortion, Dr. Fogel insists:
Every woman -- whatever her age, background or sexuality -- has a trauma at destroying a pregnancy. A level of humanness is touched. This is a part of her own life. When she destroys a pregnancy, she is destroying herself. There is no way it can be innocuous. One is dealing with the life force. It is totally beside the point whether or not you think a life is there. You cannot deny that something is being created and that this creation is physically happening.... Often the trauma may sink into the unconscious and never surface in the woman's lifetime. But it is not as harmless and casual an event as many in the pro-abortion crowd insist. A psychological price is paid. It may be alienation; it may be a pushing away from human warmth, perhaps a hardening of the maternal instinct. Something happens on the deeper levels of a woman's consciousness when she destroys a pregnancy. I know that as a psychiatrist.3
The tendency of people to think that abortion is "no big deal" is largely unchallenged because (1) immediate negative reactions tend to be dismissed as temporary and passing, and (2) most negative emotions are delayed.
When loved ones inquire how a woman is feeling immediately after an abortion, any expression of relief is quickly interpreted as meaning that she will be "fine" with it forever, which is not necessarily true. On the other hand, if the woman expresses distress, it is likely the abortion clinic staff and even her family and friends will dismiss it as just a temporary mood that will soon go away. This is what everyone hoped and expected. They anticipated that the abortion would "turn back the clock" so her life could go on as it was before. Because this is what they hope and want to believe has occurred, everyone will be quick to find reasons to conclude that their expectations were fulfilled.
In general, once a woman has made the pronouncement "I'm fine," even her most intimate friends will often not ask about the abortion again for fear of arousing bad feelings. No one wants to go below the surface because no one knows how to deal with what may lie underneath.
As we will see in the next chapter, once a woman's loved ones are assured that she is okay after an abortion, they may not allow her the opportunity to express any subsequent doubts and regrets. If she herself tries to discuss these delayed negative feelings, those around her will become uncomfortable. The message she will hear, explicitly or implicitly, is, "Don't stir up the past. Focus on the future." This was the experience of Helen:
The only one who ever asked me how I was after my abortion was my boyfriend. He asked me if I was okay on our way back from the clinic. I felt sick to my stomach the whole way home. I wanted to cry but I felt so numb. I told my boyfriend I was okay and he said, "That's my girl." He dropped me off and went to play pool. I was so angry at him for leaving me there by myself. I did not want to be alone. Later, if I ever started to cry about it, my boyfriend would tell me not to think about it. If I did, he called me a "downer." He even accused me of trying to get attention. Soon after that we broke up and there was no one else who knew. My abortion was the only thing I could ever think about -- not because I wanted to, but I honestly could not get the experience out of my head. I swallowed my grief at that point. I felt I had to be strong or no one would want me.
The predominant social experience with abortion, then, is largely based on the immediate reports of women who have told their loved ones, "I'm fine. I'm glad it's over with. I don't really want to talk about it." Unfortunately, such superficial statements reinforce the social perception that abortion is "no big deal." Friends and relatives often pass this expectation along to other women considering abortion with reassurances like, "Judy had an abortion. It was no big deal. She's fine."
In reality, abortion is a deeply private and complex experience. For most women, their feelings and memories about an abortion simply do not lend themselves to casual conversation. Women who will enthusiastically compare pregnancy and delivery stories over tea would never dream of talking about their feelings and memories related to past abortions. One of my clients, Beverly, described her inability to reveal her pain in a diary entry:
I am trying to learn to live with this and how to put on a show for the world. Sometimes, I feel like I won't be able to keep this show going for much longer. On the outside it seems like life has gone on like normal, but on the inside I feel like I am falling apart. It is even harder to pretend that I am enjoying myself when all I want to do is be alone and cry until I can cry no more, but even then the tears never seem to stop.
For Sharon, when she discovered the depth of her loss in the recovery room, she also discovered a secret connection to other post-abortive women.
When it was over, I was led into the "recovery room." I ended up sitting next to the same women I had been with when we were all still pregnant. Nobody was happy. A great heaviness hung over all of us. As we talked, between the tears, I made the remark that I was about 12 weeks pregnant. The woman next to me looked at me and said, "You were...." That's when it really hit me. My baby was gone . . . forever. On my way out I had to walk through the recovery room of brand new "patients" who were no longer pregnant. My eyes met one of them and I gave her a salute. She returned the gesture. We never spoke. We didn't have to. We were now sisters in a secret sad society of women who had done something we didn't want to do, but saw no other way out. Like brave soldiers on the front lines of the battlefield, we never had a "choice."
Through her abortion, Sharon had entered into a "sisterhood of denial" where post-abortive women support each other with no more than looks of understanding. Looks of empathy are safe. Words, especially the "a-word," are difficult, inadequate, even dangerous if they release more pain than either woman can bear.
As a general rule, women simply don't talk about their abortions as readily as they talk about their other pregnancies. The only exception to this rule of social etiquette is when abortion experiences are casually discussed in a group of vocal pro-choice feminists. But even in this case, the rules of the discussion are very strict. The recounting of one's experience must be masked by nonchalance. Dwelling on one's doubts, grief, or guilt is simply not appropriate. Such conversations provide informal group therapy with the goal of reinforcing each other's past decisions.
The expectation that abortion has no significant emotional consequences is strongly reinforced at most abortion clinics. Ignoring all evidence to the contrary, most abortion counselors will tell women that psychological reactions to abortion are rare or even non-existent. As in Patty's case, some counselors even tell women that an abortion is no more painful or risky than having a tooth pulled, a ludicrous comparison.
In a retrospective survey of 252 women who experienced postabortion problems, 66 percent said their counselors were very "biased" toward choosing abortion. This is especially important since 40 to 60 percent described themselves as uncertain of their decision prior to counseling. Of all the women surveyed, 44 percent were actively hoping to find some option other than abortion during their counseling sessions. Only 5 percent reported that they were encouraged to ask questions, while 52 to 71 percent felt their questions were sidestepped, trivialized, or inadequately answered. In all, over 90 percent said they were not given enough information to make an informed decision. These omissions are especially relevant since 83 percent said that it was very likely that they would have chosen differently if they had not been so strongly encouraged to abort by others, including their abortion counselor.4
Research also shows that a person involved in a crisis is especially vulnerable to being influenced, for good or ill, by a third party. This reliance on others, especially on an authority figure who appears capable of providing an escape from the crisis, is called heightened psychological accessibility.5 Women considering abortion are especially vulnerable to directive counseling that encourages them to ignore their doubts. Wendy was one such victim:
During the group counseling session prior to my abortion, I questioned my choice to have an abortion. I said I didn't want to abort but my boyfriend did. I was struggling because I couldn't afford to raise a child on my own. The counselor quickly told me that meant I wanted to have an abortion. She told me it was not right to have a child if you don't have money. I figured she probably knew what should be done because she was a counselor. I was too emotional and scared to think for myself. A week after I had my abortion, I wondered how she could possibly have let me do it, when I had expressed so many times that I wanted my baby.
Another client, Missy, felt manipulated by the fear that having a baby would trap her into a life she did not want. Her counselor never told her that having an abortion might also trap her into a life she did not want.
Before I had my abortion, the counselor could see that I was anxious about what I was about to do. I was thinking about leaving when she told me you can never give a baby back and that my life would never be the same with a child in it. Her words seemed to give me the reassurance I needed and confirmed my decision to terminate the pregnancy, and yet when I look back at those crucial moments before it all happened, all I can think of is why didn't I leave? I know I would have been open to another option if anyone had been positive about the pregnancy. But there was no support like that. Everyone told me abortion was the best solution.
When abortion counselors introduce their own biases into the counseling situation, or try to "sell" women on the option of abortion as the "best solution" despite the woman's own moral or maternal reservations, the results can be tragic. Michelle wrote the following entry in her diary:
My counselor told me that after a few months I would start feeling better. It has been two years now and things are not getting any better. I feel like I am losing my mind. I don't know what could be worse than this. Living with myself has been a hell. I thought I made the right choice, but hurting so much makes it feel like the wrong choice. I can't stand the pain . . . I just want it to end. Nobody told me I would not be able to live with myself for this. Everyone told me it was the best thing to do. Everyone told me I would be just fine. Well, I'm not fine! My life can and will never be the same. It is a life filled with guilt, shame, a feeling of worthlessness, and unfillable emptiness. I can't bear this pain much longer. I thought about suicide again. It's scary to have these thoughts, but it seems like the only way to end the pain.
Michelle's diary frankly shares the depth of her misery, regret, and grief. She was totally unprepared for such an onslaught of negative emotions. Fortunately, counseling and grief work enabled Michelle, Wendy, and Missy to move beyond their negative and condemning thoughts.
Research conducted at abortion clinics has also found that the majority of women seeking abortion have little or no prior knowledge about the abortion procedure, its risks, or fetal development.6 For most women, as for Nadine, the counseling they receive at the clinic is the only information they will receive.
I was so naive. I had no idea what an abortion actually was. They made it all sound so safe, so easy, so simple. They promised an abortion would take care of my problem and I'd be back to my old self and I could continue with whatever I wanted in my life. The counselor even said, "If you were my daughter, I'd be telling you the same thing. It's the right thing to do."
Everyone assured me not to worry, that there was nothing to be afraid of. The counseling I received was like, yes, you can do this; yes, it's safe; and don't worry, you won't have any problems.
I have been emotionally tortured by this experience for the past 24 years. It's made my life a pit of depression and anxiety.
Most abortion clinic counselors promote the false expectation that there are few, if any, psychological risks to abortion, despite overwhelming evidence to the contrary. The reasons for this vary among individuals and the clinics in which they are trained.
Some abortion counselors have a financial bias. They are "in the business" of selling abortions.7 Others are paternalistic, honestly believing that abortion is the best solution to every problem pregnancy and that it is their duty to guide women to make the "right" choice.8 Still others have a psychological need to see other women choose abortion, as they once did, thus seeking affirmation of a choice that still troubles them on some deeper level.9 When they give emotional pep-talks to their clients, such counselors are also giving impassioned pep-talks to themselves.
One of my clients, Rita, spent four years working as a counselor in an abortion clinic before she mustered the courage to deal with her own abortion loss.
I was completely driven to help other women obtain abortions. I was totally invested in keeping abortion safe and legal. I never recognized how pushy and one-sided my counseling was until I became pregnant and wanted a child. Everyone around me was so critical of my own pregnancy. I realized then that I had been the same way toward every pregnant woman who entered our clinic. It's almost like we needed them to abort so that we could feel better about our own abortions. I was too busy justifying what I had done to be aware that I carried any grief about it.Perhaps most worrisome of all, some abortion providers see abortion as a tool for social engineering. Whether they seek to use it to reduce welfare rolls, eliminate the "unfit," or save the world from overpopulation, these social engineers see every abortion as a step toward some "greater good." To the elitist social engineers of our society, misinformation, deception, and a "little" guilt among the women and men who choose abortion is a small price to pay for achieving this "greater good."10
While there are reasons for deliberate deception, most counselors probably do care about the women they serve. Even if they have been poorly trained or misled by their employers regarding the true risks of abortion, most would not deliberately mislead women if they knew how much it could hurt them. Of course, they have seen many women crying in the recovery room. But the counselors assume they will get over it.
This bias in perception can arise from the abortion counselor's need to believe that her work is truly benefitting the women she serves. No one who provides abortions wants to believe the horror stories of women recounted in this book. They truly want to help women. It is difficult to accept that at least some of the women they have counseled have been very ill-served by abortion.
The expectations of abortion counselors are also colored by their own very limited experience with women who have had post-abortion problems. Most women who are emotionally injured by abortion don't return to the abortion clinic.11 The more intense a woman's negative feelings after her abortion, the more averse she will be to being anywhere near the abortion clinic or its counselors, because they are emotionally connected to her grief and guilt.
One example of this I have seen in my own practice was with Amanda. She was twenty-one, industrious, bright, and very pretty. Two days after her abortion, Amanda overdosed on a nearly lethal combination of sleeping pills and alcohol. I met with her and her friends after her release from the hospital. Amanda was having difficulty speaking due to the unrelenting stream of tears and choking grief. Her bewildered friends took turns telling me what had happened. Day after day we struggled to devise a plan for her continued safety. Her friends were wonderful about offering support and reassurance to get her through this critical time. But when it came time to go back to the abortion clinic for her two-week check-up, Amanda refused go. She felt she could not handle going back to the "scene of the crime." The appointment came and went. No one from the clinic called to ask how she was doing. No one at the clinic knew she had attempted suicide.
Ruthann was another example. A few days after her abortion, she tried to hang herself in her clothes closet. Fortunately, the screws that held the rod in place tore out from the wall under the weight of her body. She then devised another plan to asphyxiate herself by running her car engine with the garage door shut. This suicide attempt failed, too. Curiously, Ruthann did return to the clinic for her two-week post-operative check-up, where she was presented with a questionnaire. Although feeling extremely suicidal, she gave "positive" responses to all the questions. As she later told me, "I just wanted to have my exam and get out of that place!" Consequently, no one at the clinic ever knew that the woman rushing through their questionnaire reporting how well she was doing had in fact become actively suicidal because of her abortion.
The simple truth is that most women suffering from post-abortion trauma simply don't want to see anyone or anything related to their abortions. If they can summon the courage to seek counseling, they are far likely to turn elsewhere, to a therapist, pastor, general practitioner, or friend. From this perspective, abortion cliinic counselors who say, "We see very few problems," are being honest. But the fact that they are in a poor position to see the problems doesn't mean that the problems don't exist.
At this point, readers may rightly question whether my own perspective is equally slanted in the opposite direction. After all, my experience with women who have had abortions is biased primarily toward women who have had post-abortion problems, rather than women who have benefitted from abortion. Therefore, it is quite likely that I would tend to overestimate the extent of post-abortion problems by instinctively projecting my clinical experience onto the whole population.
There is certainly merit to that argument. Everyone's perspective is colored by his or her own limited experiences. On the other hand, the point of this book is not to argue that all, or even most, women have the type of emotional problems described herein. My goal is simply to show that a wide variety of emotional problems can result from abortion. These problems are generally ignored by both society and health care professionals, to the detriment of millions of women. I believe that any reasonable examination of the evidence, both statistical and clinical, will prove this to be true. The best I can do in striving for a "perfectly" balanced perspective is to try to remain open to any evidence abortion proponents may bring forward to document the emotional benefits of abortion. But even if such evidence is forthcoming, it cannot erase the fact that many women are severely traumatized by abortion. This leaves us with two questions: How can we help them, and what should we do to protect others from the same negative experiences?
Despite the generalizations above, it is important to note that some abortion clinic counselors do try to prepare women for the emotional reality of abortion. For example, Charlotte Taft was a counselor and director of a Dallas abortion clinic for 14 years. Instead of steering clients away from the tough issues surrounding abortion, Taft explored them with her clients. She attempted to help women confront the loss of their children before their abortions. In some cases, she even asked women to write good-bye notes to their children. During counseling, many of her clients chose not to abort, and she respected their decisions.l2
Taft's approach, however, was harshly criticized by many abortion proponents. Planned Parenthood, for example, stopped making referrals to Taft's clinic. In defending that decision, the president of Planned Parenthood of Dallas and Northeast Texas took strong "exception to statements [made by Ms. Taft] about the pro-choice community not being completely honest with women," and issued a report stating, "there exists no evidence of significant emotional sequelae post-abortion." In response to this, Dr. William West, an abortionist at Taft's clinic, noted that in Planned Parenthood's own supporting literature, citations demonstrated that there were "marked, severe, or persistent" psychological problems in at least 10 percent of women, in short-term follow-up studies alone. Noting that even a 10 percent rate translated into over 160,000 cases per year in the United States alone, West charged that if Planned Parenthood "was not being dishonest with women . . . I can only regard it as delusion or ignorance."13
Sadly, while more abortion clinic counselors are recognizing the need for post-abortion counseling, they still struggle with telling patients that this need exists. For example, Sheila Kriefels, the head counselor at San Jose's Planned Parenthood abortion clinic, told a reporter that they had a post-abortion counseling program, but that it was only offered to women who initiated a request for it. The program was not advertised or disclosed in pre-abortion counseling. It was virtually a secret. Few people on their staff even knew about the post-abortion counseling program.
Kriefels admitted the program was not promoted for political reasons. Offering post-abortion counseling is a tacit admission that abortion can hurt women, she conceded to the reporter, and "we don't want to give ammunition to the other side."14