A Consideration of Abortion Survivors

A Consideration of Abortion Survivors Philip G. Ney, MA, MD, DPM, FRCP(C), Department of Psychological Medicine Christchurch Clinical School, University of Otago, New Zealand Abstract A Child's Awareness Three Types of Survivors Future Psychological Difficulties of the Surviving Child Growing Ambivalence Toward Children An Endangered Species Summary References Abstract It is hypothesized that children who have siblings terminated by abortion have similar psychological conflicts to those children who survive disasters or siblings who die of accident or illness. There is evidence that children are aware of their mother’s pregnancy termination. Having been chosen to survive these children may have considerable conflicts regarding their existence. Since their life depended upon being wanted and they may become obsessively determined to please or they may feel a deep sense of obligation to their parents. If children have already lost a parent the child may look upon his new unborn sibling as a potential attachment. To be deprived by his mother’s choice may stir latent hostility within the child the expression of which would be inhibited by the child’s determination to stay wanted. Abortion survivors may be over protected by parents attempting to deal with their unresolved guilt. As a substitute child the abortion survivor may have placed upon him impossible expectations. It is contended that since approximately 50 percent of Western children are abortion survivors there is need to analyze their individual and collective responses. When up to 50 percent of North American pregnancies end by induced abortion, it is reasonable to consider a live newborn as a survivor. In any situation where a mother, spouse, grandparent or physician has seriously deliberated abortion, the live child has survived a carefully considered option to destroy him. In those few situations where a live aborted infant has been given adequate medical care, he has survived a highly technical assault on his life. Both groups have survived where 50 percent of their kind have not, where they were up against forces they could not influence, where the decision to allow them to live was entirely out of their hands, and where their fate depended largely on their place of residence, sex, intelligence, physical attributes or time of existence. In these respects, survivors of abortion have in common those experiences that are the lot of most disaster survivors. This paper raises the question, do abortion survivors have any psychological difficulties known to other types of survivors ¹ ² ³ or are their difficulties unique? If children who survive abortion are psychologically affected, they are victims and as such must be studied to determine what difficulties they might encounter and what special help they might require. The victims themselves should understand the unconscious factors that will influence their attitude toward those who have determined their fate (mothers and physicians), and those who may have attacked them (doctors and nurses), and those who could remind them of earlier conflicts (their own children). A Child's Awareness Demographic studies of abortion often cite abortion rates as a percentage of the number of live births but seldom note the prevalence of fertile women or mothers who have had one or more abortions. However Jekel et al ⁴ found of the young mothers (median age 16 years) reporting to the Yale-New Haven Hospital 1967-1969 and given comprehensive service and counselling, 34 percent had an abortion during the follow-up period. The Canadian National Population Survey ⁵ done four years after the abortion law was liberalized found 46.3 percent of women 30-49 years had had an abortion. Tietz ⁶ suggest a lifetime abortion rate of 1000 per 1000 women as a plausible minimum for a country with moderately effective contraception. The lifetime rate per 1000 women in the U.S. was 520 abortions in 1975. Since it is probable that with increasing abortion rates most North American women have had an abortion, a 50 percent prevalence rate for mothers is a reasonable estimate. Whether abortion survivors are affected is partly determined by whether they perceive the experience, know of siblings who did not survive, or understand the general social attitude toward them. Though there is evidence that unborn children both perceive and remember their interuterine existence, those children who did survive an attempted abortion death will not be considered further in this paper. Psychoanalysts have often observed children’s accurate awareness and dramatic reaction to their mother’s pregnancy. Cramer ⁷ noted a 5.1-year-old boy’s reaction to his mother’s three month pregnancy, “he asked to taste her milk.” Anna Freud ⁸ discusses the use of new material in a child’s psychoanalysis evoked by the child’s awareness of his mother’s pregnancy. In the analysis of a four year old ⁹ and an eleven year old ¹⁰ the mother’s pregnancy was a very important event. Niederland ¹¹ recorded the dreams of a boy from 17 to 47 months which included pregnancies. Kestenburg ¹² indicates that even small children know of their mother’s early pregnancy partly because of changes in the way they are handled. Eissler ¹³ stares that Goethe was probably kept constantly in tension and conflict by the bewildering observation and experience of his mother’s repeated pregnancy and child deaths. Pearson ¹⁴ reports the analysis of an adolescent who stated, “I knew she had two miscarriages and then when I was five years old she stayed in bed when pregnant with my sister.” Kent et al ¹⁵ describe the perceptions of depressed women in group psychotherapy who knew of their mother’s attempt to abort them and partly because of that aborted their own pregnancies. Mothers are being advised to tell their children what is the reason when they are depressed following a miscarriage,¹⁶ and presumably this applies also to abortions. Our clinical observations tend to confirm the reports of others; even young children know of their mother’s early pregnancy,¹⁷ abortion and miscarriage. Cavenar et al ¹⁸ report the case of a five-year-old boy who became severely disturbed by the knowledge of his mother’s abortion which she had when he was two-and-a-half-years-old. A seven-year-old patient reported a dream in which three siblings went with him to play in a sand bank. While playing, the undermined bank collapsed and buried his siblings. Who they were he could not tell me but he knew they were brothers and/or sisters. His mother admitted to three early miscarriages but insisted her child could not have known. Children are jealous of any siblings who could displace them in the parent’s affection.¹⁹ However, there is no evidence that a child is glad when a sibling is killed. Rather they feel guilty sometimes because destructive urges towards a brother or sister seem to have been fulfilled. Bowlby ²⁰ describes how, if there is a loss of a parent, children form strong subsidiary attachments to each other. In a social environment where children have a 50 percent chance of losing one parent or when one parent is already gone, because of separation or divorce, a child may look upon his new unborn sibling as a potential attachment. Since safety lies in numbers, especially in the companionship of familiars,²¹ children do want siblings. Three Types of Survivors In describing the family’s reactions to a child’s death from carcinoma or accident, Krell ²² notes that because children are egocentric, the surviving children react with a gnawing sense of guilt, wondering “was it my fault?” Children may feel just as guilty about a child destroyed in abortion.²³ Krell ²² indicates a concatination of parent and child guilt produces a conspiracy of silence resulting in three possible syndromes. The “haunted child” survives to live in distrust of what may be in store for him while parents conspire not to burden him with the facts. The child is haunted by a mystery, knowing and yet not knowing. He is afraid to ask for clarification in case he discovers something more awful than he already expects. The “bound child” reflects a parental need to control those forces that destroyed his sibling. If an abortion was done for convenience, social pressure or economic necessity, the parents struggle to make sure it can not happen again. Preconsciously aware of their destructiveness, the parents overprotect the child against projected hostilities. As the child is kept free from exploring the world, so his intelligence, adaptability and curiosity are crimped. The “substitute child,” maybe an abortion survivor, is especially wanted to replace the child that is no more. This child carries a heavy burden of expectation that he may not be able to fulfill. When he is disappointing, the parents may react with enraged frustration. They may have “terminated” the life of one child that could have been all they hoped for. Now this child continually lets them down. Since almost all legal restriction to abortion in Canada and the United States has been removed, women can choose to abort an unwanted unborn infant. The state will not protect him, the community does not want him, and amniocentesis quickly determines if he is the right kind of child. Children may not be wanted because they are the wrong sex, or deformed, have limited abilities or simply because they arrived at an inconvenient time. Children are becoming increasingly aware of the fact that they exist only because their mothers chose them and chose them only because they were desirable. Since their fate once hung on their desirability, they tend to feel secure only when they are pleasing their parents. Consequently, they try too hard to please. This factor, added to their innate tendency to protect their parents, means they will tend to blame themselves whenever there is family disharmony. Consequently, a large number of children become over- anxious parent pleasers until they can no longer cope. Then they become self-blaming and depressed or hostile and rebellious. Though parents may fail to recognize the child’s depression because of their own preoccupation with guilt, there is an increasing incidence of depression and suicide ²⁴ among children which may be partly explained by this mechanism. Future Psychological Difficulties of the Surviving Child a. Abuse and Neglect Lenoski’s evidence ²⁵ indicates that 90 percent of battered children are wanted pregnancies. Barker ²⁶ found higher rates of abortion among women who have abused their children and also among siblings of abused children. Our study ²⁷ indicates that child abuse is more frequent among mothers who have previously had an abortion. The mother’s guilt or high expectations may be reasons why there is this high correlation. A more plausible cause is that because of guilt, there is antepartum depression that interferes with the mother’s ability to bond. Children not well bonded appear to be at higher risk to a parent’s occasional rage or neglect.²⁸ Recent research indicates that abortion results in depression during a subsequent pregnancy ²⁹ and immediately postpartum.³⁰ That depression from abortion or loss of a previous child appears to delay a mother’s preparation for her newborn by diminishing her anticipation. It has long been recognized that a significant personal loss without completed grieving will interfere with subsequent attachments.³¹ ³² The abortion that occurred in the first pregnancy seems to truncate the mother-infant bonding mechanism so that it does not develop as well in subsequent pregnancies. Parents have real difficulty adjusting to the loss of their newborn and grief is not significantly related to weight or duration of life of the dead infant.³³ Though longer and more intense mourning was seen in mothers for whom pregnancy was a positive experience, mothers grieved whether an infant lived one hour or twelve days, whether he weighed 2000 grams or a non-viable 580 grams and whether the pregnancy was planned or unplanned.³⁴ Lewis ³⁵ has shown how important it is for parents to mourn the loss of a stillborn. If one twin dies the mother has difficulty attaching to the survivor.³⁴ To be able to bond well, a mother must have finished mourning the loss of previous babies.³⁶ The depression can be more difficult to deal with when there is ambivalence.³⁷ Mourning is more difficult when there has been a wish for or a contribution to the death of the lost person. When an infant has been aborted there is usually intense ambivalence. Consequently it is difficult to complete mourning and the depression which interferes with mother-infant bonding will persist. These less well bonded infants are more subject to abuse and neglect.²⁷ Mary Ainsworth ³⁸ describes how a child’s early physical contact with its mother builds into him confidence to explore the environment and to become independent. Without that confidence, education and maturing may be more difficult. Some mothers who have had an abortion develop an aversion to touching babies. An intelligent young woman told me “I desperately wanted a baby after my abortion, but when they handed it to me I handed it right back, something was wrong.” Abortion may be a major factor in reducing parent-infant skin contact and therefore the development of the child’s intelligence, independence and maturity. The ability to parent depends on the mother’s and father’s ability to recognize the subtle changing needs of their infant children. If that responsiveness is tampered with, the baby’s needs will not be met as well. To abort an infant, people must first dehumanize him and ignore those demands his helpless dependency makes on them. Up to 50 percent of the population of fertile men and women must have learned to deny the reality of their unborn offspring with his needs for protection and care, before they could consent to his life being terminated. This may make it harder for them to perceive the reality of their newborn baby and respond to his needs. Under normal circumstances, fathers become increasingly attached to and protective of their child during pregnancy.³⁹ Now that men have no legal right to restrain a woman requesting an abortion,⁴⁰ they cannot protect their unborn baby. Since their baby might be destroyed at any time they hesitate to become emotionally involved and attached to that baby. Even when a man and a woman make a joint decision to have a child, the man is never sure that she might not change her mind. Rather than suffer a loss, he remains aloof and unattached. Thus, he is more likely to be unconcerned about his child’s welfare after it is born. b. An Existence that Depends on Being Wanted If children are aware of their mother’s miscarriages and abortions, they probably cannot understand why they survived when siblings did not, why they were chosen to live when a brother or sister was “terminated.” They could feel guilty for living and may develop an existential neurosis. Preconsciously realizing that something inhibits the development of their full potential, they become increasingly demanding for freedoms and opportunities. Rather than examine their own inadequacies or their lack of motivation, they escalate their demands of parents and community to provide advantages which will make them a full and mature person. Otherwise feeling guilty and helpless, they may decide they are unworthy of life and thus neglect themselves or commit suicide. Since a child’s father could not protect him and since the state had no law to safeguard his life when he was most vulnerable, the child has a potential to become very angry at paternal or authority figures. Since his existence hung by the thread of being wanted, he may distrust those who did not provide him the security of legal protection. These angry, distrustful children will not willingly work for their community but demand from it more rights and privileges. Now that many children exist only because their mothers chose them, they may feel a deep sense of unpayable obligation to their mothers. In the past, children believed they existed because God created them or because the state protected them, or because the tribe needed them, and/or the parents desired them. In every situation where abortion was seriously considered, a child now knows he exists only because his mother chose not to abort him. Since about 50 percent of fertile women have had abortions, it is likely many more considered abortions. Is it possible that when these millions of surviving children become teenagers, they will want to shed that feeling of obligation? If so, they may rebel more against mother figures and there may be increased discrimination against women. Before the state gave up its legal protection of children and before contraceptives made it possible for every child to be a “wanted child,” few people questioned whether they were wanted. Now they do. Since their security rests in their wantedness, people, especially children, keep checking with each other, “do you really want me?” Stateless persons appreciate what it is like to live an existence that depends on being wanted. It demands constant pleasantness but evokes awful anger toward those who should recognize their right to exist whether they are pleasing or not. Growing Ambivalence Toward Children It appears that more people are weighing the cost of raising a child against the chance of purchasing a house or a new car.⁴¹ Relative to the importance of attaining one’s full worth or retaining an enjoyable life style, children seem to be losing in value. The final confirmation of this is that 30-50 percent of them are destroyed in utero. The devaluation by society may result in children devaluing themselves. With diminished self-worth, adolescents care for themselves less well and they are less hopeful. They are more prone to depression which results in suicide, which is now the third major cause of death in adolescents.⁴² When children are devalued, they have less confidence they will be cared for and become more demanding. These irritating demands produce an increasingly hostile reaction from the adult world. Children are angry because they cannot count on being cared for but must be continually pleasing or incessantly demanding. Adults are angry because children are so unappreciative and selfish. The result may be a growing hostility between the generations. Since abortion survivors had parents who had more difficulty seeing and responding to their needs, they may hesitate to have children or, if they have children, they may respond poorly to their needs. Adolescents who had poor nurturing may want children to obtain vicarious gratification by trying hard to meet their infants’ needs. This may be why “sex education” has not worked in reducing teenage pregnancies.⁴³ Abortion also increases the desire to be fulfilled by having a baby. On the other hand, young people who are abortion survivors may not want to have a child because they are afraid the anger they feel toward their mothers will be displaced onto their young. Abortion may tend to run in families. In an attempt to deal with the anger and anxiety of being chosen, some survivors destroy their young as revenge on their mothers who tried to abort them.¹⁵ When a child’s subtle pleas for nurturing go unnoticed or when their demands are met with rage, the child suppresses his yearnings for love. Children who are not loved have more difficulty loving and thus, a vicious cycle of disregard, parents and children for each other, escalates from one generation to the next. Children need personal time and attention, but parents in pursuit of their own pleasures, substitute material gifts. The children who still hope, now redirect their pleas from parents to those material substitutes. That basic appeal to parents which should evoke an adult’s care and concern is becoming an increasingly raucous clamor for material possessions which in the end cannot satisfy the children. Therefore, children become both materialistic and destructive. An Endangered Species From time immemorial it was taboo to attack the helpless, defenceless, wounded, or female of the species. Even in times of terrible unleashed aggression or war, it was an atrocity to attack children. Now society legally sanctions and pays for the destruction, on a massive scale, of helpless life. That taboo has been broken by so many people that they have a suppressed response to protect the unborn and newborn. The breaking of that taboo no longer evokes a social protest. To a threat that may endanger the species, society has become increasingly passive and ineffectively permissive. Evidence shows that in countries with long periods of unrestricted abortions, the negative population growth is not stopped by tightening the abortion laws.⁴⁴ In Russia where the average woman has six to eight abortions, there is evidence they will tighten abortion laws.⁴⁵ Even when monetary incentives have been used in Communist countries, there is a diminishing desire to have children. The survival of our species may be endangered because abortion interrupts the parent-child mutuality and devalues children. With the development of prostaglandin suppositories,³⁶ the very wish of some feminists has come true.⁴⁷ Every woman can now do her own abortion in her home and attempt it at any stage of pregnancy. There will be many medical complications but even more psychiatric disorders arising from the impossible conflict of a woman trying to decide whether to flush the struggling live infant down the toilet or rush to the hospital for resuscitation. If the government outlaws prostaglandins they will be sold by drug dealing syndicates on the black market, and they will be of poor quality. If self-induced abortions remain illegal, women will not rush to the hospital to report their incomplete abortions. For these reasons, there will be tremendous pressure on the government to legalize the sale of prostaglandins and to decriminalize self-induced abortions. If approximately 50 percent of women of childbearing age are procuring abortions, it probably means 50 percent of fertile men are coercing women or colluding abortion. While abortions were done under the surgical drapes by a professional who advised the “termination,” most people could believe it was only a “conceptus” or “tissue.” When people have prostaglandin abortions in their homes they will see that what they just terminated looks truly human. The intense conflicts, ambivalence and grief may affect the parents’ health and influence how they interact with their surviving children. Summary If these observations and deductions are correct, there is a very large number of abortion survivors. That number is growing by about 60 million each year. These survivors are the indirect victims of the technical “termination” of their siblings. The knowledge they have been chosen to live creates peculiar psychological problems which may retard their development, subject them to an increased risk of abuse, neglect, existential guilt, as well as the possibility of becoming parents who have difficulty relating to their children. Having been told they must appreciate being alive, they do not complain now. We might wonder what happens in the future when abortion survivors hold in their hands the fate of those aged or enfeebled parents and professionals who regarded them so callously when as unborn children they were so vulnerable. The state has abdicated its obligation to protect every life in favour of granting women the power to decide the life or death of their unborn children. Since many people have an ambivalent regard for their own lives, they will regard with equal ambivalence those who granted them the privilege of staying alive. As living loses its traditional meaning, i.e. to sustain and enhance the life of others, so more people will question the purpose of their living. A vicious cycle ensues for which the state does not want to be held responsible. It has all too happily handed this onerous obligation to women who have accepted an impossible role. With widespread abortion on demand we are dealing with a potentially species-lethal, ecological change. We must carefully study the full and far-reaching implications. I submit we begin with a careful analysis of abortion survivors. References 1. Koranyi EK: Psychodynamic theories of the survivor syndrome. Can Psychiatric Assoc J 14: 165-173, 1969. 2. 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