Complicated Mourning: Dynamics of Impacted Post Abortion Grief

ABSTRACT: Current estimates are that one in every five women in the United States will have undergone at least one abortion, with 1.4 million abortions occurring annually. Increasingly, long-term stress reactions to abortion have been documented in the research literature. Post Abortion Syndrome (PAS), a variant of Post Traumatic Stress Disorder, occurs in women who experience their abortions as traumatic. When the emotional components of the abortion experience are repressed, as in PAS, impacted grief and complicated mourning result. Diagnosis and treatment strategies are discussed, as well as the societal dynamics that have slowed recognition of this disorder. Soon after my abortion, I began waking up at night hearing a baby crying. It seemed so real that I was sure there was a baby somewhere in the house. I would get up and begin switching on the lights, looking in closets, searching, trying to find that baby, so I could make it stop crying. My roommates thought I had lost my mind. They would tell me there was no baby crying but I was sure there was. I couldn't sleep. That's when I started taking the sleeping pills. INTRODUCTION There are circumstances in which a person experiences a sense of loss but does not have a socially recognized right, role, or capacity to grieve. When a loss cannot be openly acknowledged, publicly mourned or socially supported, grief is disenfranchised (Doka, 1989). Abortion is one of those losses. Ambivalent relationships and concurrent crises have each been identified in the literature as conditions that complicate grief (Worden, 1982; Raphael, 1972; Rando, 1984; Doka, 1989). Abortion often contains both of these elements. Attachment to the fetal child1 may occur despite the desire to rid oneself of it, to be freed of the crisis pregnancy. The trauma involved in being both attached to and responsible for the death of one's fetal child can be emotionally overwhelming, and cause a range of symptoms. Contrary to widely held assumptions, an undetermined but significant number of women are psychologically traumatized by their abortions. These women suffer immediate, chronic, long-term, delayed and/ or acute post abortion grief reactions. This range, as defined by Speckhard and Rue (1992 a & b), can vary from the experience of Post Abortion Distress (PAD), a type of adjustment disorder, to Post Abortion Syndrome (PAS), a specific type of Post Traumatic Stress Disorder caused by a traumatically experienced abortion, to Post Abortion Psychosis (PAP), which may include major thought and affective disorders. It is important to note that any of these range of symptoms would not be expected to appear if neither psychological attachment nor recognition of fetal death occurs either at the time of the abortion or at a later date. However, one would expect that for a large percentage of women having abortions, the abortion is recognized as a type of death experience, and that at least for some a bond of attachment to the fetal child has been experienced which is severed traumatically in the abortion. Women with such perceptions, particularly the latter one, are those most at risk for PAS and complicated mourning. When PAS occurs, complicated mourning and the dynamics of impacted post abortion grief ensue. Scope of the Problem At the time that abortion was legalized in the 1973 Roe v. Wade Supreme Court ruling, those in the health care sector generally assumed that with the stigma surrounding an illegal and clandestine procedure removed, any mental health risks from abortion would be marginal and minimized. In the early seventies there was little awareness of the potential psychological-health risks of the abortion procedure, and no expectation that induced abortion would be so extensively used, in some cases substituting as a form of birth control. The view of abortion as a psychologically benign procedure remains intact today. The prevailing opinion in the psychiatric-psychological literature as well as that espoused by nearly every professional health and mental health organization is that abortion has negligible mental health risks and that any negative psychological outcomes which do occur are short-term in duration (American Psychological Association, 1987; Fox, 1990). …