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Thomas W. Strahan Memorial Library
Standard of Care for Abortion
Abortion Decision-Making
Psychological Effects of Abortion
Social Effects and Implications
Physical Effects of Abortion
Abortion and Maternal Mortality
Adolescents and Abortion
Definition of Terms
Women's Health After Abortion
Material Yet to be Cataloged
Strahan Summary Articles

Psychological Effects
Validity of Studies
Risk Factors
Grief and Loss
Ambivalence or Inner Conflict
Intrusion / Avoidance / Nightmares
Self Punishment
Psychiatric Treatment
Self-Destructive Behavior
Substance Abuse
Long-Terms Effects of Abortion
Replacement Pregnancies
Impact of Abortion On Others
Rape, Incest, Sexual Assault
After Late Term Abortion

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The People of the Lie, M. Scott Peck, (New York: Simon and Schuster, 1983).

Ed Note: This is a popular book that deals extensively with the problem of deception.

"Doctor-Patient Relationships in Fetal/Infant Death Encounters," Larry G. Peppers and Ronald J. Knapp, Journal of Medical Education 54:776-780, October 1979

Many physicians thought less about death than control group subjects, patients and other nonprofessionals but they were more afraid of death.

"Psychological Treatment for Anxiety Disorders: A Review," MG Gelder, Journal of the Royal Society of Medicine 79:230-233, April 1986

There is now wide agreement that the best psychological treatment for cases of phobic avoidance is exposure to situations that have been avoided, presumably because avoidance interferes with the natural processes by which anxiety reactions are terminated.; citing Mathews, Gelder, Johnston, Agora-Phobia: Nature and Treatment. London: Tavistock Publications (1981).

Aborted Women: Silent No More, David C. Reardon, (Chicago: Loyola Press, 1987).

In a survey of 252 women who had abortions and later became members of Women Exploited by Abortion, over 70 percent reported there was a time when they would have denied the existence of any reactions after their abortions. For some this denial stage lasted only a few months, for others it lasted over ten or fifteen years.

"Abortion and the Techniques of Neutralization," W. C. Brennan, Journal of Health and Social Behavior 15:358 (1974).

The author examines various techniques of rationalization whereby aborters alleviate guilt, depression and anxiety, including denial of personal responsibility for the pregnancy; denial that the unborn is a victim by referring to it as a piece of tissue or characterizing it as an aggressor; portrayal of and-abortion activists as hypocritical, chauvinistic or morally arrogant; appealing to feminist or Protestant church groups for justification.

The Anatomy of Bereavement, B. Raphael, (New York: Basic Books, 1983), p. 238.

A woman may have required a high level of defensive denial of her tender feelings for the baby to allow her to make the decision for termination. This denial often carries her throughout the procedure and the hours immediately afterward, so that she seems cheerful, accepting, but unwilling to talk at that time when supportive counseling may be offered by the clinic.

"Testing a Model of the Psychological Consequences of Abortion," Warren B Miller, David J Pasta, Catherine L Dean in The New Civil War. The Psychology, Culture and Politics of Abortion, Ed. Linda J Beckman, S Marie Harvey, (Washington, D.C.:American Psychological Association, 1998) 235-267

Women who participated in a clinical trial of Mifepristone abortion exhibited acute pre- abortion stress which was dominated by high avoidance, intrusion, and anxiety. The authors concluded that, "what appears to be happening is that the women are trying to control their response to the unwanted pregnancy/abortion situation by avoiding thinking about it.")

"Current Status and Trends in the Development of Post Abortion Healing," Sr. Paula Vandegaer, Healing Visions Conference, Part II, Center for Continuing Education, University of Notre Dame, July 1987.

Denial can be overcome by confronting the individual factually and helping the woman talk about her abortion. Defense mechanisms such as rationalization, suppression, repression, compensation and reaction formation are some of the defense mechanisms used.

"Coping with Abortion," Larry Cohen and Susan Roth, Journal of Human Stress, 10:140- 145, Fall, 1984,

This study found a wide range of responses to the abortion procedure. A generalized stress response syndrome was reported. Groups designated as "avoiders" expressed more distress than "non-avoiders"; approachers decreased in stress over time while non- approachers did not.

"Family Relationships and Depressive Symptoms Preceding Induced Abortion," D Bluestein and CM Rutledge, Family Practice Research Journal 13(2): 149, 1993

Depression scores of women immediately before undergoing an abortion increased as denial increased.

"Understanding Adolescent Pregnancy and Abortion," Sherry Hatcher, Primary Care 3(3): 407-425, September 1976,

The early adolescent tends to deny any responsibility for her pregnancy; she has used no contraceptive measures and employs defensive denial as much as possible throughout her pregnancy experience.

"Psychophysiologic Aspects of Denial in Pregnancy: Case Report," K. Milstein and P. Milstein, J. Clin. Psychiatry 44(5): 189-190, May, 1983.

Denial is defined as "a defense mechanism, operating unconsciously, used to resolve emotional conflict and allay anxiety by disavowing thoughts, feelings, wishes, needs or external reality factors that are consciously intolerable." Despite intense denial, the patient was functioning adequately in all observable areas of her life. ( Ed Note: This case illustrates that denial may be related to a violation of moral or religious standards.)

"Denial of Pregnancy and Childbirth," P. Finnegan, E. McKinstry and G.E. Robinson Canadian Journal of Psychiatry, 27: 672, 74, December 1982.

Anxiety associated with psychological conflicts may threaten to overwhelm the pregnant woman's ability to cope in an adaptive fashion and may result in the denial of the pregnancy as a defense. Denial and rationalization of symptoms and denial of pregnancy may result in inadequate behavioral responses at the time of childbirth and may result in the death of the newborn.

"Uninformed Consent and Terms without Definitions," Joseph E. Hardison, American Journal of Medicine, 74:932-933, June, 1983.

During the time of denial, turmoil and intense personal loss and grief, it is understandable that many patients may give uninformed consent. Forcing the patient to face reality may precipitate panic, psychosis or suicide. We must give patients time and help them adjust to what is wrong, before consent is meaningfully and truly formed.

"Religious Conversion. An Experimental Model for Affecting Alcohol Denial," Marc Galanter, Currents in Alcoholism 6:69-78(1979),

Ed Note: This raises an important aspect of denial in the abortion context, as many women who have come forward to tell their story of the trauma following abortion have undergone religious conversions.

"Denial of Pregnancy in Single Women," Burns, Health and Social Work 7(4): 314- 319, November 1982,

Describes a small group of single women who conceal pregnancy, obtain no prenatal care and place the child for adoption.

"Denial: Are Sharper Definitions Needed?," Norman Cousins, Journal of the American Medical Association 248(2): 210-212, July 9,1982,

Use of the term "denial" may be inappropriate and misleading in cases where a physician makes a superficial determination. Denial can sometimes be channeled into a higher level of cooperation.

"Early Object Deprivation and Transference Phenomena: The Working Alliance." T Fleming, Psychoanalytic Quarterly, (1972) pp. 23-49.

Delayed grief and mourning due to denial created an inability to manage developmental tasks.

"Denial and Repression," Edith Jacobson, Journal of American Psychoanalytic Association, Vol. V: 6192 (1957),

In general, patients who deny show a propensity for acting out. Therapy must be directed essentially against denial and distortion of reality.

"The Longitudinal Course of Para-Natal Emotional Disturbance, N," Uddenberg, and L. Nilsson, Acta Psychiatrica Scandinavica, 52:160-169. (1975)

Ninety-five nulliparous women were interviewed during pregnancy and four months postpartum. The possibility of predicting mental disturbance postpartum was studied. When the woman was mentally disturbed during pregnancy, the prognosis was better in the case of a poor social situation, or lack of support from the father of the child should be regarded as favorable prognosis for her mental health postpartum. In contrast, repudiation of the mother as well as a negative attitude toward future child bearing seems to indicate a poor prognosis. When the woman appears well adapted during pregnancy it may be more difficult to predict mental adaptation postpartum. A tendency to keep the pregnancy experience out of the consciousness should be regarded as a warning. Denial of the pregnancy prevents the woman from gradually working through any difficulties connected with her new situation and impairs her possibilities for a gradual adaptation to motherhood. Such a gradual adaptation is probably important in preventing mental breakdown during the first period postpartum. Citing two studies.

"Early Object Loss and Denial," R. Stolorow and F.Lachmann, Psychoanalytic Quarterly, 44 (4): 596-611 (1975).

Description of the psychoanalytic treatment of a young woman whose father had been killed in a concentration camp when she was four years old. It illustrates the defensive use of denial in lieu of mourning. The ability of the surviving parent to counter the process of denial of loss, to serve as a model in the mourning process and as a necessary adjunct to the child for the eventual termination of mourning, plays a decisive role. Ed. Note: The literature contains few examples of the impact of loss of a father on a girl. Yet this seems to be of importance in the case of adolescent pregnancy. See, for example, Kane, "Motivation Factors in Pregnant Adolescents," Diseases of the Nervous System 35:131- 134(1974).

"Abortion as Fatherhood Glimpsed. Clinic Waiting Room Males as (Former) Expectant Fathers," Arthur Shostak, Presented at Eastern Sociological Society Meeting, March, 1985, Philadelphia, PA.

Thoughts about fatherhood shaped an unusual grieving process as many males mourned the loss of paternity in a hidden and denied fashion. Most males put on a show of fortitude and relief consistent with a macho role. Authentic and overt grieving got short shrift as energy focused instead on demonstrating a capacity to "take it" and keep going.

"On the Reclaiming of Denied Affects in Family Therapy," David A. Berkowitz, Family Process 16(4); 495-501, December 1977.

A central developmental task of the family is to help its members develop the capacity to cope with the grief attendant on separation and loss. In order to work through such feelings, each member must be first able to acknowledge the affect as present, internal and belonging to the self. Depending upon the degree of intra-psychic differentiation, and the degree of abandonment, family members may seek to avoid awareness of such feelings within themselves. The disclaimed emotions remain powerful unconscious motivators of behavior, exerting their influence despite their denial. Hidden intense grief stays unresolved as long as it remains unrecognized. It is an important task for the therapist to facilitate the grieving process. Quoting Paul, "The Role of Mourning and Empathy in Conjoint Marital Therapy," in Zuk and Boszormenyi-Nagy, eds, Family Therapy and Disturbed Families, (Palo Alto: Science and Behavior Books, 1967).

"Development of a Quantitative Rating Scale to Assess Denial," T. P. Hackett and N.H. Cassem, Journal of Psychosomatic Research 18:93-100 (1974).

Denial is defined as "the conscious or unconscious repudiation of part or all of the total available meaning of an event to allay fear, anxiety or other unpleasant effects." Major deniers shared certain characteristics. They verbally denied fear, tended to minimize or displace symptoms to other organ systems, downplayed danger, displaced the threat to other objects (e.g., finances), projected their fear, displayed a jovial, hearty manner, regularly debunked worry and used cliches whenever asked about death.A rating scale of 31 items was developed).

"Denial and Affirmation in fullness and Health," Arnold R. Beisser, American Journal of Psychiatry 136(8): 1026-1030. August, 1978.

"Positive" attitudes about health may have a powerful effect on patients. For the most part, these attitudes have been based in religious faiths. Physicians and behavioral scientists have frequently taken the role of adversary to these faith and faith healing perspectives as they have observed how patients are sometimes influenced to ignore symptoms and fail to obtain medical care with disastrous consequences. There is a new recognition that there are states of consciousness and awareness which are inadequately explained by concepts of illness and its absence and that these states may produce higher levels of functioning and health (i.e., the holistic health movement). The patient and the physician find different meanings in the situation. The physician is concerned with the "reality" of the patient's illness; the patient is concerned with the "reality" of what makes life worth living. Behavioral scientists have come to regard denial as a primitive defense and to view its presence as a signal of serious underlying psychopathology. (Ed. note- This author at times seems to be talking about hope rather than denial, although he uses the word denial.)

"The Relationship Between an Avoidance of Existential Confrontation and Neuroticism: A Psychometric Test, P," Thauberger, and D. Sydiaha-Symor, Journal Humanistic Psychology, 17(1): 89-91, Winter 1977.

A positive correlation was found between avoidance of existential confrontations and neuroticism using previously developed scales. Sources of existential anxiety indude death, fate, guilt, emptiness, meaninglessness, loneliness and isolation. Existential anxiety cannot be avoided except through the distortion of reality. Such distortion breeds neurotic anxiety-the distress produced by yielding to the illusory hopes of overcoming contingency and finiteness. Alternately, confronting existential anxiety means to acknowledge its presence and incorporate it into one's being. Neuroticism may give rise to avoidance tactics which at least temporarily serve the well-being of the individual by sparing him or her from existential stresses which would be overwhelming and self- defeating. Quoting J. F. Bugenthal, The Search for Authenticity New York: Holt, Rinehart and Winston (1965).


"Mediation of Abusive Childhood Experiences: Dissociation and Negative Life Outcomes," E Becker-Lausen, Am J Orthopsychiatry 65(4): 560, 1995

Dissociation was significantly related to reports by females of previously becoming pregnant and having an abortion in high school. The author stated that individuals who detach from reality by dissociation may disregard clues that may otherwise warn them of danger and become "sitting ducks" for later abuse.

"Partial Dissociation as Encountered in the Borderline Patient," Paul Dince, Journal of the American Academy of Psychoanalysis 5(3): 327-345, 1977

Partial dissociation occurs as a consequence of the patient's need to bring about an altered state of consciousness in order to shut out or expel a danger-laden piece of psychic reality. Patients can engage in purposeful, deliberate and initially conscious triggering of dissociated ego states which gradually slip further and further from the individual's control until they take over and run their course. Dissociative capacities of the borderline patient, which are at times consciously (volitionally) set in motion and which at times constitute semi-automated responses to highly charged aggressive or sexual- aggressive effect, are fueled and maintained by the chronic, persistent reliance upon denial as the main mechanism of defense. The dissociated self, the not-me has to be triggered and take over in order to do that which would evoke fearful guilt and shame in the original hated self.

"Fragmentation of the Personality Associated with Post-Abortion Trauma," Joel O Brende, Association for Interdisciplinary Research in Values and Social Change Newsletter 8(3):1-8, July/August, 1995.

Splitting and dissociative mechanisms are used as one of the defenses to keeping unwanted traumatic memories, shame, and undesirable emotions out of awareness and hiding the internal pain by using ego defenses which may appear adaptable but are potentially unstable and destructive.

"Childhood trauma, dissociation and self-harming behaviour: a pilot study," G Low et al , Br J Med Psychol 73(Pt 2) 269-278, 2000.

A British study reported a strong association between high levels of dissociation and an increasing frequency of self-harming behavior.

“Forbidden Grief .The Unspoken Pain of Abortion”, Theresa Burke and David Reardon (Springfield Il: Acorn Books, 2002) 130-131

People use terms like “spacing out” and “not being with it” to describe the detached sensations that therapists call “dissociation”… It is very common for women to undergo abortions in a dissociated state. Their bodies are there, but their emotional self is not.


For many, abortion is looked upon as a "quick fix" to a problem pregnancy. This is the primary reason why those supporting abortion emphasize " relief" following abortion, even if there are other negative consequences.

The Culture of Narcissism, American Life in an Age of Diminishing Expectations, Christopher Lasch, (New York: W.W. Norton, 1979)

The contemporary climate is therapeutic, not religious. People today hunger not for personal salvation, let alone for the restoration of an earlier golden age, but for the feeling, the momentary illusion of personal well-being, health, and psychic security.

"Narcissistic Personality Disorder: Clinical Features," V. Siomopoulos, Am. J. Psychotherapy, Vol. XLII, No. 2:240-253, April, 1981)

Excellent over-view of the subject and review of the writings of H. Kohut and 0. Kernberg. Narcissistic individuals are dominated by rage and shame.

Aborted Women: Silent No More, David C. Reardon, (Chicago: Loyola Press, 1987) p. 23.

In a survey of 252 post-abortion women, "many of those surveyed reported that their abortion left them feeling extreme and chronic 'anger' or "rage' at others. Anger, resentment and even hatred was directed at husbands or boyfriends who had been involved in the abortion. "Postabortion anger is often directed against the abortionists or abortion counselors who "didn't give me the other side of the picture.")

"Outcome Following Therapeutic Abortion," R. Payne, A. Kravitz, M. Notman and J. Anderson, Archives General Psychiatry 33:725, June 1976.

In a study of 102 women up to six months following abortion, it was found that Catholics
exhibited more guilt and shame than Protestants and Protestants more than Jews. Women who had previously borne children experienced significantly less guilt and shame than did a woman who never had a child. Women with a negative or ambivalent relationship with their children experienced greater depression and shame. Women who became pregnant using the rhythm method, foam or no contraceptive had more guilt and shame (p=.048) than did women using a diaphragm, IUD or contraceptive pills.

The Long-Term Psychological Effects of Abortion, C. Barnard, (Portsmouth, N.H.: Institute for Pregnancy Loss, 1990).

An elevated narcissistic response, in post-abortion women, nearly 3 times greater than the sample on which the test had been normed, was found on the Millon Clinical Multiaxial Inventory (MCMI) in a sample of 80 women 3-5 years post-abortion. (32.5 vs. 11.0, Chi- Square - 42.02, P= .01 ) ( 60% were found to have given the wrong phone number to the abortion clinic).

"Women who seek Therapeutic Abortion: A Comparison with Women who Complete Their Pregnancies," C. Ford, P. Castelnuovo - Tedesco, and K. Long, Am. J. Psychiatry 129(5): 546-552, Nov, 1972.

Women obtaining abortions tend to be narcissistic and regard the fetus as a competitor for the succorance and dependent care they themselves need.

"The Abortion Clinic: What Goes On," Susan Reed, People Magazine 24(9): 103- 106, August 26, 1985.

Women at a Phoenix, Arizona abortion clinic have an appointment to return in two weeks. The counselor stresses, "It's important to come back. We need to check for possible infection and to see that your cervix has healed properly." However, it is reported that two- thirds of them will never be heard from again. "We'll call the number they've listed, and it will be non-existent, explains the counselor." (Ed Note: There is evidence that many of these women were ashamed at having an abortion.


"Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery and women in the general population of Sweden," JP Fryzek et al, Ann Plast Surg 45(4): 349-356, 2000.

Women with cosmetic implants were significantly more likely to be current smokers, have had a prematurely terminated pregnancy (induced abortion or miscarriage), and have fewer live births compared to women who had breast reduction or women in the general population.

"Characteristics of Women With and Without Breast Augmentation," KS Cook et al, JAMA 277:1612-1617, 1997

A population based study of U.S. white women found that women with breast implants were twice as likely to have had a history of termination of pregnancy than other women.

"Motivation of Surrogate Mothers: Initial Findings," Philip J Parker, Am J Psychiatry 140(1): 117, January, 1983.

In a sample of 125 women who applied to be surrogate mothers, 44 (35%) either had had a voluntary abortion (26%) or had relinquished a child for adoption. Most women admitted that they would experience some feelings of loss and sadness but minimized them by saying, " It would be their baby, not mine"; " I'm only an incubator"; " I'd be nest watching"; and "I'll attach myself in a different way-hoping it's healthy."

"Psychodynamic Aspects of Delayed Abortion Decisions," J Cancelmo et al, British J Medical Psychology 65:333, 1992.

A study of New York city women who were primarily women of color found that abortion at later gestational ages was significantly associated with a greater disturbance of the basic sense of self due to gender/sexual conflict and lower levels of internalized striving or ambition.

Self-Punishment (Masochism) or Punishment of Others (Sadism)

"Abortion-Pain or Pleasure?" Howard W. Fisher in The Psychological Effects of Abortion, ed. D Mall and WF Watts (Washington, D.C.: University Publications of America, 1979) 39-52

A sample of postabortion women who had abortions between 1971-78 was described by a psychiatrist as being ill medically and psychiatrically, low in achievement, and prone to act out in destructive ways. The author described their view of pregnancy as " outside" the psychological self, but inside the physical self… As long as the pregnancy is indistinguishable from the inner-self, the woman can be "unaware" of it and logically abort "it" as though it was not there. Because of incomplete separation-individuation, these women have difficulty conceiving of the fetus as separate because of problems with self- object discrimination. This is a basic problem in reality testing. In a sense, the fetus is like an inner feeling that is denied, something these women did regularly with all their feelings, especially angry ones.
Since pregnancy is viewed as a punishment visited on the self, abortion is a "logical" attempt to rid the self of painful responsibility, a form of expiation. But psychologically, abortion is further self-punishment which occurs because the "thing" that is sacrificed is felt to be a portion of the self. It is a though the self seeks the pleasure of conception and the pain of loss in one unconscious moment, making abortion truly masochistic… It is interesting that women who need self-punishment do not abort themselves more often… the projection of responsibility to an external punishing agent (physician) accomplishes a lessening of guilt. Abortion is done "to" the woman, with her as only a passive participant. This is a further indication of masochism.

"Psychosocial Aspects of Induced Abortion.Its Implications for the Woman, Her Family and Her Doctor," : Part 1, Beverley Raphael, The Medical Journal of Australia, July 1, 1972 pp.35-42.

Self-punishment or self-destructive influences may operate so that either the pregnancy itself or the abortion represents a way of punishing herself for unrecognized feelings of guilt. This guilt may derive from earlier events in the woman's life (a previous abortion, a sadistic or rejecting act, etc) or may be related to deep-seated conflict concerning her sexuality, which she may perceive as being bad, sinful, dirty or uncontrollable…The pregnancy and its disturbance of the woman's life represent the punishment which may be timed so that school or career patterns are disrupted, shame is publically displayed, or a relationship which promised intimacy and security is broken. The abortion may represent the punishment of the loss of a longed-for child. Some women appear to harbour deep masochistic needs which lead them to repeated illegitimate pregnancies or repeated illegal abortions, and their self-destructiveness may be so intense that they may have personality characteristics in common with those who attempt suicide.

"Psychiatric Illness Following Therapeutic Abortion," N Simon, AG Senturia and D Rothman, Am J Psychiat 124 (1): 97-103, 1967

Therapeutic abortion offers an optimal circumstance for acting out sadomasochistic fantasies and impulses, both in terms of interaction between the patient and the physician and also by the actual physical circumstances of the abortion itself. Pregnancy in many ways fulfills the role of gratifying the woman's unconscious masochistic wish, while the abortion gratifies the sadistic impulse (directed against the fetus) as well as the masochistic wish ( assault on the self).

"Fragmentation of the Personality Associated with Post-Abortion Trauma," Joel O Brende, Association for Interdisciplinary Research In Values and Social Change Newsletter 8(3): 1-8 July/Aug 1995

People who have endured extreme stress often suffer profound rupture in the very fabric of the self. Fragmentation predisposes to unstable and destructive relationships including sadistic, masochistic, abusive, and battering relationships.