Vicariously
Experienced Pain During Abortion
Philip G. Ney, MD, FRCP(C), MA, FRANZCP,
RPsych
October 2001
As the psychology and neurochemistry of PTSD is increasingly
well researched, there appears strong evidence that people who
experience overwhelming life threatening stress or prolonged periods
of extreme stress, develop a unique psycho-biological reaction.
1,2,3 There is also evidence that this reaction, mediated
by a variety of hormones, creates a more or less permanent memory
and abnormal stress response many years later.4,5,6
Though there are good reasons not to classify the parent's abortion
experience as a post traumatic stress disorder (PTSD), it may
be that PTSD symptoms found in people following abortion arise
less from their own painful experience and more from the agony
of the baby being aborted. The unborn baby's terrifying trauma
may be vicariously experienced by the mother via a combination
of psychological and neurochemical mechanisms. Hormones associated
with the infant's stress and pain probably cross the placental
barrier in sufficient amounts to be perceived and experienced
by the mother. Sensations from the uterus during abortion also
may evoke images in the mother's mind. Like all mothers, the woman
undergoing an abortion automatically empathizes with her infant's
distress, especially if she had a painful infancy. Though this
vicarious experience of trauma may be repressed, it makes an indelible
imprint, which may later affect the woman's health. If these deductions
are correct it could help explain why many women cannot forget
the intense pain felt at the time of abortion.
Not everybody feels acute stress or pain during abortion. It
is possible to explain a numbing or even euphoric response mediated
by the same neurochemistry. Several different neurotransmitters
are involved in the modulatory actions of the pain circuits, and
these exert a bi-directional control of pain through ON cells
that facilitate and OFF cells that inhibit dorsal horn nociceptive
neurons. "There is evidence that this circuit contributes
to analgesia in humans and may be activated by acute stress or
the expectation of relief."7 "A decrease
and subsequent increase in nociceptive threshold in the whole
body are clinical symptoms frequently observed in the course of
acute systemic infection." "The switching of nocisseptor
from hyperalgesia, accompanied by sickness, may reflect changes
in the host strategy for fighting microbial invasion as the disease
progresses."8 Whether the immediate response to
acute trauma is distressing or numbing, the memory of either can
be biochemically ingrained. This could explain why distress or
euphoria from abortion results in conflicts that persist and even
increase with time.
Geraldine*, a 51 year old married woman, was referred to me for
assessment and possible treatment by her new family physician
because of her intermittent depression, persistent pain in her
body, and irritable bowel syndrome. She had fired her previous
family doctor, because she felt he did not take time to listen
and get to the bottom of her problems. She feels that life should
be good, but she cannot enjoy it. She and her husband are retired,
live a relaxed life and spend long vacations in the tropics. She
likes to go on leisurely walks, doesn't listen to "negative
people", and avoids violence - even the news on television.
However, she has "pain in every muscle and joint of my body."
She's angry because her husband won't just cuddle her and their
sex life has progressively deteriorated.
Geraldine believed she had a reasonably good childhood although
she always hated her stepfather. Between marriages she was raped
and became pregnant. "The worst part was finding myself pregnant.
I just wanted to get rid of it. I know that sounds cold and I'm
not a cold person. You must believe me that it doesn't bother
me now." When she first talked about her abortion she cried
profusely, but on subsequent occasions stated that "it was
absolutely not a problem."
Geraldine is a tense, clinically depressed woman who indicates
one of her greatest concerns is nightmares. They are always about
people who are chased, cut up, shot up, brutally beaten, stabbed,
or otherwise come to a violent end. She is surprised she doesn't
recognize any of the people in the dreams. These nightmares often
awaken her with a frightening knot in her stomach. She shakes
her husband who gradually calms her down before she can go back
to sleep. At the time of examination the only medication she took
was for pain, but it seldom took away the deep discomfort. For
lack of evidence her doctor was loath to diagnose anything specific,
but agreed it could be fibromyalgia.
Although most women are reasonably well anaesthetized during
an abortion, many later report intense pain. Not infrequently
the memory of this pain haunts them years later. There seems to
be no good explanation, but the possibility that the woman is
experiencing vicariously the intense pain of the infant while
it is being terminated is a hypothesis that should be explored
clinically and in carefully conducted research. The way in which
the mother vicariously experiences the agonizing dismemberment
of her unborn fetus could be mediated through pain hormones absorbed
into the mother's bloodstream.
Evidence is accumulating that chronic stress while pregnant may
result in lower birth weight babies and a heightened risk of mood
disorders and cognitive deficits. Elevated glucocorticoid hormones,
induced in the mother in response to stress, appear to be mediators
of events programming the developing central nervous system of
the fetus and rendering it to dis-function in later life."
9 It is apparent that stress also increases the estrogen
levels of the mother, which in animals can feminize the unborn
male offspring. "Early life Ôprogramming' of neuroendocrine
systems and behaviour by stress and exogenous and endogenous glucocorticoids
appears to be a fundamental process underpinning common disorders."10
If hormones associated with pain and stress can cross the placental
barrier from mother to pre-born baby (PBB) then it is logical
that the same hormones can cross from infant to mother. At the
same time, various sensations perceived by the mother during the
abortion from pain fibres in her uterus, coupled by the ability
of the mother to empathize with her infant's terror and pain,
could produce an indelible image in the mother's mind.11
A combination of these three mechanisms could produce an indelible
impact in the mother's mind. Childbirth which may be very painful
and stressful, very seldom results in post traumatic problems
possibly because oxytocin prevents the over-consolidation of childbirth
memories.
The PBB being aborted doesn't die instantaneously, but feels
a succession of shocks beginning with the introduction of the
curette into the amniotic sac. Abortions last from two to twenty
minutes. Not a long time but an eternity of anguish if you are
being progressively dismembered. This is evidence an unborn baby
feels pain, possibly beginning in the first trimester. "Invasive
diagnostic and therapeutic techniques are increasingly applied
to the fetus. It is not known if the fetus feels pain during such
procedures, but the fetus does mount significant stress, hormonal
and circulatory changes in response to these, from 18 to 20 weeks."12
While cortical processing of pain theoretically becomes possible
after development of a thalamo-cortical connection the 26th week
of gestation, noxious stimuli may trigger complex reflex reactions
much earlier. "Triggering stress responses most likely effect
the development of an individual at very early stages."13
Tissue injury causes nociceptor nerve terminals to depolarize."
"Efferent supra spinal influences, in turn, determine the
activity of the interneurons by releasing a variety of neurotransmitter
substances."14 "...fetal pain causes changes
in behaviour, hemodynamics, and hormonal functions..."15
"The definition of pain proposed by the International Association
for the Study of Pain is not adapted to the newborn, or to the
fetus, because it assumes recognition and verbal expression of
an unpleasant experience."15 "The pain system
may be activated in fetal development before its projections will
penetrate the frontal cortex; therefore, painful experience may
induce some physiological consequences even if it has not been
perceived as pain, and may lead to long lasting and profound consequences."16
But, even if the sensations felt as adults experience discomfort
are lacking, tearing tissue will result in the outpouring of hormones
associated with pain and stress. When experiencing severe stress,
people secrete endogenous stress hormones that over-consolidate
traumatic memories.17
The pathophysiology of pain involves neuron pathways and a variety
of pain producing substances. These include acetylcholine, serotonin,
histamine, bradykinin, prostaglandins, substance P, somatostatin,
cholecystokinin, vasoactive intestinal polypeptide, noradrenaline
and endogenous opioid peptides.18 It appears that cholecystokinin
and their receptors "are expressed in the human pancreas
at early stages of gestation".19 In one study
of pre-term infants and their mothers it was found that both plasma
somatostatin and cholecystokinin levels were significantly higher
in infants than in their mother.20 Through opioid and
cholecystokonin, milk also causes affectives changes that facilitate
infant mother bonding.21
Human parents feel a keen sensitivity to their baby's distress
especially when their infant hurts itself and cries. You can see
the pain reflected in the parents' faces. Parents may have tried
to deny the existence of the unborn infant's humanity and suppressed
their response to the abortion, but the vicariously felt pain
could make a persistent impact. During the woman's vigorous and
healthy life she is able to avoid the subconscious expressions
of the unborn infant's pain, but as she ages, that impact may
become increasingly undeniable. Eventually she presents to her
physician with various kinds of body pain, muscle tension, abdominal
or chest pain that is not easy to diagnose or medicate.
In psychotherapy when women are able to identify the source of
their pains as coming from the unborn infant's anguish, they initially
recoil in horror, then relax with a useful piece of insight. When
they are able to recognize the unborn infant's individual humanity,
welcome that person, visualize the terrible death and their contribution
to it, inter the body and commit the spirit to its maker, there
is considerable relief.
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