Why We Should Avoid the use of the Term “Post-Abortion Syndrome”: Commentary on Boulind and Edwards (2008)

Boulind and Edwards (2008) present a case study of Grace, a women suffering, in their words, from post-abortion syndrome (PAS). In this commentary I argue that while Boulind and Edwards' (2008) report is useful in terms of documenting the therapeutic processes engaged in, they would have been better served in not hanging the distress experienced by Grace on the diagnostic category of post-abortion syndrome. Reasons for this are that: PAS is not a recognised category of diagnosis, despite having been initially proposed in 1981; applying a PTSD framework to abortion is questionable; PAS focuses attention on the abortion itself in isolation from the fact that abortion occurs in the context of severely problematic pregnancies and other important socio-cultural stressors; PAS, in the very manner in which it is formulated, invokes to a very complex politics of the foetus. Boulind and Edwards (2008) are careful in their documentation of the complexities of the case, and thus their use of PAS is unfortunate.     

The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa

This article reports a clinical case study of “Grace”, a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace's experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.     

Abortion and victimisability

ABSTRACT This paper begins with a review of major difficulties with both extreme conservative and extreme liberal views on foetal moral status and the morality of abortion. There follows an outline and defence of a moderate position on abortion which is centred in an account of emergent foetal victimisability in being killed. Lastly, various perplexities about this view are explored, particularly the question whether, once victimisable at all, the victimisability of a foetus should reasonably be thought to increase proportionately with further biological development.     

The Meaning and Impact of Partner's Accompaniment on Women's Adjustment to Abortion1

The present study examined the meaning of accompaniment to an abortion clinic by a male partner and explored the effects of accompaniment on women's immediate and three-week post-abortion psychological distress. A comparison of accompanied and unaccompanied women revealed few differences in demographic or psychological characteristics, although accompanied women perceived greater levels of social support from their partners and reported that they were in more committed relationships. The effects of accompaniment on women's post-abortion distress were neither universally positive nor universally negative, but depended on the personal characteristics of the women involved. Consistent with Conservation of Resources Theory (Hobfoll, 1988), accompaniment was more beneficial for women who were high in personal coping resources than for women low in these resources.     

Abortion outcome as a function of sex-role identification

The present study investigated the relationship between sex-role identification and abortion outcome in 120 women receiving first trimester abortions. The sex-role concept dimension was measured both by self-attributions of sex-role traits (as measured by the Bern Sex-Role Inventory) and by life-style (career vs. homemaker) trait attributions. Psychological and physiological aspects of abortion outcome were included; slightly more than 7% of scores were in the symptomatic range, similar to percentages found in previous studies. Both Androgyny (r = -.42, p <.001) and Masculinity (r = -.23, p <.05) were found to be related to positive abortion outcome. Androgyny was more strongly related, which suggests that a balance of masculine and feminine traits, at least for women in the post-abortion situation, is preferable to high Masculinity scores alone. Congruence between one's self-image and one's image of a career woman was also found to be related to abortion outcome (r =.31, p <.01). In attempting to differentiate between the upper and lower 10% of the distribution of abortion outcome, only two variables, Androgyny and self-career congruence, survived parameter criterion, and accounted for 32% of the variance.     

Male Partners' Appraisals of Undesired Pregnancy and Abortion: Implications for Women's Adjustment to Abortion

The impact of men's attributions for pregnancy and expectations for coping with abortion on their partner's post-abortion adjustment was examined. Men's and women's attributions and coping expectations were assessed in a sample of 73 couples prior to obtaining a first-trimester abortion of an undesired pregnancy. Women's depression was assessed 30 minutes post-abortion. Partners did not differ in their coping expectations or attributions of the pregnancy to chance, situation, another person, or their own behavior, but men blamed the pregnancy more on their own character than did their partners. Male partner's coping expectancies affected women's adjustment only if the women themselves had low coping expectancies. Among women with low coping expectancies, those accompanied by partners who also had low coping expectancies were the most depressed. Men's attributions were unrelated to their partner's adjustment.     

Killing, Letting Die, and the Morality of Abortion

abstract   David Boonin, in his A Defense of Abortion, argues that abortions that involve killing the foetus are morally permissible, even if granting for the sake of argument that the foetus has a right to life. His primary argument is an argument by analogy to a 'trolley case'. I offer two lines of counterargument to his argument by analogy. First, I argue that Boonin's analogy between his trolley case and a normal unwanted pregnancy does not hold. I revise his trolley case in light of my objections. Second, I argue that Boonin's arguments for the permissibility of killing, when applied to this revised trolley case — and by extension, typical unwanted pregnancies — do not succeed in justifying killing.     

Nobody Puts Baby in the Container: The Foetal Container Model at Work in Medicine and Commercial Surrogacy

This article argues that a particular metaphysical model permeates cultural practices surrounding pregnancy: the foetal container model. Widespread uncritical reliance on this view of pregnancy has been highly detrimental to women's liberty and reproductive autonomy. In this article, I extend existing critiques of the medical treatment of pregnant women to the context of the burgeoning commercial surrogacy industry. In doing so, I aim to show that our philosophical analysis in both spheres is constrained by the presupposition that the foetus and pregnant woman are metaphysically and ethically distinct entities. By exploring the similarities and differences between the expectations placed on pregnant women in these two spheres, I show that the foetal container model is not a homogeneous understanding of pregnancy applied consistently across contexts; rather, it has been used to justify various practices and attitudes toward pregnancy and pregnant women through different moral frameworks, in the service of different overarching aims.     

Emotional response to abortion: a critical review of the literature

Anti-abortion groups in the US cite the existence of a post-abortion syndrome--a sense of loss, emptiness, and grief similar to that reported by trauma survivors. Although research on the longterm effects of induced abortion is marred by methodological errors, most studies have found no adverse psychological sequelae; rather, there appears to be a sense of relief and opportunity for personal growth. Nevertheless, there is a small group of women who do experience emotional distress after abortion and it is important to identify the demographic, social, and psychological factors that place women at risk of such a reaction. In terms of demographic factors, young age (adolescence), low or nulliparity, 2nd-trimester procedures, and Catholicism have been characteristics of women who suffered post-abortion depression. Of the social variables that have been examined, a lack of support from significant others (parents or partner) has been linked in some studies to emotional distress after abortion. A relatively consistent finding is that women who feel coerced to abort or are ambivalent about their decision at the time of the procedure are most likely to experience regret, depression, and anger. Women whose coping style involves avoiding responsibility are also prone to post-abortion distress. As noted, the literature does not support the contention that abortion causes longterm trauma. On the other hand, given the fact that 1.5 million abortions take place each year in the US, the existence of some post-abortion distress in even as small percentage of acceptors is enough to indicate a need for pre- and post-abortion counseling to help women determine the meaning of the experience and own their decisions.     

Abortion in adolescence

Sexual attitudes and behavior of adolescent females have been the topic of much interest over the past decade. Feelings about contraception, conception, and abortion have been described in relation to the adolescents' beliefs about the possibility of becoming pregnant, who will or will not "protect" them, and the influence of significant others on their decision making. This study explores differences in 35 women who had abortions during their teenage years with 36 women whose abortions occurred after the age of twenty. A demographic questionnaire, the Millon Clinical Multiaxial Inventory, and the Beck Depression Inventory were completed by women who were members of a patient-led support group. Premorbid psychiatric histories, the decision-making process itself, and distressing symptoms postabortion are reported. Specific differences in perceptions of coercion, preabortion suicidal ideation, and nightmares post-abortion were found in the adolescent group. Antisocial and paranoid personality disorders as well as drug abuse and psychotic delusions were found to be significantly higher in the group who aborted as teenagers. Hypotheses regarding the influences of adolescent development on mother/child relationships, power struggles, and the use of fantasy as a coping device are explored.     

Foetal trauma,body memory and early infant communication: a case illustration

This paper presents the complex case of a male patient who started life as an unwanted pregnancy and adoptee in an era of socio‐cultural shame and blame. When able to contact his birth mother later in life, he experienced a number of confronting synchronicities as well as visions which he felt were related to failed abortion attempts and to other pre‐ and post‐natal events. The case material lends weight not only to Freud's, Ehrenwald's and FitzHerbert's assertions that the earliest form of mother‐infant communications is telepathic in nature but that this mode of communication can be retained if emotional trauma inhibits normal developmental processes. Contemporary neuroscience research is presented supporting the hypothesis that emotional memory can become imbedded in the psyche/soma of the foetus. Such memory traces can later emerge into imagery and/or words if the traumatic impingement has been substantial enough and if other defensive strategies are in place. Clinical implications are then suggested regarding analysts’ attention to the emotional conditions underpinning their patients’ conceptions and foetal development; the connection to projective identification components of the countertransference as being aspects of the earliest telepathic mother/infant communication channel and the need for reductive analyses in analyst training programmes.     

Wrongful Life and Abortion

According to theories of wrongful life (WL), the imposition upon a child of an existence of poor quality can constitute an act of harming, and a violation of the child’s rights. The idea that there can be WLs may seem intuitively compelling. But, as this paper argues, liberals who commit themselves to WL theories may have to compromise some of their other beliefs. For they will thereby become committed to the claim that some women are under a stringent moral duty to have an abortion: a duty that could, without injustice, at least sometimes be enforced by the state. WL theories in other words imply that some women will lack a right to choose, under which both the decision to abort, and the decision to carry the fetus to term, are protected against interference. The paper exposes a dilemma, then, for liberals who are committed both to (a) the rights of future people not to be subjected to a harmful existence, and (b) the rights of women to refuse an abortion.     

An Inter-Rater Reliability Study of Parental Alienation Syndrome

The dual purpose of this study was to first test the acceptance of the concept of parental alienation among therapists, and secondly, to assess the validity of parental alienation as a syndrome among therapists who are familiar with this phenomenon. The study measured the independent variable, symptoms of parental alienation syndrome, and the dependent variable, therapists' perception of the syndrome.

The respondents analyzed five cases using Dr. Richard Gardner's differential diagnosis chart built into a questionnaire for the potential alienator and the child. For the measurements of reliability and inter-rater reliability, the researcher used Microsoft Excel and Kendall's coefficient of concordance.

The findings showed a significant level of concordance among raters in all five cases except in Case 2, where there was a lower consensus on the presence of parental alienation syndrome or meeting Dr. Gardner's criteria due to the complexity of the case presentation. Similarly, findings also reflect the relatively recent discovery of this phenomenon, evidenced by some level of apathy from the general population of therapists to get involved.

The completed surveys were from therapists familiar with parental alienation syndrome, which indicated their level of understanding of the phenomena and how their views differed from other therapists who were unfamiliar with PAS. The data gathered from the completed surveys was sufficiently reliable to suggest a wider study for the purpose of classification in the next edition of the DSM.     

Abortion and Mental Health

Abstract

Unwanted pregnancy and abortion are common life events, and therapists are likely to work with clients who experience them. Legal abortion currently entails little physical or mental health risk; most women currently cope effectively with these life events without need of clinical intervention. But current abortion politics include efforts to make abortion a more threatening, stressful, and stigmatized experience and to create a “postabortion syndrome.” Using a stress and coping framework, we examine how antiabortion activists spread myths and misinformation aimed at women's appraisal processes, and discuss approaches therapists can use to enhance women's strategies for coping with abortion. We also discuss specific issues and useful techniques for counseling about abortion concerns, including cultural sensitivity and strategies for promoting positive sexual health.     

PAS in Kedah: cultural politics of pigs and development

On March 8, 2008, PAS led the coalition to victory in Kedah, winning 16 seats, while Barisan National won only 14 state seats. This paper highlights cultural dimensions of the shift from BN to the opposition coalition in this state of the Malay heartland. The PAS manifesto and campaign speeches in Kedah emphasized Islamic ethics, a just, clean, and pure government which would strive to improve the conditions of all the people. These notions of a “just” and “unmixed” party struggling to “strengthen Islam” resonated with many Malays in Kedah. In contrast, UMNO was depicted as corrupt practitioners of bribes and money politics who prioritize the interests of the rich over the needy. They were criticized as materialist, elitist figures stuck in their ways like the Pharaoh, while PAS’ commitment to upholding Islam was likened to the prophets. In addition, this paper discusses the way PAS approaches the issue of the “social contract” between Malays and other ethnic groups and the way their construct of Malay identity spoke to many Malay voters. I argue that PAS rhetoric must be viewed as more than political use of Islamic symbols, and that its effectiveness rests in the way it evokes more extensive cultural models. Finally, this paper considers the controversial post-election demolition of a pig slaughterhouse in a predominantly Malay kampong in Kota Setar, Kedah. Here I argue that this case embodies and reaffirms the cultural politics of the general election.     

“Throwing Baby out with the Bath water#x201D;: Some Reflections on the Evolution of Reproductive Technology}

This article discusses section 156 of the Criminal Justice and Public Order Act 1994 which prohibits the use of eggs from aborted female foetuses for the purposes of reproduction. I argue that the pre-legislative debates focus only on the biological relationship between the aborted foetus and any ensuing child and foreclose the possibility of useful discussion about the potential merits of such technology. Kristeva's theory of abjection has been used in order to elucidate the strength of feeling about the use of eggs from the expelled foetus. I suggest that the ‘yuk’ factor stems from the potential for the blurring of the boundaries between life and death. In addition, I suggest that the stress placed on the biological link means that the foetus is ascribed special properties not given to live donors. Woman's very crucial role in reproductive technologies is therefore erased. The article argues that there are very good reasons why the debate on the subject should remain open. At present women donors have to undergo highly intrusive procedures in order to give eggs and the process is not without its health risks. The use of eggs from aborted foetuses certainly raises important consent issues but these could be addressed by placing women at the centre of the decision making process, starting with the recognition that it is women and not foetuses who have the remit and responsibility for giving consent for the use of their genetic material. Moreover, there should be an acknowledgement that women are perfectly capable of making informed decisions about donation and of considering the potential implications of participating in egg donation. This revised version was published online in June 2006 with corrections to the Cover Date.     

Fairness,Care, and Abortion

Only women can bear the burdens of gestating fetuses. That fact, I suggest, bears on the morality of abortion. To illustrate and explain this point, I frame my discussion around Judith Jarvis Thomson's classic defense of abortion and Gina Schouten's recent feminist challenge to Thomson's defense. Thomson argued that, even assuming that fetuses are morally equivalent to persons, abortions are typically morally permissible. According to Schouten's feminist challenge to Thomson, however, if fetuses are morally equivalent to persons, then abortions are typically morally impermissible because there is a collective moral obligation to care for the vulnerable. The consideration that is my topic, however, poses a problem for that feminist challenge to Thomson. There is reason to believe, I argue, that it is unfair that only women can bear the burdens of gestating fetuses. And, if that is unfair, it would undermine that feminist challenge to Thomson. I show, in other words, that there is a plausible and well-motivated basis for believing that, even if fetuses are morally equivalent to persons and there is a collective obligation to care for the vulnerable, then abortions are nevertheless typically morally permissible. That is how fairness bears on the morality of abortion.     

Psychosis proneness and clinical psychopathology: examination of the correlates of schizotypy

The present report examined the associations between the Perceptual Aberration Scale (PAS), a prominent psychometric index of hypothetical psychosis proneness, and several measures of clinical psychopathology in a nonpsychotic psychiatric sample (N = 101). Patients were examined by experienced clinicians using structured psychiatric interviews to assess DSM-III-R Axis I and II conditions and rated for anxiety, depression, severity of illness, and current adult social competence. Elevated scores on the PAS were most closely associated with anxiety and depression as well as schizotypal, schizoid, avoidant, and obsessive-compulsive personality disorder symptomatology. Hierarchical regression analysis identified schizotypal symptoms and anxiety as the two underlying psychopathological processes most useful in explaining variance in PAS scores. Results are interpreted as supporting both the clinical relevance and research utility of the PAS and enhancing the construct validity of Meehl's model of schizotypy.     

Denial of the Parental Alienation Syndrome Also Harms Women

Denying reality is obviously a maladaptive way of dealing with a situation. In fact, denial is generally considered to be one of the defense mechanisms, mechanisms that are inappropriate maladaptive, and pathological. In the field of medicine to deny the existence of a disease seriously compromises the physician's ability to help patients. If a physician does not believe that a particular disease exists, then it will not be given consideration when making a differential diagnosis, and the patient may then go untreated. This is in line with the ancient medical principle that proper diagnosis must precede proper treatment. Or, if for some external reason the physician recognizes the disorder, but feels obligated to use another name, other problems arise, for example, impaired communication with others regarding exactly what is going on with the patient, and hence improper treatment. This is what is occurring at this point with the parental alienation syndrome, a disorder whose existence has compelling verification. In this article I discuss the reasons for denial of the PAS and the ways in which such denial harms families. Particular emphasis will be given to the ways in which this denial harms women, although I will certainly comment on the ways in which the denial harms their husbands and children. In the past, denial of the PAS has caused men much grief. Such denial is now causing women similar grief.