P.A.T.H.S. 
POST ABORTION TRAUMA HEALING SERVICE

Breaking the silence - information, hope and healing after abortion
 
 
 


  Psychological Effects 



There is a general perception that women are liberated by abortion.

However, the attempt to “get rid of” a problem, often produces problems of its own.

There is no such thing as a simple uncomplicated abortion,

because abortion is always the disruption of the psycho-biological process of pregnancy

and always involves the loss of a child, albeit unborn.

The trauma involved in being both attached to, and responsible for

the death of one’s foetal child can be emotionally overwhelming.(1)


Dr Julius Fogel, a psychiatrist and obstetrician who has performed hundreds of abortions himself said: 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 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. (2)

Regardless then of how a woman views the developing baby growing inside her or experiences her pregnancy, there is a sense there exists a primitive bond between mother and child, which although not able to be glimpsed from the outside is a profound attachment that may seem shadowy and submerged even to her. If this was not the case, having an abortion would not be more difficult than having a tonsillectomy or appendicectomy.(3)

There are physiological changes associated with the disruption of an otherwise normal pregnancy, and sudden hormonal changes can create mood swings and bodily upsets in the early stages after an abortion, as with any pregnancy loss. Termination of pregnancy for health reasons or for foetal abnormality can be complex and mourning may be complicated.

Significant distress may be experienced, particularly for women who suffer post-operative complications necessitating further treatment and/or hospital admission, those who experienced a high degree of ambivalence about the pregnancy, moral conflict over the abortion decision, or pressure to abort the baby.

In the absence of initial complications, the short term effect of an abortion is often relief - the operation is over and there is no longer a need to face the unwanted or difficult pregnancy with all the accompanying distress and subsequent responsibilities. This may be “followed by a period psychiatrists identify as emotional “paralysis”, or post-abortion “numbness.” (4) Psychological defences, such as denial and repression of feelings, tend to come into action fairly quickly, to cope with the stress and changes incurred in the decision making process, living through the actual procedure, the recovery and adjustment period afterwards, relationship issues and other aspects.


Some women may experience acute and severe reactions. Others appear to adjust well to the loss incurred in the abortion and it would not appear to impact greatly. Some have no identifiable symptoms and show few negative reactions initially, but are at risk of developing symptoms of at some future stress point (often a new pregnancy, inability to conceive or complete a pregnancy, or some other major loss or crisis). Many women are suffering emotionally from a procedure which was supposed to be emotionally benign.(5)


References:

1.  Complicated Mourning: Dynamics of Impacted Post Abortion Grief, Anne Speckhard, PhD, and Dr Vincent Rue, PhD, Pre-and Perinatal Psychology Journal, 1992 
2.   Aborted Women: Silent No More By Dr David C Reardon, Loyola University Press, 1987, p141 
3.   Complicated Mourning: Dynamics of Impacted Post Abortion Grief, Anne Speckhard, PhD, and Vincent Rue, PhD, Pre- and Perinatal Psychology Journal, 1992, p2 
4.   Bereavement in Post-Abortive Women: A Clinical Report, presented at the annual meeting of the Canadian Psychiatric Association, Kent, et.al., Saskatoon, Sept. 1977 
5.   Giving Sorrow Words, Melinda Tankard Reist, Duffy & Snellgrove, Sydney, 2000
6.   Post-traumatic stress disorders in women following abortion: Some considerations and implications for marital/couple therapy, D. Bagarozzi, Internat. Journal of Family and Marriage 1:51-68, 1993; The Long Term Psychosocial Effects of Abortion, C. Barnard, Institute of Pregnancy Loss, Stratham, New Hampshire, 1990. Also refer Hanley et al. 1992. 


ABORTION LOSS AND TRAUMA

There is a spectrum of abortion loss and a spectrum of abortion trauma.

Loss incurred may not be just about the baby loss. There may be a myriad of losses experienced including: loss of a role and identity, loss of a dream and life plan, loss of innocence, loss of relationship e.g. with partner, loss of confidence and trust, loss of self esteem or sense of self worth. Whatever changes and losses a person may incur through the abortion experience many people will need to journey through grief at some point.

Trauma associated with an abortion may be minor, moderate or severe. Researchers suggest that women can report abortion-related distress at some point after their abortion. Only a small percentage of women will develop an actual Post Traumatic Stress Disorder (PTSD), symptoms of which may only be triggered later in life. Most women who experience abortion trauma will encounter feelings of horror or terror at the time of the abortion, relating to either the actual procedure or how they were treated by people. Some women  may deny having had an abortion, and others may not recognise or acknowledge any trauma relating to the event. This denial can be a significant contributing factor to the development of post traumatic stress.(6)

In 1987, the American Psychiatric Association stated in its then newly revised manual of diagnostic criteria, the Diagnostic and Statistical Manual of Mental Disorders III-R (DSM-III-R), that abortion is a type of ‘psychosocial stressor’ (an event outside the range of usual human experience) of the type capable of causing ‘post-traumatic stress disorder’. Interesting that it was removed as a recognised stressor in subsequent editions of the manual, which may have more to do with politics than reality. Certainly for a small percentage of our clients PTSD is part of their experience post abortion. It doesn't matter what the pattern of symptoms is labeled the important thing is to be aware of and acknowledge when dealing with post-abortive women that their symptoms and experiences are real, and provide appropriate counselling and support to manage what is being presented.


Abortion Related Post Traumatic Stress Disorder (PTSD)

The following pattern of symptoms consistent with PTSD are sometimes experienced in relation to abortion


1. Re-experiencing the trauma

  • nightmares, flashbacks, recurrent dreams (of the abortion, the baby or death)
  • anniversary reactions (on date of abortion or expected date of delivery)
  • distress at exposure to events that resemble some aspects of the abortion (pelvic examination, sexual intercourse, childbirth, sound of vacuum cleaner)

2. Avoidance or denial type behaviours

  • avoiding thoughts or feelings about the abortion
  • avoiding situations or activities that cause thoughts of the abortion (medical examinations/procedures, exposure to babies or pregnant women, conversations about pregnancy or abortion....)
  • memory blocks or inability to recall aspects of the abortion
  • emotional numbing, withdrawal from others

3. Increased arousal

  • sleep disturbances e.g. insomnia
  • irritability or outbursts of anger
  • difficulty concentrating
  • hypervigilance e.g. being watchful, on the alert, suspicious
  • exaggerated startle response - on edge, jumpy, overreactive


 

GRIEF AFTER ABORTION

Post Abortion Grief - does it affect you? (A Checklist of questions for you to see if you may be affected by grief from an abortion)

Every mother or father of an aborted child knows the truth - their children are gone forever and cannot be brought back or replaced. There will always be a void in their lives - a void made more painful by memories and regrets, and dreams of what their child might have been.(1)

Grief is a normal, natural, healthy process, of acknowledging and experiencing our real feelings about and adjusting to living with any significant loss. Expressing painful and hurtful feelings helps to release you from them and relieve the pain they induce. Gradually as you move through the feelings, you become less overwhelmed by them and they lose some of their power over us. Some of the feelings may never go away entirely, but the power they have over you and your life will diminish.

After an abortion, it is not unusual after an initial sense of relief, you might plunge into an unpleasant, painful place of distressing feelings and confusing thoughts. Life takes a dip. With awareness of the loss you may sink down and feel overwhelmed. The dip can take you down into a mix of feelings e.g. sadness, hurt, anger, guilt, fear... which may be experienced very intensely, over and over, and mixed together over time. This ebb and flow of feeling can be distressing, and many people try to avoid going through it. However, the only way through is through, if you are to find new features to give your life meaning and direction.

Even though an abortion decision has seemingly been your ‘choice’ and a voluntary decision, the reality of the loss of the baby through the termination of the pregnancy, often evokes feelings of sadness and grief, which may be expressed immediately following the abortion as distress, or may be suppressed. If you hang on to the feelings they may begin to consume you - you may internalise the feelings and they become more and more who you are, or they may manifest as physical symptoms. Unexpressed feelings, such as anger, may manifest as depression, affecting sleep patterns, appetite, energy levels, libido, ability to concentrate, motivation.... or anger may be expressed outwardly, and sometimes inappropriately, at others.

The perception of loss of a pregnancy is individual, and the experienced impact of the loss of a baby through abortion varies from person to person. The significance of that loss may not be uncovered until the healing process has begun and grief is expressed. Understanding the process of grief then, is about understanding the significance of the loss for the self, and what it means. If you experience the abortion as particularly traumatic, or feel that your personal boundaries have been violated, or feel abandoned... and if your grief becomes impacted, the process of recovery may be prolonged and complicated.

Abortion grief may only surface when another significant change or trauma occurs in your life. Conversely, other unresolved grief issues may surface, and need to be dealt with in conjunction with the abortion grief.

Grief is a process and can take time. Sometimes the grief process may begin, but is not completed as you become stuck at a particular point. It can feel particularly difficult to get past the feelings of guilt and anger if these dominate your heart. Before grieving can be fully entered into you need to confront your guilt and deal with anger. You need people who can be there for you, listen to your confusion, tolerate your feelings, and who will give you ongoing support. Sometimes it is helpful to talk to someone uninvolved who has special skills of listening and caring.

I lament the death of my baby
I feel empty inside

Overwhelmed by a sort of haunting sadness....
 
Why didn’t anyone ever tell me
that grief felt so like fear,
and that I would cry
more than I would laugh..
 
I never dreamed it could be so painful -
It all feels so unreal, and it’s like
Going through the motions quite disembodied.
Now my baby is gone, my partner is gone,
and I am alone......


WESTBERG'S JOURNEY THROUGH GRIEF

  1. Shock & denial - These mechanisms help you to absorb your sense of loss without being totally overwhelmed. There may be a feeling of numbness and sense of moving like a robot or disembodied feeling. You may not remember much of events surrounding the abortion or immediately following.

  2. Immediate expression of feelings - Pain & sadness (tears), anger, fear... are not uncommon.

  3. Disturbances in physical functions - Bottling things up and holding the pain in can increase the stress in our bodies e.g. gastro-intestinal disturbances, problems sleeping, headaches, abdominal pain....

  4. Depression & panic - All is dark and gloomy, life feels like a nightmare, it may be hard to cope, you may question "Is life worth it?"

  5. Guilt - Tormenting yourself about failings, regrets and feelings of remorse may happen and keep happening until you begin to address what really happened in the abortion and what is meant for you.

  6. Anger, resentment, rage - These feelings and emotions need to be expressed and may relate to feelings of being let down, betrayed, abandoned.... You may feel you need to come to forgive before being able to turn the corner.

  7. Idealisation - Holding the past as best and convinced life cannot be good again. When your energy is locked into what was, could have been or should have been, there is less energy available to develop the future positively.

  8. Realisation begins to dawn - When you are able to see the weakness of the past situation and accept the bad with the good you can begin to hope again.

  9. New patterns begin to emerge - Here there is some new thinking and new routines, finding new reasons to get up and go on with everyday life.

  10. Living with the loss - There has been significant adjustment to the loss and the loss becomes part of the fabric of life and integrated into the self. At times feelings of sadness or fear may cause disruption but life begins to hold new meaning and you are functioning well.


References:

1. Men and Abortion, Grief and Healing, Brauning, Dr Wayne, Post Abortion Review, Vol 4, No.4, Fall 1996
2. Adapted from Good Grief, a Constructive Approach to the Problem of Loss, Granger E. Westberg


 
 
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