Friday, May 05, 2006

Feel-Good Propaganda from the Guttmacher Institute

Everywhere someone’s getting over
Everybody cries, and sometimes
You can still lose even if you really try

Talking ‘bout the dream like the dream is over
Talk like that won’t get you no where
Everybody’s trusting in the heart
Like the heart don’t lie

~ “All I Need,” Matchbox Twenty

For most women…the time of greatest distress is likely to be before an abortion; after an abortion, women frequently report feeling “relief and happiness.”

~ “Abortion in Women’s Lives,” a report from the Guttmacher Institute, p. 24

The Guttmacher Report offers the survey results mentioned above as evidence against the development of post-abortion psychological problems, particularly post-traumatic stress disorder (aka post-abortion stress). The authors of this report would like us to believe that these good feelings of relief and happiness are proof that abortion does no harm to us psychologically. But since we first defined the disorder, we’ve known that emotions after a traumatizing event do not, in and of themselves, tell us whether the victim has been traumatized to the point of illness and whether they can or will develop PTSD.

To understand the nature of how post-traumatic stress disorder develops and the criteria for its diagnosis, we will try to understand how trauma is defined within the context of the illness; what factors precipitate development of the disorder (emotional responses are not strict indicators); and some examples of other traumatizing events that can leave us suffering from PTSD right alongside feelings of relief and happiness.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), defines a traumatic event as follows: “The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,” (Scaer, p. 1). As Dr. Scaer relates, that which is traumatizing has violated the boundaries of self:

“Violent physical assault in any form needs no rationalization to qualify as a survival-threatening event. The sense of safe separation between the assaulted person and the real world is shattered, especially if associated with physical pain and injury. Although a life-threatening illness presents a less physically tangible assault on one’s sense of self, the safe haven of our body is ruptured and redefined…witnessing a violent event involving life-threatening bodily injury of death may redefine what constitutes a safe boundary for us, may shrink that boundary, and therefore constitute a threat to our survival,” (Scaer, pp. 4-5).

According to the DSM-IV definition, that which is traumatic threatens the integrity of our bodies or our selves in a life-threatening manner. However, the DSM-IV definition does not reflect new research into the occurrence of PTSD. As stated by Dr. Glenn Schiraldi, author of The Post-Traumatic Stress Disorder Sourcebook, “consensus is emerging…that a variety of secondary factors can increase the risk of developing PTSD following exposure to traumatic events. These factors become more influential as the severity of the traumatic event decreases,” (Schiraldi, p. 37). Dr. Scaer maintains “…that the definition of a recognized response to traumatic stress must include not only those symptoms related to reexperiencing, arousal, and avoidance defined in the DSM-IV, but also must address comorbid, associated, and somatic symptoms known to be related to past exposure to trauma,” (Scaer, p. 132), and further, “…numerous studies support the concern that prior life traumatic events and psychiatric morbidity are associated with a higher risk of developing PTSD after a new trauma, and that this vulnerability may result in an enhanced traumatic reaction even with less intense traumatic exposure. As a result, even minor nonviolent societal trauma should not be dismissed as a source of significant trauma in selected populations,” (Scaer, p. 139).

What should this mean to the Guttmacher reporters? They tell us, “most abortion…occurs in the context of an unwanted pregnancy, and it is very difficult to tease apart the effects of these two events. Psychological problems that develop after an abortion may not be caused by the procedure itself, but instead may reflect other factors associated with having an unwanted pregnancy, or those unrelated to either the pregnancy or the abortion, such as a history of emotional problems or intimate partner violence,” (p. 24). In their efforts to separate abortion from any psychological problems that result, the Guttmacher authors ignore a significant and growing body of research that urges us to consider a history of trauma, including the trauma of the unwanted pregnancy itself, as a trigger for a traumatic response to abortion.

There are other factors in addition to a history of traumatiziation that come into play in the development of the disorder, risk factors that can make “ordinarily” stressful events assume life-threatening proportions. According to Dr. Glenn Schiraldi, author of “The Post-Traumatic Stress Disorder Sourcebook,” these risk factors include (Schiraldi, p. 38):

• Underdeveloped protective skills, problem-solving skills, self-esteem, resilience, creativity, humor, discipline, ability to express emotions to others, ability to tolerate distress.

• Personality and habitually negative thought patterns (e.g., pessimism, depression, introversion).

• Biology. Some people appear to have overactive nervous systems. Heredity and a history of drug abuse appear to influence this factor.

A poor family environment during childhood that does not support a child's safe exploration of boundaries may result in our failure to learn what constitutes these boundaries, and can also make us more susceptible to developing PTSD as a result of stressors that would not ordinarily be viewed as life-threatening (Schiraldi, pp. 38-39). An accumulation of stressors can also weaken our defenses against serious illnesses such as PTSD, and include divorce, illness, financial pressures, or losing a job. Dr. Schiraldi calls all of these risk factors “pre-trauma vulnerabilities,” (ibid).

At the time of the traumatic event, PTSD is more likely to occur if the victim dissociates, perceives that she is responsible for the event or responded inappropriately, and/or feels alone or isolated. After trauma, PTSD is more likely to occur if the victim is still isolated; cannot talk about the pain she experienced; or is “…disbelieved, stigmatized, shamed, or shunned,” (Schiraldi, p. 39), particularly by those who are supposed to help the victim instead of inflicting further harm, as when a rape victim is asked whether she could have prevented her assault; and as happens when a physician …”minimizes the symptoms, belittles [the] one seeking assistance, or even refuses to render treatment,” (Schiraldi, p. 40).

Having defined what constitutes trauma, and the factors that can contribute to the development of PTSD even in the absence of an actual threat to life, let’s look at other known traumatizing events to determine whether emotions of relief and happiness have any bearing on whether the trauma victim will develop the disorder.

Surgery is an excellent example, and is listed in the DSM-IV as a potentially traumatizing event. Even if anyone would agree to surgery without expecting to benefit, few surgeons would operate if they did not anticipate offering the patient some relief. For example, if surgeons amputate a gangrenous leg, the patient may report feeling relieved and happy, because her life is no longer threatened. However, she remains vulnerable to PTSD, according to the DSM-IV which specifically lists amputation as a traumatizing event. Removing a burst appendix saves the life, but violates the integrity of the body; a hysterectomy may remove a source of cancer, and a threat to life, that can leave a woman feeling relieved and even happy; but it can also result in post-surgical psychological trauma.

Police officers who kill in the line of duty are not bound to negative emotions as a result. Their actions may have saved the life of another, or earned the regard of their peers. As Dr. Rachel MacNair writes in Perpetration Induced Traumatic Stress: The Psychological Consequences of Killing, “The officer’s traumatic symptoms are viewed as a sign of virtue and sacrifice for being a good officer…if it happens to a good officer doing his or her duty, acknowledging psychological difficulties is no insult….It is perceived as one of the reasons to be sympathetic to police officers.” Yet, no one would argue that police officers can’t develop PTSD because they have done their duty and may have positive emotions as a result; we often treat them immediately after a shooting in an effort to preempt the disorder. But as Dr. MacNair points out, “…as with all cases of Perpetration-Induced Traumatic Stress (PITS) [a form of PTSD], there are confounding possibilities on having PTSD before the incident…The extent to which PTSD symptomatology already exists before a shooting incident complicates the study of the etiological nature of the shooting itself,” (MacNair, p. 58). In fact, PTSD can develop in spite of an officer’s actually having been rewarded by his peers and society for his bravery; trauma and the illness that can result do not take such rewards into account.

PTSD was first identified, and early research focused on, the experiences of combat veterans, who, like police officers, kill in the line of duty and may receive honors for having done so. The most extensive work done on the psychological effects of killing and trauma in combat is On Killing: The Psychological Cost of Learning to Kill in War and Society, by Lt. Col. Dave Grossman. Grossman defines the stages of emotions that result after the traumatizing act of killing:

“When soldiers kill the enemy they appear to go through a series of emotional stages. The actual kill is usually described as being reflexive or automatic. Immediately after the kill the soldier goes through a period of euphoria and elation, which is usually followed by a period of guilt and remorse. The intensity and duration of these periods are closely related to distance. At midrange we see much of the euphoria stage…If a soldier goes up and looks at his kill – a common occurrence when the tactical situation permits – the trauma grows even worse, since some of the psychological buffer created by a midrange kill disappears upon seeing the victim at close range,” (Grossman, pp. 111-112).

Consider this in relation to a phenomenon reported by the Guttmacher authors in an effort to show us that we must ensure women have access to early abortion procedures:

“Thirty-four percent of women who have had an abortion at or before six weeks’ gestation would have preferred an earlier procedure; this proportion increases to 74% at 9-12 weeks and 92% at or beyond 13 weeks,” (p. 17).

The authors give us several reasons why women delay obtaining an abortion procedure, which I will cover in another article; however, they make no effort to explain why women who had later abortions more often reported a desire for an earlier procedure. They do not purport that these women suffered from more complications than women who had earlier procedures, although that is a risk. So why do the women who waited wish they had had the procedure earlier? Was it increased proximity to the kill, as Grossman would call it? According to the American Pregnancy Association,

“Some moms can feel their baby move as early as 13-16 weeks. These first fetal movements are called quickening and are often described as flutters. It may be difficult to determine whether this feeling is gas or your baby’s movements, but soon you will begin to notice a pattern. First-time moms may not feel these movements as early as second-time moms. Some moms, especially those in their first pregnancy, may not feel movement until 18-20 weeks...There is a broad range of when the first detection of movement can be felt, ranging from 13-25 weeks."

The independent movement of the fetus is an indication that what we lose in abortion is not an extension of ourselves, but a live being with an existence separate from our own. This would increase the likelihood that the late-aborters had an opportunity to consider the unborn as a child. This identification may increase our proximity to the kill, or traumatizing event, a factor that increases the likelihood that PTSD will develop. Additionally, the post-thirteen week abortion is likely to be surgical and/or painful. Surgery, as we’ve already noted, is invasive and threatens the integrity of the self, as does severe pain. Are these “preferences” reported in the Guttmacher report indications that these women were negatively affected by their abortions? But if abortion results in our feeling relieved and happy more often than not, why wouldn’t we be relieved and happy at any stage of the procedure? And why wish that a past event would have happened differently, an emotion we often call regret?

We can feel some or all of the entire human array of emotions after abortion, including relief, happiness, sorrow, and regret. But however we feel, it doesn’t matter, because we are still vulnerable to developing post-traumatic stress disorder, perhaps because the procedure or act of abortion violates the integrity of self/body, or because we have past experiences or conditions that predispose us to developing the disorder, or because we have been isolated, shunned, and shamed – and not just by those who disapprove of abortion, but also by those who provide them.

The Guttmacher report is blowing proverbial smoke, asking us to believe, contrary to the accepted diagnostic criteria for PTSD (and the growing body of research), that the report of a positive emotional response precludes the development of this neuropsychological illness. This misuse of information is detrimental to women’s health. Propaganda is defined as “information that is spread for the purpose of promoting some cause.” We will continue to evaluate this particular piece of same in future segments.


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