This article was originally published in the Canadian Journal of Diagnosis, Vol. 16, No. 1, pp. 113-119, 1999. For reprint information please see the Pioneer Publishing Order Form in our resource section.

Abortion and Family Psychology:
A Study in Progrss

Philip G. Ney, M.D., M.A., F.R.C.P.(C.), F.R.A.N.Z.C.P., R.Psych.

Fifteen year old Susan was referred by her family physician because she had become increasingly moody and irritable, dropping out of various school activities, experimenting with drugs and found to be reading books about suicide and death. She had a rapid series of relationships, often with younger boys. Her mother complained that she was alternately picking fights with her parents or frightening them with her morbid preoccupations.

Her well-educated, well-dressed mother, Elizabeth, was mystified. "I think she hates us and I don't know why. We have a stable, loving home. She has one younger brother who is giving us no trouble at all. Both our children were planned pregnancies. We are trying to make sure our children have all the advantages we never had as children. I did have difficulty bonding to Susan. I wanted so much to breast feed her, but she wouldn't cuddle. When she was older she clung to me. My little boy pushed me away and has always maintained his distance." In vain, I searched the child's and family history for any of the usual etiological factors associated with family conflict or depression.

When seen by herself, the good-looking, intelligent fifteen year old was pleasant and co-operative. Susan showed no evidence of distress until I began probing into how she felt about being alive. She indicated that many times she felt that life was not worth living, but could not tell me why. There were times when she did not feel she deserved to be alive. "I feel guilty for just being here, almost like I'm alive and shouldn't be because..." And then she trailed off. When I indicated I felt this was serious, she perked up and again began talking. "How come no one else seems to be worried about this. Sometimes I think if I killed myself the whole family would be much happier. My mom keeps telling me I was wanted, but that doesn't always sound so good. I wonder what happens if she stops wanting me. What happened to any of her pregnancies that she didn't want? If she had an abortion, that would mean that she killed one of my brothers or sisters. I feel I should have had a little sister." Then she spontaneously poured out her conflicts and intensely ambivalent feelings that went back "as long as I can remember." Then she abruptly changed the subject to fights with friends at school and worries about her popularity. When she left she said, "Thanks, Doc, for listening to me."

In the next session I saw both parents, who confirmed that they aborted two pregnancies before Susan because they were both working and weren't ready for family life. They had been striving to save for a house to give their children the best advantages possible. They made sure their children were wanted. When I mused out loud that maybe being wanted wasn't the best criteria to determine which unborn child lived and which died, the parents looked first shocked and then interested. I pointed out their daughter had many of the signs and symptoms of a girl who has what I roughly called, for want of a better title, the Post-Abortion Survivor Syndrome. The father could see no logic in that idea, but his wife became thoughtful. She said, "I've never told the children I had abortions. But since I see no need to feel ashamed or guilty, I have talked to others. It's possible she overheard some remark."

I pointed out their daughter had; 1) survivor guilt (she felt that she didn't deserve to be alive because her little siblings had died), 2) distrust of her parents (she realised they were capable of contributing to the death of her unborn siblings, 3) high anxiety (from a sense of impending doom, wondering whether some overwhelming, powerful and arbitrary force in the future might also destroy her), 4) morbid pre-occupation and risk-taking behaviour (trying to face down her fears by daring death), 5) collusion about pseudo-secrets (these interfered with her desire to know and to express her feelings, but she couldn't face the awfulness of the truth she suspected), 6) anxious attachment to her parents (wanting to be close and protected, but afraid of her mother's destructiveness and her father's inability to protect her), 7) a wide variety of doubts about herself (how could she learn to trust herself if she couldn't trust her parents), 8) an ontological guilt (for not using her considerable talent and opportunities), 9) rage (having tried to stay likeable, she now felt a burning anger at her parents for dangling her life by the thin thread of wantedness), and 10) searching for a sibling (trying to replace a terminated sibling and yearning to be close to a younger boy like herself). These are similar to the conflicts in children who have survived other terrors. [1,2]

When I had outlined these findings, the father continued to protest, "You're just making these up. I suspect you're anti-abortion." But the mother confirmed all of these apart from the pseudo-secrets. "I see all those problems in Susan that you're talking about, but I never thought there were any secrets between us. We prided ourselves for being open and honest with our children." They both agreed there was an urgent need to help Susan. Then the father said, "I'm also worried about our twelve year old son, Doug. I think he's trying too hard to be good." I suggested that, as with other types of problems, a good beginning to resolving underlying conflicts is to have a thorough discussion of the whole matter.

At the following appointment both children and both parents were there and apprehensive. All wanted to talk about something other than this most delicate issue. When I asked the parents, if they didn't want to bring up the matter could I do it for them, there was silence followed by the father's, "No, we must deal with this." Upon learning that there had been two abortions, Susan's reaction was, "I knew it. I knew it. All my life I believed I had an older brother and sister. Why didn't you tell me sooner?" Her fury was mixed with relief. Doug buried his hands in his face and then rushed out of the room. Later his father was able to retrieve him and the family settled down to an in-depth discussion of the two abortions. A wide variety of intense feelings were expressed, some of it aimed at myself for daring to raise such a painful issue. Eventually the parents apologised to their children, "We didn't think this would hurt you so much. We were doing it for your good." The apology was tentatively accepted by Susan, but there was only a scowl from Doug. Obviously there were many issues to resolve, including the boy's question, "So why didn't you abort me, too?"

I suggested the parents stop telling their children they were wanted because of a very dubious implication, i.e. if the first right of the children is to be wanted, then if they are not wanted, they have no right to be. I encouraged them to welcome their children. A welcome has the connotation that they would always be part of the family regardless of who, why or what they were in whatever condition they were. The mother phoned in less than a week to report that her daughter was considerably brighter and had returned to some school activities. In the five sessions that followed, communication greatly improved, the trust level was much better and the future looked brighter for everyone. They readily agreed on names and characteristics for the aborted children. Having been given an identity, they could now be grieved. On follow-up, although the father insisted, "I still think we made the only choice we could under the circumstances," the whole family acknowledged the benefits from facing this otherwise taboo subject.

You may say a case like this is a rare event. Not so when you consider the fact that, as approximately one quarter to one third of all the pregnancies in Canada are aborted, approximately 40%-50% of children grow up in circumstances similar to this one. You might contend that children are unlikely to know about their parents' abortions. The evidence from our study [3] shows that most children either guess, have an intuitive understanding, are strongly suspicious, or have been inadvertently informed. You might argue that none of this should bother children since it is obvious that the aborted siblings are not real humans. Most children now-a-days have seen pictures of pre-born children and, since these look like babies, they respond to them as such. John Bowlby [4] points out that where there is a good possibility that children may lose one or the other parent, as in Canada where divorce approaches 50%, then siblings become increasingly important. You may believe that discussing abortion makes people feel unnecessarily guilty. It is my experience that the guilt is almost universally there. It is better for the parents to deal with their contribution than it is to have children feel they are guilty for existing. Like so many other conditions in medicine, if you don't believe the possibility of a Post-Abortion Survivor Syndrome affecting children and make some inquiries, you are unlikely to detect it. Of course, there is also a possibility I might be inferring something that does not exist. I am still collecting and analysing data and hope soon to write something more definite. In the meantime, I hope other physicians will keep PASS in mind when they are confronted with a similar constellation of signs and symptoms in adolescents.

References

1. Koranyi EK: Psychodynamic theories of the survivor syndrome. Can Psychiatric Assoc J 1969; 14: 165-173.

2. Krell R, Rabkin L: Effects of a sibling death on the surviving child, A family perspective. Fam Process 1979; 18: 471-477.

3. Ney PG, Peeters-Ney, MA: Abortion Survivors. 1998; Pioneer Publishing: Victoria, Canada.

4. Bowlby J: Attachment and Loss. Vol 2, Separation. 1973; Basic Books: New York.