Abortion’s Psychological Price

“I frequently quote myself.” said George Bernard Shaw. “It adds spice and flavor to the conversation.” At the risk of seeming presumptuous I begin by quoting from a sermon on the transcendence of God I preached last January:

In the final analysis the great importance of belief in God’s transcendence is that it makes a difference between reverence and irreverence. Reverence is translated into all of life. Without belief in a God who transcends our own experience and our own consciousness, man must come to believe that he is the Lord of Life, and sooner or later he is led to either arrogance or despair. In his arrogance he will decree when the lives of others shall begin and end. He will develop the perfect world with just the right number of people. No one will be born with physical defects and no one will be born who is unwanted; no one will live longer than is good for himself and the community—all this in the name of humanitarianism. But in a time of despair this earthbound Lord of Life may logically decree the conclusion of his own.

In the context of this I subsequently gave considerable thought to the question of legalized abortion. I consulted the psychiatric, general medical, and legal communities; these should not, of course, be the final determinants of a spiritual conclusion, but theological judgments about an issue made without recourse to experts in related disciplines are often unsound. My presentation is strong on psychiatric reference, but for a good reason: most legal abortions occur with the blessing of psychiatry, since only a small minority can be justified on strictly physical grounds.

In consulting related disciplines I soon found that even accepted facts should be carefully scrutinized; contradictory arguments often use the same evidence. Reflecting on this at a seminar in Miami Beach on “Psychiatry and the Law,” Dr. Carl Marlow, professor of psychiatry at the University of Miami Medical School, called for a careful separation of genuine data from opinion. Applying this to the often posed threat of suicide as a reason for psychiatric abortion, he reported several studies. A typical one dealt with sixty-two women who were denied abortions. All had implied or stated suicidal intentions, but not one suicide had occurred, even several years after the women gave birth. Repeated follow-through of other control groups led to the conclusion that the threat of suicide is a minimal risk, even when the woman is known to suffer from a depression psychosis. Dr. Marlow flatly stated that most abortions performed for psychiatric reasons are at best recommended on the basis of peripheral psychoses but “are generally performed for socio-economic reasons.” He calls for a careful examination of the contraindications for an abortion as well as the positive indications, since the former may well outweigh the latter.

This current warning from a member of the psychiatric community recalls the concern Dr. Sydney Bolter voiced in 1962 before the American Psychiatric Association. Dr. Bolter stated,

Since pregnancy is seldom a serious threat to the life of the mother in the face of modern medical management, it must follow that many of the recommendations for therapeutic abortion are on other than strictly medical grounds. It must follow, also, that these cases fall into the cloudy area of psychiatric indications for interruption of pregnancy and are, at best, of somewhat dubious legality.

He recommends as an alternative to abortion on psychiatric grounds the increased practice of psychotherapy to assist a patient through a pregnancy. The problem for psychiatrists, Dr. Bolter said, is that they are pressed not only by the patient “but every bit as much by the referring physician who has already decided in his own mind that the patient should have a therapeutic abortion but can find no good medical reason for it.”

A psychiatrist in general practice for whom I have a high regard raised a question about the incidence of guilt-related psychoses emerging after a therapeutic abortion. He feels this danger has been exaggerated as an argument against abortion. Perhaps so, but I doubt that enough follow-through evidence is yet available to prove or disprove that opinion. Some doctors, such as Julius Fogel of Columbia Hospital for Women in Washington, D. C., hold otherwise. Colman McCarthy recently reported Dr. Fogel’s observations in the Washington Post (Feb. 28, 1971). Although he does not claim that abortion necessarily brings on mental illness, Fogel does say,

It is not as harmless and casual an event as many in the pro-abortion crowd insist; a psychological price is paid. It may be alienation, it may be a pushing away from human warmth, perhaps a hardening of the maternal instinct. Something happens on the deeper levels of a woman’s consciousness when she destroys a pregnancy. I know that as a psychiatrist.

I can attest to this from a recent experience in personal counseling. One of the problems in the marital relationship of a young couple was found to be an earlier abortion. Even though the woman was quite certain that she suffered no problems of guilt and had properly managed the situation, it became quite apparent that even though she was able to handle the question intellectually she was still paying an emotional price.

The current legal situation of abortion varies considerably from state to state. Even the constitutionality of existing laws is in abeyance because of conflicting and pending decisions of state supreme courts and lower federal courts. However, the Supreme Court has held that the state must demonstrate overwhelming necessity before interfering with basic freedoms, and proponents of liberalized abortion laws generally cite this as well as the constitutional question of the freedom of religion. I agree that if it can be demonstrated that opposition to abortions generally as well as in particular is a peculiar tenet of one or even several religions, laws against abortion should not be imposed on all to insure the responsible actions of members within a particular minority group. However, reverence for life is not peculiar to any one religion. Certainly the overwhelming necessity that a state hold to this reverence for the good of society can be demonstrated.

The question inevitably arises, What is life? I long believed with countless others that the time when a specific human life begins is a question of ethical belief rather than scientific conclusion. I am now not so sure that this is true. Dr. Landrum Shettles of Columbia University states, “From the union of the germ cells there is under normal development a living definite going concern. To interrupt a pregnancy at any state is like cutting the link of a chain; the chain is broken no matter where the link is cut.” Dr. Jules Carles of the French National Center for Scientific Research also reports, “This first cell, formed by sperm and egg union, is already the embryo of an autonomous living being with individual hereditary patrimony.” The scientific community unanimously holds that the tissue of a fetus from the time of conception has a unique nature, though it must be nurtured and protected by the mother until viability. It is far more than simply a biological extension such as a tonsil or an appendix; every aspect bears the attributes of individuality.

My conclusion is that individual life, and not merely life potential, begins at conception. The abortion simply becomes more repugnant as the term of pregnancy increases. Even many who prefer that abortion be an individual matter may feel the law should limit abortion to the first three months, except in clearly demonstrable cases of impaired health to the mother or fetus. Numerous doctors and nurses who have assisted in legal abortions are increasingly squeamish about its practice. One general practitioner in Maryland summed it up to me in this way, “Too many people are concerned more about the issues than the individual fetus or the mother. Everyone who stumps for more legalized abortion should be made to view the operation even under the best operating-room conditions. He might change his mind.”

Certainly our hearts go out to the unfortunate few women who have clearly demonstrable problems of personal health or are carrying a fetus known to be malformed. We are also naturally concerned about victims of rape, although this raises a legal question about anticipating the guilt of the accused before the conclusion of a trial. It is my opinion that the law should make provisions for those desiring abortions under these three circumstances, but even then the decision to terminate pregnancy should be made only after careful personal reflection and competent consultation. I think we all know of cases in which a child born with a serious physical defect not only lived a happy and productive life but also brought resources to individual members of the family that might otherwise not have been present. I must in all charity allow that this situation should not be forced on everyone. But this is a long way from advocating abortion simply because the pregnancy is inconvenient or embarrassing; the result of this approach is to demean all of humanity. Perhaps the time would come when there would be no aftermath of guilt, but I hate to think of what our individual and corporate consciences would then be like.

There are already legal precedents giving exception to the general rule that legal personality begins at live birth. For instance, the law of property grants to a fetus yet unborn a conditional legal personality. Suit may also be brought on behalf of a fetus in case of accidental injuries. Generally this is limited to the time of pregnancy when the fetus is viable—that is, able to live apart from the mother. The present New York state law permits abortion up to twenty-four weeks, well past the viable stage. It is interesting that while medical technology is pushing viability closer to the time of conception, the clamor is loud for later abortions. We are in danger of regressing to a state previous to that of the law of the jungle when we attempt to deny survival to even the fittest. If for no other reason than the question of protecting related human rights, therapeutic abortions must be granted, but only on the basis of clearly demonstrable severe health impairment.

Psychiatry, for which I generally have the profoundest respect, could then return to its real purpose—that is, helping a patient to handle a problem rather than simply removing it and possibly thereby introducing new problems. This means to assist in the acceptance of the fact of pregnancy and stop being a rubber stamp for abortions on questionable legal, medical, and moral grounds. Perhaps the psychiatrist from a professional viewpoint should not worry about morality, but he certainly must concern himself with sound legal and medical practice.

Beyond this the Christian, and anyone of a godly inclination, must always tell himself that what is legal is not necessarily moral. He has the added responsibility of not succumbing to social pressures by simply living within the technicality of the law. There are many instances, some of which I have observed, in which the mother of an unwed pregnant daughter has urged abortion when the girl entertains serious doubts; the mother may think she is doing her daughter a favor when actually she is trying to avoid personal embarrassment.

I conclude with a summary of a counseling situation in which I was personally involved. This is related with the young woman’s full permission, and anonymity is not difficult because the case is frighteningly typical. She was unwed, a college graduate, and significantly employed. She had become pregnant, and even though the father had agreed to marriage, she felt this would compound one mistake with another. Her general practitioner referred her to an obstetrician who in turn referred her to a psychiatrist. After a consultation, arrangement was made for an abortion. There was no parental objection; in fact, everyone seemed to support the idea.

However, one friend, more astute than the others, detected in the girl a definite reservation and spoke of it to a mutual acquaintance who referred her to me. It became apparent that the situation urgently needed further exploration, and the legal abortion was temporarily postponed. I did not at any time sit in judgment but attempted to help the girl come to a decision that would be satisfactory to her. Not without grave concern would I interfere with any medical opinion, but the whole process was handled in such a cursory manner by all the professionals involved that it was difficult to consider this opinion a product of sound medical investigation. The very factors in the girl’s emotional and intellectual composition that were superficially given as reasons for the abortion were significant evidence for deciding against it.

She did decide to continue the pregnancy until full term and gave birth to a healthy baby who is now bringing joy to a previously childless couple. I have seen her several times since. She has changed from an indecisive girl haunted by feelings of inferiority to a wholesome young woman, and is currently happily contemplating marriage to a young man who has been told of the whole situation. Although this can be only an opinion, I believe in this case an abortion would have been devastating.

We began in the context of the transcendence of God—the God who gave order to the universe and commandments for wholesome life, the God who offers forgiveness and reconciliation—and we end with Isaiah’s reflections on this God:

Let the wicked forsake his way, and the unrighteous man his thoughts; and let him return unto the LORD, and he will have mercy upon him; to our God, for he will abundantly pardon. “For my thoughts are not your thoughts, neither are your ways my ways,” says the LORD. “As the heavens are higher than the earth, so are my ways higher than your ways, and my thoughts than your thoughts.”

Kenneth J. Sharp, canon pastor of the Washington Cathedral (Episcopal), Washington, D. C., is a graduate of Franklin and Marshall College and Mount Airy Seminary and did further work at General Theological Seminary.

Have something to add about this? See something we missed? Share your feedback here.