Wednesday, May 03, 2006

Guttmacher Report Supports Abortion-PTSD Link

“Since the APA panel’s review of the scientific literature, there has been a new wave of analyses that report correlations between a history of abortion and a range of conditions, including psychiatric treatment, depression, anxiety, substance abuse and death…Many of these studies, however, have methodological shortcomings that make it impossible to infer a causal relationship. None adequately control for factors that might explain both the unintended pregnancy and the mental health problem, such as social or demographic characteristics, preexisting mental or physical health conditions, childhood exposure to physical or sexual abuse, and other risk-taking behaviors. (Childhood exposure to physical or sexual abuse, for instance, is known to be associated with unintended pregnancy and abortion, and also with risk for a psychological disorder.) Because of these confounding factors, even if mental health problems are more common among women who have had an abortion, abortion may not have been the real cause.”
~ Abortion in Women’s Lives, a Guttmacher Institute report (emphasis mine)

Reading this report by the Guttmacher Institute (an arm of Planned Parenthood), “Abortion in Women’s Lives,” is much like reading about the health effects of cigarette smoking as prepared by RJ Reynolds. In other words, the fox guarding the hen house isn’t about to tell us he has a conflict of interest, so we must read with care. HT: to Annie Bano of After Abortion, who sent me the link to this report. It serves some useful purposes – the fox is the only one who can tell us how many hens he is guarding. However, as a guide to whether or not there are dire psychological consequences related to abortion, the report is wishy-washy. On the one hand, the authors want to dismiss the relationship between abortion and PTSD because it is not proven as causal; and on the other hand, they offer information that supports the existence of a correlation.

Any first-year student of psychology can tell us the difference between cause and correlation. Yet, the report’s authors expect us to read the above paragraph as stated without regard to the definition of these terms, and without explaining that reaching conclusions about causal relationships in psychological research is always problematic. Most relationships drawn in psychological research are correlative because psychology is not a hard, objective science like physics, or mathematics, where certain laws exist that are apparently immovable – drop an apple from a tree on planet Earth, and it will fall to the ground because of gravity. However, not everyone who experiences trauma will develop PTSD – a + b does not always equal c in the subjective social sciences.

The “new wave of analyses that report correlations between a history of abortion” and psychopathology are doing just that – reporting correlations. Remember that the majority of PTSD sufferers have experienced multiple traumatic events – identifying one “real" cause is difficult, because it is the cumulative history of trauma that is most likely responsible for the onset of illness. Still, the report’s authors are leveling criticism against these studies on the basis that they cannot show a causal relationship. This implies a lack of understanding of the nature of post-traumatic stress disorder itself, at a very basic level that should make us suspicious about whether the report’s authors are qualified to discuss its existence as a consequence of abortion beyond the mere reporting of statistics.

For expert advice, let’s turn to Dr. Robert Scaer, MD, author of “The Body Bears the Burden: Trauma, Dissociation, and Disease.” I have no difficulty finding evidence of his qualifications to speak about trauma – Dr. Scaer is a neurologist and psychiatrist who has done a great deal of research into the kindling effect of multiple traumatic experiences on psychological and physical health (See this article, “One, Two, Three Strikes – You’re Out!” for a description of kindling theory). It is evident that a history of trauma weakens our defenses against developing PTSD. For example, studies show a higher incidence of PTSD among combat veterans with a history of trauma; past experiences, and our subjective understanding of them, contribute to the way we deal with current stressors. As Dr. Scaer notes, “The female victim of incest or rape predictably might develop acute PTSD after an experience of transient fondling on a crowded bus, whereas a previously nontraumatized female might respond with anger and fear, but not dissociation,” (Scaer, p. 129).

But the Guttmacher authors grudgingly admit to the correlation between traumatic history and psychological problems before and after abortion: “Certain factors are more common among women with a history of unwanted pregnancy and abortion than among other women, and health outcomes that might be more common among women with a history of abortion may be the result of these unmeasured factors that preceded the abortion. For example, a history of childhood sexual abuse, emotional problems, intimate partner violence or high levels of stress may be more common among women who have unintended pregnancies (and thus abortions), and may also lead to later psychological problems,” (p. 23, inset).

So, women with a history of trauma, particularly in childhood, may be at a higher risk for psychological problems after abortion, but not necessarily as a direct result of their abortions; instead, the Guttmacher authors tell us that the abortion added fuel, or kindling, to the fire, and these problems are appropriately associated with a series of traumatizing events. It isn’t exactly a causal relationship, but then, “….people are primed to respond to a variety of stressful events based on a myriad of predisposing factors. What may produce surprise and perhaps consternation in one individual may induce shock and dissociation in another. The potential for an event to be traumatizing depends in part on the meaning of the event to the person experiencing it,” (Scaer, p. 132). Prior traumas are part of our medical history, and "studies of PTSD and other psychiatric disorders implicate the patient’s past emotional health in the development of these disorders,” (Scaer, p. 147).

To blame the occurrence of PTSD after abortion on a history of psychological, emotional, and/or social problems does not refute the possibility of its developing after abortion and as a result of abortion(note that the report does not state that it is impossible for abortion to be interpreted as a potentially traumatizing event); indeed, the Guttmacher authors are giving us evidence to support the relationship between PTSD and abortion, even if that relationship cannot be strictly defined as causal, because they are telling us that women with a history of trauma more often seek abortions than those without that history, and they confirm that this history predisposes women to develop psychopathology after (additionally, in telling us that many women who seek abortion have preexisting psychological and/or social problems, they are calling into question whether the act of seeking an abortion is intrinsically a choice made by women in their "right" minds).

But they do so in a way that suggests we should ignore the medical history of women who seek abortions, which suggests that they are unconcerned with the consequences of adding burdens to those who have already been traumatized. They blame the victims for having preexisting conditions which they would like to ignore. But as Dr. Scaer cautions, “It certainly behooves us as the caregivers and healers who attempt to lessen the ravages of unresolved trauma not to contribute to its effects through procedures, institutions, traditions, and behaviors that unknowingly serve to initiate or perpetuate trauma,” (Scaer, p. 156).


At 10:47 AM, Blogger GrannyGrump said...

I suppose the fact that they mentioned it at all, rather than the usual Rah! Rah! attitude, is progress. Of a sort.

At 3:07 PM, Blogger j2 said...

Julie, very good review. I was aware of this information several months ago but hadn't drawn the connections with PTSD the same way that you did. I am so glad that you are writing again as you definitely add to the conversation.

The group "Feminist for Life" seem to be very well placed in legislative circles. Perhaps you could work with them to initiate an interest in funding a more comprehensive study of the after effects without using the Guttmacher Institute's data. The APA is known for its politicized bias, but they are more apt to recognize the validity of a PAS-PTSD connection when approached the way you have been doing it.

At 9:39 AM, Blogger aus blog said...

Put simply:

Post Traumatic Stress Disorder (PTSD).

The essential feature of "Post Traumatic Stress Disorder" is the development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience.

Many things can cause PTSD. War can be a trigger, as can abortion, in fact any significant traumatic experience can do it.

In people who have experienced a traumatic event, about 8% of men and 20% of women develop PTSD after a trauma.

Symptoms of PTSD can include the following: nightmares, flashbacks, emotional detachment or numbing of feelings (emotional self-mortification or dissociation), insomnia, avoidance of reminders and extreme distress when exposed to the reminders ("triggers"), irritability, hypervigilance, memory loss, and excessive startle response, clinical depression and anxiety, loss of appetite, powerlessness, hopelessness and profound guilt, just to name a few.

Many of us may be susceptible given a harrowing enough experience.


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