Academic journal article Pre- and Peri-natal Psychology Journal

Abortion Trauma: Application of a Conflict Model

Academic journal article Pre- and Peri-natal Psychology Journal

Abortion Trauma: Application of a Conflict Model

Article excerpt

ABSTRACT: This paper advances the proposition that in carrying out the decision to undergo elective abortion, a woman experiences a potentially traumatizing psychological event. Vignettes from clinical practice illumine the symptoms and development of post-traumatic stress disorder in the aftermath of abortion. A model of psychic trauma is presented to account for the nature of abortion as a traumatic Stressor. It is based on psychoanalytic considerations, with an emphasis on the role of aggressive energy in the reconfiguring of psychic activities following trauma. The concept of an intrapsychic conflict between the basic drives leads to an understanding of the post-traumatic state, and its persistence.

INTRODUCTION

In the polarized political atmosphere that clothes the societal debate over elective abortion, relatively little attention appears to be directed at the impact of the event on the central actor, the pregnant woman. On one hand, evidence has been presented (Dagg, 1991) suggesting that the negative impact of abortion is transitory, and may be overshadowed in the long run by positive effects. In contrast, Speckhard (1987) has documented deleterious long-term effects for a sample of post-abortion women, and Barnard (1991) has presented data on posttraumatic symptoms three to five years post abortion that rival those of Viet Nam veterans.

Whatever the overall incidence of post-abortion trauma turns out to be, the clinical reality is that for many women, the event is a powerfully stressful one, requiring psychotherapeutic or spiritual intervention (see, for example, Selby and Bookman, 1990; Stanford, 1986). Networks of post-abortion support groups, such as Women Exploited By Abortion (WEBA) testify to the experience of victimization incurred when actions taken under tremendous stress have unanticipated effects (Reardon, 1987).

Despite the availability of these data-oriented studies, accounts of treatment interventions, descriptions of indigenous support/self-help groups, and first-person testimonies, there continues to be resistance within the professional community to the acknowledgment that elective abortion can be traumatic. This resistance is exemplified by a recent commentary in the Journal of the American Medical Association (Stotland, 1992) which concludes flatly that: "There is no evidence of an abortion trauma syndrome (p.2079)"

The purpose of this paper is to contribute to an understanding of the post-traumatic stress reaction that clearly occurs in a number of instances. The intention is to illuminate the clinical syndrome in the light of a generic approach to psychic trauma. Debates about incidence and prevalence await empirical answers; however, considering that some 1.6 million abortions are reported annually, in the United States alone, it will be seen that even very small percentages would reflect large numbers of individuals.

THE NATURE OF PTSD

Post-Traumatic Stress Disorder (PTSD) formally entered the psychiatric nosology in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). It was retained in DSM-III-R (American Psychiatric Association, 1987) with only minor revision. Descriptively, PTSD is a unique diagnosis in that it requires, as a diagnostic criterion, identification of an external originating event. For an event to be considered "traumatic" it must be of such a nature that it falls "outside the range of normal human experiences" and "would be markedly distressing to almost anyone." While this criterion (A) might better be determined by anthropologists or sociologists than psychiatrists, the intent seems to be to identify an event that violates expectations or assumptions about one's place in the world (see, for example, Janoff-Bulman, 1985) and one's preparedness for such an event. Thus, to lose a loved one to illness, even suddenly, would be a cause for grief, but to lose a loved one to murder might well be considered traumatic. …

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