Abortion can lead to mental illness

Not some mindless opinion but the considered research of the Royal College of Psychiatrics:

Women may be at risk of mental health breakdowns if they have abortions, a medical royal college has warned. The Royal College of Psychiatrists says women should not be allowed to have an abortion until they are counselled on the possible risk to their mental health.

This overturns the consensus that has stood for decades that the risk to mental health of continuing with an unwanted pregnancy outweighs the risks of living with the possible regrets of having an abortion.

This is hugely important because MPs will vote very soon for a reduction in the time imit for abortions. Pressure is growing from all sides to reduce the limit from 24 weeks to 20 weeks as evidence mounts that not only can children who are 21 weeks survive early birth, but also that they experience great pain during any abortion. A clear majority in the country agree with MP Nadine Dorries on this:

As an amendment to the bill it could get only an hour of debate, but it is one about which the public feels strongly. A YouGov poll for The Sunday Times today shows that 48% of people say they would support Dorries’s measure – a figure that rises to 59% among women – while 35% would keep the limit at 24 weeks; 8% would ban abortion altogether.

See though the arrogance of the Government on this – a discussion about reducing the legal limit on abortion gets only 60 minutes debate, despite the fact it is one of the ethical hot potatos of the moment. Presently women who come looking for an abortion are given only scant information about counselling and other options and that is unacceptable. The Royal College of Psychiatics agree:

The Royal College of Psychiatrists recognises that good practice in relation to abortion will include informed consent. Consent cannot be informed without the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health. This may require the updating of patient information leaflets approved by the relevant Royal Colleges, and education and training to relevant health care professionals, in order to develop a good practice pathway.

Watch the attempts this week of the Government Minister Dawn Primarolo to stamp out this amendment to the bill. Heaven forbid she lets professional medical opinion get in the way of political expediency and dogma.

14 Comments on “Abortion can lead to mental illness

  1. Hello Peter,

    haven’t been following the news that closely today but I don’t think the debate has happened yet (has it?)… only say that because it’ll be interestng to see what comes of it, given that as you say there is such a very tight time limit.

    But to be a bit cheeky – what about a post about the Royal College of Psychiatrists’ submission to the C of E’s listening process on sexuality? I don’t doubt you wouldn’t agree with all of it, but surely it too counts as considered research, not mindless opinion?

    in friendship, Blair

  2. I think my disagreement with the RCP submission on sexuality is that it doesn’t actually refer to any research and positively ignores other pieces. For example, there are multiple senior members of the RCP who have been made aware of people like myself, but to the best of my knowledge none of us have ever been approached to contribute to the RCP thinking on this subject. That’s the equivalent of the Wolfenden Report process having refused to engage with any homosexuals in its discernment process.

    Compare this to the statement on abortion and mental health where a great deal of research has gone on to discern what does and doesn’t actually happen after abortion.

  3. Morning Peter,

    just quickly – I don’t think it’s true that the RCP submission doesn’t refer to any research. Am at work so haven’t time to give a reference, but if you look at the submission there’s about 20 or so endnotes linking to various papers. Or did you mean research on orientation change specifically – though if you did, I think the RCP does refer to Robert Spitzer’s controversial 2003 study.

    in friendship, Blair

  4. Hi Peter, me again…

    not sure if this will work, but I’ve copied and pasted below the list of references from the RCP’s submission to the Anglican church’s listening process. You’ll see that Robert Spitzer’s 2003 study is in the list (excuse my slight desperation to prove myself right :)

    Out of interest though, why was it “especially” Dr Spitzer’s 2003 study you hoped to see referred to? Many criticisms have been made of it and Spitzer himself cautioned against some inferences that were drawn from it. Would be interested in your take on the study from a statistician’s viewpoint.

    Reference List
    (1) King M, Bartlett A. British psychiatry and
    homosexuality. Br J Psychiatry 1999 August;175:106-13.

    (2) Bell AP, Weinberg MS. Homosexualities : a study of diversity among men and women. New York: Simon and Schuster; 1978.

    (3) Mustanski BS, DuPree MG, Nievergelt CM, Bocklandt S, Schork NJ, Hamer DH. A genomewide scan of male sexual orientation. Human Genetics 2005 March 17;116(4):272-8.

    (4) Blanchard R, Cantor JM, Bogaert AF, Breedlove SM, Ellis L. Interaction of fraternal birth order and handedness in the development of male homosexuality. Hormones and Behavior 2006 March; 49(3):405-14.

    (5) King M, McKeown E, Warner J et al. Mental health and quality of life of gay men and lesbians in England and Wales: controlled, cross-sectional study. Br J Psychiatry 2003 December;183:552-8.

    (6) Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health 2001 June;91(6):933-9.

    (7) Bailey JM. Homosexuality and mental illness. Arch Gen Psychiatry 1999 October; 56(10):883-4.

    (8) Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 2001 November; 91(11):1869-76.

    (9) McWhirter DP, Mattison AM. Male couples. In: Cabaj R, Stein TS, editors. Textbook of Homosexuality and Mental Health. Washington: American Psychiatric Press; 1996.

    (10) Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol Bull 2001 July;127(4):472-503.

    (11) Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol 2000 May;10(4):224-38.
    4

    (12) King M, Bartlett A. What same sex civil partnerships may mean for health. J Epidemiol Community Health 2006 March 1;60(3):188-91.

    (13) King M, Semlyen J, Killaspy H, Nazareth I, Osborn DP. A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual & transgender people. Lutterworth: BACP; 2007.

    (14) Bartlett A, King M, Phillips P. Straight talking: an investigation of the attitudes and practice of psychoanalysts and psychotherapists in relation to gays and lesbians. Br J Psychiatry 2001 December;179:545-9.

    (15) Spitzer RL. Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Arch Sex Behav 2003 October;32(5):403-17.

    (16) Shidlo A, Schroeder M. Changing sexual orientation: A consumers’ report. Professional Psychology: Research and Practice 2002;33:249-59.

    (17) King M, Smith G, Bartlett A. Treatments of homosexuality in Britain since the 1950s–an oral history: the experience of professionals. BMJ 2004 February 21;328(7437):429.

    (18) Smith G, Bartlett A, King M. Treatments of homosexuality in Britain since the 1950s–an oral history: the experience of patients. BMJ 2004 February 21;328(7437):427.

    (19) Haldeman DC. Gay Rights, Patient Rights: The Implications of Sexual Orientation Conversion Therapy. Professional Psychology – Research & Practice 2002;33(3):260-4.

  5. Hi Blair,

    Sorry for the delay getting back to you – it’s a busy time of year for priests!!!!

    I think what’s interesting about the Spitzer paper is that he very clearly argues that for some people (a significant number of people), change motivated by religious identity can occur. Compare that with the RCP sub-group paper who say about such studies:

    The first study claimed that change was possible for a small minority (13%) of LGB people, most of whom could be regarded as bisexual at the outset of therapy. The second showed little effect as well as considerable harm.

    That’s not a fair representation of Spitzer’s own conclusion.

    Secondly, the paper begins (and builds) on the argument that

    However, things began to change for the better some 30 years ago when in 1973 the American Psychiatric Association concluded there was no scientific evidence that homosexuality was a disorder and removed it from its diagnostic glossary of mental disorders.

    In reality, we need to admit that the 1973 decision was railroaded through the committee and that a large body of evidence suggesting that forms of reparative therapy worked were specifically ignored.

    Finally (as it’s almost 10 and Torchwood is about to start) the statement

    Despite almost a century of psychoanalytic and psychological speculation, there is no substantive evidence to support the suggestion that the nature of parenting or early childhood experiences play any role in the formation of a person’s fundamental heterosexual or homosexual orientation.

    is specious to the extreme. Multiple twin studies have all indicated a significant component of environmental factors in the development of sexual attraction. The sub-committee report makes it sound as though all the evidence points to a clear biological causation – nothing could be further from the truth as the best evidence clearly indicates a complicated mix of nature/nurture which may be unique for each individual.

  6. Hello again Peter,

    no need to apologise as far as I can see :)

    I should say I haven’t read Robert Spitzer’s paper (wouldn’t know where to access it online if that’s possible), but I think it’s worth saying that Dr Spitzer himself has repeatedly presented his own conclusions as being that change is possible, but rare. It’s the ‘but rare’ part that he particularly wanted emphasised as Dr James Dobson and Focus on the Family didn’t (he says) mention that bit when they publicised his study.

    As I said earlier I’d be interested in your view of Dr Spitzer’s study as a statistician – and (as someone who’s numerate but not mathematical if that makes sense) to know in general what makes something statistically valid. E.g., what sort of sample size is statistically significant? (But understand if you don’t have time to answer in Holy Week!)

    On the 1973 decision by the APA – there are quite widely varying accounts of this. I realise that’s not surprising, but perhaps it should make us careful about how we retell the story now. It must be worth noting that Robert Spitzer was one of those who was involved in the 1973 decision, and also his keenness that his 2003 study shouldn’t be seen as a ‘backtracking’ from that involvement. I think it’s also notable that the World Health Organisation followed the APA’s decision in 1992 – I know no details of that move, though am tempted to assume (conveniently!) that perhaps it could have been that they felt there was persuasive evidence…

    Talking of which, out of interest what forms of reparative therapy were proven to work that were ignored in ’73? Slightly at a tangent to that: I was at the LGCM-organised fringe meeting at General Synod last month, where Prof Michael King presented the RCP’s submission. He said that clinicians who used behavioural / aversion therapies were among the few (the only?) ones to follow up their patients, and that such therapies were stopped because they were found to have been harmful. As I say, that’s not directly relevant and I don’t remember whether or nto he said that such evidence was available in ’73.

    I agree to an extent with your last point, as the RCP report does indeed suggest that there’s only a biological component in the origin of homosexuality. I think you’re a bit harsh to say “nothing could be further from the truth” though – perhaps a key word in the sentence you quote is “substantive”, which could suggest that if there is such evidence, it’s not ‘solid’. Also, there being a “significant component of environmental factors” is not positive evidence that it’s specifically “parenting or early childhood experiences” playing a role. But I think it could be argued that the RCP report leaves something out here, although I don’t think that that alters their conclusions, and as I’ve said before (too many times probably!) the likelihood of “environmental factors” being involved does not of itself make homosexuality pathological.

    Again I’ve gone on quite long enough – still, if you ever have trouble sleeping … :)

    Blair

  7. Hi again Peter,

    will try and be briefer this time…

    Thanks for the link – have been skimming thru’ the American Psychological Association’s new booklet (linked to by Anglican Mainstream). After an admittedly very quick read, it looks pretty good to me – comprehensive but concise. Would like to highlight a few things in it, starting with this paragraph:

    “No, lesbian, gay, and bisexual orientations are not disorders. Research has found no inherent association between any of these sexual orientations and psychopathology. […] Despite the persistence of stereotypes that portray
    lesbian, gay, and bisexual people as disturbed, several decades of research and clinical experience have led all mainstream medical and mental health organizations in this country to conclude that these orientations represent normal forms of human experience. Lesbian, gay, and bisexual relationships are normal forms of human bonding.
    Therefore, these mainstream organizations long ago abandoned classifications of homosexuality as a
    mental disorder.”

    Earlier in the document is this paragraph on the causes of homosexuality:

    “There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal,
    developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation”.

    – so the CitizenLink article AM quotes does report this point accurately. CitizenLink also quoted Randy Thomas of Exodus, saying “They [the APA] are starting to have the integrity of reporting accurately about the condition of homosexuality” – to be blunt that’s a bit rich, given the misinformation there is in places on the Day of Truth website, much of whose material is from Exodus.

    This is part of what the document says about therapy intended to change a person’s orientation:

    “All major national mental health organizations have officially expressed concerns about therapies promoted to modify sexual orientation. To date, there has been no scientifically adequate research to show that therapy aimed at changing sexual orientation (sometimes called reparative or conversion therapy) is safe or effective”.

    Lastly there’s some useful material summarising research on children raised by lesbian women (apparently there are very few studies on gay male parenting) – essentially it says there are very few differences between the development of children of lesbian parents vis-a-vis that of children raised by straight parents.

    As I said it looks good to me – and accurate, importantly… though in truth I can’t fully judge that. It doesn’t give a list of references by the way.

    Like the new look, especially the pic of you and Gayle at the top – but I did prefer the old font!

    Blair

  8. This thread has gone a long way off-topic hasn’t it…. obvious I know. Also, and I know this is a bit sad – but is there a way of keeping spaces between paragraphs? The new look comments takes them out.

    Blair

  9. Hi Blair,

    I think the paragraph issue is to do with the internet browser you’re using. Looks great in FF2 and IE7!!!

    Update Blair, update!!!!

    And yes, we’re way off topic aren’t we?

  10. Um, but I think this is IE7 as it’s got tabbed browsing…. The quoted paragraphs in blue come out, it’s just that if I put a line between paragraphs when leaving a comment, the blank line’s removed when the comment appears. Ok, I’m off before the medal for pedantry gets handed out…

    Blair

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