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Traumatic reactions to abortion are often not recognised, especially since many health workers expect abortion to offer "relief" from an unwanted or untimely pregnancy. Since abortion is legal under the Choice on Termination of Pregnancy Act 92 of 1996, the humanity of the foetus is not recognised and it is easily assumed that the woman has nothing to grieve about. In terms of the law, life begins at birth and not at the scientific start of life - conception. If the life of the foetus was recognised in South African law, abortion would be murder. And while abortion continues to evoke public debate on the part of the Church and pro-life and pro-abortion groups, counselling services for the "second victims" (Ross 1992) - the mothers who undergo abortions on demand - leave much to be desired.
Studies have shown that men, women, families and even health workers may be subject to the negative psychological reactions that result from abortion (Speckhard & Rue 1992).
Under the new legislation abortion may very well function as a relief from stress in the case of many unwanted pregnancies, but at the same time and subsequently it may also be experienced as a psycho-social stressor by some people. It is this latter "problem of double effect" that leaves society unsympathetic and even with a condemnatory attitude towards the woman: if she experiences symptoms of trauma after an abortion, then she is "paying" for her "sin". Society's denial that abortion is a traumatic stressor means, furthermore, that post-abortion syndrome is not picked up and is often incorrectly diagnosed.
A. Post-Traumatic Stress Disorder
According to Louw (1989:144), the traumas that lead to serious post-traumatic stress disorder include a serious threat to the person's life or physical integrity; a serious threat to the person's children, spouse or other close family members or friends; the sudden destruction of the person's home or community; or the sight of another person who has been seriously injured or killed as a result of an accident or physical violence. In certain cases the trauma may centre on a serious threat or harm to a good friend or family member (for example the person's child being kidnapped, tortured or killed).
The essential feature of this disorder is the development of characteristic symptoms following a traumatic event that falls outside normal human experience (for example marital conflict and financial loss). Victims of war and crimes such as hijacking and rape, and persons who have been held hostage, are classic examples of sufferers of PTS.
Wilmoth et al (1991) are of the opinion that post-abortion syndrome is not a typical post-traumatic stress disorder, as one undergoes an abortion at one's own discretion and the consequent trauma can, therefore, not be attributed to "circumstances beyond the victim's control".
However, according to Speckhard & Rue (1992), it is precisely the discretionary nature of, and "voluntary participation" in, the abortion decision-making that is responsible for the degree of traumatisation that is experienced. Some "second victims" also feel that their abortions were not totally voluntary, but that they were forced into them as a result of socio-economic factors, etc, and that this was the only "option" available. Others, again, feel that they were not properly informed beforehand.
Diagnostiese en Statistiese Handleiding vir Geesteswetenskappe (Diagnostic and Statistical Manual for Mental Sciences) (4th edition) did not include the section on post-abortion disorder, but according to Van der Spuy (1997:33) post-traumatic stress disorder is the nearest thing to post-abortion syndrome. He holds, furthermore, that early researchers on post-abortion syndrome noticed a remarkable similarity between the symptoms of an abortion victim and those of Vietnam veterans suffering from PTS.
According to Speckhard & Rue (1992) post-abortion syndrome can be defined as the long-term, chronic and dysfunctional disordered adaptations that are the result of:
- an inability to process emotional reactions to a traumatic event;
- a sense of loss after an abortion and the subsequent inability to grieve about it;
- an inability on the part of the person to find peace within themselves, others and God as long as the feelings related to the abortion are suppressed and denied (Van der Spuy 1997:28).
The consequences of an abortion are not a superficial feeling of guilt or sadness or doubts about the moral implications of the deed. According to Collins (1988:429) they include a deep mourning, self-destructive acts, broken relationships, sexual disorders, a poor self-image, an increase in child abuse, suicide, alcoholism, drug abuse and also a cry to God who may never forgive them because they have "murdered" their own children. It is significant that women with post-abortion syndrome often experience the abortion as the death (murder) of the foetal child, which to me is a pro-life argument.
The following symptoms are also mentioned:
- Memories, for example nightmares, flashbacks, the anniversary of the abortion, and the sight of other pregnant women, babies, vacuum cleaners and doctors' consulting rooms.
- Delayed reactions: reduced interest in meaningful activities,
alienation from others and numbed feelings.
- Related symptoms such as rage, guilt, stress, depression, substance abuse, disturbed sleep and a preoccupation with the aborted child.
- Interpersonal problems with men. According to research, 70 percent of relationships break down within a month of the abortion (Ross 1992). Future intimacy is also reduced.
- Broken trust. If the relationship survives the abortion, the loss is either minimised or maximised.
- The effect on later children. On the one hand the mother may be unable to bond, because she is afraid something serious will happen to them, or she may become overprotective and see the child(ren) as a substitute for the aborted child.
- The relationship with the woman's family. Sometimes the abortion is seen as a "family secret" that is not talked about and results in division or distance between the woman and the family.
- A spiritual existential crisis. A feeling of intense guilt and estrangement from God is experienced.
The range of symptoms must be the cause of a clinically significant sorrow or curtailment of social, work or other important areas of functioning and must be present for more than a month before a diagnosis of PTS can be made.
B. Acute Stress Disorder
The development of anxiety and dissociation within a month of exposure to a serious traumatic stressor characterises this disorder. According to Van der Spuy (1997:35), the abortion or post-abortion period can be experienced as a serious traumatic stressor. In reaction to the abortion, the mother develops symptoms that create distance, for example:
- a feeling of an absence of emotional responses;
- a feeling of "living in a daze";
- dissociative memory loss (for example psychogenic memory loss) - some women cannot remember the most traumatic aspects of the abortion;
- a loss of reality and self-worth.
The symptoms of Acute Stress Disorder must last for at least two days, and improve within four weeks, or the diagnosis changes to Post-Traumatic Stress Disorder (Spuy 1997:36).
C. Adjustment Disorder
Adjustment disorder is a mild disorder and is characterised by poor performance at work or school and temporary changes in social relationships. The onset of this disorder occurs immediately or shortly after the stressor (abortion), and is characterised by an increased risk of suicide.
D. Bereavement
The process of bereavement is characterised essentially by mourning, a period of sorrow after a loss as a result of death or an important separation, for example the loss of a person or even a part of the body. The symptoms of persons who are grieving may overlap with those of what we call a "major depressive episode" (like an oppressive psychological pain and a feeling of helplessness). The process of grieving often follows the stages proposed by Kubler-Ross (1969), ie denial and withdrawal, rage, negotiation, dejection and acceptance.
Healthy sorrow is devoid of guilt or shame. Abnormal sorrow, as in the case of that of the "second victim", is characterised by the following: the person extends the period of sadness with a feeling of guilt; the sorrow is suppressed or delayed, or the dead person becomes a relic as a symbol of one's inability to work through the trauma. The person who is grieving sees the depression and period of yearning as "normal" and does not generally seek help.
Therapy
Our constitution does not protect the foetus, but protects the right of the woman to choose whether she wishes to have an abortion or not. It remains an open question in many cases whether women make an informed decision. Choices require responsibility, and the responsibility lies with both the woman and the counsellor to consider and understand the implications of an abortion before a decision is made.
The condemnatory attitude of the church, which suppresses the grieving process, and the denial by society that abortion is a traumatic stressor, result in post-abortion syndrome not being picked up, or in being incorrectly diagnosed. It is significant that women who belong to a more conservative church are more susceptible to post-abortion syndrome (Van der Spuy 1997:41).
According to Ross (1992), therapy for post-abortion syndrome patients must include the following: the denial must be broken; the rage (towards herself and others) must be dealt with; she must find peace, forgiveness and release; and she must be allowed to grieve and to plan a strategy for dealing with future triggers that bring up memories.
The number of women who are open about their abortions is, as can be expected, underrepresented in abortion statistics. Furthermore, abortion is often not given as the main reason when help is sought. It is essential that therapists who work with women should be able to recognise the symptoms of post-abortion syndrome. Secondary problems, such as suicidal tendencies, substance abuse and so forth, are easily incorrectly diagnosed as primary symptoms without attention being given to the unresolved trauma of abortion. Therapists must also bear in mind that timidity and hidden emotions are features of post-abortion women.
Seeing the dismembered remains of a foetus is a serious stressor, not only for the mother, but also for the nursing staff. It is clear that the psychological, social and mental impact of abortion trauma on society has far-reaching consequences that urgently demand serious attention. Counsellors' and therapists' often strongly-coloured pro-life or pro-abortion views have a negative effect on treatment, to the disadvantage of the "second victim", who is already traumatised. Without effective counselling services, post-abortion recovery programmes, educational seminars, workshops and support groups, the decision to allow abortion on demand may result in more than just a first and second victim - it may escalate to a psycho-social disaster involving a whole society.
Bibliography
Collins, GR (ed). 1988. Christian counselling: A comprehensive
guide. Dallas: Word.
Du Rand, MC (ed). 1997. Proceedings of the symposium on abortion
held on 15 March 1997 at Pretoria University (Foundation
for Ethical Medicine) (pp 26-53).
Kubler-Ross, E. 1969. On death and dying. New York: Macmillan.
Louw, DA. 1989. Suid-Afrikaanse Handboek vir Abnormale Gedrag
(South African Manual for Abnormal Behaviour)
(p 144). Johannesburg: Southern Book Publishers (Pty) Ltd.
Ross, L. 1992. Post-abortion counselling: Treating the victims of
"choice". Lecture given at the Second International
Congress on Christian Counselling. Atlanta: Georgia.
Schoeman, V. 2004. Gewurg en geskel (Strangled and scolded). Die
Son, 3 September 2004 (p 4). City Deep: Media
24.
Speckhard, AC & VM Rue. 1992. Postabortion Syndrome: An emerging
public health concern. Journal of Social Issues.
Vol. 48, No. 3, pp 95-119.
Wilmoth, G, D Russell & B Wilcox. 1991. Abortion and family policy:
A mental health perspective. In: EA Anderson &
RC Hirla (eds). The reconstruction of family policy (pp
111-127). New York: Greenwood.
Works by the author:
Stoornis
(pictured left)
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Nini Bennett was born in Pretoria in 1972. She obtained
a BA (Honours) (cum laude) in Literary Studies (Algemene Literatuurwetenskap)
from the University of Pretoria. In 2002 she obtained a Masters
degree in Creative Writing (also cum laude) under the supervision
of Etienne van Heerden. Her short story collection Stoornis
was published by Tafelberg Publishers in 2002 and was awarded
the RAU Mardene Marais Prize for the best debut publication
in Afrikaans (2003).
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