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The anti-abortion movement has newly latched onto Post-Abortion Syndrome, a controversial diagnosis that it claims mimics PTSD. The pro-choice response: the syndrome doesn’t exist. How women’s grief became the latest abortion battleground

Outside the walls of Toronto’s Mount Sinai Hospital, a light snow falls quietly on the streets. Inside, the waiting room is not much louder. Several women and a few couples sit in silence. A nurse calls 23-year-old Yana’s name. She walks into a doctor’s office. She sees white walls, an angry-looking nurse, and stainless steel. Yana lies down on a hospital bed. Her legs are pushed back and she gives herself over to anesthesia while a surgeon terminates her pregnancy.

One week earlier in January 2013, her “semi-boyfriend,” who is not in the waiting room, drove her to a sports bar near her house in Richmond Hill and handed her a pregnancy test he bought because his friends told him girls sometimes make this stuff up. It made her feel violated, like he didn’t trust her. She, after all, had trusted him when he showed up two months before that with a handful of articles to read—if the guy pulls out, chances of pregnancy are slim. She had believed him. But now she sat in a bathroom stall and peed on the stick: pregnant. Nine weeks.

“Nine weeks means fingers,” says a friend from her ball hockey team. Yana tries to block the image from her mind. Alone on a gurney, she wakes to a faint outline of the surgery room, vomits on her hospital gown, and wonders if “it’s out.” Fifteen minutes later, she’s eating cheese and crackers on a La-Z-Boy in a room full of La-Z-Boys. Her parents walk her to the car. Her father doesn’t say much, but drives her home.
Back in her bedroom, she Googles anything about post-abortion. The guilt she feels or doesn’t feel. The selfishness she should feel deep inside her gut—her ball hockey friend is sure of that. She clicks onto anti-abortion websites and abortion rights websites. On one of the anti-abortion websites, she sees a book for sale: What God Thinks of You. She sees the word “repent.” A lot of women cry on their babies’ due dates, according to several anti-abortion websites. Yana’s due date was September 27. She chooses the name Helena. When Yana was born, her mother called her a wolverine because of her wild brown hair. Helena, Yana thinks, would look like a wolverine. There’s a blizzard rushing in, layering the driveway, piling on the roof.

Anti-abortion supporters believe Yana’s post-abortion feelings and actions can be attributed to Post-Abortion Syndrome (PAS), a controversial condition coined by U.S. anti-abortion advocate Dr. Vincent Rue in 1981. According to Rue and those in the anti-abortion camp, PAS refers to the negative psychological effects experienced by women who are “traumatized” by their abortions. PAS has never gained recognition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), however, and many scientific studies—not to mention abortion rights advocates—have questioned that it even exists. Still, it’s managed to dominate Canadian and U.S. counselling services available to women post-abortion—to the point that unbiased, in depth and non-politically charged counselling is often very hard to find.

So where does this leave women who, like Yana, just want someone to talk to? What about those who are free to choose but unable to talk freely about abortion, barred from emotions, frozen between affirmation and regret?
In Canada, many post-abortion counselling services are offered through distinctly anti-abortion Christian-based ministries and organizations; abortion rights advocates, wary and dismissive of PAS, are also largely indifferent to any need for counselling. It’s been this way since the late 1980s—nobody, really, seems to be able to separate PAS from a woman’s need (or not) for counselling. As always seems to be the case with abortion, we have become lost in the political consequences.

PAS was first introduced as a subset of post-traumatic stress disorder (PTSD) believed to cause a range of symptoms from nightmares to loss of appetite, directly related to a past abortion. It soon gained political stamina in 1987 when President Ronald Reagan appointed surgeon general C. Everett Koop to study PAS with Rue as a consultant (according to several anti-abortion websites). Anti-abortion supporters hoped the study would force the reversal of Roe v. Wade. Koop, however, was unable to provide conclusive data about the mental health effects of abortion.

Meanwhile Rue was relentless. He later wrote in his 1992 essay, “Post Abortion Syndrome: An Emerging Public Health Concern,” that “the decision to elect abortion can generate significant resulting psychosocial distress.” In 1995, he wrote PAS is “capable of causing … PTSD.” According to the new DSM 5, this seems unlikely. It states PTSD is not induced by a co-occurring medical condition. Rather, the disorder, resulting from exposure to a threatened or actual death, injury or sexual assault, is diagnosable based on four symptom clusters: re-experiencing the event, avoiding trauma-related stimuli, negative changes in mood, and heightened arousal—such as self-destructive behaviour. Incidentally, these are all criteria anti-abortion advocates claim is present in PAS.

Central to this discussion is the word trauma. Anti-abortion advocates and the post-abortive women who join their debate say a woman can experience trauma if she knew abortion was wrong, but went through with it anyway or was forced into having one. The Canadian Centre for Addiction and Mental Health defines trauma as “the emotional response when a negative event is overwhelming.” Because people respond to negative events differently, symptoms can range from no emotion to feelings of helplessness, anger, shame or even panic.

Criticism surrounding post-abortion trauma, however, predates even PAS. In 1963, for instance, Dr. Jerome M. Kummer published a study in the American Journal of Psychiatry called “Post-Abortion Psychiatric Illness—A Myth?” He found no correlation between psychiatric illness and therapeutic abortion. Kummer stated, “If the ill effects of induced abortion have been so grossly exaggerated, we must ask ourselves why?” He speculates this was “part of the means of enforcing the taboo.”

The taboo has since created much frustration among the scientific community. In an effort to completely demystify the issue, a 2008 study led by the American Psychiatry Association Task Force on Mental Health and Abortion reviewed all empirical research on PAS since 1989. Results found that women who have abortions suffer no greater trauma than women who give birth. It did nothing to silence PAS-believers.

Among the most prominent today is David C. Reardon, an anti-abortion advocate and founder and director of the Elliot Institute for Social Sciences Research in Illinois. Reardon began pursuing the connection between poor mental health and abortion in the ’80s. Though his studies are largely considered flawed and were even disputed in the May 2003 issue of the Canadian Medical Association Journal, 10 he continues publishing. In the March 2012 issue of the British Journal of Psychiatry Reardon writes, “Many self-aware women want help coping with a past abortion experience. Why is it so hard to simply accept their self-assessments and stated needs? Women deserve better.” Maybe, but is the guilt-and-shame approach of PAS really the best approach?

Late February 2013, the snow has melted to a knee-deep slush in Scarborough. Today, like every Thursday since 1990, Second Chance Ministry, a Catholic post-abortion support group, gathers in the basement of Scarboro Missions at 7:30 p.m. On a small table, there’s a rosary with white hologram fetuses encased in light blue beads. Julia, a middle-aged, blue-eyed woman comes every Thursday. She says God keeps calling her there, to share her story with others; Julia is also a speaker for Silent No More Awareness, a campaign where Christian women hold public demonstrations to share why they regret their abortion. She places the rosary in my hands because in several minutes we’re about to pray specifically for priests who, in the days ahead, must choose a new pope. I glance up at the door. No other women are coming tonight.
Father Vince Heffernan, a soft-spoken, white-haired priest, enters the tiny room. He decided to advertise help for PAS in the church bulletin and around the city after he read a story about a woman who regretted her abortion. Usually, several women visit the group each session.

Julia heats up water for instant coffee. I choose lemon tea. She begins to tell her story. After spending years managing depression as well as trust issues within her marriage, she concluded her abortion, over 20 years ago, was the root cause. 17 Indeed, PAS has recently acquired new political leverage in the reframing of anti-abortion rhetoric: women are now victims, not villains. The real villains in this new sympathetic messaging are coercing partners, pro-abortion society, and feminists, as Paul Saurette, a University of Ottawa associate professor, explained on CBC’s The Current in April, 2013.

Certainly Julia believes she’s a victim of a pro-abortion society. She says healing finally ensued when she participated in a mass where women name their so-called unborn children. She named hers Marissa. “The children grow up in heaven,” says Heffernan. This leads to a discussion about ghosts, the occult, evil, if I live with my boyfriend outside the bounds of marriage, and how abortion traumatizes the psyche. The tea bag expands in my mug. Too cold to drink.

Post-abortion support groups such as Second Chance are widespread across Canada. Most are Christian-based, many are anti-abortion, and together they promote a type of closure that cannot exist without repent or shame. Project Rachel, a weekend retreat and ministry, advertises PAS research by Reardon via a website link called Hope After Abortion, while the website of the Pregnancy Care Centre in Toronto has posted a video of a woman who found relief in sharing her story and is now an anti-abortion rights advocate. Abortion Recovery International, an association that is “dedicated to connecting and assisting like-minded abortion recovery centers,” states they have no political component to their support, yet lists resources such as afterabortion.org, an anti-abortion website dedicated to Reardon’s research celebrating “25 years of pro-woman/pro-life leadership.”

Second Chance is co-founded by Angelina Steenstra, the national coordinator for Silent No More Awareness Campaign in Canada. The U.S.-based National Pro-Life Religious Council founded Silent No More in 2003. Its purpose is to “expose and heal the secrecy and silence surrounding the emotional and physical pain of abortion,” encouraging women to attend abortion after-care programs, but also to educate the public that “abortion should be unnecessary and unthinkable.”The first time I see Steenstra is at the University of Waterloo on a rainy afternoon in March 2013. Silent No More Awareness Campaign has set up a table in the Student Life Centre.

Steenstra, dressed in a bright red blazer, stands on a podium surrounded by clusters of sandwich-eating, iPod-wearing students, holding a sign that says, “I regret my abortion.” Julia, who met Steenstra at Second Chance, stands by her side. The university’s Students for Life group invited the group. Steenstra says she was there to “share her personal testimony about abortion” but the timing also complemented the discussion on Conservative MP, Mark Warawa’s Motion 408 which condemns sex-selective abortion. (Both a Parliamentary sub-committee and its parent committee, Procedure and House Affairs, has since ruled the motion non-votable, resulting in Warawa’s decision to not appeal, but rather, replace the motion with “The Safe at Home bill” that aims to protect sex abuse victims.)

Steenstra tells her story. Her voice is muffled under the noise, but certain words find their way through: “date rape . . . illegal abortion . . . suicidal . . . starved myself as punishment . . .” She talks to people who give her eye contact. Most don’t. A group of girls huddle over a sheet of mathematical graphs. A guy in a fringed wool hat and dress shirt gives the finger to another guy across the lounge.

A girl with a black puffer jacket stands to the side, talking into her cell phone. “I mean, I understand the sex-selective thing, but the other stuff . . .” This “other stuff” cannot be explained in one sentence. This “stuff” is why one guy just looked up from his Watchmen comic and stuck his headphones back into his ears. This “stuff” is also why five eager campus anti-abortion advocates and Steenstra’s husband, Walter with the video camera, sit in the middle among dozens of empty chairs. This “stuff” includes politicizing emotions, ulterior motives and suggesting one’s personal feelings speak for all women—a ten-minute narrative about hurt, seeking to end a long, laborious story about choice.

Later, two students approach Steenstra and say they want to get involved; they look as if they just got out of high school. They sift through stacks of hand-outs sitting on a white cloth-covered table. One pamphlet reads, “Goal: Get 10 post-abortive men & women who regret their abortion to sign up on our website.”

That same month, on a warm afternoon in Toronto Miriam McDonald, an editor at the Marxist newspaper Spartacist Canada, struts up and down a hallway at the Ontario Institute of Secondary Education at an International Women’s day rally. “Abortion is just a medical procedure like getting a wart off, except it’s all politicized,” she says. “A woman’s capacity to control her fertility opens the doors to full equality. That’s why it’s … stigmatized.” Another woman standing next to her in a baseball cap, handing out newspapers, says post-abortive women need counselling, not to overcome negative feelings related to abortion, but rather, to cope with society’s stigma and culture of shame. Three young people in lime green shirts with the words “reproductive freedom fighters” scurry back and forth.

Some women may need counselling services before or after they have an abortion, says Joyce Arthur, executive director of the Abortion Rights Coalition of Canada (ARCC). She does not believe, however, that PAS is real. “It’s like the anti-choice movement works in its own bubble,” she says, “making up it’s own science and ignoring mainstream evidence and consensus.” The result, she adds, is confusion—public misinformation that scares women considering abortion. In Arthur’s mind, the act of abortion continues to be blamed for the source of trauma when, in reality, the unwanted pregnancy is often what’s truly traumatic. It’s not to say women don’t experience negative effects, she adds, just that it’s more complex than the anti-abortion activists portray.

At the ARCC table, a pamphlet featuring ARTS4CHOICE, a photographic narrative project that seeks to end shame surrounding women’s abortions, reads, “Now is the time to have the focus of the abortion debate shifted to women and their experiences.” I can’t shake the feeling that it’s a storytelling platform like Silent No More. The parallels are there: today’s display still insinuates politics, just from a different belief system. By placing the emphasis of trauma on the pregnancy, advocates dismiss the legitimacy of what women may feel after abortion. Everywhere I turn, it seems women are expected to take sides before we’re allowed to feel something. It’s as if our feelings represent something greater than our individuality, a value, a duty. Holding the pamphlet in my hand, I can’t help but think: shouldn’t the focus have always been on women and their experiences—minus the debate?
Not all anti-abortion advocates—or even abortion rights advocates—buy into the politics of post-abortion counselling. While the number is small, there are both groups and individual counsellers working to provide women-first, unbiased counselling services. Susan Armitage is one. Armitage is a therapist with a masters in divinity who works in Richmond Hill, not far from Yana. She advertises post-abortion counselling but doesn’t want women to misinterpret her Christian-based website as a strict anti-abortion point of view. To her, counselling is an opportunity to speak—just speak. “It’s a controversial time,” she says. “I’m pro-life, but people who support pro-choice shouldn’t be condemned.” She tells me a good counselling model should be based on the realization of how difficult the lives of pregnant women can be. “If I had a teenage girl come to me and tell me she was pregnant, I would help her understand what both decisions would be like,” she says. “Not paint a picture by saying the baby will make life so much better.”

Over in Vancouver, Everywoman’s Health Centre is an abortion clinic that provides free, non-judgmental counselling services and resources like the book, Peace After Abortion. Erin Mullan, who’s been a counsellor for over 20 years, works there. “When it comes to abortion, nothing is in the range of normal,” she says. “A woman’s culture, her religion or history, could all inform how she’ll feel.” For the small number of women she refers out to other counsellors who offer long-term support, abortion is not the main cause of negative feelings, but rather, “it opens a door of pain.” That door can reveal bad relationships, abuse, or mental depression. Mullan points out that coercion—if a woman’s been forced to have an abortion—accounts for one third of the problems she treats. “It can sit unfinished, inside of her for years,” she says, “if she wasn’t given the space to make choices.” At this clinic, the acknowledgment that abortion can be intimately connected to negative feelings serves no greater purpose than a woman’s well-being.

Post-abortion counselling is an available option at other abortion clinics across Canada. Arthur knows of at least two in Vancouver. Very few attend. Other parts of the country? Arthur polls a pro-abortion right listserv, of which she’s a member. The messages roll in from abortion clinics. Ottawa, Vancouver, Toronto, Winnipeg, Edmonton, Calgary, and Yellowknife all have services. The consensus among these clinics is that women with mental health concerns are referred to other therapists outside the abortion clinic. Some women prefer a telephone follow-up after abortion, while a small percentage return for a free session, without need for long-term care. Many women book the free appointment and cancel. Some just don’t show up. But why would they? Expressing feelings, in the same space one must barricade feelings, seems ironic. Abortion can also be a lonely time and returning to the clinic can be a reminder of this loneliness. Many women don’t want to walk backwards at a place where they’re expected to run forward.

But at the London Health Sciences Centre, in London, Ont., one counsellor says a significant portion of outpatient work follows women who have had genetic terminations—abortion due to fetal abnormalities—a population suspected to be under-served in other centres. It’s also not uncommon for women to seek treatment around their baby’s proposed due date which, strangely enough, happens to be a so-called symptom of PAS, one that Yana had stumbled across while searching websites after her abortion. But for every negative feeling—shame, heartbreak, confusion or otherwise—there are political innuendos that render women voiceless, many of whom are left with a multitude of questions, building up in a culture of silence.

In 1995, Melanie hadn’t been with her roommate’s brother for long, maybe eight months. By the time they had broken-up, he was off to university elsewhere, and she was in school in college, 21-years-old and pregnant. She found out after she vomited into a garbage can on the way to class. Her ex hopped on a bus, travelled to her off-campus residence and made out with her the night before her abortion, something she felt guilty about for a long time. The next day a James Taylor song played over a speaker while she lay on a bed behind closed curtains. Her ex bused back to London and left her alone. Her grandfather died the following day and she found herself travelling home, buying a dress for the funeral, shovelling her emotions into mourning his death.

“It was a whirlwind experience,” she says 18 years later, while making green tea, her apartment windows open. Cars sweep through the rainy Toronto streets, blending into jazz music playing on her radio. Recently, anti-abortion advocates stood outside the church across from her apartment with posters of fetuses. She’s not sorry about the decision, but sorry she was “stupid” for not using birth control. She feels guilty for not feeling guiltier. She feels guilty throwing out vegetables. Melanie wishes there were some way to make post-abortion counselling part of the process. She felt alone. She was uncomfortable going to her friends, her mother died when she was younger, and her father, she believes, would have been overly emotional—abortion is too political, too loaded.

When I was in the eighth grade at St John’s Elementary School in Guelph, I remember watching a black and white film of babies piled up in garbage cans. Years later, at 25, I walked into a Gramercy Park clinic in New York City, where I was living at the time, and had an abortion. Afterwards, I ate a carrot muffin from a deli on the corner and cabbed across town to my Hell’s Kitchen studio. I sat on my boyfriend’s lap, rearranging the small apartment in my mind: where the crib would have gone, the changing table, the play area. There was no room anywhere and I wanted to finish my degree and the decision was not a decision any more. We grabbed coffee down the street at the Galaxy diner. I was wearing a burgundy sweater I no longer own. We talked about the clinic, the doctor, my blood type (O-), the play he was writing, getting a second cup of coffee. We didn’t talk about “stuff.”

But I couldn’t erase the garbage-can babies from my head. I felt shame in talking about my abortion to most people. I had no regrets, but then I’d feel damned, caught in a grey area between lucky and inhuman. Reminded—in small ways—by friends, media or religion, that I should feel immoral and incapable. I ended up scavenging online message boards late at night, reading random abortion dialogue between faceless strangers. People, suspicious of their own feelings. No face with a real name to help me affirm I’d made the right choice —to remind me how fortunate I was. Like Yana, my waiting room was also silent. I told my mom five years later on a pitch-black November evening, driving down a gravel road, when I was visiting home. The Michael Bublé song “Home” played on the radio. It seemed like the right time. It made sense.

Back in Richmond Hill, past rows of strip plazas with Cash for Gold shops and walk-in health clinics, Yana dips her brush into sky blue paint at Your Fired, a ceramic craft studio. Recently her ball-hockey friend threatened to hit her hard with a ball during a game because of her abortion—because she should feel like a murderer. Yana spent the game guarding the net as a goalie, frightened. After, she says she spent the week alone in her room, crying and thinking about taking her own life. “Just feelings that came up,” she says. “But I’m fine now.”

She paints a ceramic letter “J” for a friend’s new baby, gently curving the edges with her brush. A Taylor Swift song fizzles in and out of an old stereo tucked into a ledge above us, mixing into Yana’s words. She says she made the right decision, even if her friend tries to convince her otherwise. What hurts the most now is losing her voice: she’s been a singer since she could speak. “The other day,” she says, “my voice was swallowed inside of me, in this place I couldn’t get to any more.” Last weekend, a jazz musician took her on a “semi-date” and asked her to sing in his band. She’s tried singing around the house. Working on not feeling guilty. Working on getting her voice back.