Transcript The 2008 APA Task Force Report on Abortion and Mental Health.

The 2008 APA Task Force Report on Abortion
and Mental Health
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(Affirmers) Some clinicians and researchers
(almost invariably pro-life) claim a link
between abortion and mental illness,
including “Post-Abortion Syndrome” (PAS).
(Deniers) All authoritative sources and
professional associations (almost invariably
pro-choice) deny any such link.
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Grant that abortion is bad, causes
unhappiness and grief, etc. why should we
think that additionally it causes mental
illness?
Should it matter that it does?
Do we think that other horrific actions must
cause mental illness? e.g. enslaving,
dropping atomic bombs, concentration camp
guards?
But cf. Prof. Pete Kilner’s research at West
Point.
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Grant that abortion leads to mental illness
for some women—does this imply that there
is a general risk, of the sort that should enter
into official policy and advice?
◦ Childbirth can lead to mental illness—should this
be raised when a couple contemplates having a
child?
◦ Note: we dismiss bad effects of good things as
‘accidental’; we regard bad effects of bad things as
‘significant’.
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It’s common for deniers of the link to say that
‘abortion is no more highly correlated with
mental illness than any life stressor’.
But is this very satisfying, given today’s
common ‘stressors’?—divorce, abandonment,
betrayal,etc.
Are our standards too low?
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Pro-lifers are not ipso facto committed to
abortion-mental health link.
◦ We wouldn’t be surprised to find a link.
◦ We are prepared to find the evidence, if it exists (we
won’t overlook anything).
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Pro-choicers are ipso facto committed to
denying a link.
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Wikipedia has a lengthy article on ‘Abortion
and Mental Health”. Periodic studies of the
issue.
The need constantly to deny a link 
abortion isn’t an ordinary ‘medical
procedure’?
No Wikipedia articles on ‘Appendectomy and
Mental Health’.
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It appears to be a comprehensive review of all
the best studies, but …
The APA since 1969 has advocated abortionon-demand.
The lead author of the Report, Brenda Major,
is a leading author of studies denying a link.
The Report gives short shrift to claims of PAS.
“This perspective argues that abortion is traumatic
because it involves a human death experience,
specifically, the intentional destruction of one’s
unborn child and the witnessing of a violent death, as
well as a violation of parental instinct and
responsibility, the severing of maternal attachments
to the unborn child, and unacknowledged grief (e.g.,
Coleman, Reardon, Strahan, & Cougle, 2005; MacNair,
2005; Speckhard & Rue, 1992). The view of abortion
as inherently traumatic is illustrated by the statement
that “once a young woman is pregnant…it is a choice
between having a baby or having a traumatic
experience” (original italics; Reardon, 2007, p. 3).”
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Moira Gaul (FRC), “Biased APA Report Ignores
Abortion Risks”
Priscilla Coleman, “APA Report on AbortionMental Health Problem Link Politically Biased”
This may be true. But the charge of ‘bias’ is
easily flung back: “You claim it is biased
because of your (equal) bias.”
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Abortion Distortion: Professionals who
otherwise act with competence and integrity
depart from professional standards (rigor,
consistency, cogency) when adherence to
those standards would imply a conclusion at
odds with abortion-on-demand.
In cases of Abortion Distortion, restrict your
criticism to violations of the relevant
professional standards.
Analogy: don’t say “the auditor lacked
independence” but prove the audit was faulty.
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Sets down criteria for good methodology.
Examines over 50 studies since 1989 in peerreviewed journals.
Rejects all but 2 studies, as failing to meet
criteria for sound methodology: Gilchrist et
al. (1995) and Fergusson et al. (2006).
Favors Gilchrist over Fergusson as being
methodologically better.
Bases its conclusion on Gilchrist alone.
“Based on our comprehensive review and
evaluation of the empirical literature published in
peer-reviewed journals since 1989, the Task
Force on Mental Health and Abortion concludes
that the most methodologically sound research
indicates that among women who have a single,
legal, first-trimester abortion of an unplanned
pregnancy for non-therapeutic reasons, the
relative risks of mental health problems are no
greater than the risks among women who deliver
an unplanned pregnancy (71).”
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The yes-or-no, “accept or reject” approach to
examining studies.
Basing a conclusion on a single study.
The fallacy of inferring “evidence of absence”
from “absence of evidence”.
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If studies agree in claiming an effect, the
effect is usually stronger or weaker
depending upon the better or worse design of
the study.
If studies conflict about an effect, then one
side can be dismissed only if the error can be
explained (which is to ‘explain it away’).
This especially true when conflicting studies
are basically sound.
“As I stated to the APA committee in my
review [of an earlier draft], the only
scientifically defensible position to take is
that the evidence in the area is inconsistent
and contested. Under these conditions the
only scientifically defensible conclusion is to
recognize the uncertainty in the evidence and
propose better research and greater
investments in this area.”
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Even if there was no conflicting evidence, it is
not recommended that a conclusion (esp. on
a major social problem) be based on a single
study.
APATask Force on Statistical Inference (1999):
“ The thinking presented in a single study
may turn the movement of the literature, but
the results in a single study are important
primarily as one contribution to a mosaic of
study effects.”
“What I also think the APA committee has failed
to recognize is the size of the research
investment needed to pin these issues down
thoroughly. The tobacco example is a clear one:
there have been literally tens of thousands of
studies in this area (I have in fact published over
10 papers on tobacco related topics). This
amount of research is needed in an area in which
there are strongly divided opinions and deeply
rooted agendas. The moral of all of this is very
simple: In science drawing strong conclusions on
the basis of weak evidence is bad practice. The
APA report on abortion and mental health falls
into this error.”
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Gilchrist reaches a negative conclusion: it
fails to find statistically significant
correlations between abortion and mental
illness.
The Report reaches a positive conclusion:
“…the relative risks of mental health
problems are no greater than the risks among
women who deliver an unplanned pregnancy.”
The fallacy echoed in media headlines:
“Abortion does not cause mental illness,
panel says” (New York Times).
Fergusson (who is ‘pro-choice’) says it lies with the deniers:
“What the Committee has, in effect, said is that until there is
compelling evidence to the contrary, people should act as
though abortion has no harmful effects. This is not a
defensible position in a situation in which there is evidence
pointing in the direction of harmful effects. In this respect,
the response of the APA committee to this situation appears
to follow the type of logic used by the Tobacco industry to
defend cigarettes: since, in our opinion, there is no conclusive
evidence of harm then the product may be treated as safe. A
better logic is that used by the critics of the industry: since
there is suggestive evidence of harmful effects it behooves us
to err on the side of caution and commission more and better
research before drawing strong conclusions. History showed
which side had the better arguments.”
But a denier might say that it lies with the affirmers.
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When examining—or looking for—evidence,
we reasonably bring to bear expectations
about ‘what one should expect, given
background knowledge’.
We then interpret evidence relevant to ‘what
should be expected’.
Statisticians refer to this sort of reasoning as
‘Bayesian’.
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Pregnancy is a diseased or abnormal
condition of the body.
The fetus is a kind of unwanted growth, like a
wart.
The mother is an autonomous, rational being,
who is right to conceive of her body as an
instrument for advancing her rational
purposes.
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Abortion returns the woman to a normal
condition.
The procedure, although internal, is no more
invasive in reality than the removal of a wart.
The mother’s decision to have an abortion is an
unexceptional instance of instrumental
reasoning.
An abortion is the removal of something that
shouldn’t be there in a woman who shouldn’t be
in that condition, by someone who reasonably
judges that an abortion would advance her
interests as an autonomous self.
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Pregnancy is a perfectly normal condition of a
mature woman’s body.
The fetus is the woman’s offspring, not an
alien growth (it’s equivalent a part of her
which is so closely related that it’s just about
the same as her).
Everything about the woman, not simply her
body but also her thoughts and emotions (her
‘soul’) are mobilized, and designed to be
mobilized, to protect and nurture this child
within her.
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Abortion destroys the normal and intended
condition of the woman—violently, by
suddenly reversing something that she and
her body are designed to achieve.
It destroys something so closely related to
the mother, that it is as if she is destroying
herself.
It is an irrational act, since reasonability in
this case involves a kind of sensitivity to and
cooperation with forces that do not admit of
complete rational explication.
The following tend to promote good mental
health and are protections against mental
illness:
 Realism (as opposed to the denial of reality)
 Internal harmony (as opposed to conflict,
strain, and stress)
 A stable sense of self-worth (as opposed to
an unstable sense)
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Two possible views:
1. The thing in her womb is her ‘baby’. She is a
mother. She has an ultrasound taken; she gives
this being a name; she starts buying clothes for it;
and so on.
2. The thing in her womb is a ‘clump of cells.’ She
does not have a baby. She is not a mother.
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Both can’t be realism.
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Disharmony exists if a woman has an
abortion, adopts the second view above, but
also:
◦ Conflictedly also thinks she is killing her baby.
◦ Later she conceives and adopts the view that the
thing in her womb is a baby and she is a mother.
◦ She is in circumstances in which she is asked to
sympathize with a pregnant mother who is thinking
of the thing in her womb as a baby.
◦ She has two friends, one of whom thinks that the
thing in her womb is a clump of cells, and the other
who thinks it is a baby, and she is asked to
sympathize with each.
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Suppose a woman who gets an abortion tries
to avoid or resolve mental conflict by holding
that both views are valid. It’s a difference in
‘social construct’ or ‘conceptual system’.
She thinks, ‘There is no fact of the matter as
to whether this living being I am carrying is
my baby or not. It’s a baby if one thinks it’s a
baby, and it’s not a baby if one thinks it is
not a baby.’
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The thing in the womb has worth only if
someone thinks that it does.
We tend to think about ourselves in the way
that we think of others. (Mothers do this
especially in relation to their child.)
Therefore? … “I have worth only if someone
thinks that I do.”
Contrast this with a mother convinced of the
intrinsic priceless worth of her baby, who
then thinks that she has worth in the same
way that her baby does.
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A study of women recruited by GPs in
Scotland and England and then observed by
these GPs from the years 1976 to1987.
A woman was recruited if she has an
“unplanned pregnancy” (defined as “an
unintended pregnancy or one in which the
woman could not state, to within 3 months,
the duration of her attempts to conceive”
(243)) and agrees to participate in the study.
Based on the GPs diagnosis, these women were
sorted into four classes of morbidity:
1. prior psychiatric illness other than psychosis;
2. prior psychosis;
3. no prior psychiatric illness but previous deliberate
self-harm (DSH);
4. no prior psychiatric illness or DSH.
These groups were then studied prospectively,
after their choice of abortion or delivery,
with their GPs continuing to provide
information about mental health sequelae.
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A woman left the study if either she left that GP’s
practice; died; or became pregnant again.
Gilchrist found statistically significant results in
only two cases:
(i) women without prior psychiatric illness were more likely
to develop psychosis if they delivered their baby as
opposed to aborting; and
(ii) women without prior psychiatric illness were more
likely to inflict DSH if they aborted as opposed to
delivered their baby.
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All other correlations lacked statistical
significance.
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The GPs diagnosed 106 cases of puerperal psychosis among the
6000 women who delivered, which is approximately 20 times
greater than the recognized and established incidence of this
illness.
Because of this aberration, Gilchrist ended up disregarding these
diagnoses. For evidence of ensuing psychosis, he relied instead
on hospital admissions for psychosis.
In the published article, Gilchrist admits that, therefore, the
statistically significant finding of greater psychosis in women
who deliver as opposed to abort should be disregarded.
Thus, the only statistically significant result of the study is a
finding of greater incidence of deliberate self-harm among
women who abort rather than not!
Note: given that GPs’ diagnoses were thus inaccurate, it would
seem that the sorting of women into four initial classes of
morbidity would also be unreliable, since this depended upon a
determination of prior psychosis or not.
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The study was not double-blind: one might
expect that GPs who had moral qualms about
abortion would not seek to participate in the
study, whereas GPS who had a prior interest
in vindicating legal abortion would self-select
in participating in the study.
Moreover, the recruitment of women was not
random, as GPs were apparently asked to
recruit women with a view to balancing
sample sizes. This also would allow bias to
enter.
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High attrition rate: When the study concluded
in 1987, only 34% of women who chose
abortion were still in the study, and only 42%
of the women who delivered.
Attrition would bias results: women are
removed from the study if they conceive
another child or leave the practice. But this
would remove:
◦ Women with PAS who conceive a ‘replacement
baby’.
◦ Women who move to another location because of
divorce or other problems.
This is why the Task Force favors Gilchrist over
Fergusson.
The Task Force holds that the correct control
for women who have abortions is not either
(i) women who don’t have abortions, or
(ii) women who have a baby instead of an
abortion, but rather
(iii) women who have an unplanned
pregnancy and who don’t have an abortion.
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One way of reformulating their claim is to say
that they are presupposing that the question
research should aim to answer is:
Suppose a woman is facing an unplanned
pregnancy, should one counsel against abortion, in
such circumstances, on the grounds of greater risk
to mental health than giving birth to the child?
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Some women do not plan their pregnancies
precisely because they don’t perceive the
circumstances they are in as difficult.
For other women, who do conceive without
planning in circumstances that they view as
difficult, their perception of their situation
changes over time, so that by the time the baby
is born, they welcome the child’s birth.
Also, some women who plan pregnancies
nonetheless regard their pregnancies as difficult,
or later regard come to regard them as so.
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A study which used the control group
advocated by the Task Force would show at
best only the health risks of abortion in
relation to the health risks of having a child in
(it is presumed) difficult circumstances.
That’s like: “There’s this risky situation, A,
and getting an abortion poses no more
serious health risks than being in this other
risky situation, A.”
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But advocates of abortion typically present
abortion to women as a kind of cure-all, as
something that ‘solves their problem’ and gets
them back to a status ex ante, before they
became pregnant. It makes their lives as if they
were never pregnant to begin with—that’s the
problem.
It is hardly impressive to say that women who get
abortions have the same histories of mental
illness as women whose life and lifestyle a
woman is supposed to be trying to avoid by
getting an abortion.