J.J. Spaulding, & Cavenar, J.O., Jr. (1978). Psychoses Following Therapeutic Abortion. American Journal Of Psychiatry, 135 (3), 364-365.
Most literature on elective abortions suggest that there are few negative psychological effects from the procedure. One study concludes that “women without gross current psychiatric illness can usually take the procedure in stride.” The experience of Spaulding and Cavenar, however, contrasts sharply with this study and others: “We have seen a number of patients who did have emotional difficulties after a therapeutic abortion.”
The authors present two cases in which the patients functioned normally before the abortion, yet became psychotic after the event. Ms. A., a 17-year-old unmarried girl raised in a large, southern, religious family became pregnant the summer following her sophomore year, by her first boyfriend, and aborted without her parents’ knowledge. On the eve of the first anniversary of the abortion, she experienced psychosis and was referred for psychiatric care. She had the delusion of being the Virgin Mary, having been impregnated by Satan or by God. She assumed the fetal position and moaned about her sin. She smeared her feces on herself and around the room. She saw people growing fangs that could “puncture” her. She had seizures characterized by movements resembling coitus. She thought the male attendants were trying to seduce her, and made overt attempts to seduce them in turn.
Gradually, Ms. A verbalized her concerns about the abortion. She felt overwhelming guilt. Her strong religious views led her to believe that she had unforgivably sinned. After a 5-month hospitalization, she returned to her usual level of functioning, but continued taking anti-psychotic medication for a year following her release. As of the publication of this article, she was completing college with no apparent further psychological problems.
Ms. B., a 24-year-old unmarried woman employed in a position of great responsibility, became pregnant and obtained an abortion. Six months later, at the time she would have had the baby, she experienced severe depression necessitating psychiatric hospitalization. She began to dress “inappropriately,” applying her makeup “heavily” and “improperly.” She had a delusion of having “died in spirit and being reborn,” and of “sexual persecution.” She made ambivalent statements such as, “I am a not a fool; I am a fool.” She had an hallucination of “seeing babies in their mothers’ arms with their fathers present.” After receiving medication, she was able to talk about her profound guilt over both the pregnancy and the abortion. Able to work through many of her feelings, after four weeks, she was discharged. Upon publication of this article, she was continuing outpatient follow-up and experienced no further psychotic symptoms.
The authors conclude:
…some individuals do feel guilty about abortion. One may attempt to rationalize, intellectualize, or otherwise defend against the guilt, but one cannot escape one’s superego. We suggest that psychiatric difficulties do occur and that physicians may be somewhat reluctant to recognize this.
Questions for Reflection and Discussion
- What are some possible explanations for the discrepancies between the experience of these doctors and the current literature on the subject?
- What do you think would have happened if Ms. A had been required to notify her parents before the abortion?
- Did she commit a sin? If so, was it unforgivable? If not, why not?
- To what degree were Ms. A’s problems spiritual? To what degree were they psychological?
- Counseling and psychiatric care can be helpful when an adolescent or young adult woman feels guilt from an abortion. Spiritual help is also key to a complete cure and resolution of a guilt problem.
- Parents need to be sensitive and to communicate full acceptance of their daughter. At the same time, it is important to confront her with the reality of the abortion. Referring her to a minister or counselor can help her deal with its spiritual effects. More intensive counseling may be needed, however, to help her address the mental and emotional effects of the abortion.
- In some cases, a significant adult may be more helpful than a parent. If a girl who has had an abortion seeks out or is referred to a concerned adult, again it is essential to be accepting and non-judgmental, without making light of the realities of abortion. Concerned adults can help with spiritual issues, but they need to know when they are overwhelmed and should refer the girl to a qualified professional.
- The most important thing that youth leaders, educators, and helping professionals can do is to become personally involved. Educate yourself. Educate others. Volunteer with or contribute to community programs and organizations working with teenagers considering abortion. Consider volunteering at a home for women in crisis pregnancies.
- Look for symptoms of depression such as sad appearance, changes in eating or sleeping habits, withdrawal, or deterioration in athletic, academic, and other performances. Depression, guilt, and unresolved grief can devastate meaningful relationships, and cause inefficiency in school and the work place. In some cases it can lead to physical illness, psychological disorders, or psychosis.
- If an adolescent girl shares her guilt and other feelings associated with an abortion, it indicates that she wants forgiveness and healing. For this to happen she needs an emotionally supportive, non-judgmental family. She must have friends who will not abandon her in difficult times. She needs a church that will neither condemn her nor minimize the reality that an abortion takes the life of an innocent human.
- Communities must recognize that abortions can and do leave emotional and spiritual scars. They need to provide support groups for these women.
- Ultimately the goal of is to bring the person to the point at which she has experienced enough healing to continue on her own. A youth leader should review the healing process with her while discussing her present feelings and how she is coping with them. The adult also should discuss her future. What are her goals and aspirations? If and when she displays healthy coping mechanisms and hope for her future, she is probably ready to begin terminating counseling on the issue. It will be important for the adult to follow up with her from time to time, at decreasing intervals.
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