Regardless of the reasons why they have chosen to abort, and even if they are morally comfortable with their decision, many women experience abortion as a violation of their "physical integrity," as it is termed in the definition of PTSD. In many cases, women have described their abortions as feeling like "surgical rape."9 This analogy is not surprising when one considers the actual mechanics of abortion. The woman is prone on her back, legs spread, with a masked stranger plunging instruments into her sexual organs, painfully and literally sucking life out of her womb. Linda described her abortion as follows:
I was fully awake, no pills given, or shots. I lay there with tears rolling down my face. The room was cool. My tears felt like fire on my face, cutting it, slice by slice, tear by tear. My hands were wet with sweat; my right hand squeezed the counselor's thin, cold hand as though squeezing the life out of her. My left hand lay fisted, clenched tightly on my vibrating stomach as the abortion occurred. It felt as though someone was raping me with a 15-Amp canister vacuum hose with no mercy as I lay there helpless, crying calmly, as if agreeing to be raped.
This experience of abortion as a violation of a woman's physical integrity is likely to be even more pronounced in women with a history of being sexually abused or raped. In these instances, the abortion is a connector to these other traumas. This is why a history of sexual abuse is a risk factor for greater post-abortion psychiatric problems. Adding trauma on top of trauma is not healthy, even if the victim is freely consenting to the abortion. As we will see in the next chapter, the intrusion aspect of trauma means that the victims are more likely to recreate trauma in their lives. Providing abortions to women with a history of sexual assault or abuse contributes, in many cases, to self-destructive tendencies. This is especially worrisome in light of recent studies that indicate that up to one-third of women have been the victims of rape or sexual abuse.10
According to one abortion clinic nurse, "Abortion is the narrowest edge between kindness and cruelty. Done as well as it can be done, it is still violence.... "11 According to Missy:
My abortion was extremely traumatic. The pain was excruciating. They kept telling me not to arch my back. I remember nurses coming in to hold me down. The machine sounded like a broken-down air conditioner. It was so loud. I felt helpless, trapped, violated. I fainted when I sat up after the abortion.
By its very nature, abortion requires a violation of a woman's body. Her cervix, which nature has designed to remain closed to protect the developing human fetus, must be forcibly opened. Then, her womb, which is designed to nurture life, must be penetrated, suctioned, and scraped. For many women, this experience is nothing less than their first intimate encounter with death.
The pain of the abortion procedure was a physical manifestation of the taking of life from my body. It was an experience I will never forget. After it was over, I felt confused and shaken; then, sitting in the recovery room, I was overcome with enormous regret. I felt so overwhelmed by the emotion that I didn't even sit there for 40 seconds before I got up, dressed, and walked out, pretending as if nothing in my life had changed. But everything had.
For Rosemary, the sight of babies became the connector to the death experience of abortion.
When I was on that table, for the first time ever in my life, I experienced death in all its blackness and finality. Now I have what I call "lock on" syndrome. I zoom in on every single infant around me wherever I am and am reminded of the incredible pain and guilt and panic at the horror of my choice. I am having deep feelings of regret and self-hatred. I am having immense difficulty reconciling the life around me with the death and the irretrievable loss I feel inside.
To fully ponder the tragedy of aborting one's own child is frightening, overwhelming, and perhaps simply impossible. For Heather, this memory lingered at the edges of her conscience, keeping the pain of her loss intensely alive.
The pain of my abortion is so real. The thought of killing your own child can push you over the edge. It has taken me years to overcome this grief. Abortion destroyed not only my child, but myself. I wish people knew that the aborted baby never really goes away.
For Kari, the death of her child also involved a death of some part of herself.
A part of me died, and it took me nine-and-a-half years to identify what died. The part of me that died from my abortion was my son or daughter whom I'll never know. I repressed and denied this for so long that emotionally I started to die too. I started to lose interest in life. My husband didn't matter. My children didn't matter. I wanted to die, but I never knew why. I felt like I was a lost child who didn't want to find my way home. I was a tree in spring without a bud of life on any branch. My roots lost their ability to drink the water of life. I never quite knew what was wrong with me.
It is extremely important to note that PTSD is not limited simply to "victims" as we normally think of the term. The perpetrators of violence can suffer from PTSD just as easily as their direct victims. Indeed, as Dr. Judith Lewis Herman has noted, "the risk of a post-traumatic disorder is highest of all when the survivor has been not only a passive witness but also an active participant in violent death or atrocity."12 This is because the horror of what has happened is magnified by a sense of personal responsibility and self-blame.
In the case of abortion-related PTSD, women are generally more likely to see themselves as perpetrators than victims. From a third-person perspective, however, it has been my observation that in the vast majority of abortion cases there are elements of both free consent and lack of freedom. On one hand, most women know on some level what will truly happen and are responsible for choosing or consenting to an abortion. On the other hand, most also feel hemmed in by outside pressures, whether from individuals or their circumstances, that make them feel they have no choice but to concede to an abortion. In this respect, they share the characteristics of victims.
My boyfriend called the clinic and set up the abortion for two weeks later. I never told anyone else about my situation and still no one close to me knows what happened. I never wanted the abortion, my boyfriend did. The day of the abortion, the counselor asked me if I wanted my boyfriend to come in with me while she talked to me. I said yes, knowing that I could not tell her myself that the abortion was what I wanted. She asked me questions, and he answered them for me. I don't see how she could have missed the tears in my eyes and the lump in my throat. She must have sensed my reluctance, but it seemed like all she cared about was "selling the abortion." I admit that most of the blame lies with me for allowing my boyfriend to bully me into this. My motherly instinct to protect the baby was running strong within me, but I was scared. I felt like I was in a dream where I tried to scream but no sound would come out -- l was petrified and paralyzed with fear. However, I do not feel the clinic should have allowed my boyfriend to set up the appointment and to answer for me.
As one woman put it, rather than choosing abortion, she "made the choice to be weak," to simply allow those around her to guide her into the "only thing" that could be done. In such cases, an abortion may lead women to experience all three of the responses that are marks of trauma: fear, helplessness, and horror.
It is quite likely that most women having abortions fall into this overlapping category. Numerous studies have shown that most women see abortion as involving their participation in the destruction of a human life, specifically, their own child's life. Eleanor describes her experience:
I am in the abortion clinic with at least 100 women in the waiting room, sitting, standing -- everywhere! To protect our identities, we were each given a number. So I waited for my number to be called. For hours there was dead silence. I felt like I was in a morgue. Frozen in fear, I hear my number being called. They check your name to match your number; then they take you to get ready for the procedure. "Everything will be fine," says the nurse, "it will be over in a few minutes." As I lay in terror, I hear a voice shriek through my head, "No Mommy! Nooooo!" I sit up in shock and terror. The nurse pushes me down saying, "It's okay; it's all over now!" The doctor leaves to go to the next patient. I grab the nurse in tears: "I heard my child's voice! I heard my child cry!" "Don't worry," says the nurse. "In time it will go away." Somehow I blocked that moment out until 12 years later in therapy I began to face my fears. Slowly I began to deal with all the problems in my life.
Seventy percent of women undergoing abortion believe abortion involves the killing of a human life, which violates their own moral standards.13 Thirty to 60 percent were initially happy about being pregnant and enjoyed being pregnant.14 As many as 60 to 80 percent would actually have preferred to give birth if only their circumstances had been better.15 And between 30 and 55 percent report that they felt pressured to abort by others.16
These statistics underline two points in the above discussion. First, the majority of women having abortions recognize it as an event that involves the killing of an innocent life. Second, they participate in this violation of their consciences because they feel helpless to resist or change the circumstances that are "forcing" them to choose abortion. Lorri reflects on her experience:
I regret that no one comforted me and offered a different solution to my situation. You see, that baby was in my womb. The bond was between my baby and me, and not even an abortion could break it. However, the love I feel for my baby is mixed with an incredible amount of guilt for taking his life; and I miss him so very much. I am left alone with the memory of the warmth of that little life within me, and the shame of allowing it to be killed.
For most women, abortion is, at best, "a type of murder" that is endured as an evil necessity only because it will "save her life."17 The desperation that lies behind many abortion decisions has been well described in the analogy: "No woman wants an abortion as she wants an ice cream cone or a Porsche. She wants an abortion as an animal caught in a trap wants to gnaw off its own leg."18
There are a wide variety of reactions to abortion. No woman will experience every symptom that has been reported. Some women experience clusters of symptoms; others may have a very dramatic and debilitating reaction; still others may appear to tolerate the procedure and its aftermath with little, if any, effect, at least during the period in which their reactions are studied.
When one listens to the intense pain, grief, and confusion women experience after an abortion that was supposed to make their lives better, it is easy to understand their need to withdraw and deny their experience. Without the understanding and support of loved ones, it is simply too much to bear on one's own. For many, the denial begins immediately For example, Terry spent four hours in a subway coffee shop after her abortion.
I was in a complete daze. I couldn't believe what I had actually done. I couldn't think about it. I sat and stared at people walking by. I felt as though I had left my own body.
For another client, Sonnie, the fear of confronting the source of her trauma resulted in years of confused denial.
I was afraid to think about my abortion. I couldn't allow myself to think of my abortion as a loss. For years I did not even know what was wrong with me. I never identified the source of my anger and pain. I just knew I was hurting inside . . . real bad. I cut myself off from my feelings. I was always numb.
No woman is safe from these negative emotions. Even those who have spent years battling for abortion rights, and who have intellectually confronted all the issues surrounding the question of abortion, may suddenly find themselves ill-prepared to cope with the emotional impact of abortion.19 As previously quoted, Dr. Julius Fogel, a psychiatrist and obstetrician who has performed more than 20,000 abortions, 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.20
As described in Appendix B, there are no clear answers as to how many women experience negative emotional reactions to an abortion. The diagnosis of abortion as producing a traumatic reaction is especially politicized, as described in Appendix A.
While many studies have looked at a wide variety of post-abortion reactions, very few have collected statistically validated data directly examining the PTSD model. Perhaps the most important of these studies was conducted by Catherine Barnard, who studied 80 women who had all undergone abortions at a Baltimore clinic three to five years earlier. Using standardized measures for PTSD, Barnard found that approximately one in five women (19 percent) met all the criteria for diagnosable post-traumatic stress disorder (PTSD). Approximately half had many, but not all, of the symptoms of PTSD, and 20 to 40 percent showed moderate to high levels of stress and avoidance behavior relative to their abortion experiences.21
Barnard's study would appear to have established a base-line estimate of around 20 percent for the incidence of PTSD following abortion in the general population. The actual rate of PTSD, however, may be significantly higher, since half of the women who were contacted refused to participate in the study. (Other research has shown that the women who refuse to participate in post-abortion follow-up studies are the most likely to match the characteristics of the women reporting the most problems.22 In other words, women who find their abortions a painful subject are least likely to participate in studies examining their pain.) Among women who actually seek out post-abortion counseling, as many as 73 percent may be diagnosed as suffering from PTSD using standardized tools for evaluation.23
A person's immediate emotional response to a traumatic event does not solely determine whether or not that person will suffer the symptoms of PTSD. A considerable period of time may intervene between the trauma-causing event and the traumatic reaction. For example, imagine a new terrorist recruit who is instructed to throw a bomb over a wall. At the sound of the explosion, the young terrorist may actually feel powerful rather than helpless, courageous rather than fearful, jubilant rather than horrified. But if the young bomb thrower later walks around the wall and sees the bodies of his victims, his emotional response might be instantly changed. Though in his mind he knew what to expect, the horror of actually seeing the results of his act may overwhelm his intellectual justifications for doing what "had to be done." If he subsequently develops symptoms of hyperarousal, intrusion, and constriction, he has developed PTSD.
Similarly, for many women, the traumatic nature of their abortion is not fully released until some subsequent event triggers a fuller understanding of everything that has happened. In the case of abortion, PTSD symptoms can obviously be triggered by exposure to the ghastly image of a dismembered fetus. But a similar sense of horror can also be triggered by what are normally wonderful experiences. Any experience that arouses a sense of awe about the value of life can trigger the release of a traumatic reaction to a past abortion. From such a summit of awe, the memory of having been involved in an abortion may suddenly appear to be a terrible horror. This was Audrey's experience during the pregnancy and birth of her first child.
Throughout my pregnancy I was anxious. The experience of having a baby brought on all the memories of my abortion and an enormous amount of guilt. I thought I would die after seeing my first ultrasound. I watched the screen amazed and mortified. Amazed to see my baby, the outline of her face, her hands, beating heart, spine and so forth. Mortified that this is not at all what I thought was being "evacuated" years before when I had an abortion.
For Robin, it was a visit home for her parents' anniversary and the sight of her nieces and nephews that released her traumatic reactions.
I had my abortion at the age of nineteen. I was fine afterwards, and grateful to the clinic and staff who assisted me. I became pregnant again two years later and had another abortion. Later, I helped several of my friends get abortions because I was the "experienced" one. I used humor and sarcasm to deal with any feelings. I entered the airline business and traveled all over the country. Most people thought I had a glamorous life, and my freedom was the envy of many.
Then one summer it all fell apart. I was invited home for an anniversary party that my brothers and sisters were having for my parents. I had not been home in 11 years. I felt terrified to go and thought of all the ways I could avoid the trip. I became depressed and started drinking a lot. A good friend asked me what I was afraid of . . . and I honestly could not tell her. Anyway, I forced myself to go home . . . and that's when everything fell apart. Returning home brought up some very painful memories regarding my abortions. When I saw my parents and all my nieces and nephews I had crazy thoughts . . . I wondered why I didn't have kids? I felt like my own children should have been there with us. I felt so much grief! I could not believe the amount of pain and anguish which flooded my heart. I found myself crying all the time, and drinking to numb the pain, and wanting to sleep the days away. I stopped eating, and became very withdrawn. I honestly could not function, and I cursed the fact that I had ever come home. All I could think of was that I had to get away. But even after I left, the grief followed. There was no escaping my misery and it affected everything . . . my job, my friendships, my self-worth. The depression, the drinking, the crying spells . . . it went on for a long time before I sought help.
In the Elliot Institute survey discussed in Appendix C, over 60 percent of the women surveyed reported that there was a period of time during which they would not have reported any negative feelings about their abortion. They reported that the average time before they even recognized that they had negative reactions was slightly over five years. This delayed reaction to abortion is one of the major reasons why abortion trauma is so poorly understood by both society and mental health workers.
1 For a more complete information on the Bobbitt case see a series of articles in The Post-Abortion Review, 4(2):1-15 (Spring-Summer 1996). These articles are also posted on the Internet at http:www.afterabortion.info. [Back]
8 David C. Reardon, Julie Makimaa and Arny Sobie, Victims and Victors: Speaking Out About Their Pregnancies, Abortions, and Children Resulting from Sexual Assault (Springfield, IL: Acorn Books, 2000). [Back]
13 Zimmerman, Passage Through Abortion, op. cit. (introduction, no. 1) 69. In Zimmerman's study, only 15 percent explicitly denied that the fetus was a person or a human life (194-195). In a national poll, 74 percent of women with a history of abortion agreed with a statement that abortion is morally wrong. (Los Angeles Times Poll, March 19, 1989.) See also Hunter, Before the Shooting Begins, op. cit. (ch. 3, no. 1) 93, regarding views of the general population regarding the fact that abortion causes the death of a human life. [Back]
14 Zimmerman, Passage Through Abortion, op. cit. (introduction, no. 1) 194-195; Miller, "An Empirical Study of the Psychological Antecedents and Consequences of Induced Abortion," op. cit. (ch. 3, no. 2); also Reardon, Aborted Women, Silent No More, op. cit. (introduction, no. 1). [Back]
16 Even the prominent abortion defender Daniel Callahan, director of the Hashings Center, writes: "That men have long coerced women into unwanted abortion when it suits their purposes is well-known but rarely mentioned. Data reported by the Alan Guttmacher Institute indicate that some 30 percent of women have an abortion because someone else, not the woman, wants it." Daniel Callahan, "An Ethical Challenge to Prochoice Advocates," Commonweal, Nov. 23, 1990, 684. Similarly, a survey of women who subsequently regretted their abortions found that 55 percent reported feeling "forced" into their abortion by other people, with 61 percent saying they felt their lives at that time were being controlled by others (Reardon, Aborted Women, Silent No More, op. cit. (introduction, no. 1) 11. Similar findings are reported in Zimmerman, Passages Through Abortion, op. cit. (introduction, no. 1) 110-112, 122; and Miller, "An Empirical Study of the Psychological Antecedents and Consequences of Induced Abortion," op. cit. (ch. 3, no. 2). [Back]
23 Rachel L. Anderson et.al., "Methodological Considerations in Empirical Research on Abortion, in Post-Abortion Syndrome: Its Wide Ramifications, ed. Peter Doherty (Cambridge, Great Britain: Cambridge University Press, 1995) 103-115. [Back]
Theresa Burke, Ph.D., is a psychotherapist and founder of Rachel's Vineyard, a post-abortion training and healing ministry that annually serves thousands of women and couples throughout North America and overseas.
David C. Reardon, Ph.D., is one of the nations's leading researchers and authors on post-abortion issues and the founding director of the Elliot Institute.
Book: Forbidden Grief
by Theresa Burke, Ph.D. with David C. Reardon, Ph.D.
Acorn Books, Springfield, Illinois