Tuesday, June 07, 2005

PTSD, Abortion, and Chronic Pain

As established in the last segment, abortion is intrinsically traumatic, although not all will be traumatized by it. But some women will develop a form of post-traumatic stress disorder known as post-abortion stress syndrome, or PAS. The existence of PAS is in dispute in the medical community, for what I can only imagine are ideological reasons that have nothing to do with health or care. As discussed previously, even abortion clinic workers are traumatized by what they are doing, and many of them claim to be doing it for benevolent reasons. It is clear then that the perceived benefit of abortion is no defense against being traumatized by it. Many women do not express regret over their abortions because they believe the abortions helped them, and sometimes they even believe the abortions helped the unborn child. We’ve already seen, though, that guilt and regret are absolutely unnecessary in the development of post-traumatic stress disorder. The perpetrator can indeed be traumatized by her own actions because the traumatic response occurs in the brain at a fundamental level that does not consider the belief systems she may have constructed that justify these actions. When she develops post-traumatic stress disorder, she is responding to the perceived threat against her own life that is inherent in the destruction of the life held so intimately in her own body.

But while guilt is not a factor in the development of PAS, a feeling of helplessness is, according to Dr. Robert C. Scaer, MD, author of The Body Bears the Burden: Trauma Dissociation and Disease (The Haworth Medical Press, 2001). In his words, PTSD “is produced by threat, shock, or injury that occurs in a state of helplessness,” (Scaer, p.xxi). In the animal kingdom, we see three different responses in situations which threaten the survival of the animal: the fight/flight/freeze response. Most of us are familiar with the fight or flight response. The freeze response is less commonly understood, according to Dr. Scaer. When the animal is helpless, unable to flee or defend itself against a threat, nature provides a third mechanism by which it might possibly survive: the animal freezes in an instinctual and unconscious reflex into a state of immobility, created and sustained by the parasympathetic nervous system, a division of the autonomic nervous system.

Sometimes the predator, faced with prey that is suddenly and entirely immobile as if dead, gives up and the animal survives – “playing possum.” Additionally, in the freeze response, the brain releases endorphins, which we all know as the body’s natural pain killers. Dr. Scaer remarks, “Whether this analgesia has survival value, or is a gift from a greater Being to prevent a painful death is open to debate,” (Scaer, p. 16). Another reason for the animal to be dissociated from the pain might be to keep it from its natural desire to tend to its wounds before it has completely reached safety, just as endorphins work in the flight or fight response to keep the animal from feeling pain that would impede either action.

Following the freeze response, there is a “discharge” of this autonomic nervous energy, which has been stored while the animal mimicked death. Animals in the wild and in the laboratory have been observed to tremble and perspire when they arouse from the freeze response, and oddly enough, the first movement they make is often a postural representation of what they were doing at the exact moment the freeze response was invoked – their legs will work as though running, for example, if they froze while being pursued, even while they are still lying on the ground. This is indicative of a period of unconsciousness or amnesia.

Dr. Scaer postulates that the freeze response exists in humans, but not usually to the extent it is seen in the animal kingdom. He describes it as the psychological equivalent of dissociation, in which specific, anxiety-provoking thoughts, emotions, or physical sensations are separated from the rest of the psyche: “…people [suffering trauma]…will frequently relate that they felt as if they were ‘in shock.’ This is often related as a sense of detachment, numbness, and even confusion. Time often seems to stand still. Some patients report that they feel as if they are detached and removed from their body, occasionally reporting the events of the trauma as if they were seeing them as a third person…many of the posttraumatic symptoms that occur often for years after the unresolved trauma are characteristic of dissociation, or recurrence of the symptoms of freezing,” (Scaer, p. 19).

Humans also don’t seem to have a period of discharge of autonomic nervous system energy after trauma, either, which leads Dr. Scaer to speculate that “the self-perpetuated circuitry involved in kindling is remarkably compatible with absence of discharge…” (Scaer, p. 20). “Kindling” results from the build-up of nervous energy that is not dissipated. Dr. Scaer believes that without the dissipation of this autonomic nervous system energy, “the ‘survival brain’ may continue to perceive that the threat continues to exist, and is unable to relegate it to memory as a past experience,” (Scaer, p. 21). In other words, post-traumatic stress disorder is physiologically expressed by autonomic nervous system dysfunction.

Kindling refers to the spontaneous combustion of materials reaching a certain critical temperature. In neurological terms, kindling refers to the process by which electrical impulses can add up and trigger spontaneous responses. The PTSD nervous system smolders with undischarged energy that bursts into full flame, and the resulting neuropsychological symptoms include flashbacks, intrusive memories, cue-related memories, nightmares, anxiety, panic attacks, phobias of events and places reminiscent of the trauma, memory and situation-induced arousal, mood changes, irritability, stimulus sensitivity (to light and sound, for example), exaggerated startle response, and insomnia. Furthermore, because the autonomic nervous system is involved, there are “often dramatic physical symptoms, including bowel disorders, myofasical pain, and cognitive impairment….We therefore seem to be dealing with a syndrome affecting all aspects of a person’s being, including body, mind, and spirit,” (Scaer, p. xxi).

This leads Dr. Scaer (and others) to the conclusion that “many of those chronic diseases that seem to be the most common,” and the most difficult to treat, “may well have their roots in the insidious systemic effects of traumatization,” (Scaer, p.21). He continues, “in fact, I believe that the most common complaint in current medical practice, that of persistent and unexplained chronic pain, has its roots in the persistent changes in brain circuitry associated with unresolved traumatization, and the continued tendency for dissociation to occur in the face of stress or threat,” (ibid). He describes the disorders resulting from post-traumatic stress disorder as psychophysiological, and they include fibroymalgia, chronic fatigue syndrome, reflex sympathetic dystrophy, and somatization disorders that drive people to doctor after doctor, seeking a diagnosis for that which apparently cannot be explained. Dr. Scaer is very sympathetic to these patients, adding that they suffer the burden of being retraumatized and devalued by a medical community that will deny the physical validity of their very real pain (Scaer, p. 81).

The physical complaints associated with post-traumatic stress disorder include headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain and other pains throughout the body. NIMH explains that “Often, doctors treat the symptoms without being aware that they stem from PTSD. NIMH, through its education program, is encouraging primary care providers to ask patients about experiences with violence, recent losses, and traumatic events, especially if symptoms keep recurring.”

One of the most mysterious of the psychophysiological disorders is fibromyalgia. More than 90% of those diagnosed with fibro are women of reproductive age. Researchers have already noted that large numbers of those women diagnosed with fibromyalgia have some kind of trauma in their histories – most often, it is childhood physical and/or sexual abuse. The physical symptoms of fibromyalgia include: headaches, fatigue, pain, vertigo (dizziness), chest pain, irritable bowel syndrome, low-grade fever and flu-like feelings. It seems likely that Dr. Scaer and the National Institutes of Mental Health are correct in speculating that fibromyalgia and its cousins may actually be undiagnosed post-traumatic stress disorder, undiagnosed in my opinion because physicians and researchers aren’t able to identify a source of trauma – but then, they aren’t looking for abortion in our medical histories. For the most part, it seems the medical community is standing around scratching its collective head while women get sicker and sicker with illnesses they can’t quite diagnose or understand.

As we can see from Dr. Scaer’s model of the freeze response, helplessness is a primary factor in determining whether a traumatic event will be traumatizing. According to the Elliott Institute’s report, Forced Abortion in America, eight in ten women who had abortions report they would have chosen to give birth instead if they had received support and encouragement from friends and family. The woman who aborts her child because she feels she has to, because she is financially, socially, or otherwise isolated and without help submits to a procedure that results in violent death, and is primed to develop post-traumatic stress disorder as a result.

Not all women who have abortions will develop PAS, as I’ve mentioned before, but that shouldn’t ease our minds. Most people who suffer from post-traumatic stress disorder have multiple traumas in their histories which did not at that time trigger symptoms of PTSD, but which weakened them against future traumas, making them more susceptible to develop the disorder each time. Also, the symptoms of PTSD appear on a continuum – some will suffer less than others. Again, each successive traumatic event will be more difficult to handle, and, because of the kindling effect in the nervous system, it actually takes less severe trauma to incur the most severe results as time and stress march on. Occasionally, I have to take a second look at the title of my blogspot – abortion hurts. We have been practicing unrestricted abortion on demand in this nation for thirty years without regard to the consequences, and without medical research that determines whether or not this is really as benign a procedure as we are promised it will be. It's pretty clear to me, though, that the evidence is already in. Not only is abortion not benign, it is malignant, and it is making us sick.

Friday, June 03, 2005

Perpetration-Induced Traumatic Stress

It was several months ago, and the question posted at the After Abortion blogspot was intriguing: “If Terri Schiavo dies, will Michael Schiavo suffer from post traumatic stress like women who have abortions do?” T he questioner was in earnest, and it got me thinking – not whether Michael Schiavo would suffer from PTSD – but whether or not our own involvement in creating trauma has any significant effect, especially on women who abort.

As it turned out, we weren’t the only ones wondering if and how we can cause our own PTSD. Rachel M. MacNair explores the issue in her book, Perpetration Induced Traumatic Stress: The Psychological Consequences of Killing, published in 2002 by Praeger Publishers. MacNair describes PITS as a subset of post-traumatic stress disorder. She provides detailed results of scientific studies of those who participate in sanctioned killing in addition to rich, anecdotal evidence from historical accounts of those who have killed, sanctioned and otherwise.

The evidence that post-traumatic stress disorder can and does result even when one is the perpetrator of the violence is clear. MacNair describes it in detail as it results in combat veterans, executioners, law enforcement officers, Nazi war criminals, and abortion clinic workers. She avoids any extensive discussion of PTSD as it applies to women who procure abortions, saying only:

“Some scholars have proposed that women who undergo abortion have a variant of PTSD, which they call Post Abortion Syndrome. Controversy rages over whether this exists or not. Some studies show that it does, others show that it appears not to, and there seems to be a high correlation between the bias of the researcher and the results. Opponents of the concept of postabortion problems believe that proponents are trying to undermine the actual benefits of abortion. Proponents, on the other hand, believe that people who are making a profit or have an ideological commitment are trying to ignore the negative. Over 300 studies with varying outcomes have been done on this matter, and it is subject to intense debate,” (MacNair, p. 71).

Regardless of the controversy and bias of researchers, there is enough evidence in the existing research to conclude that abortion can and certainly does cause post-traumatic stress syndrome. MacNair says it best herself, introducing the chapter on PTSD among abortion practitioners: “Defenders of abortion believe that it is a form of medicine. Opponents believe it to be killing. If abortion is the taking of a human life, then the psychological consequences of PITS could be expected among those who perform abortions. If we find no such aftermath, the case is strengthened that abortion is not violence at all.” I have to add that if we find evidence of PITS among abortion clinic workers, we are unreasonably blind to think the woman who aborts is somehow shielded from the same trauma.

So do abortion practitioners show signs they suffer from Perpetration Induced Traumatic Stress, or PTSD? MacNair says there has been little research, but there is plenty of anecdotal evidence, and all of it says they do. She finds only two studies that were not done by researchers who work in the abortion field and which looked at large numbers of people, both performed by abortion proponents, and notes, “in contrast to the studies of postaborted women, they both note the high prevalence of symptoms that fit under Posttraumatic Stress Disorder,” (MacNair, p. 72).

According to MacNair, the National Abortion Federation has addressed the issue of trauma among abortion clinic workers already, but it is a well-kept secret. Warren Hern, an abortion specialist, in a paper given to the Association of Planned Parenthood Physicians said the following: “Some part of our cultural and perhaps even biological heritage recoils at a destructive operation on a form that is similar to our own, even while we may know that the act has a positive effect for a living person.” In other words, it doesn’t matter if we think the unborn child is a person or not. It doesn’t matter whether we believe it is aware or sentient.

The physical and psychological resemblance of the unborn to that which is instantly recognizable as human is enough for us to recoil at its destruction. Our brains recognize it as human death, at psycho-neurological levels that are not affected by the higher cognitive functions where we develop the belief systems that justify killing. MacNair says “it is not normal for medical staff to regard surgery as trauma,” yet clinic workers report a common and widespread symptom of trauma: dreams and intrusive thoughts about the aborted fetuses. The American Medical News reported from the National Abortion Federation Workshop, “they wonder if the fetus feels pain. They talk about the soul and where it goes. And about their dreams, in which aborted fetuses stare at them with ancient eyes and perfectly shaped hands and feet asking, ‘Why? Why did you do this to me?’” (MacNair, p. 75). Clearly, abortion is intrinsically and always psychologically traumatic because it involves at least the idea, if not the physical evidence, of the destruction of human life.

The destruction of human life is traumatic. Quite simply, it has to be. Human beings must have an aversion to killing each other more often than not, or we wouldn’t be able to live together. Additionally, the killing of another human being is designed to invoke in us the automatic and autonomic nervous system response we know best as “fight or flight.” This response also includes a third option “freezing,” as described by Dr. Robert C. Scaer, in The Body Bears the Burden: Trauma, Dissociation, and Disease published by the Haworth Medical Press in 2001. Freezing is our “deer-caught-in-the-headlights” look, and it is this response that Dr. Scaer says causes post-traumatic stress disorder. This is a simple survival response because what killed another human might also kill us, and it is processed in what some call the most primitive part of the brain, an area we cannot consciously control. This is also why and where we recognize and differentiate human versus non-human. A dead tree in the forest is not usually a sign of imminent danger, unless it’s on fire, perhaps, but a dead human can certainly be. Our brains recognize the features of human faces even as infants.

I don’t like the word, “primitive” as it applies to brain function because it implies that our brains were once less than what they are, and I simply don’t believe that. It is more likely to me that what works in simpler animals for survival works equally as well for human survival, and a good designer doesn’t keep reinventing the wheel. It also implies that the automatic regions of our brain are somehow inferior, and therefore, we terminate the lives of people whose only brain function is the most basic. It’s an absurdly out-dated idea. There is memory in the brainstem, and emotional responses – things we use all the time, that are a part of who we are as individuals. Death, human and violent, affects us directly and immediately, because we need that kind of response in order to survive.

My premise is that abortion is traumatic because it is always perceived as involving death, and consequently, it will always stimulate the autonomic nervous system response to danger. To begin, here is my very primitive description of how the autonomic nervous system works. It is not primitive – it is foundational. Perhaps it is the equivalent of the operating system of the body, and higher levels where thought and declarative memory (memories we can put into words) exist are like applications. Some of us have stronger applications than others, but we all have the basic operating system. The autonomic nervous system runs the things we can’t possibly take the time to think about doing. I t regulates things like digestion, heart rate, breathing, reproductive cycles, and reflexes. Imagine if we had to think about beating our hearts 90 times a minute. There wouldn’t be any time to do anything else, but if our hearts don’t beat, we die. That’s another feature of the autonomic nervous system – it takes care of the things that keep us alive so we don’t have to think about those, either, and in order to do that, it has a memory of its own.

Why is it a matter of survival for the autonomic part of our “thinking” system to take over in a life-threatening emergency? Because what matters most when our lives are in danger is how quickly we react, and how effectively we react. Our responses have to be fast because most threats appear suddenly. They also have to be learned permanently the first time, because we may not get another chance to learn how to avoid the danger. Imagine you are in the jungle, and a large orange animal with black stripes jumps out at you from the bushes. You’ve never seen an animal like it before. How do you know if it is a threat? If at that point in time you had to mentally compare the animal to every other animal you have ever seen or read about, detail by detail, you would be killed and eaten before you’d eliminated “aardvark.” Certain features are going to stand out, features that can be evaluated and compared to current knowledge quickly, in an easily accessed part of the brain where memory/recognition of important things like this is stored. The sight of fangs, the sound of a growl, the smell particular to meat-eating animals, perhaps a human finger caught in those giant teeth – this input from all of our senses is received and processed in our brains autonomically, so we can climb the nearest tree quickly without taking precious, life-saving time to think about whether it’s necessary.

Our responses to danger have to be learned permanently, too. If the tiger goes away after we’ve climbed the tree, then we learn that it is an effective way to avoid being killed by one. So after the first tiger grows bored and leaves us alone, when we continue down the path and run across the next tiger, not only do we instantly recognize him based on less information than we needed to the first time, but we also remember to head for the nearest tree, and fast. It’s called “conditioned” learning, and it’s the same thing that made Pavlov’s dogs slobber at the sound of the bell even when there was no food to eat, because he had taught them to associate the food with the sound.

In the tiger situation, fear is an appropriate emotional response, and it results in the autonomic fight/flight/freeze response that we commonly think of sending adrenaline coursing through our veins. Our bodies get ready for what we have to do – if we are to flee, or fight, adrenaline increases our strength. If we are unable to do either, then we resort to freezing, like animals caught in a trap. It is the autonomic nervous system directing our physiological responses the whole time – releasing endorphins, for example, to help us ignore the pain if the tiger claws our legs on the way up the tree. Here then is the relationship between post-traumatic stress disorder and autonomic nervous system dysfunction as described by Dr. Scaer, who postulates that the autonomic nervous system is malfunctioning in those whose initial alarms fail to subside after the threat has passed (in other words, in those who develop PTSD).

How does the autonomic nervous system response to danger apply to women who submit to abortions? It’s been established that the thought or sight of human death causes us to fear for our own lives, putting us in a state of autonomic nervous system arousal. Can the thought or the sight of human death make us fear for our own lives even when we cause the death of the other human being? In other words, does anticipating the traumatic event have any effect on whether the event is traumatic? No, it doesn’t. Dr. Scaer is a neurologist and psychiatrist who works with people who have been traumatized in motor vehicle accidents. In his experience and in the research, he finds there is absolutely no significant difference between the traumatic response of those who saw the accident coming, and those who didn’t. Consequently, even if we can expect to see someone die because we are causing it, it doesn’t matter. The death itself is recognized as a threat autonomically, so anticipating it on a higher level in our brains doesn’t do anything to block the automatic response. Yes, killers can be traumatized by their own actions, and women who abort can be traumatized by their abortions, too.

MacNair looks at the conclusions of Dr. Lisak, a counselor of deathrow murderers, who established from his case studies that, “…the act of murder can indeed traumatize the murderer…They were the creators of these scenes of horror, but they were by definition also witnesses to them. The images seared them no less than those images would sear any witness,” (MacNair, p. 62). Guilt is also an unnecessary component in trauma, although it can certainly be a complicating factor in recovery. And there is certainly reason to believe that symptoms of PTSD can underlie future violent activity, particularly since outbursts of rage are a common symptom.

This journaler suffered from PTSD:

“Toward the end of the first two years, which had passed monotonously and without any special incident, I was overcome by a most peculiar state of mind. I became very irritable, nervous, and excited. I felt a disinclination to work…although I had hitherto thoroughly enjoyed…work. I could no longer eat and I brought up every mouthful that I forced myself to swallow. I could not read any more and became completely unable to concentrate. I paced up and down…like a wild animal. I lay awake all night, although I had up to then always fallen at once into a deep and almost dreamless sleep. I had to get out of bed and walk round…, and was unable to lie still. Then I would sink exhausted on to the bed and fall asleep, only to wake again after a short time bathed in sweat from my own nightmares. In those confused dreams I was always being pursued and killed, or falling over a precipice. The hours of darkness became a torment. Night after night I heard the clocks strike the hour. As morning approached, my dread increased. I feared the light of day and the people I should have to see once more. I felt incapable of seeing them again. I tried with all my strength to pull myself together, but without success. I wanted to pray, but my prayers dissolved into distressed stammering. I had forgotten how to pray, and had lost the way to God. In my misery I believed that God had no wish to help me, since I had forsaken Him.”

Rudolf Hoess, the infamous commander of Auschwitz who oversaw the gassing of approximately two million people from July 1941 to the end of 1943 wrote the above journal entry in 1924, while in prison for a savage murder he committed with his own hands. He was one of a group of Nazis who were administered a Rorschach inkblot test while imprisoned after the Second World War. His responses to that test, as well as his jail cell complaints from 1924, were consistent with someone who suffers from PTSD. MacNair concludes that, in Hoess’ case, “what caused what and when has been lost in the mists of time, but Hoess’ case illustrates the possibility that knowledge of PITS serves not only as a way of dealing with those who suffer from it, but perhaps also as an important tool in prevention efforts,” (MacNair, p. 54).

Hoess and other Nazis, who personally oversaw the death of millions, had PTSD symptoms. Law enforcement officers who kill on the job, because they have to, suffer from it to the extent that many police departments have mandatory counseling for every officer involved in a shooting, particularly a fatal incident. And abortion clinic workers suffer from trauma because of their proximity to perceived human death. Yet somehow we are expected to believe that women who undergo abortions are exempt from the trauma of death when it comes to bumping off their unborn children. How could this even be possible? Well, it isn’t. It is in fact arguable that her proximity to the unborn child, including the chemical communication that exists between her body and her child’s, which begins at conception when the fertilized egg sends chemical signals to the mother’s body to prepare it for implantation and pregnancy, makes it even more likely that the mother will identify abortion with the death of another human being, one close to her.

Violent death is inherently traumatic. Abortion is perceived as an act of violence resulting in death even by those who believe they are doing it for benevolent reasons. This is because the human response to death is perceived at an autonomic level in our brains that does not consider the philosophical idea, but only that visceral, gut response that moves us to avoid those things that can hurt us. It is reasonable to conclude that abortion is intrinsically traumatic. Not every witness to a traumatic event develops PTSD, but those who do can become very ill indeed, because unlike the abortion practitioner, the woman who submits to an abortion has an added complication: the “helplessness” factor. No longer able to fight, certainly unable to flee, she faces this life-threatening situation by freezing. In the next segment, I will describe how this freezing response to the trauma of abortion is responsible for psychophysiological illness, based on the research of Dr. Scaer. Later, we will examine the consequences when maternity is associated with trauma, and the possible physiological brain mechanism that makes an inability to bond with our children a potentially unavoidable consequence of abortion.