Report of Anne C. Speckhard, Ph.D.

• Author: Speckhard, Anne C.

Regarding: Karlin et al. v. Foust et al. August 12, 1996

1. I am a licensed professional counselor in private clinical practice working in Alexandria, VA (in the metro Washington, D.C. area). I have a general practice treating children, adults and families and a specialized expertise in dealing with psychological trauma, traumatic pregnancy loss issues, complicated mourning and developmental and family systems issues. My formal training includes a masters degree in child development as well as a doctorate that includes both clinical and research issues in family social science. I have experience consulting to the federal government and have provided training in many academic arenas in regard to pregnancy and reproductive clinical and public policy issues. In 1996 I was the organizer and chair of the Georgetown University Medical Center's Trauma Loss & Dissociation Conference, a national conference I also chaired and organized in 1995. I am both a clinician and researcher. My professional writing and formal presentations have been focused on the topics of trauma, consciousness, attachment issues and traumatic pregnancy loss.

2. My opinions in this case will focus on five areas: [a] the nature and quality of the maternal-infant attachment bond as it develops during pregnancy; [b] the incidence, nature and severity of psychological trauma that occurs when an attachment has formed and is traumatically severed by abortion; [c] patient vulnerability in crisis pregnancy situations; [d] the nature of counseling, the deficiencies of pre-abortion counseling in general and specifically, the abortion counseling provided by Plaintiffs; [e] information regarding the psychological aftermath of abortion as conveyed by Plaintiff abortion providers to their patients; and [f] in the medical, psychological literature there is evidence of emotional injury following abortion.

3. The basis upon which my opinions for this case are formulated includes but is not limited to the following sources: my knowledge of the literature pertaining to posttraumatic stress, child development and attachment theories; theories of bereavement and complicated mourning; and the general literature pertaining to traumatic pregnancy loss including infertility, miscarriage, stillbirth and abortion. In addition my opinions reflect my 16 years of clinical experience of treating women traumatized by abortion, my research and consulting experience with this issue and the results of interviews with numerous women who have had traumatic abortion experiences, including Wisconsin women. While it is impossible to provide an exhaustive list of sources consulted in formulating my opinion I have included an abbreviated listing of citations following this report along with the other requested materials. The general nature of my opinions are outlined as included below:

   1. Maternal-Infant Attachment

4. Psychological attachment is common in pregnancy, beginning for some women even in early pregnancy. As a human process, attachment occurs irrespective of perceived wantedness of the pregnancy. The basis of maternal attachment is both psychological and physical. On the psychological level attachment relies upon the images a woman is forming of her fetal child, images which invoke protective responses within her. The protective urges of maternal attachment form often irrespective of the pregnancy having been intended or wanted.

5. When maternal attachment occurs in pregnancy, even very early pregnancy, the traumatic disruption of this attachment bond is capable of causing enduring psychological damage. The consequences of disrupting maternal attachment via abortion can include psychological trauma and bereavement resulting in complicated mourning.

   2. Abortion as a Psycho-Social Stressor Capable of Causing Traumatization

6. Induced abortion is by definition an invasive act terminating a natural process. The homeostatic mechanisms (emotional, cognitive and physiological) following the birth of a live child which reorganize the mind and body to deal with pregnancy's termination do not exist in the same manner following induced abortion. If abortion were only a physical event, this absence would likely be less problematic. However abortion is a heavily meaning-laden event for most women, and the meanings attributed to the event coupled with the coping resources which are available are central to the level of reorganization that occurs post-abortion.

7. Just as the timing of maternal attachment is individually defined, so too are the meanings assigned to pregnancy and its loss. For some women the meanings assigned to pregnancy include that of becoming a mother, with the developing embryo being defined as one's own child. For these women in particular abortion has a strong traumatic potential. To the extent these women are not evaluated in preabortion counseling prior to obtaining an abortion, they are at risk of postabortion maladjustment.

8. For the woman whose individual meanings define pregnancy as involving the conception of a human being, abortion is a human death event. This death event is further complicated for the woman who has formed an image of her fetal child and who has begun an attachment to this child; abortion then becomes defined for her as the death within her body of "my own child." To the woman who has formed an attachment to her fetal child and/or who responds to abortion as involving a human death event, the meanings attributed to the abortion generally include terrifying images of helplessness, fear and horror--her own and that of her fetal child.

9. The American Psychiatric Association in its Diagnostic & Statistical Manual of Mental Disorders - IV (DSM-IV) defines a traumatic event capable of causing posttraumatic stress disorder (PTSD) as one in which the following two items were present:

   (A) the person experienced...