Report of Basil Jackson M.D., Ph.D., Th.D., J.D., D.Litt.

• Author: Jackson, Basil

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

1. Statement of Opinions

   1. The loss of a fetus/child in abortion can be a stressful event of significant proportions. For some, the experience will have minimal impact. For others, whatever negative reactions that might occur are transient. For others still, the loss can precipitate an enduring and overwhelmingly painful decline in functioning. Some degree of stress regarding such a major life decision then should always be anticipated by the abortion provider.

   2. The ability to deal adequately and appropriately with such stress is usually directly related to [a] the quality of the pre-intervention psychiatric status of the individual woman; [b] the quality of the pre-abortion counseling received; [c] the adequacy and accuracy of the information provided prior to the abortion; [d] the degree of social support she received; and [e] the degree of value conformity and integration she incorporated into her decision.

   3. Some patients following an abortion evidence significant emotional distress of varying degrees and types. The resulting condition may be: [a] denovo; [b] aggravation, recrudescence, or [c] precipitation of antecedent psychopathology.

   4. Such distress is more likely to occur in individuals with antecedent psychopathology. However, posttraumatic stress disorder often occurs when there is no evidence of pre-existing psychopathology.

   5. The recognition, diagnosis and evaluation of the extent and significance of such antecedent risk factors, including pre-existing psychopathology, requires: [a] academic training in a mental health field; [b] skill; [c] competency; [d] empathy; [e] neutrality; and [f] time.

   6. A variety of additional stressors related to: [al background; [b] value systems; [c] support response; [d] medical status; and [e] others, may also contribute to a high stress response following abortion.

   7. There is now general recognition that women seeking abortion require the benefits of counseling beforehand. In this regard, inadequately trained "counselors" may do more harm than good. Such may eventuate in: [a] failure to recognize pre-existing psychopathology thereby exacerbating her already weakened pre-abortion level of functioning; [b] failure to recognize the transference phenomenon; [c] counter-transferential pressure; [d] failure to understand or appreciate the particular value system of a particular patient or attempt to wrongfully persuade her to alter her beliefs and values; [e] failure to provide her with sufficient and accurate information resulting in misinformed consent and later regret; and [f] failure to assist her in the exploration of all options open to her thereby contributing to her sense of personal failure afterward.

   8. Postponing the intervention for a reasonable period of time (24 hours), in no way increases the potential for psychiatric difficulties. Rather it provides a meaningful reflection period necessary for the management of considerable information, stress, and conflict emotions and values--all intricately linked to the complexity of a woman's difficult abortion decision. In the absence of such a waiting period, the prospective abortion patient is all too likely to be encouraged to act quickly to "resolve" her problem pregnancy. This may precipitously increase the risk of deleterious after effects for some women evidenced by regret and guilt.

   9. The doctrine of transference teaches the extreme difficulty a patient may have in making a major life decision of which the "counselor," or parental surrogate may disapprove. At moments of intense emotional conflicts and ambivalence characterized by the decision to abort, individuals tend to be transference-ready, and therefore, particularly susceptible to covert or overt communications of what the "counselor" may personally approve or disapprove.

   10. Value systems cannot be separated from the human experience. They are ubiquitous, and, whether examined, recognized or not, play a crucial part in our decision-making process. This is certainly true for the woman with a crisis pregnancy considering an abortion. The difficulty is that an individual in this moment of crisis is usually impeded in the process of objectively enunciating and examining her value system. It is for this reason that highly stressed patients often have difficulty in expressing their value systems, and it usually takes the skill and time of a competent professional to help the individual see and understand the existence of internalized injunctions which tend to be major forces guiding human decision-making and behavior. For the abortion patient, an additional problem is the reluctance of the individual to examine her value system as much as she is able emotionally to do so in the face of a significant transference object, i.e., abortion counselor, because of the perceived threat...