This letter is in response to the Viewpoints column in the July 20 issue
titled "The Myth of Abortion Trauma Syndrome" by APA
President-elect Nada Stotland, M.D. Dr. Stotland wrote that "the
assertions of psychological damage, made by legislatures and the [U.S] Supreme
Court, are contrary to the scientific evidence.... 'Abortion trauma syndrome'
and 'post-abortion psychosis' are inventions disguised to mimic those
diagnoses, and they demean that careful process" of crafting the titles
and definitions of psychiatric diagnoses.
On the July 20 PBS show "NOW" hosted by David Brancaccio, there
was a discussion on the cases of 2,000 women who had certified before a notary
public that they had suffered repercussions following their abortions. Among
the symptoms they noted were extreme emotional states, tears, guilt, remorse,
and depression. At least several suicidal attempts had taken place in this
group of 2,000. To assert that abortion does not cause significant, negative
psychiatric repercussions in some women, as did Dr. Stotland, who also
appeared on this program, boggled my mind. She implied that any negative
psychological repercussions following their abortion were due to past problems
in their lives and not due to the abortion.
In my experience in 45 years of psychiatric practice, most of my patients
had some genetic, cultural, environmental, and personality factors in their
background that played a part in their reactions to stress. Abortion can be a
difficult and painful decision. To suggest that the responses women portrayed
on "NOW" weren't related to their abortion is to deny a likely
cause-and-effect relationship. Why isn't it possible that some women are
vulnerable to developing an "abortion trauma syndrome"?
Denial can be a very useful and powerful defense mechanism. It permits us
to cope and move forward (or backward). I presume that the majority of women
who choose abortion are able to move forward and cope. I surmise that there
are some others who experience guilt, remorse, ambivalence, or feelings of
loss then or later regarding their abortion.
Years ago, I treated a woman who was pregnant and wanted to keep her baby;
she ultimately complied with the wishes of others to terminate the pregnancy.
If psychiatric symptoms develop following this decision, isn't it reasonable
to consider the possibility of a diagnostic category such as"
post-abortion trauma"? I wonder what some of your other readers
Dr. Weisner raises important questions. There are women who experience
sadness and regret after abortions. What there isn't is evidence of a
significant causal relationship between abortion and psychiatric illness, or a"
post-abortion" syndrome. Feelings are not psychiatric
The program cited, which can be accessed online at<www.pbs.org/now/shows/329/index.html>,
shows women actively recruited into religious anti-abortion groups in which
abortions that took place years earlier are blamed for a whole range of
psychiatric symptoms without consideration of the participants' mental health
before the abortions, the circumstances that led to it, or events in the
These women are then expected to provide notarized statements attesting to
the mental health problems they attribute to their abortions. The program
clearly demonstrated that the assertion that abortion causes mental illness is
now the central strategy of the anti-abortion movement.
Postpartum psychiatric illness was recognized by Hippocrates."
Post-abortion depression" or "post-abortion syndrome"
was recently invented, for political purposes. That is why APA is opposed to
the use of those terms and that is why it is important for psychiatrists to be
informed about psychiatric aspects of abortion.
The scientific literature indicates that the best predictor of a patient's
mental health after an abortion is her mental health before the abortion.
Women have abortions because they are in difficult circumstances: overwhelming
responsibilities without adequate resources, pregnancy resulting from rape or
incest, abandonment by their partners, and mental illness.
Still, the incidence of mental illness after delivery of a baby—the
only alternative to abortion for a pregnant woman—is considerably higher
than that after abortion. Having an abortion under duress, like Dr. Weisner's
patient, is both an indication of serious life stress and a risk factor for a
negative outcome. Clinicians should obtain full reproductive histories from
patients and help them, nonjudgmentally, to address any unresolved feelings
they have about any reproductive event, while recognizing that feelings about
any life decision or event change as a patient's circumstances change over
Suggestions for new psychiatric diagnoses can be submitted to the
DSM-V Steering Committee, already hard at work doing the careful
research that will drive decisions about our psychiatric nosology.
As I said in my Psychiatric News column, religious or moral
objections to abortion deserve our full respect; inventing psychiatric
illnesses for political purposes does not. ▪