Psychiatry by its very nature should become more deeply concerned about the positive aspects of family planning and the quality of life that results from such planning. It is altogether fitting that psychiatry become involved in these areas since the sexual act begins first in the psyches of men and women.

As a physician, I feel a responsibility for making it possible for women, regardless of socioeconomic status, to terminate unwanted pregnancies with medical safety, dignity, and privacy and without public stigma. Society must make it possible for women to limit. family size to their own needs and desires and make every child a wanted child.. We must remove the moral and social stigmata from the practice of legal abortion and make it as acceptable as any other surgical procedure. This, in my opinion, would be the practice of humanitarian medicine at the very best.

In conclusion, I want to say that as a long-time advocate of legalized abortion, I am greatly concerned about the impact these amendments now before this subcommittee would have. The Supreme Court decisions placed the responsibility for a decision to terminate a pregnancy during the first 2 trimesters on the patient and her physician, where it rightly belongs. There is no convincing evidence of psychiatric complications in well-motivated women who obtain a legal abortion. For most women faced with an unwanted and unplanned pregnancy, a legal abortion is, in fact, truly therapeutic. Therefore, Mr. Chairman, I urge you to reject these proposed amendments to the Constitution to prohibit abortion.

Thank you.

Senator BAYH. Thank you, Doctor.

In the reoprt which you mentioned, was it Osofsky's?
Dr. LEBESNOHN. Osofsky's.

Senator BAYH. In this report relative to the type of psychological effect produced by abortion, was any effort made to try to determine over how long a period of time after the event that effect continued? Dr. LEBENSOHN. They do not have long-term followups in the Osofsky study. I think it is a matter of, at most, months or 1 to 2 years. The longest followup is, of course, the Scandinavian followup, by Forsmann and Thuwe, in which they studied a series of women who had been denied a therapeutic abortion and were forced to have a child and followed them up to the age of 21. They then compared them with women who had come in pregnant at the same time and had wanted to have a child. They discovered that the children of those who were denied an abortion were psychologically worse off in every respect.

The quotation, the exact quotation is:

The unwanted children were worse off in every respect. The differences were often significant statistically, and when they were not they pointed in the same direction to a worse lot for the unwanted child.

These are the longest term followup studies, to my knowledge. I would agree with you that more long-term followups are needed. In a sense, of course, every psychiatrist has his long-term followups in his practice. Rarely does a week go by without a woman telling me in the course of a psychiatric history that she had an abortion at one time in the past, most often without any difficulty. The patient.

had come to me for an entirely different reason, something totally unrelated to this episode. This gives the clinician a type of informal long-term followup. Another type of long-term followup is illustrated by the many well-known women writers, politicians, and other prominent women who have signed their names to public statements stating very clearly that they have had abortions during their childbearing years and make no bones about it. These women have gone on to great achievements in the in the field of art, letters, science, and even in politics.

Senator BAYH. I note in your conclusion you say:

There is no convincing evidence of psychiatric complications in well-motivated women who obtained a legal abortion.

Dr. LEBENSOHN. Yes, sir.

Senator BAYH.

For most women faced with an unwanted and unplanned pregnancy, a legal abortion is, in fact, truly therapeutic.

Both of those sentences seem to be based on health standards. Dr. LEBENSOHN. Yes. Well, when we say therapeutic, one must realize that prior to the Supreme Court ruling and prior to the passage of liberal laws in many States, the only way for a woman to obtain an abortion was to have some medical indication for it. As. Dr. Bernstein pointed out, quite correctly, the most frequent medical reason cited was a psychiatric illness. I have earlier stated that I do not think that a psychiatrist should be involved in the abortion decision. I think that it is very clear to any doctor-obstetrician, general practitioner, or any physician-that a woman faced with an unwanted and unplanning pregnancy is overwhelmed by feelings of despair, anxiety, and depression, which are enough to justify the decision for abortion. This mental distress has been quantified by some workers quoted by the Osofsky's in the article which I have asked to be made a part of the record, in which they did psychological testing of women before and after abortion. They used the Minnesota multiphasic personality inventory-MMPI. They found objective evidence that prior to abortion these women were indeed disturbed. They were again tested 6 weeks following the abortion, and there was no longer any evidence of the pathology.

In other words, one could say that in these cases the abortion was truly therapeutic. But it is hard to say that they were suffering from a specific psychiatric disorder. They were suffering from an unwanted pregnancy.

Senator BAYH. I wanted to find out what kind of therapy it was. mental or physical, but it was the health and well being of the mother that the therapy was directed at.

Dr. LEBENSOHN. The therapy was the abortion. The therapy, which resulted in the improvement of these women was the abortion itself.

Senator BAYH. It is interesting to note that in establishing the grounds for abortion you mention religious, moral, ethical, socioeconomic, political, and legal considerations, but you do not put medical or health considerations in there at all.

Dr. LEBENSOHN. No; I did not. I think that this, of course, could be added. But I think most abortions are done for the reasons previ

ously cited. The socioeconomic reason is perhaps the most common. You asked earlier in the previous testimony whether the psychiatrists who participated in those examinations, had an honest difference of opinion or were they lying? I think one could honestly find the pathology of anxiety, sleeplessness, and unhappiness, in women who want an abortion and who are denied it. We see less and less of this anxiety now because these women know that relief for their situation is now available, without paying exorbitant fees or having to travel to some foreign country. These advances have cut down the anxiety and have also cut down the amount of guilt. The medical considerations do come in, but they are, I think, much less important than these other considerations which I have mentioned.

Senator BAYH. Unlike Dr. Bernstein, you argue there is a lack of psychiatric effect-sequelæ, is that the word?

Dr. LEBENSOHN. Sequelae-a sequel, a consequence, if you wish. Senator BAYH. A lack of psychiatric sequelæ displayed as a result of the abortion. He did not use the word "sequela", but he suggested that many of the manifestations of psychiatric problems that existed in women during pregnancy had passed after the birth. You do not concur in that, I guess, or maybe I did not understand you on that point.

But he emphasized, or at least touched on, the fact that these studies he alluded to showed there were very few evidences of psychiatric problems that were the direct result of the pregnancy. They probably existed before the pregnancy and they would be there after the pregnancy or after the abortion if left untreated.

Dr. LEBENSOHN. Yes; I would agree with that. I think that an unwanted pregnancy produces an acute state of anxiety, despair and depression which is relieved by the termination of that pregnancy. In some cases it is necessary to evaluate the problem on an individual basis. I remember very well the case of a young high school girl, 1712 years old. She came from Maryland several years ago accompanied by her father. When she came into my office I said, "I understand that you are here because you are faced with a unwanted and unplanned pregnancy." She replied, "Well, Doctor, it was unplanned, but it was not unwanted." The moment she said that the entire picture was changed for me. I realized that she had been very much in love with the boy-who was something of a rounder-and the parents had not handled the situation too well. I called the parents in and told them to have another conference with the boy to see what they could work out. Furthermore, I could not recommend a termination of the pregnancy in this case because the young lady wanted the pregnancy and there was a conflict which might cause serious consequences if they pushed abortion too much. Her parents were obviously disapproving of the young man, but they had not given him a chance to prove himself. And I suggested that they start communications very rapidly, which they did and with good results.

This example shows that these cases must be individualized. Even so, I do not think psychiatrists have any place in the decisionmaking process for or against an abortion unless there is clearcut evidence of psychiatric illness or tremendous conflict.

Senator BAYH. But you would put no limitation on the access to abortion?

Dr. LEBENSOHN. None whatsoever. I would agree with the Supreme Court. I think the Supreme Court decision is excellent. I think that it is very sensible. I think it tends to protect the mother. It was written very, very carefully, and I would subscribe to it wholeheartedly.

Senator BAYH. Inasmuch as in your opening remarks you alluded to the legal question, the moral question and the religious question and ethical, are you at all concerned about the legal, moral and religious issue that is raised, particularly when you get a child beyond viability or even at an earlier stage, but particularly after viability? Dr. LEBENSOHN. The Supreme Court decision permits abortion only during the first and second trimester, and I am very much opposed to conducting abortions at any time when viability is possible. In other words, the longer the pregnancy continues the greater reluctance I would have in ever recommending it if I had anything to do with it.

For that reason, I think that if women have ready access to abortion they will tend to have abortions during the first 3 months, during which time the amount of trauma is neglible, both physically and mentally. I am also concerned about the religious question. I have a tremendous respect for anyone with religious convictions. I think that they should be strongly respected.

But I feel that those people who are very much opposed to abortion by virtue of their own religious convictions should not need any specific law to support their principles. The late Cardinal Cushing is quoted as saying that Catholics do not need the law to support their moral principles.

Senator BAYH. Was this relative to abortion?

Dr. LEBENSOHN. Pardon?

Senator BAYH. Was this relative to abortions?

Dr. LEBENSOHN. It was relative to abortions, yes.
Senator BAYH. In other words, Cardinal Cushing-

Dr. LEBENSOHN. What he meant to say was that Catholics do not need laws. If they are good Catholics they do not need laws. They adhere to the laws of the church, and they should. That makes eminently good sense. He was a very sensible man.

Senator BAYH. May I ask you to give me your thoughts relative to one thing referred to by Dr. Bernstein when he said this was post partum psychosis, and he said in practice a typical woman who develops such a psychosis was not one who wanted an abortion, but rather is an obsessive compulsive patient-for example, a married woman with a strong moral code who had a planned pregnancy and was considered to be a good mother by her peers. I bring that up relative to what you said about the unwanted-child situation.

Dr. LEBENSOHN. Yes; but I think Dr. Bernstein later on hedged a bit and said there were exceptions, and I could not agree more. There are exceptions. But I think in the final analysis we cannot predict those who are going to have post partum psychoses.

I remember a case of a young women who, during her first pregnancy, was given some very careful psychological and psychiatric tests in the course of a research project which she entered voluntarily. The tests were administered at no cost to the patient, and they were designed to reveal attitudes toward their first pregnancy.

The psychoiatrists and psychologists thought that this gal was a pretty healthy young lady. Well, a few weeks after the birth of her first child-the delivery went along quite well-sshe developed an acute post partum psychosis which was really schizophrenic in nature. She had to be hospitalized immediately and responded very quickly and very dramatically to electroshock therapy.

Now, here is a woman who had careful psychological and psychiatric screening. The research team did not anticipate this reaction at all. This example shows that these things cannot be predicted, not even in retrospect. I have followed this young woman for the last 10 years. She now is the mother of three fine youngsters. One would assume from the history that she was going to have another post partum psychosis if she became pregnant again. She did not. To be sure, I did see her in psychiatric treatment during the entire time and I gave her some medication when it was necessary. She is doing splendidly now and she has been an extremely fine mother to her children.

Senator BAYH. Well, thank you, doctor. I appreciate your taking the time to be with us this afternoon.

Our next witness is Dr. Samuel Nigro, the assistant professor of child psychiatry at Case Western Reserve University School of Medicine and University Hospital of Cleveland.

STATEMENT OF DR. SAMUEL NIGRO, M.D., ASSISTANT PROFESSOR OF CHILD PSYCHIATRY, CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE AND UNIVERSITY HOSPITAL OF CLEVELAND

Dr. NIGRO. Mr. Chairman and fellow members of the subcommittee, at least I hope you will pass these remarks on to other members.

Senator, I am Samuel Nigro, M.D. I am a husband of one and a father of four, and a homemaker in Cleveland Heights, Ohio. After that, I am a child psychiatrist at Case Western Reserve and other places on the statement that I have given you, and I am not going to go over those for the sake of time.

However, I do want to make clear that my views represent myself and not any group with whom I am associated.

I am here to address myself to the issue of the effects of unwantedness on children in reference to the abortion issue. Everychild-a-wanted-child: Statements like that, have always been used for a reason for abortion. I think we have to examine that, and I would like members of the committee to address themselves to this issue.

When one talks about unwantedness on a child, there are several distinctions that you have to make, and I am going to try to make four distinctions for you. To confuse the distinctions is to mistake unwantedness as damaging, to mistake abortion as treatment, and to mistake adult advocacy for child advocacy.

The first distinction is that of unwantedness in reference to the child after being born. There is no doubt unwantedness of a child after being born is detrimental to a child. But this is so, I want to emphasize, only if the unwantedness is pervasive, complete, and if