The Nightmares of Choice

by Rachel M. MacNair

“I have fetus dreams, we all do here: dreams of abortions one after the other; of buckets of blood splashed on the walls; trees full of crawling fetuses,” reported Sallie Tisdale of her time as a nurse in an abortion facility. Writing in Harper’s magazine, she told of dreaming that two men grabbed her and dragged her away.

“Let’s do an abortion,” they said with a sickening leer, and I began to scream, plunged into a vision of sucking, scraping pain, of being spread and torn by impartial instruments that do only what they are bidden. I woke from this dream barely able to breathe and thought of kitchen tables and coat hangers, knitting needles striped with blood, and women all alone clutching a pillow in their teeth to keep the screams from piercing the apartment-house walls.

It is not joyful or easy work. “There are weary, grim moments when I think I cannot bear another basin of bloody remains, utter another kind phrase of reassurance,” she wrote“... I prepare myself for another basin, another brief and chafing loss. ‘How can you stand it?’ Even the clients ask... I watch a woman’s swollen abdomen sink to softness in a few stuttering moments and my own belly flip-flops with sorrow.”1

What is the emotional impact of doing abortions on the people who do them? Those who do them have written and said enough to show that it is no ordinary medical procedure. Some, like Tisdale, suffer nightmares. Others suffer many of the other symptoms associated with Posttraumatic Stress Disorder (PTSD), once called “shell shock” and “battle fatigue.”2 The practice of medicine, of healing, should not give you nightmares, should not leave you shell-shocked.

In the following, only pro-choice doctors and nurses and official medical publications will be quoted, except for the two doctors quoted at the end. Their belief that dealing constantly with abortion was an unusual and significant source of stress, more so than ordinary medicine, did not by any means come from opposition to abortion.

Their Trauma

Remarkably little study has been done of the doctors, nurses, counselors, and other staff in abortion facilities. Only two scientific studies that look at a large number of people have been done by researchers who did not work in the abortion field. One (by M. Such-Baer) appeared in Social Casework in 1974 and the other (by K. M. Roe) in Social Science and Medicine in 1989.

Both studies were done by people in favor of legal abortion, yet they both note the high prevalence of symptoms that fit the condition now called Posttraumatic Stress Disorder (PTSD). The study published in 1974, before the term was adopted, noted that “obsessional thinking about abortion, depression, fatigue, anger, lowered self-esteem, and identity conflicts were prominent. The symptom complex was considered a ‘transient reactive disorder,’ similar to ‘combat fatigue’.”3

The other study listed similar symptoms: “Ambivalent periods were characterized by a variety of otherwise uncharacteristic feelings and behavior including withdrawal from colleagues, resistance to going to work, lack of energy, impatience with clients, and an overall sense of uneasiness. Nightmares, images that could not be shaken, and preoccupation were commonly reported. Also common was the deep and lonely privacy within which practitioners had grappled with their ambivalence.”4

The case that abortion practitioners suffer from PTSD because they perform abortions cannot yet be made. It is a difficult thing to prove: It may be difficult to ascertain who is and who is not doing abortions; those who have suffered worst may have already left the field; it may be that those people who have been through traumatic events already are more inclined to participate in abortions; and finally, the current political debate can affect the way people feel about their work.

However, the evidence so far accumulated shows that further research is certainly needed.

American Medical News, a magazine published by the American Medical Association, reported that the discussions at a workshop of the National Abortion Federation “illuminate a rarely heard side of the abortion debate: the conflicting feelings that plague many providers. . . . The notion that the nurses, doctors, counselors and others who work in the abortion field have qualms about the work they do is a well-kept secret.” Among the stories:

A nurse who had worked in an abortion clinic for less than a year said her most troubling moments came not in the procedure room but afterwards. Many times, she said, women who had just had abortions would lie in the recovery room and cry, “I’ve just killed my baby. I’ve just killed my baby.” “I don’t know what to say to these women,” the nurse told the group. “Part of me thinks, ‘Maybe they’re right.’”

A doctor in New Mexico admitted that

he was sometimes surprised by the anger a late-term abortion can arouse in him. On the one hand, the physician said, he is angry at the woman. “But paradoxically,” he added, “I have angry feelings at myself for feeling good about grasping the calvaria [the top of the baby’s head], for feeling good about doing a technically good procedure which destroys a fetus, kills a baby.”5

Almost All Negative

Such-Baer’s study, done in 1974, a year after Roe v. Wade legalized abortion across the country, reported that “almost all professionals involved in abortion work reacted with more or less negative feelings.” Those who have contact with the fetal remains have more negative feelings than those who do not, and their response varied little: “All emotional reactions were unanimously extremely negative.”6

The largest published study involved interviews with 130 abortion workers in San Francisco between January 1984 and March 1985. The authors did not expect to find what they found. “Particularly striking was the fact that discomfort with abortion clients or procedures was reported by practitioners who strongly supported abortion rights and expressed strong commitment to their work,” they noted. “This preliminary finding suggested that even those who support a woman’s right to terminate a pregnancy may be struggling with an important tension between their formal beliefs and the situated experience of their abortion work.”

In response, the researchers decided “to interview only practitioners who identified themselves as pro-choice and were committed to continuing their abortion work for at least six months.” They thought that these people, “as most free of pre-existing anti-choice sentiments and most resistant to their potential influence, would provide rich insight into the current dilemmas and dynamics of legal abortion work.” This lowered the sample to 105 workers.

Seventy-seven percent of those brought up the theme of abortion as a destructive act, as destroying a living thing. As for murder: “This theme was unexpected among pro-choice practitioners, yet 18 percent of the respondents talked about involvement with abortion in this way at some point in the interview. This theme tended to emerge slowly in the interviews and was always presented with obvious discomfort.”7

Even Tisdale, who still believed in abortion, admitted the ambiguity of performing them. Abortion, she said, “is the narrowest edge between kindness and cruelty. Done as well as it can be, it is still violence—merciful violence, like putting a suffering animal to death. . . . It is a sweet brutality we practice here, a stark and loving dispassion.”8

The stress seems to grow as the unborn child develops. “As the pregnancy advances, the idea of abortion becomes more and more repugnant to a lot of people, medical personnel included,” an abortion doctor named Don Sloan noted in a book that vigorously asserts the need for legal abortion. In response, “Clinicians try to divorce themselves from the method.” After describing the procedure in graphic detail, including the need to check the body parts to make sure every part of the fetus has been removed from the uterus, he concluded: “Want to do abortion? Pay the price. There is an old saying in medicine: If you want to work in the kitchen, you may have to break an egg. The stove gets hot. Prepare to get burned.”9

Late-term abortions pose “an unusual dilemma,” said Warren Hern, an abortion specialist, in a paper given to the Association of Planned Parenthood Physicians. The doctors and nurses who do it have “strong personal reservations about participating in an operation which they view as destructive and violent.” He explained their reactions this way:

Some part of our cultural and perhaps even biological heritage recoils at a destructive operation on a form that is similar to our own, even while we may know that the act has a positive effect for a living person. No one who has not performed this procedure can know what it is like or what it means; but having performed it, we are bewildered by the possibilities of interpretation. We have reached a point in this particular technology where there is no possibility of denial of an act of destruction by the operator. It is before one’s eyes. The sensations of dismemberment flow through the forceps like an electric current... The more we seem to solve the problem, the more intractable it becomes.10

Bad Dreams